After the tragedy at Sandy Hook Elementary School two years ago, many of us were haunted by the thought what if Adam Lanza had gotten more attention for his emotional problems, and the right kind of help, the lives he took might have been saved. So it comes as a surprise to learn how many red flags were noticed, and how many efforts at help were directed at him at many points in his life. But not, it seems, the kind of help that might have averted the tragedy he caused.

Connecticut’s Office of the Child Advocate recently published a report on Adam Lanza’s history to help determine where opportunities were missed and mistakes were made, and to provide recommendations on how future tragedies might be prevented.

One of the points the report made clear was that what happened in Sandy Hook was rare—in fact people with mental disorders are more likely to harm themselves or be harmed by others. But Adam had an atypical preoccupation with violence, and his mental condition was deteriorating rapidly, without any preventative measures and in near-total isolation, towards the end. The report notes Adam was “completely untreated in the years before the shooting and did not receive sustained, effective services during critical periods of his life, and it is this story that the report seeks to tell.”

The report makes troubling reading. Adam had significant developmental challenges as a young child, and was referred for special education services as early as preschool. His parents seemed committed to getting him the best help they could, even paying for an independent evaluation. He had Individualized Education Plans throughout his education.

But the problems identified seemed to stop short of behavioral or emotional development challenges, and the report notes that this pattern continued. “This appears to have been the start of a pattern of education evaluation and service delivery that addressed only aspects of AL’s cognitive and social-emotional development.”

His social-emotional challenges increased dramatically as he got older, but he apparently never received help for them. He developed severe anxiety, including OCD symptoms, but never got therapy (although he was twice prescribed Aquaphor for his hands which were raw from compulsive washing).

When the family visited the Yale Child Study Center for an evaluation, the doctors cautioned strongly against letting Lanza be educated at home:

We believe that there is a significant risk to AL in creating, even with the best of intentions, a prosthetic environment which spares him having to encounter other students or to work to overcome his social difficulties. Having the emphasis on adapting the world to AL, rather than helping him to adapt to the world, is a recipe for him to be a homebound recluse, unable to attend college or work productively into his twenties and thirties and beyond.

But their recommendations were not included in his school record or IEP, and the report says that when efforts to mainstream him failed the IEP team reverted back to the home-based environment that the Child Study Center warned against.

The lack of communication between providers is another point stressed in the report. Lanza saw multiple treatment and service providers in his life: pediatricians, special educators, and out-patient mental health clinicians, but there was no clear coordinator, so diagnoses were overlooked and appropriate services weren’t provided.

The person doing much of the coordinating was Lanza’s mother, who was in denial of Lanza’s needs and thought keeping him at home and accommodating him as much as possible was the best course of action. From the report:

We note that it is not uncommon for parents to vacillate between acknowledging and denying their child’s need for services. All children are a little different from each other, and gauging whether a child’s differences are in need of outside intervention or special attention at any given stage of development can be daunting to determine.

That’s why the report stresses that it is essential to help educate and engage parents in treatment, as well as provide coordination support. Once again we see the damaging effects of isolation—for Adam and his mother, the lack of interaction with a larger family, friends, school or community in those critical years had a devastating effect, and many in the Sandy Hook community paid the price.