Severely aggressive school students with psychiatric illness

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In one of the Boston school districts, students with a history of repeated aggressive behavior may be referred for a comprehensive psychiatric evaluation. In this issue of The Journal, Rappaport et al report an initial qualitative study of 33 students. There was a very high rate (32/33) of severe and untreated psychiatric illness, which was complicated in many cases by learning disorders. The average student evaluated had 3 diagnoses. In addition, 33% had a history of substance abuse and 30% had other chronic medical conditions. Such students must be common in school systems across America, and many are never diagnosed. Even in the school district from which these students were drawn, three times as many such cases received disciplinary action as opposed to psychiatric evaluation. Rappaport et al argue convincingly for the benefits of a comprehensive psychiatric evaluation and treatment.