Cruz’s threat to stab elementary teacher, aide was not ‘serious aggressive’ behavior, psychiatrist says

Dr. Laurie Karpf: Cruz had attention-deficit/hyperactivity disorder, oppositional defiance disorder

Dr. Laurie Karpf, who treated Nikolas Cruz from 2008 to 2011, testified about his psychiatric treatment. (Copyright 2022 by WPLG Local10.com - All rights reserved.)

FORT LAUDERDALE, Fla. – The Parkland school shooter’s defense team that is trying to persuade jurors to reject the death penalty as punishment for the 2018 Valentine’s Day massacre at Marjory Stoneman Douglas High School called a psychiatrist who treated him from 2008 to 2011 to testify on Thursday in Broward County court.

Dr. Laurie Karpf said she met Nikolas Cruz’s adoptive mother Lynda Cruz on June 25, 2008, after he had completed second grade at Coral Springs Elementary School. Karpf said they had been referred to her by his pediatrician.

“She was concerned about irritability, low frustration tolerance, tantrums, sibling rivalry,” Karpf said.

Karpf later agreed with Assistant Public Defender Tamara Curtis about “aggression” also being a concern at first. A few months later, as Karpf adjusted his medication, Cruz would go on to threaten to stab a teacher and aide. It was an action Karpf referred to as not a “serious” aggressive behavior.

When she started to treat Cruz, Karpf said she contacted Frederick M. Kravitz, Cruz’s psychologist, and John Newnham, a school counselor at Coral Springs Elementary, who both testified on Wednesday. His adoptive father, Roger Cruz died at 67 on Aug. 11, 2004.

Karpf said she met 9-year-old Cruz on July 3, 2008, after another psychiatrist had already diagnosed him with attention-deficit/hyperactivity disorder and prescribed him Focalin XR, a stimulant with long-acting extended release, and Strattera, a non-stimulant that works 24 hours.

Karpf decided to lower the Focalin XR dosage and started to increase the dosage of Strattera. She said Lynda Cruz reported his “temper was a little bit better,” “he was getting punished less often” and was “a little bit less distracted” after the adjustment.

Karpf said Lynda Cruz returned on September 2008 to report that Cruz, then in third grade, was having “trouble with anger, cursing at a teacher and trashing his desk at school. At home, the mother reported Cruz took apart the mailbox and threw it in the street, and when “he didn’t want to do math homework put his math book in the pool,” according to Karpf.

The situation at school worsened. On Oct. 15, 2008, Lynda Cruz reported that 10-year-old Cruz had threatened to stab a teacher and an aide and police responded. After the threat, Karpf said she didn’t feel like Cruz required hospitalization. She said Cruz denied being suicidal or having hallucinations.

“By the time I saw him, the incident was over, he had calmed down,” Karpf said adding that Cruz was not exhibiting “serious aggressive behaviors.”

Karpf said she decided to decrease Strattera and prescribe a low dose of Risperdal, a mood stabilizer, “to calm” him down. That appeared to have been successful.

“I got a call from the mom a couple of days later that he was calmer at home, doing better in school,” Karpf said.

The stability didn’t last long. After learning that Cruz had hit a classmate with a lunchbox a few weeks later, Karpf said she decided to discontinue the Strattera “on the chance” that it was “agitating him,” and she considered increasing the dosage of Risperdal.

In November 2008, Lynda Cruz reported “picking behavior,” so Karpf said she recommended a neurological exam and more psychological evaluations. Lynda Cruz also reported he had “ripped up a planner,” “hit somebody with a rock,” and “cut his hair when he was angry.”

Karpf said she increased the Focalin “a little bit” because “he was still having some issues ... impulsive angry behaviors.”

Karpf agreed with Assistant State Attorney Nicole Chiappone that by January of 2009 Cruz was “pretty stable” and was sleeping in his own bed after having to sleep with his mother. In August 2010, Karpf said she decided to prescribe Intuniv, a non-stimulant that the U.S. Food and Drug Administration had approved in 2009 and because it was new it was very expensive.

“I am sure when something frustrated him or agitated him, it was kind of beyond his control. The medication was designed to minimize that ... We use the medication to try and raise the frustration tolerance, decrease impulsivity, and keep mood and anxiety under control, but when kids like that get upset, get frustrated, it’s very difficult for them to control their behavior,” Karpf said.

In March 2011, Lynda Cruz reported that at 12 years old, Cruz had “screamed and cried” when he wasn’t able to get a Spiderman video game that he wanted. Karpf said she last saw Cruz on December 2011 after Lynda Cruz changed insurance companies.

Karpf said during the course of his treatment, she also diagnosed Cruz with oppositional defiance disorder, which makes children uncooperative, defiant, and hostile. Karpf said for a period during her treatment Cruz was also attending group therapy at Tomorrow’s Rainbow and treatment from Henderson Behavioral Health.

The defense needs only one of the 12 jurors to oppose the death sentence. Without a unanimous jury vote, Cruz will be sentenced to life in prison without the possibility of parole for the 17 counts of murder and 17 counts of attempted murder that he pleaded guilty to in October.

Watch Dr. Karpf’s full testimony

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About the Author:

The Emmy Award-winning journalist joined the Local 10 News team in 2013. She wrote for the Miami Herald for more than 9 years and won a Green Eyeshade Award.