After Columbine: Experts Offer Tips for How to Talk to a Troubled Child

Mary Ellen O’Toole, a retired senior FBI profiler and psychologist, is seen here during an interview with Diane Sawyer.PlayABC News
WATCH Sue Klebold Explains Why She's Coming Forward: Part 1

Sue Klebold, the mother of Columbine killer Dylan Klebold, sat down with Diane Sawyer for her first television interview to talk about the son she remembers and how she missed warning signs that could have helped save him and other victims.

In her book, “A Mother’s Reckoning: Living in the Aftermath of Tragedy,” out on Feb. 15, Sue Klebold writes about how it took her years to come to terms with the fact that her son had committed such a brutal and horrific crime before ending his own life. Klebold said she is donating her book profits towards research and charitable foundations focusing on mental health issues.

Resources for Suicide Prevention, Mental Illness Concerns, Helping Parents Cope

FULL COVERAGE: Diane Sawyer's Exclusive with Sue Klebold

ABC News spoke to several experts who have studied mental health in children and teens, as well as studied the Columbine tragedy.

“Early on everyone was looking for the profile of a school shooter,” said Dr. Peter Langman, psychologist and author of “School Shooters: Understanding High School, College, and Adult Perpetrators.” “The consensus now is there is no profile. Different types of people commit different types of attacks for different reasons. And it's important to recognize just how diverse school shooters can be.”

In a recent Centers for Disease Control and Prevention survey of nearly 14,000 American teenagers, 17 percent of high school students report they seriously considered attempting suicide in the past year. Eight percent had attempted suicide one or more times in the past year, and 2.7 percent of high school students actually made a suicide attempt that resulted in an injury, poisoning, or overdose that required medical attention.

“And many times, those attempts have not ever been detected by anybody,” said Dr. Gregory Fritz, president of the American Academy of Child and Adolescent Psychiatry. “This is self-report data, but it’s very consistent year over year."

Experts discussed tips for parents who may be concerned about their children and how to recognize certain warning signs that could mean a child needs help.

1. Watch For Changes in Behavior

Parents know their child’s behavior patterns better than anyone, experts say, so parents should look out for changes in their kid’s mood or behavior that seems out of place.

“First, what you do is [ask] ‘what is the typical, normal behavior of this person on any given day?’” said Dr. Mary Ellen O’Toole, a former FBI profiler and psychologist. “And now, let's compare and contrast it to the behaviors seen now. And how is that different? Then, you can start to give more credibility to those behavioral changes.”

Fritz agreed and suggested parents take notice of when their child’s personality changes and how it changes over time. It’s not so much that they are happy one day and grumpy the next, he said, it’s that they seem to get progressively more down or angry.

“It's sort of a continuum, a gradual increase from no depression to very profound depression,” Fritz said. “But instead of sleeping late, it's in bed all day, or instead of complaining about the food, they stop eating.”

2. Recognize Problems Without Rationalizing Them Away

Experts say parents shouldn’t ignore their instincts if they feel a child isn’t doing well or something seems to be bothering them and they are shutting down. They should seek outside help.

“If they [parents] are sensing pain or problems in their kids, they just want so much for it to go away and not be there in the first place,” said Fritz. “But it also gets in the way of recognizing problems when they need to be recognized or, rationalizing away evidence that really shouldn't be rationalized away.”

Sometimes, Langman said, a child can be very direct and openly talk about wanting to kill or hurt others or themselves, and parents shouldn’t ignore those statements.

“I once had a student in the hospital I evaluated, he had articulated seven different methods of mass murder at his school. He had thought about this a lot,” Langman said. “But the mother's response was, ‘You know, he's a nice boy. He's never hurt anyone. It's just fantasy.’ And maybe he never would've done anything. But there was reason to be concerned. But it was hard for her to believe the boy she had always loved would be capable of that.”

3. Parents Should Focus on ‘Active Listening’

Fritz suggests sitting down with your child in a quiet place without distractions where you can calmly ask them what’s wrong and explain to them why you are concerned.

“You say,‘you said nothing was wrong yesterday when you came home from school, but I can tell that you were feeling bad. Tell me what went on yesterday. I just want to understand,’” Fritz said.

He added that parents shouldn’t feel afraid to ask their kids directly if they are feeling suicidal if there is that concern.

Experts say it’s important for parents to talk to their child from a place of love instead of demanding their child to tell them what’s wrong.

“Say it with the idea that, ‘The reason I'm talking to you is because I love you, and I don't want anything ever in the world to hurt you, and I know you're sad and I know … your world is very dark right now, but I love you this much, that whatever we need to do, we're going to do,’” O’Toole suggested.

4. For Parents, Normal Rules of Privacy Don’t Always Apply

It can depend on the age of the child, Fritz said, but parents should have access to their kids’ social media passwords and even regularly ask their kids to show them their writings or share what they talk about or read online.

There’s a difference between a student writing a dark fiction story and a troubled kid planning to carry out an attack, experts say, so it’s important for parents and teachers to pay attention to detailed descriptions their kids might say in conversation or write down.

“Look for steps that the student has taken to carry out the threat,” O’Toole said. “For example, a student writes that they are going to go into the school, and they are going to shoot and kill fellow students on February the 1st, that's very specific. But you also want to look for, okay, has the student been purchasing guns? Have they gone on a website and tried to purchase ammunition? Have they been going to a firing range? So each detail you get, you take it the next step further to make sure that this is not a student who is just saying some scary things.”

5. Engage Your Child’s Community of Teachers, Doctors and Mentors on Mental Health

If parents feel they aren’t getting anywhere with their child but still feel something is wrong or their child is depressed, Fritz suggests parents reach out to their child’s teachers, coaches, physician, pastor or other adults in the child’s life.

Parents who are especially worried about their kids often have a harder time getting through to them, Fritz added.

“It's not easy, and especially … not easy in teenage years, because there's so much turmoil, there's so much change, teenagers are uncomfortable with themselves much of the time and they're in the process of breaking away from their parents and establishing their own identity,” Fritz said. “So there's always that little bit of tussle and some acting out and that sort of thing… [but] if there's a problem there that the parent can't get to. And I would encourage them to get professional help.”

6. Treat Mental Health the Same Way You Treat Physical Health

While it can be hard to find mental health services in certain areas, Fritz said parents shouldn’t be afraid to book an appointment with a therapist for their child or have their child undergo a mental health screening, even if it’s just the child’s primary doctor asking a few questions.

“I think that parents shouldn't feel like that getting an evaluation from a mental health professional is any different than getting an evaluation for a cough or a chest pain or something from a pediatrician, and the threshold shouldn't be very high,” Fritz said. “There's rarely a downside to it.”