Psychiatrist testifies: Eileen Ryan explains Tanner Horner’s mental state

[0:01] wait wait no one to come back all right y'all ready ready okay let's go missing one everybody [1:45] can be seated that's why they put extra chairs in there so i can make sure that everybody's here [1:54] they're ready to proceed ladies and gentlemen this witness has been sworn [2:15] uh previously to testify truthfully ms anderson thank you your honor your honor before we proceed [2:23] with dr bryan uh the defense offers make sure i get the numbers correct uh defense exhibits number 80 [2:36] 81 82 83 and 84 which have all been on file with the clerk of court and the state has also been given [2:50] copies any objections none your honor thank you uh defense exhibits 80 through 84 are admitted [3:03] good afternoon dr ryan how you doing good thank you uh dr ryan if you would please just uh [3:10] go ahead and introduce yourself to the jury i am dr ryan and dr ryan what do you do for a living [3:17] i am a professor of psychiatry behavioral health at the ohio state university college of medicine [3:25] i'm the vice chair of clinical affairs and i am a general adult child and adolescent and forensic [3:33] psychiatrist could i have you slide that over just a little bit your voice is very soft so there you [3:39] go that's the first time anyone said i understand miss anderson that's something you and i share in [3:45] common um dr ryan tell the jury a little bit about your educational background so i uh graduated [3:55] undergraduate from new york university um i went to medical school at midwestern university which then was [4:03] called the chicago college of osteopathic medicine after that i did a medical surgical internship at [4:12] baptist medical center in new york then i did my general psychiatry and child and adolescent psychiatry [4:21] fellowship at the university of pittsburgh western psychiatric institute and clinic [4:26] uh i did a forensic fellowship at the university of virginia dr ryan you have said that you were a [4:35] doctor of osteopathic medicine is there a difference between osteopathic and a medical doctor uh not all [4:44] that much anymore uh osteopathic physicians um have uh education in osteopathic manipulative technique [4:53] uh during medical school there proportionately are more osteopathic physicians go into primary care [5:02] like family medicine internal medicine pediatrics than mds do um and i think osteopathic physicians [5:12] have always prided themselves on having a more holistic approach although i think teaching in an md [5:18] medical school now i think mds have certainly adopted that over the years osteopathic manipulation what [5:25] does that mean um well it's different from chiropractic uh but it's manipulation of the [5:32] musculoskeletal system for various um you know disorders for example back pain various musculoskeletal [5:43] disorders well dr ryan are you licensed to practice medicine in the state of ohio yes are you licensed to [5:49] practice medicine in any other state uh i'm licensed to practice medicine in virginia also in kentucky [5:57] are you board certified in in any discipline yes i am board certified in general psychiatry in child [6:05] and adolescent psychiatry and in forensic psychiatry dr ryan for this particular case did you have to obtain [6:14] a temporary medical license to practice in texas yes and were you able to do that yes you had [6:21] mentioned that you were a professor at ohio state university how long have you been a professor uh since [6:29] 2017. you had also mentioned that you were a vice chair what does that mean basically it is a um title [6:43] that encompasses the promotion of the clinical enterprise within the department so my role is to [6:53] basically promote clinical excellence uh in all of our clinical endeavors so we have an 84 bed [7:00] inpatient hospital we have a huge ambulatory footprint um consult liaison emergency psychiatry uh also um one [7:12] of the my roles is to integrate psychiatry into the medical center so we have our psychiatrists in [7:18] neurology and neurology and in our cancer hospital etc so does that mean you still see patients yes [7:26] and how often do you see patients um i see patients probably about three ten three days a week [7:35] my primary clinical role at this point in time is uh in our psychiatric emergency service [7:43] uh at ohio state because i'm a child and adolescent psychiatrist i also uh work in the pediatric crisis [7:52] department over at nationwide children's hospital i see some outpatients and i also do some inpatient work [8:00] so you mentioned child and adolescent psychiatry is that your specialty area well it's one of my specialty [8:08] areas what are the specialty areas what are the specialty areas do you have um i would say forensic psychiatry is one also [8:14] emergency psychiatry is there any uh do you have a focus within your uh clinical practice [8:27] i would say um that clinically i see patients with mood disorders um i guess what i would be [8:38] most known for is uh suicidal patients the um study of and uh treatment of patients who were suicidal [8:48] risk assessment violence risk assessment a variety of of clinical uh things that i do and you're on [8:56] may approach the witness yes ma'am dr ryan [9:05] what's been marked as defense exhibit number 78 do you recognize this uh that's my cv or resume [9:15] is this a true and accurate representation of the experience that you bring to court today [9:19] yes it is your own defense offers defense exhibit number 78 no justice uh defense 78 is admitted [9:29] dr ryan i was looking at your resume and i saw something related to university of virginia yes [9:48] um were you the medical director at the sorry uh were you the medical director of the institute of law [9:59] psychiatry and public policy there yes i was what does that mean well the institute of law psychiatry [10:06] and public policy is is really a think tank um uh that assists in advising um the state legislature [10:24] uh we have a clinic that evaluates um uh primarily defendants uh i also initiated doing more uh civil work [10:33] also uh started the the child forensic clinic um we also teach uh how to do various types of [10:42] evaluations for example capital sentencing evaluations insanity evaluations company competency to stand trial [10:51] sex offender evaluations a variety of forensic evaluations so you're one of the people that trains [10:58] people to do what you do i did when i was at uva and now i work with fellows those are individuals [11:06] who have their physicians who've completed medical school and their psychiatry residency sometimes [11:12] their child and adolescent fellowship also and are now doing a forensic psychiatry fellowship [11:18] uh dr ryan have you ever been published in any peer-review publications yes what does it mean [11:26] to be peer-reviewed that means uh well maybe it's easier to talk about the process you submit an article [11:34] it could be a research article it could be a review article it could be a variety of different types of [11:38] articles to a medical journal and then the editor sends that out to um various experts in that field to [11:48] review it and uh critique if it's suitable for publication if the methodology is good um if uh it's [11:58] something that adds to the to the research body to the literature body and then if it's accepted [12:06] typically nothing is accepted the first time around um and it's sent back with revisions and if the [12:12] authors are able to do the revisions and resubmitted it it may be published and dr ryan [12:18] what type of articles have you written what generally was your topic of publication well it it would [12:25] sort of vary depending on um you know kind of what my interests and work was at the time and i started out [12:35] uh at university of pittsburgh being very interested in self-injurious behavior so i wrote an article on [12:42] that you know people who cut themselves or headbang things like that um i also have uh uh submitted [12:50] and written articles that have been published on competency to stand trial sexual assault um mood [12:57] disorders among juvenile offenders uh and also uh my research when i was at uva was in uh violence against [13:06] staff um uh in in a psychiatric hospital so i had done research and published on that i've published on [13:14] mental illness and the death penalty um yeah with so and other things yeah personally how many times have [13:22] you been publishing peer review articles i guess i have never counted them up but i guess about 15 times [13:28] and then i have book chapters also that i've written on suicide um malingering or deception um psychiatric [13:38] emergencies interviewing other than book chapters have you written any books uh yes i i edited and wrote [13:47] part of a book on uh juvenile sexual offending uh dr ryan have you ever consulted on legal cases before [13:58] yes approximately how many times have you consulted on cases um probably uh over the last 25 years [14:11] i would say about at least 50 times maybe closer to 75. have you worked for both the state and the defense [14:21] yes i have have you worked in both state and federal court yes i have dr ryan are you being paid for [14:30] for for your time to be here yes i am now are you i understand that you work for ohio state university [14:38] how does that work with you working for them and you being here with us do you get paid or does ohio [14:44] state get paid ohio still the payment goes to ohio state dr ryan what is your hourly fee seven hundred [14:54] dollars an hour is the standard and within the practice that you've seen yes some less some more [15:02] some experts less some experts more approximately how many hours have you worked on this case so far [15:10] i haven't counted them up again osu gets that payment but i would say it's at least a hundred hours [15:19] dr ryan what were you asked to do in this case what was your what we call the referral question [15:26] uh i was asked to do a comprehensive forensic psychiatric evaluation uh for the purpose of [15:35] mitigation what is a psychiatric a forensic psychiatric evaluation for purposes of mitigation so uh [15:46] mitigation in a capital case would be uh doing a thorough psychiatric evaluation um to help inform the jury [15:57] uh about the life of the defendant um and are there any mitigating factors that they might consider [16:07] with respect to uh coming to the conclusion of death versus life in prison without the possibility of [16:15] parole and that's something that is is law essentially um that the death penalty uh according to the supreme court [16:25] is reserved for the worst of the worst and i'm sorry for interrupting dr ryan uh you had mentioned that [16:32] you perform these evaluations but uh is there testing involved in these evaluations uh other experts [16:39] potentially will will do testing i don't do testing um some i don't think i have ever done testing in a [16:47] capital mitigation case sometimes i will do testing in other types of forensic evaluations but [16:54] uh what i do in terms of my methodology is a comprehensive review of all of the records [17:03] um that would be do you want me to talk about what records i read or okay yeah um were you provided [17:12] i mean you said that you reviewed records um did you prepare a report in this case yes i did is there a [17:22] comprehensive list of the records that you reviewed contained within that report there is are there any [17:29] additional records that you reviewed after completing your report i want to add one thing um which uh during [17:36] the previous hearing i was in error about i didn't um include my um interview of the in-home therapist [17:47] um so that was done uh prior to getting additional records and then after completing my report i received [17:57] additional documents and provided uh the prosecution with a list of those you who provided the prosecution [18:06] with a list where did you get the records that you reviewed from the defense team did you receive any [18:15] reports from other experts as well yes i did did you rely solely on the records you received and the [18:27] reports that you received from the other experts when doing your evaluation no what else do you do in [18:34] an evaluation in this kind of a forensic evaluation you um do a comprehensive interview typically several [18:46] interviews with the defendant and i met with mr horner for about 18 and a half hours over the course of [18:54] four times i also spoke with interviewed collateral sources of information people who might be able to [19:03] shed some light um on the defendant his development his functioning i met some of those individuals in [19:12] person others i use zoom or by phone and dr ryan why is it important to have all of this information [19:23] well in any forensic evaluation you have to have a low threshold for suspecting malingering um and so it's [19:33] a forensic evaluation is different from a and malingering would be deceptive uh a uh clinical evaluation your [19:43] your thresholds for suspecting that is much lower and again i'm sorry for interrupting but would you [19:49] please explain to the jury what malingering means deception um malingering is um a uh basically uh [19:58] attempting to deceive uh with the purpose of some gain uh so in a civil case it might be uh attempting to [20:08] you know portraying yourself as far more impaired than you actually are in order to get a big payout for [20:15] example um in a criminal case it might be uh feigning or pretending to be psychotic uh in order to uh you [20:26] know get uh an insanity defense something like that and in order to determine whether a person is malingering [20:39] is that why you look at all of the records that's one of the reasons um also you know every individual [20:45] uh in every case not only in forensic evaluations often you know there are family members and others [20:52] who have more insight into how they function than they might have themselves that's true of even [20:58] neurotypical people um and with someone who has an autism spectrum disorder that's even more the case [21:07] do you try to review all of the records before conducting the interviews with uh with the client [21:16] i review all of the records that i have uh received prior to interviewing the client the yes your client [21:27] may i approach your own yes ma'am so ryan i'm going to hand you what has been marked as dependents [21:42] exhibit number 79 do you recognize that uh yes this is my report is this the report that you prepared [21:48] after interviewing mr horner reviewing the records and interviewing all the final witnesses yes is it a [21:56] true and accurate representation of your findings yes it is your honor defense officer defense exhibit [22:03] number 79 defense exhibit 79 is admitted now dr ryan in your review of the records did you review [22:15] records from the wise county health systems yes did you review records from tarrant county nhmr yes [22:26] did you review records from the hospital known as jps yes i did did you review records from the [22:35] hospital known as milwood yes and did you review other records from the hospital known as jps yes you [23:02] conduct a forensic psychiatric evaluation how important is it to get a family history it's very important [23:11] why is it important well for a variety of reasons one is uh you find out about the uh upbringing of the [23:21] defendant um you also find out about uh the family mental health history um because many [23:30] psychiatric disorders have a familial basis a genetic basis that um you want to be aware of [23:38] it's also important to uh expounding on what i had said earlier understanding the developmental history [23:47] of any defendant you really need to know what kind of a family uh they grew up in what kind of influences [23:55] they were subjected to both positive and negative dr ryan based upon your review of the records and your [24:03] interviews with all the witnesses in this case do you feel that you were able to get a pretty comprehensive [24:12] medical history of uh tanner's family yes i did i want to talk to you a little bit about the psychiatric [24:20] history that you were able to obtain specifically related to the maternal side was there any significant [24:32] history of mental health issues on tanner's maternal side yes there was significant uh mental health history on [24:42] the maternal side um his maternal grandmother uh suffers from depression she's been diagnosed with bipolar [24:53] disorder but she doesn't believe that she has bipolar disorder um and the records that that i reviewed [24:59] weren't very clear on that either um she also uh was very traumatized during her own childhood sexually abused [25:08] um his mother has a history of significant severe mental illness now she's been diagnosed with major depression [25:21] with psychotic features schizoaffective disorder and bipolar disorder now those disorders are kind of [25:28] mutually exclusive you can't have all three of those but from reviewing the records she had extensive [25:34] psychiatric records that i reviewed um she has been psychotic and uh it didn't appear that that was only in the [25:43] context of substance use that that persisted even outside of substance use and i believe you said that all of [25:50] these diagnoses were documented in medical records that you reviewed they were all documented in the medical records yes [25:56] the maternal um uh grandmother has uh several uh siblings two of whom completed suicide uh a sister who was [26:07] apparently um uh very successful um and had a diagnosis of bipolar disorder who killed herself when she was about 40. [26:18] um um there's also a brother who um killed himself uh by firearms uh a younger brother [26:27] and she has other older brothers um who have been diagnosed with one with paranoid schizophrenia [26:37] another one with bipolar disorder why is all of this important when you evaluate tanner for this particular case [26:46] it it gives me some insight into what kind of biologically based vulnerabilities he may have to mental illness [26:53] there's also family history is also replete with substance use disorders and those we know are also um [27:01] you know there there's an inherited basis potentially to those also with regards to the substance use disorder [27:08] and was that on both the maternal and the paternal side yes there's um the paternal side i [27:17] his his biological father um died uh before i had any opportunity to uh interview him but he uh reportedly [27:30] and there's actually medical records that i reviewed i reviewed his records uh he has a history of [27:35] depression um significant substance use he also had a serious suicide attempt uh while in jail which [27:44] during which he was cut down and in the process of being cut down when he fell to the floor broke [27:49] his foot what do you mean cut down he was found hanging dr ryan i want to turn your attention to tanner [27:58] horner in this case all right uh you said that you had reviewed all of the medical records in this case [28:06] were you um able to obtain a comprehensive history or view of tanner's own psychiatric issues yes [28:17] historically speaking what kinds of diagnoses has tanner had over his lifetime he has had over his lifetime [28:29] asperger's disorder autism spectrum disorder as the diagnostic category changed major depressive disorder [28:39] recurrent and severe he has had adhd significant attention deficit hyperactivity disorder [28:55] that has been since childhood he's also received the diagnosis of bipolar disorder that was also in the [29:03] medical records based upon your review of the medical records were you able to determine whether he had [29:11] ever been prescribing medications yes he was prescribed numerous medications over the years when he was um a [29:19] uh early adolescence i believe potentially middle school he was prescribed what we call stimulant medication [29:27] for adhd medidate um and concerta he's also been prescribed stratera and that was prescribed quite [29:36] recently prior to um this offense uh he's been prescribed several antidepressants uh sertraline uh which [29:46] is zoloft mirtazapine which is red remeron and fluoxetine which is prozac also bupropion which is well-gintrin he's been [29:56] prescribed um two anti-psychotics although it appears that those were prescribed more for [30:03] sleep disturbance than any actual psychosis olanzapine and quetiapine and dr ryan are these medications [30:13] consistent with the diagnoses that you saw in the records yes i'd like to talk to you a little bit [30:21] about some of the specific instances that you've read about in the records i want to turn your [30:31] attention to the records for millwood and 2018 do you recall an instance or do you recall why tanner [30:42] was admitted to millwood in september of 2018 yes um the uh police were called by um his ex-girlfriend [30:54] uh he had um indicated to her that she should look at facebook because he was going to be killing [31:03] himself um and she rushed over to where he was living at the time i believe it was his grandmother's shed [31:12] and uh found him unconscious and uh the police were called um and he was involuntarily admitted to [31:22] melwood he didn't want to go voluntarily do you recall how long he was in the hospital he was in [31:29] the hospital for about a week i want to turn your attention to the records from tarrant county in 2022 [31:43] based upon your view of the records were you able to determine whether or not tanner was [31:48] seeing anybody at tarrant county hmr on a regular basis he was specifically in may of 2022 [32:01] did he see his provider the individual who prescribed medication yes yes and he also [32:09] was seeing i believe a therapist too when he went to see the provider was an intake performed do you [32:22] recall i don't recall but but i don't recall exactly the intake itself okay but he was diagnosed with [32:30] major depression with major depression with current um adhd and adhd and prescribed uh antidepressants to [32:39] antidepressants and stricara do you recall if he talked to his provider about any of the stressors [32:50] in his life that he was experiencing at the time in may of 2022 yes um he uh basically went for [33:02] um treatment because uh he was feeling increasingly depressed and suicidal um he uh was not hospitalized [33:16] at that time but was um referred to this called this something called a mobile crisis program uh which [33:25] is what he was involved in um he was under a great deal of stress uh he um had difficulties in terms of [33:34] his relationship with his fiancee's family um i believe that uh he was living with them [33:42] um and was having a lot of uh stressors around that not only in terms of the relationship but in [33:49] terms of the number of people living in the house and just the noise factor um and kind of the chaos in [33:56] the home he also uh was um stressed by work uh he his fiancee um had experienced and i was going to say [34:10] i'm going to stop you right there for a moment because i want to go back to may of 2022 and then [34:17] we'll get to the other issues that he was dealing with in just a moment um based upon the records that you [34:25] reviewed from tarrant county was the last date of service october of 2022 yes was uh that about six [34:38] weeks before the kidnap and murder of famous ran yes it was now after his arrest was there an incident [34:48] in the weiss county jail involving tanner yes tell the jury about that um so uh i'm trying to [34:59] recall um it was several months after he had been incarcerated in the jail uh he attempted to uh kill [35:11] himself um by cutting his um upper extremities and uh cutting lower extremities and this was a serious [35:21] suicide attempt um in that uh when he was brought to the hospital he was hypotensive which means he had [35:28] very low blood pressure due to a loss of blood and according to the records i reviewed required a [35:35] transfusion what is the transfusion a blood transfusion what does that mean it means that and and reviewing [35:44] his labs something called his hemoglobin and hematocrit were low which indicates that he had lost a lot of [35:52] blood and his if i remember correctly i think his systolic blood pressure which is that top number in [35:58] your blood pressure which is typically about 120 i think this was like 50 um or 60. um so he had lost [36:06] quite a bit of blood what does it mean to have a systolic of 50 or 60. that you the term is hypotensive [36:13] he was not his blood pressure was very low and that means that there wasn't a lot of blood for the [36:20] heart to pump around the body and uh he was um if i remember correctly in the records it seemed like [36:29] he was confused um somewhat disoriented so this was a legitimate a very serious attempt dr ryan in [36:39] addition to the hanging attempt in 2018 the suicidal ideations in may of 2022 and the suicide attempt in [36:52] the jail in may of 2023 were there other instances that you noted in the records of tanner either causing [37:02] self-harm or trying to commit suicide well there's the head banging and the self-harm um that he [37:10] experiences when um he becomes very dysregulated and overwhelmed but there was also an incident um when [37:19] uh he was hit with a with a plank um uh by his grandfather uh he didn't see that coming in in [37:33] large part because of his difficulty with perspective taking and seeing you know kind of how people are [37:39] registering emotion his father knocked him down with a plank um or some big stick uh to the floor and [37:48] um this he he um indicated this to me and his grandmother did also and he went upstairs and cut [37:58] himself very deeply uh in a in a suicide attempt uh then he came downstairs he was bleeding profusely [38:08] his grandmother took him from the hospital uh and he received 16 sutures uh he did not reveal to the [38:17] hospital personnel um that he had cut himself he said he had i believe he told them that he had cut [38:24] himself he had fallen off a roof or something and fell onto a gutter and cut himself that way and dr ryan [38:32] based upon your review of the records and your evaluation of tanner is it your opinion to a reasonable [38:43] degree of medical certainty that tanner meets the diagnostic criteria for autism spectrum disorder [38:51] yes what about alcohol related neurodevelopmental disorder associated with exposure that's a little [38:59] redundant on my part but yes a neurodevelopmental uh disorder related to fetal alcohol does he meet [39:09] the criteria for major depressive disorder yes he does recurrent post-traumatic stress disorder yes [39:16] attention deficit hyperactivity disorder yes motor tick disorder yes and um you've mentioned bipolar [39:29] disorder rule out what does that mean you know the records had numerous references to um him having [39:38] manic or what we call hypomanic episodes um and i believe that he has been diagnosed in the records [39:46] at some point with having bipolar disorder however you know the the kind of evaluation that i i'm able to [39:54] do in a forensic evaluation is far more comprehensive than the kind of evaluations that i can do in 15 [40:00] minutes in my practice clinically i just don't have that kind of access uh in a psychiatric evaluation [40:07] clinically i was able to review all of these records talk with numerous uh collateral sources and also to [40:15] talk with uh mr horner himself and i could not um determine that he actually met criteria for that [40:24] disorder because you know all of these disorders have pretty strict criteria you have to meet a certain [40:31] number of criteria in order to get the diagnosis he clearly needs the diagnosis for major depressive [40:38] disorder but you have to have for hypomania four days at least uh of clear hypomanic symptoms most of the day [40:49] on consecutive days and for mania it's seven days and i just couldn't get enough uh information to make [40:56] that diagnosis so does that mean he didn't have bipolar no it doesn't mean that i just did not have enough uh [41:04] information to to make the diagnosis to a reasonable degree of medical certainty okay hold on one moment [41:11] you also have some diagnoses of substance use yes dr ryan how important are diagnoses for a forensic [41:45] psychiatric evaluation in a capital murder case well just generally the jury might consider these diagnoses [41:56] these disorders to be mitigating um they certainly impact um how mr horner developed moved through the world [42:11] how he came to be the person that he is i want to talk to you a little bit about some of these individual [42:26] diagnoses we have talked about autism throughout this trial based upon your [42:36] review of the records and review of the reports from other experts in this case was tanner given [42:48] a diagnosis of autism spectrum disorder at some point later yes um he was given the diagnosis of asperger's [42:59] disorder and uh with the diagnostic and statistical manual um moving from dsm-4 to dsm-5 [43:11] there was a change in that diagnostic schema so there is no more asperger's disorder [43:19] um individuals like mr horner who um they would now fall under the category of autism spectrum disorder [43:31] is there a difference between asperger's and autism well in the dsm-4 autistic disorder asperger's [43:47] disorder and something called unspecified pervasive developmental disorder were all under the diagnostic [43:54] category of pervasive developmental disorder and autistic disorder typically uh was describing individuals [44:04] who were significantly impaired in terms of their intellectual ability so they often [44:14] you know more than 70 percent would have fallen into the uh intellectually disabled category what [44:22] used to be called mental retardation and they didn't have language um so that was that was the difference [44:29] asperger's was um the diagnosis for individuals who had normal or above average iq and also had developed [44:40] language but they still had excuse me they still had severe um social communication deficits based upon [44:52] your evaluation of tanner and of the witnesses um what kind of deficits did he present throughout his life [45:07] he's had the the major first criteria um are persistent deficits in social communication and social interaction [45:16] um and these have to be across multiple domains not only in one uh domain and he certainly from the [45:23] records uh it was very clear that he had these difficulties deficits in what we call um social emotional [45:31] reciprocity uh being able to recognize social cues i don't want to go into a lot of detail if that's already [45:39] been gone into but um deficits in nonverbal communication uh it was noted in the records that he made eye contact [45:47] he didn't make good eye contact what was interesting um and i suspect that this was related to some of the [45:55] in-home therapy that he got uh he his eye contact was far too much uh during throughout my evaluation [46:07] um staring you know not doing you know when typically when neurotypical people um interact with someone [46:14] they don't maintain eye contact constantly you drop your eyes you you look away a little bit he very seldom did [46:23] that um and i'm gonna stop you right there and say what significance is that that he um has deficits in [46:30] in non-verbal communication so that's one of the things that that if you're with him um for a significant [46:39] amount of time you you start to feel a little uncomfortable right because there's that staring um there's [46:45] also uh deficits in developing and maintaining relationships and that was very clear in the records [46:53] and from the history that i got from collateral sources speaking of the collateral sources were [47:00] the collateral sources that you spoke with were they able to give you any further insight into the [47:07] deficits that tanner exhibited well i spoke with his mother and his grandmother so they um his grandmother [47:18] particularly in retrospect recognized uh deficits very early on one of the things that she mentioned [47:25] which is very typical of of autistic individuals is instead of playing with a car the way that a little [47:32] kid would play with a car he was kind of focused on turning the wheels which is kind of this focus on [47:39] parts rather than whole the whole um they noted that he tended to play by himself um and when he was in [47:48] preschool uh other kids uh other kids didn't really um want to play with him and also when they would [47:55] approach him to play uh he didn't interact with them in in the way that other kids um would would be [48:02] expected to interact uh he had difficulty now you know preschoolers uh are not known for sharing but he was [48:10] even more you know focused on just doing his own thing and the relationship issues have progressed [48:18] throughout his life um that was noted in the school records it was noted by the in-home therapist [48:25] uh these deficits that really uh prohibit him from taking other people's perspectives communicating [48:33] adequately and then in adulthood you know these these kinds of deficits um that you see with with [48:40] individuals on the spectrum they become in many ways more pronounced in adolescence because you have [48:48] to um do things in adolescence in terms of relationships that are more complicated than than during childhood [48:54] so things only got worse i said dr ryan um the information that you received from the collaterals [49:03] did they corroborate the testing of other experts did they corroborate what you saw in the medical [49:11] records going back a decade totally i want to talk about the diagnosis of major depressive disorder [49:26] how common is it to have a comorbidity of depression with autism very common did you find that to be the [49:37] case with tanner yes explain to the jury what major depressive disorder is so major depressive disorder [49:46] is a mood disorder um in which uh someone is uh pervasively depressed down sad mood um uh or losing interest [50:01] or pleasure in usual activities for at least two weeks and it's not a kind of on and off thing it doesn't [50:08] have to be every single minute but it's pretty you know pretty much most of the day nearly every day [50:14] for at least two weeks and then you need to have five out of nine symptoms in order to meet the criteria [50:22] for example sleep disturbance appetite disturbance loss of energy the loss of pleasure that i mentioned before [50:30] um preoccupation with death or suicidal ideation um decreased concentration feelings of helplessness [50:39] hopelessness so there are nine of them i don't know if i mentioned them all in that but you have to have [50:44] at least five and dr ryan how does depression can i just add one thing it has to really limit your functioning [50:54] well how does depression affect a person's functioning well it's very individualized of course right [51:03] um uh some for some individuals they you know decrease motivation is another one of the the symptoms so [51:11] you know it can be uh an increase in sadness it can be an increase in irritability uh it might be [51:21] a lack of motivation to work for example so you might see that someone uh with a excellent work ethic um [51:29] suddenly starts showing up late for work um work isn't performing at work the way they used to [51:36] uh what about cognitive abilities definitely affects cognitive abilities um in terms of memory uh in terms [51:45] of uh there are your neural circuitry um that's affected in depression in terms of uh you know being able to [51:55] utilize foresight it does affect your cognition it makes you slower potentially in terms of your thinking [52:04] dr ryan another one of the diagnoses that you noted was attention deficit hyperactivity disorder also known as adhd [52:13] what um during your evaluation of tanner did he exhibit any signs or symptoms that would [52:22] lead you to believe or let me rephrase that what signs or symptoms did he exhibit that led you to [52:30] believe that adhd was a valid diagnosis well you have to be you have to recognize that in a structured [52:39] setting i mean we were in a interview room just him and i um and even individuals with significant adhd might be [52:51] able to uh focus um in an interview uh it's when they're in unstructured settings that you really see [52:59] some of those deficits more profoundly so with me you know it was kind of difficult to um separate out [53:07] what was the autism um versus what was distractibility secondary to uh adhd but he was distractible [53:18] um he was also you know kind of impulsive but he has a he had um what i would call impulsive responding [53:26] that was at times very inappropriate that could also be related to his uh his asperger i mean his [53:33] autism spectrum disorder i think if i may i think what's important is recognizing that these comorbidities [53:43] rather than just being additive are compounding so when you're adding in primarily autism spectrum [53:53] disorder major depression adhd and ptsd you're sort of you're creating uh problems that are more [54:04] significant than each of those disorders creates individually well let's look at these uh these three [54:13] that we had just talked about you know we talked about autism depression and adhd but before we do [54:22] that uh one thing that i wanted to ask you that i almost forgot about was there was testimony related [54:30] to tanner eating coins would that information be relevant to his adhd diagnosis well yes um you know the [54:43] the records seem to indicate and the history from sources that i spoke to was that he had a particularly severe [54:50] form of adhd you know we see that with individuals who have had exposure to alcohol um prenatally [55:02] uh that is related to um you know that fetal alcohol spectrum disorder is associated with pretty severe [55:09] adhd that level of you know kids pick up things and put them in their mouths right but it sounds like [55:17] his eating coins was way out of proportion to what you would see particularly if there was any level of [55:24] supervision with just a a kid who has adhd there's also um you know uh to um be eating inanimate objects [55:36] would be something called pica which is another disorder i don't have enough information to be able [55:43] to diagnose that but you know just eating random things that are are objects dr ryan so when looking [55:52] at the autism looking at the depression looking at the adhd diagnoses how would these three working [56:01] together impact a person's ability to cope with anxiety or stress uh well just the autistic spectrum [56:13] autism spectrum disorder alone hammers one's ability to cope with anxiety and stress so you add all of [56:20] these other disorders and you've got a compounding of his difficulties dealing with stress and you know [56:29] what stress is kind of a very generic term but there are very specific kinds of stressors that really um [56:40] are particularly uh problematic for him so disruptions in routine for example all right and um in about [56:52] half a page we're going to talk some more about the stressors in this case but i want to go back to the [56:58] diagnoses for a moment okay um these diagnoses that we talked about they seem to have had an impact on [57:10] impulse control now with regards to the other diagnoses that he had you had noted that there was a prenatal [57:21] alcohol exposure so i'd like to talk a little bit about that um does a a fetus have control [57:31] open up what the mother puts into her body no are women supposed to consume alcohol while pregnant no why [57:40] not well alcohol is a neurotoxin um and uh there is a great deal of research on the uh toxicity to the [57:52] um fetal brain it's not clear how much um is too much uh you know some um uh some literature and research [58:06] indicates that two drinks in one sitting can be which i think may be a little excessive actually but [58:12] there's research that indicates that can be uh neurotoxic that can be toxic to the developing brain [58:18] it all really depends on where this kind of an insult hits so you know in in mr tanner's case [58:27] his mother was heavily very heavily consuming alcohol for the first eight and a half weeks [58:35] i was going to ask are there times in a pregnancy that a developing fetus is more vulnerable than other [58:42] times yes the brain is is developing during that first trimester and so what can happen if a mother [58:49] drinks during the first trimester it can have a very negative effect on the fetus's developing brain [58:58] what kind of effect can alcohol exposure have on a child's executive functioning it can negatively it can [59:07] very negatively affect executive functioning and executive functioning is um basically uh the frontal lobe [59:16] of our brains um that area in the front behind the forehead is what is responsible for executive [59:23] functioning particularly what's called the prefrontal cortex so that is important in terms of judgment [59:31] rational thinking impulse control uh those types of functions how can drinking during the first trimester [59:44] affect um adaptive deficit behavior can you explain what you mean by that how about if i move on to the [59:53] next question because that one didn't make any sense so um how can drinking during the first trimester [1:00:02] affect a child's social and emotional functioning well particularly if it affects the frontal lobe um [1:00:14] which you know is one of the areas that we would be looking at it can affect their impulsivity and as i said you [1:00:21] know children with um fetal alcohol uh disorder and there's two things there's fetal alcohol disorder right which [1:00:29] has you know characteristic facial features which mr horner does not have and then there's what we call [1:00:37] fetal alcohol spectrum disorder and individuals with fetal alcohol spectrum disorder have significant [1:00:45] deficits with respect to impulse control judgment um uh rational thinking um being able to kind of consider [1:00:57] alternatives uh and that that's what we in my opinion we're seeing with mr horner does are there any [1:01:12] secondary diagnoses that are more prevalent for those with who have been exposed to alcohol in utero well [1:01:22] adhd is definitely one of them is there a correlation between alcohol exposure and autism spectrum disorder [1:01:32] uh there's no causation that the the research has not shown any for example that alcohol exposure [1:01:39] causes um autism spectrum disorder however um many children with fetal alcohol uh uh exposure um and fetal [1:01:52] alcohol symptoms um they have autistic traits so one of the questions is you know are are both of the [1:02:02] diagnoses can exist independently but children who have fetal alcohol spectrum disorder children who have [1:02:09] fetal alcohol syndrome can have autistic traits and have a higher percentage of autistic traits than the [1:02:16] general population so is it uh correlative not positive definitely not causative there's some correlation [1:02:27] not between the disorder but autistic traits dr ryan one of the things that you had mentioned earlier [1:02:36] was talking about i believe that you said a causative effect of all of these diagnoses and how they [1:02:45] kind of built upon each other compounding compounding that was the word explain to the jury how all of [1:02:55] these deficits and all these diagnoses can compound each other because it if you have three different [1:03:03] diagnoses that all label impulse control shouldn't that just be one impulse control issue no because as [1:03:12] i said it's kind of it compounds and creates more problems than if it's just each one individually um so [1:03:20] exam for example uh you know mr horner um uh tends to um not only be impulsive but to uh kind of [1:03:33] uh what we call catastrophize or think about worst case scenarios and jump to the worst case conclusions [1:03:42] depression major depression causes something that we call cognitive distortion right which can make [1:03:47] these kinds of um these kinds of thought patterns worse so that would be an example dr ryan we have a lot of [1:03:59] diagnoses here did any of these diagnoses cause tanner to commit the offense to which he pled guilty no did any of these diagnoses lead you to believe that tanner was insane at the time of the commission of the offense no you understand that he did plead guilty [1:04:29] guilty to this case um is insanity part of a guilt innocence or would it be part of the mitigation well it [1:04:44] would be the guilt innocence because um you know one would do an evaluation to determine whether someone [1:04:51] met that that threshold for insanity which would be that you didn't know the nature character consequence of [1:04:57] your act or didn't realize that it was wrong if that were the case um then it would go to an insanity [1:05:04] trial not a mitigation not a sentencing hearing so just to you know put it in layman's terms when [1:05:12] we're talking about insanity one of the issues is knowing right from wrong that's correct and that's [1:05:18] not why we're here today right okay did any of these diagnoses prevent tanner from knowing right from wrong [1:05:30] no so why is it important to look at all these diagnoses if they don't give rise to a defense [1:05:40] or an excuse to the offense well i think that you know in my opinion these diagnoses uh indicate that mr [1:05:51] horner is a severely compromised individual and that that is mitigating in understanding how [1:06:01] he was functioning leading up to the offense um and what kinds of factors went into him thinking the [1:06:11] way that he was thinking around the time of the offense and you know there's lots of other aspects [1:06:18] of it that a jury might find mitigating in terms of his childhood and development to keep get into the [1:06:26] place where he is now and so with these diagnoses do you believe that they are important [1:06:33] to help the jury understand his behavior during the interrogations yes or during the offense [1:06:42] itself yes uh what about uh during any phone calls after he was arrested yes would they these diagnoses [1:06:54] help the jury to understand why or how he wrote the letters that he did after or before his suicide [1:07:01] attempt yes dr ryan i want to talk to you about the evaluation of mr corner when conducting a forensic [1:07:17] psychiatric evaluation do you get personal information from the person that you're evaluating [1:07:27] yes do you ask them the intimate details of their lives yes do you ask about traumatic events that may [1:07:34] have occurred in their past yes i do do you also talk about the facts of the case yes is it always easy [1:07:45] for a person that you're interviewing to open up with you the moment you sit down it's not typical for [1:07:58] them to open up the moment that i begin the evaluation note is it uncommon to not get the truth from the [1:08:06] person the first time out it depends on the person but it certainly can happen is it or do you find it [1:08:18] uncommon that a person being evaluated might be less than honest about the traumas that they experienced [1:08:25] yes so uh why wouldn't a person just come out and say this was my trauma this was the bad thing that i [1:08:39] did why is that so difficult well i think i would look at it in in terms of neurotypical people and [1:08:50] individuals with autism spectrum disorders so even for neurotypical individuals it can be very difficult to talk [1:08:58] about traumas that happened in their lives for example sexual trauma because they perceive it to be shameful [1:09:09] for someone with autism spectrum disorder you've got the additional layering of difficulty with [1:09:21] communication knowing their own basically knowing how they feel and being able to express how they feel [1:09:30] is that why it's so important for a clinician and an evaluator to build rapport with the person they're interviewing [1:09:37] yes is report instantaneous typically not no so does it sometimes take several visits to develop [1:09:50] that rapport with someone it depends on the individual but it can and it's not excuse me it's not so much [1:10:00] rapport as you know a sense of uh i would say safety in terms of that that person is less likely to [1:10:11] judge um the trauma that you might be revealing is that one of the reasons why you spend so much time [1:10:21] with the one-on-one evaluations that's one reason it's also to you know um understand about [1:10:29] consistencies and inconsistencies with collateral sources and within the evaluation dr ryan i want to [1:10:37] talk to you about the facts of this case now during your evaluation with mr horner did tanner talk to you [1:10:49] about the facts in this case yes did this happen the first visit no then it happened on the second visit [1:11:01] i don't believe so i didn't ask him anything about the offense on the first visit i typically don't [1:11:07] but why don't you ask anything about the offense on the first visit typically because that is is often [1:11:14] a very um difficult thing for individuals to talk about um and i don't want to disengage or shut down the [1:11:27] interview um by asking about the facts in the first interview what do you mean by shutting down not [1:11:40] talking any further or um feeling so uncomfortable or so anxious that they don't provide the kind of [1:11:51] information that i need to put the whole picture together so there's a lot more information that i needed [1:11:59] than just information about the offense itself in order to understand more about what happened with [1:12:06] athena i needed to know about him i needed to know what led up to this i needed to know things about his [1:12:14] background all of that stuff and i i'm typically not willing to compromise that by jumping into the [1:12:21] offense right off do you find it more productive to wait yes and talk about the offense later yes that [1:12:28] probably would have been a briefer way to say that yes i want to talk to you about what tanner told [1:12:36] you about the offense okay did he tell you why he picked up athena and placed her in that truck yes [1:12:47] and why did he do that she saw him snorting cocaine dr ryan you mentioned the word earlier that and i cut [1:12:58] you off on that one but i'm going to bring it up now uh you mentioned the word catastrophize what does that [1:13:05] mean that means immediately and with a lot of emotional valence or a lot of emotion um imagining believing [1:13:17] that the worst possible thing is going to happen uh regardless of how minor the event might be [1:13:24] you had the opportunity to see some of the the video of the incident and you reviewed some of the [1:13:38] records related to the transcripts based upon your conversation with tanner and the evidence in this [1:13:48] case that you reviewed is it your opinion that this was one of those moments that tanner catastrophized [1:13:57] yes why do you say that well there's more to the the catastrophizing in a lot of respects is due to his [1:14:06] autism right but layer on that uh his adhd and his depression uh you know he immediately jumped to the [1:14:19] conclusion that uh that athena saw him snorting cocaine and so um she was going to tell and he was [1:14:30] going to lose his job which meant that he was not going to be able to support his son he was going to lose [1:14:39] his son um and that that couldn't happen and he's been sort of laser focused on on his son for a long time [1:14:50] and his son was living with the uh his fiance's mother uh and uh he had had limited contact with um with [1:15:00] his son and was was distraught over that and when he thought he was going to lose his job that was going [1:15:06] to be the end was that a reasonable jump from point a to point z completely unreasonable and is that jump [1:15:20] from point a to point z related to any of the other diagnoses other than the autism or is it just kind [1:15:28] of a a combination of everything that's been going on i think it's the compounding um i think that the [1:15:36] autism was definitely a major component of that um but i think that the impulsivity that goes along with [1:15:45] adhd uh his the major depression um i think that he's also very emotionally reactive related to his [1:15:55] own past trauma uh but i think that that in that moment that catastrophizing around she saw me using [1:16:04] the cocaine she's going to tell on me i'm going to lose my job that's the end for me i'm going to lose [1:16:09] my son was what went into this so after tanner has a thing that in his drug did he tell you what [1:16:20] happened next well getting up to that point um there was from what he told me um he uh didn't know [1:16:33] what he was going to do initially um he was having trouble kind of thinking at that point once he made [1:16:42] up once he was convinced that he was going to lose his job because of of athena seeing him do this he [1:16:50] kind of didn't know what to what to do uh and so he said that he um you know kind of uh said there's [1:17:00] something um in the truck and he was going to look for something do you want me to well i'm going [1:17:06] to stop you right there for a moment um i want to take you i want to fast forward a little bit okay [1:17:13] to athena is already in the truck did he talk to you about assaulting athena eventually did he deny it [1:17:25] at first yes so um did you believe him when he first denied it no why not because i had read the [1:17:36] transcript and and i was i had uh i knew in my opinion what had gone on in the truck he had covered [1:17:43] the camera so one couldn't see it but from what the transcript was i later heard the audio like yeah [1:17:52] and i'm sorry i didn't mean but even before that reading the transcript was enough so um at any time [1:18:02] did you challenge tanner on the lies that he told you yes was he eventually able to tell you what had [1:18:10] happened yes to the best of his ability i think did he have any difficulty talking with you about it at [1:18:18] first yes what was his demeanor when talking about this it was the only other time that he had a similar [1:18:28] demeanor was talking about his own rape um when he was 10. um he was halting he um he had what i would [1:18:37] call an autonomic reaction which is very difficult to fake the autonomic nervous system he he was flushed [1:18:46] um he uh his breathing was was different than it had been before his eyes were downcast uh in much the [1:18:59] same way as he had talked about this other episode what did that mean to you as a forensic psychiatrist [1:19:08] well independently as a forensic psychiatrist not much but in in context with everything else [1:19:16] um that i knew and had spent time with him talking about my opinion was that he was deeply ashamed [1:19:23] um and that was a major factor in in in his lying um and uh hesitancy to to talk about what had happened [1:19:37] um and i i felt in talking with him at that moment in my opinion he appeared to be quite remorseful about [1:19:47] what he had done dr ryan after this attempted assault um did he tell you about what [1:20:03] he did to try to kill athena yes and what did he say about that in detail if you could just give us a brief [1:20:17] overview okay he said that um at x i should backtrack a little bit you know he was pretty clear that he did [1:20:27] not um decide to kill athena until she was in the truck and then he began to think now i'm in even worse [1:20:41] trouble than he was before um i think he just he described it as it started it snowballed into an [1:20:48] avalanche and he then um said that he he he knew he had to kill her um and he tried to make it as he [1:20:59] put it as painless and quick as possible so he tried to as he put it i think it was these were snap her [1:21:07] neck um but it's not like in the movies and it wasn't working um and so he attempted to strangle [1:21:16] her uh and he had a number of attempts to strangle her which were unsuccessful yeah what did you make [1:21:23] of the several attempts that it took i of what significance did you place on that in my opinion [1:21:33] it was a combination of ambivalence and incompetence in this particular scenario would that be consistent [1:21:44] with um with sadism that was not my opinion that that he was um deriving some any pleasure out of [1:21:53] her suffering actually it made him more and more dysregulated what do you mean by dysregulated more [1:21:59] uh distressed more unable to think clearly uh more um uh yeah just having more difficulty thinking [1:22:12] rationally than than usual when he already has trouble with that dr and you had mentioned covering [1:22:21] the the camera lens i have a question for you if a person was trying to cover up an offense [1:22:32] or prevent other people from seeing them committing an offense would it make more sense to cover up the [1:22:41] lens before you commit the offense or after you commit it did you object as a speculation on her part [1:22:54] in your professional opinion is what i'm asking is would it make more sense to cover up a lens before [1:23:04] committing an offense if you wanted people to not see it still object speculation under [1:23:10] suit and i'll let her answer that based on her uh evaluations it would make more sense to cover it up [1:23:19] before you did anything then after or in the midst of what does that tell you about tanner's thought [1:23:29] processes throughout that incident oh they're not linear um and he's uh not really thinking [1:23:43] in a um strategic manner in terms of the way that in a strategic criminal manner dr ryan you had started [1:23:58] to tell us about some of the stressors that tanner had been experiencing leading up to this event and i [1:24:06] wanted to go back to some of that okay were you able to determine whether or not tanner was under any [1:24:20] significant amount of stress leading up to this event yes he was under a significant amount of stress [1:24:29] and your honor may we approach sure okay brie so we've been listening to this um psychiatrist and [1:27:47] you were telling me you actually think out of everything you've heard this is the most effective [1:27:52] testimony you've heard from a witness for the defense and talk to me about why that is so i think [1:27:58] that she has added the most value been the most clear had the most authority um and and sort of [1:28:05] okay brie so we've been listening to this and come from a place there we go and has come from a place of [1:28:11] like okay i can i can believe her i can trust her she's the one that sort of walked us through all of the [1:28:16] diagnoses um she is the one you know so she's sort of made everything like less like oh you know your [1:28:25] family sucks and you had a terrible home life and whatever and more like you know sort of at the [1:28:31] not at the end of her testimony but but during her testimony for example you know i think susan [1:28:37] anderson the lead defense attorney on this case said to her you know what are what are your thoughts [1:28:41] based on like your training and experience and your clinical background and your medical background and [1:28:45] she said that she thought that tanner horner was a severely compromised individual and that that was [1:28:51] mitigating and it wasn't coming from a place of sympathy it wasn't coming from a place of [1:28:55] you know oh let's feel bad that he had a crappy childhood it was coming from the place of this is [1:29:01] a person that has all these diagnoses this is a person that couldn't function in the same way that [1:29:06] the rest of us do this is a person that tried to kill themselves several times like all of the things [1:29:10] and because of that he's severely compromised and that that's that should be considered mitigation and [1:29:16] i thought that that was the most effective piece of information that we have gotten from the defense [1:29:24] in the last five days right okay i mean it's taken us a while to get there but finally we we've got a [1:29:30] witness who at least this is you feel like we're getting somewhere let's bring rebecca lopez our senior [1:29:35] crime and justice reporter who's um at the courthouse in uh rebecca we've gone on break do you know what's [1:29:40] going on right now yeah no just just on break and then they're going to uh finish up her uh testimony [1:29:47] the judge does want to try to let this jury and everyone leave this courthouse uh early because uh [1:29:53] of the bad weather that is about to hit uh dfw and so uh he is very uh aware of that uh so he's going [1:30:00] to probably try to end here in the next hour or so before those storms hit tanya but uh this witness [1:30:06] uh i heard also testified during the uh the hearings and initially uh during the hearings before when [1:30:13] the jury wasn't here she uh it does sound a little bit more sympathetic towards what tanner horner's [1:30:20] life was like when in the defense definitely uh cleaned up a little bit of that because initially [1:30:27] during the first hearings they did not ask her well it was the prosecution that finally asked her well [1:30:33] okay you've got all these diagnoses but does that excuse what he did and it was the prosecution's [1:30:38] questioning during the first hearings um a few days ago that she said well no it doesn't excuse what he [1:30:44] did we're not here to make excuses for what he did we're just here to uh to testify i'm just here to [1:30:49] testify about how we got here uh but now it was interesting because the defense asked those questions [1:30:55] that i expected the prosecution to ask on cross-examination but i think at the uh at the end the [1:31:03] prosecution is going to say but tanner horner said that he killed athena because now he claimed she [1:31:08] was snorting cocaine he told somebody else that it was because he ran over her he's got all these [1:31:13] different excuses and the prosecution's definitely i think on cross-examination gonna press her on that [1:31:20] because some of what she determined uh in some of her thought about how he goes to the worst case [1:31:25] scenario he's lying to her and she does later on admit she will if the prosecution continues this line of [1:31:31] questioning they ask her but he lies and she's like yes and he's lying and he's lying about she's [1:31:36] the one that testified during the hearings that he was lying about having multiple personalities that [1:31:41] about zero that she just he just made that up as a coping mechanism so they're going to push well he's [1:31:46] a liar uh i think brie yeah i mean i think that they are going to push that he's a liar um but i don't [1:31:55] think that that's going to undo the fact that she has determined based on her you know 100 plus hours of [1:32:02] work on this case at 700 dollars an hour that he's a severely compromised person now i do recall when [1:32:10] she was testifying that she said that his mental health does explain his behavior like it gives the [1:32:17] background how did we get here like rebecca just said um you know and it explains you know sort of [1:32:23] the offense it explains the police videos is it explains the phone calls it explains his suicide [1:32:28] attempts once he got into custody like it explains everything it's not an excuse and i think that [1:32:33] what is so important that we distinguish here is because we're in punishment regardless of how the [1:32:39] jury votes tanner horner is never going to be in our society in our community ever again so life without [1:32:48] the possibility of parole if that's the choice that the jury makes is still keeping everyone else safe from [1:32:54] him versus a death sentence and so i think that she's done a good job so far of just saying this [1:33:00] is what mitigation means it really means that somebody is not functioning like the rest of us [1:33:05] they're making terrible decisions that are violent and dangerous and they need to be in prison forever [1:33:10] but but does that mean that we impose the death penalty for somebody that doesn't function like the [1:33:15] rest of us and i think so far i'm not saying it's like you know perfect or or there aren't you know lots [1:33:21] and lots of people that would totally disagree with her but so far i think she has done the cleanest job [1:33:28] of of just owning that at the end of the day these things for some people can and should be mitigating [1:33:36] to the extent that tanner horner should be sentenced to life without the possibility of parole okay um [1:33:45] do you have any sense rebecca about how much longer she's going to be on the stand part of the reason [1:33:48] i'm asking is because uh bre and i are probably because of the weather we're being advised that [1:33:53] we probably should be out of the building by three o'clock from here um because they're expecting [1:34:01] yeah i feel like the judge yeah but i know that the judge is aware of this and is trying to get them [1:34:06] out of here before those storms hit so i i don't think that she'll be on the stand a whole lot longer [1:34:12] um you know possibly maybe an hour or so at the most but um yeah so we'll see but tanya i had the [1:34:19] exact same when i heard her testify the first time during the hearings before the jury uh wasn't in [1:34:25] the court uh courtroom i thought the same thing i thought that she was the witness that uh was [1:34:32] painted a clear picture about why there might be mitigating circumstances but i also thought that [1:34:37] on cross-examination the prosecution did a decent job at also raising uh questions about her uh testimony [1:34:46] so we'll see and and again the jury is human and they still cannot undo what they heard i mean yes [1:34:54] i know they all took an oath and they all said i can listen to the and follow the law and listen to [1:34:58] the testimony and and answer these questions but when you see athena strands family sitting there all [1:35:05] dressed in pink and there you've heard the mom testify what happened in you know to you know how it's [1:35:12] just hurt this family hurt this community uh how painful it was what happened to their daughter and [1:35:18] then you hear that hour-long tape of him killing because he tells the the psychologist oh well i [1:35:23] just wanted to do it quick and painless but it wasn't quick and painless it was an hour of him [1:35:29] strangling this child uh over and over and then telling her to shut up uh in the middle of it over [1:35:35] and over shut up i'm gonna hurt you more several times he screams at the top of his lungs while she is [1:35:40] crying in pain to shut up and i'm telling you it's going to be difficult for this jury to get over [1:35:45] listening to that tape brie yeah i mean i i think that again i it's it is at the center of this really [1:35:55] you know in terms of the decision that a juror is going to make i think it really is going to be based [1:36:00] on what they observed and heard on that tape and is there anything that they're hearing in the defense [1:36:06] case that is going to say maybe this is something that we you know like something that we can [1:36:14] consider and i agree with rebecca that i mean unless you're going to come out and like you know [1:36:21] somebody is going to say that he really did have multiple personality disorder or somebody is going [1:36:24] to say that he really does have like you know mental illness to the extent that he literally i mean [1:36:30] like without that i totally agree with rebecca that i i don't there are things that are mitigating but [1:36:36] it doesn't mean that that mitigation is going to get us above a death sentence exactly and so you can [1:36:42] feel and the interesting part about this type of case is you can feel that tanner horner had all of [1:36:48] these mental health diagnoses you can feel that tanner horner had a terrible childhood and a drug [1:36:52] addicted mother and a grandfather that beat him and whatever else you believe um and you can believe that [1:36:59] those things are potentially mitigating but that they're not mitigating enough right to overcome [1:37:04] a death sentence and i think that that jury is going to say to themselves yeah but still we listen [1:37:10] to an hour of him killing this seven-year-old girl and one of the other things that she testifies is [1:37:17] that he's very remorseful she believes that he is remorseful about what he did but this jury saw him [1:37:23] smoking a cigarette after he kills athena making phone calls and then the next day going back to the [1:37:28] crime scene and uh and saying oh you know just talking like oh nothing's happened here and what [1:37:34] a little girl when somebody tells him little girl's been kidnapped he's like seriously and then the [1:37:39] telephone calls that he makes between mom and uh and grandma and him that are made from the jail and [1:37:45] you listen to him uh you know kind of joking around with them but then also uh again it's about him and [1:37:53] uh what's happening to me and you know what's happening i can't see my son never once thinking [1:37:58] about athena families uh the pain and what he did to athena uh and you don't hear that in the jail [1:38:05] calls later on so while he might have where she thought that he was remorseful maybe when she's [1:38:10] interviewing him when those phone calls are being made to mom and grandma he certainly does not sound [1:38:15] remorse right right exactly and you know it's just but even uh you know she's regurgitating [1:38:23] the story that he told about the cocaine and terry was saying yesterday and of course you guys saw that [1:38:28] video and or and and heard that video said that there's he's not snorting a line of cocaine he's [1:38:34] dropping off a package well and then remember tanya you pointed out the fact that would the seven-year-old [1:38:40] know what cocaine was would she have even you know said to herself ooh he might get in trouble because [1:38:47] he's like she's seven so i don't even think it's a rational thought to to say oh you know as that [1:38:53] being one of his stories she doesn't say to him i saw you snort cocaine she says to him are you a [1:38:59] kidnapper correct you know yeah they're talking about like yeah she's talking about he's talking about [1:39:07] her teacher and going to school and uh oh is that your lunch and why do you bring your lunch stuff [1:39:13] like that says never anything about drugs in that in that tape and uh you know so again it just and [1:39:21] this is why the prosecution is going to continue to push well he is just a liar that you know care less [1:39:27] about what he did and if they do in fact have a witness which is what this whole secret hearing was [1:39:32] about or not really secret but this uh hearing that the judge had outside the presence of the [1:39:37] jury and cleared the courtroom to seal uh whatever this hearing was about if they do have a witness [1:39:42] that's going to come out here and say that maybe tanner horner did something to them or there's [1:39:46] something else that's just completely going to undo uh i think what this defense a witness is saying [1:39:53] yeah i i it it really is if that if that's true and if somebody comes forward like you've described [1:39:59] rebecca i i i don't know i don't know that there's a set of circumstances or a scenario where you come [1:40:06] back from that as a defense i i you know what i mean like i just so this isn't the first time that [1:40:10] he's done something like this it's just the first time that he actually took it to the next step and [1:40:14] killed the person right i don't know how you overcome that well if you if he did if they come back with [1:40:21] something that's even remotely in the arena of this it you're you're i mean i i i would have to then [1:40:29] completely be on board with our internet jury you know what i mean or whatever and say that i just [1:40:35] don't think that there's a way um to overcome you know to overcome the ultimate punishment if that if [1:40:40] that were the case now obviously we don't know right um but yeah that would be tough well and remember [1:40:48] he has covered the camera two other times before uh uh he kidnaps athena so when she says oh he wasn't [1:40:57] planning on uh killing her it was a you know a reaction but he the prosecution is pointing out [1:41:05] that this was premeditated he was out stalking children uh so uh that is also i think gonna be [1:41:12] a key part of their closing and to put on my devil's advocate hat i i don't disagree that he has [1:41:22] you know that the fact that he did it two other times you know means is this you know is significant [1:41:27] right but i don't know that it automatically means that if he had gotten another child in that [1:41:33] in that truck that he was going to kill that child in other words i i think it can be believable that [1:41:39] he decided to kill her once she was inside not stalking her or watching her with the attention [1:41:45] intention of getting her and killing her you know what i mean so i think that those can be separate [1:41:49] things okay guys let's bring the courtroom shot up we're gonna let you go rick a bit rebecca because [1:41:54] this is uh they're back in the courtroom uh were you able to determine whether he was under a [1:42:02] significant amount of stress just in the months prior to this yes is stress and anxiety different [1:42:13] for a neurodivergent person versus a neurotypical person uh yes how so well there are ways of course [1:42:22] in which it's similar um in terms of uh anxiety worry um except one of the difficulties in uh about 50 percent [1:42:37] of individuals with autism spectrum disorder is that they um have significant deficits in understanding [1:42:46] their own emotions uh and being able to express their own emotions so there's the this there is the [1:42:54] perception that they are um significantly distressed but they can't name what the emotion is and that [1:43:04] ends up being problematic because if not only if you if you can't name your own emotions it's very [1:43:14] difficult for you to be able to understand what other people are feeling and so it's also very difficult [1:43:20] for you to regulate your emotions so for example if you're feeling depressed if you're feeling sad i'm not [1:43:29] going to be about clinical depression but if someone's feeling uh sad about something um you know you [1:43:35] you might take steps to remediate that or if you're feeling anxious about a situation uh you might either [1:43:43] for example if i'm feeling anxious about preparing for a test you may study harder you might you know do [1:43:49] some meditation or exercise and you've learned kind of what it is that you're experiencing and what you need [1:43:55] to do to kind of improve your state mr warner doesn't have that capacity i want to talk about some of [1:44:06] the stressors that were going on in tanner's life at that time are these incidents documented in the [1:44:15] report that has been offered into evidence in this case yes they are i want to talk about just a few [1:44:21] of them that are noted in your report uh in your report you had noted that tanner was having problems [1:44:29] with his fiance before becoming pregnant with tanner's child was the fiance working and contributing to the [1:44:42] household yes she was also um working double shifts at times um throughout the pregnancy throughout most of [1:44:52] the pregnancy were they able to make ends meet at that time uh yes and they had some financial pressures [1:44:59] they had a number of moves but yes they were able to kind of keep their heads above water so after [1:45:07] tanner's child and tanner's son was born was his fiancee still able to work no she um and this is uh from the [1:45:17] information that he provided his grandmother provided and cat and his fiancee herself provided she had a [1:45:25] severe postpartum depression uh and this lasted uh about a year in which she was not working and not [1:45:34] only was not working but was not really able to care for the baby adequately and was spending most of the [1:45:41] time in the time in bed so even though she wasn't working were they still trying to maintain the social [1:45:50] lifestyle that they had while she was working yes did this cause problems financially yes there was a lot [1:45:59] of for example uh almost all the meals for doordash or uh grubhub kind of meals a lot of money being spent [1:46:09] um in that way you had said that the severe postpartum depression had led to her staying in bed [1:46:19] who picked up the slack while the fiancee was not able to take care of the child well there's [1:46:29] tanner the porter himself was was picking up some of that slack but especially toward um leading up to [1:46:37] the offense he was working about six days a week um and so uh very long shifts there's the issue of of [1:46:45] after he um took about a week off in may after he was very depressed and suicidal and they switched his [1:46:54] route um so that it was no longer the um route that he had had an azole which he was very familiar with [1:47:02] um and so that was a significant stressor and um i want to get back to the problems at home okay [1:47:11] where were tanner and his fiancee living at the time of the event they were living in the shed behind his [1:47:19] grandmother's house where was their child living well especially when there was [1:47:25] the for timing the baby lived with them but then when it got to the point where he might be starting [1:47:35] to walk actually even crawl they felt that it was a very unsanitary environment um you know cassie was [1:47:45] was too impaired to be taking care of uh of the house i mean you know the the shed was bad enough even [1:47:53] before um and the house because there were limitations on on his grandmother there was [1:48:00] i was told it was dog feces on before um it was extraordinarily unsanitary and so the decision was [1:48:07] made that that the baby would um stay with cassie's and we're not going to talk about the names oh sorry [1:48:14] that's okay it's uh and you've spent a lot of time with these people so i understand that this [1:48:20] look so that's okay um so at any point did tanner his fiancee live with his fiancee's mother yes and [1:48:33] grandmother and other people in the home so it sounds like they had a full house over there as well yes [1:48:42] after they had moved out of the mother's home and back into his the shed behind his grandmother's house [1:48:51] did he have the opportunity to um spend any time with his son some uh but not very much and how [1:49:03] what kind of impact did this have on on his mental health it certainly uh contributed to be kind of [1:49:11] becoming more depressed feeling more desperate um there were a lot of other things that happened around [1:49:19] that time uh as i mentioned the the uh his route was changed um his contract was sold off to another [1:49:28] company um he uh the car broke down um which created problems okay so um after he moved out of the [1:49:41] fiancee's mother's helmet and back home who all was living in that home or i should say the shed behind [1:49:51] his grandmother's home who was living in that home mr horner and his fiancee and in the main house uh [1:49:58] his grandmother his mother and his brother did they have any pets many pets based on your interviews [1:50:10] with family members and with tanner what was the environment there was it calm and serene or was it [1:50:18] chaos it was somewhere in between it was very chaotic how can that kind of chaos affect a person [1:50:29] who was on the spectrum well it can affect that individual in a number of ways so first of all [1:50:36] there's the sensory um issues uh that someone on the spectrum has you know he was arguing there was [1:50:45] loudness um then there is the need for you know kind of sameness and routine uh that someone on the [1:50:54] spectrum has and that was definitely disrupted dr ryan you noted in your report that tanner had also [1:51:02] been having difficulties and issues with his own mental health what kind of mental health issues was he [1:51:10] having in the months leading up to this event feeling increasingly anxious um hopeless about the situation [1:51:23] um and and some of that hopelessness was in my opinion clearly a a product of of his severe depression [1:51:33] because shortly before um the defense uh cassie had actually gotten a job i mean they still [1:51:42] had you know significant stressors the car had broken down and they didn't have their child and they [1:51:48] didn't have enough money um in order to move out and that was the whole thing and move out get their [1:51:54] own place so that they could get their child back so he was feeling increasingly hopeless desperate um [1:52:02] and anxious on in addition to the depression and then his baseline deficits in terms of how he deals with [1:52:09] with stress and problems was it during this time that tanner had the suicidal ideation of walking into [1:52:20] traffic that was i believe around may um when he went to uh get mental health treatment um he told the um [1:52:34] and i believe he told me but he in the record it was that he had told the the person who evaluated him [1:52:40] that the only thing that kept him from killing himself um was his son the thought of his son and [1:52:48] that friend you had mentioned that tanner's roots had changed and that that was causing significant stress [1:52:58] in his life tell me more about that why would a change of route on a for a delivery man cause some stress [1:53:09] his previous route he was very familiar with he was very familiar with the area um he had essentially [1:53:17] grown up most most of the time there um he uh had a a uh sort of routine in terms of how he would be able [1:53:29] to deliver packages um you know i think the the reality is his his new router route um was would not it [1:53:41] it might have been um anxiety provoking at the beginning for someone who was neurotypical [1:53:48] uh it it took him much longer to deliver packages uh i guess from what he told me the driveways were [1:53:56] much longer on this route he he was much less efficient and his work day was far longer than it had been [1:54:05] before generally speaking how long does it take someone who is neurodivergent to settle into a new [1:54:17] routine does it take longer than a neurotypical person yes it would take longer and you know i one [1:54:25] of the things that that he told me was typically prior to his son he would have quit his job he wouldn't [1:54:33] been able to handle it and he had um left multiple jobs like one time he left he left his job at outback [1:54:40] steakhouse because the dishes were piled too high you know part of it is that he had methodically clean [1:54:47] every single plate a certain way which is why the dishes piled up but you know he just walked out one [1:54:53] day because it just got too overwhelming for him the thing that kept him from doing that in this job was the [1:55:01] recognition that he he is he believed he needed to work doctor i want to switch gears a bit okay during [1:55:13] your forensic evaluation did you discuss any past trauma with tanner yes what role does past trauma play [1:55:29] in a person's current life well significant trauma uh we know now does create brain changes [1:55:39] um particularly childhood trauma um and can create a situation um where that thinking and rational part of [1:55:50] your brain that frontal lobe sort of is is overtaken by another part of your brain called the amygdala which [1:55:58] is part of the limbic system which is that emotional part of your brain so that you know you you don't [1:56:05] process threat for example in the same way um as someone who doesn't have significant trauma that [1:56:13] you're much more likely to be super sensitive to threat so i think that you take someone who's got [1:56:21] autism spectrum disorder adhd major depression and has a significant trauma history and you've got what [1:56:29] i mentioned before these compounding effects that when under stress they're just not functioning um [1:56:37] in any way even at their baseline let alone what someone who's neurotypical would is there a difference [1:56:47] in how trauma or childhood trauma affects brain development versus maybe trauma that we experience later in life [1:56:57] well the the uh research shows that because brains are not are still under development particularly in [1:57:08] childhood and even you know up to age maybe your early to mid-20s that you know these traumatic insults [1:57:16] have a more significant effect um than they would you know for an adult with a fully developed mature [1:57:26] brain and the frontal lobe is the sort of last part of our brains to fully develop we have heard evidence [1:57:35] today or over the last couple of weeks about tanner's home life and about what it was like growing up in [1:57:45] that home i want to focus some more on specific traumas that tanner had endured did tanner suffer any [1:58:00] significant traumas during his life other than just the basic home life that we've discussed before [1:58:11] yes what types of traumas did he uh suffer well there was severe bullying um which has has been described [1:58:26] um uh bullying in school bullying in high school um that is we know that is traumatic even for if the [1:58:36] bullying is severe that's even that's traumatic even for neurotypical individuals one of the probably the [1:58:42] biggest um uh trauma was a rape at age 10. were there any other traumas that you noted that related to his [1:58:59] mother and his mother's drug use yes um so he um there were two instances where he um walked in on her [1:59:14] in the bathroom after she had overdosed one time when when i think he was very young um and i believe [1:59:22] his grandmother and mother had had mentioned that um and another time when he was older whether he was [1:59:29] around 12 or 10 i'm not sure um but he actually found her passed out um and with her pants down um which was [1:59:42] a very upsetting event for him um passed out on the on the toilet and he thought that she was dead [1:59:52] what kind of effect could that have i mean finding your mother passed out on the toilet thinking that [1:59:59] she's dead how could that affect a child it's a very traumatic event um it would be traumatic for [2:00:07] anyone right um let alone someone who has difficulty processing their feelings uh being able to uh rationally [2:00:20] think um i believe he went and got his grandmother um who fortunately was was in the home uh but just [2:00:28] feeling completely powerless not knowing what to do uh and believing that his mother uh might be dead [2:00:38] you talk about compounding effects of diagnoses are there compounding effects of childhood trauma [2:00:48] yes explain that to the jury please well you know you're you're uh what i had mentioned before [2:00:56] your uh you know trauma can affect the brain in such a way that it's called um sort of a you no longer [2:01:05] uh are uh have a top down effect where during stressful situations you're able to rationally [2:01:11] think your way out of them um you're more on emotional overdrive and your emotions are basically taking [2:01:19] over um and the more traumatic events that you experience the the more the more of a deficit state [2:01:32] you're potentially going to have that situation is going to get worse [2:01:37] so i would say that that's what you know there's there's trauma upon trauma now there's a significant [2:01:43] amount of trauma in his life um that he was not able to express to me um how he felt uh about the [2:01:53] trauma it was only during with these very significant ones that he was able to express any kind of [2:02:01] emotion or thinking about what was going on because they were kind of overwhelming [2:02:11] you had mentioned some of these traumas one of the traumas that you had mentioned was the fact that [2:02:21] tanner had been sexually assaulted how old was he when that occurred 10 what happened what he explained to me [2:02:34] was that he and um two other kids were um setting little brush fires in a field um and peeing them out [2:02:45] and one of them got out of control and came close to the house uh it was put out um by the landlord of the [2:02:54] property and somebody else and his mother um afterward told him to go over and apologize uh to the landlord [2:03:03] who um he went over there and some subsequently was raped by the by the landlord were you able to [2:03:12] to corroborate tanner's story well there was no witnesses to it actually but but there were there [2:03:22] was information that um hung together with it in such a way um first of all it was how he narrated the [2:03:31] event to me he was deeply ashamed um he kept saying that he didn't want anyone to know he didn't want his [2:03:40] mother and his grandmother to know uh they would think that he was gay uh if if it was revealed um [2:03:47] um as i said he was very distraught as he uh as he told me about this um he said that for about two years [2:03:57] after this he struggled with a lot of symptoms of of pts day um intrusive thoughts nightmares um he also [2:04:08] uh hated to go to the bathroom hated to um defecate because uh he didn't want to wipe himself [2:04:16] because it reminded him of the abuse that he was anal intercourse um and so he would hold his stool [2:04:28] uh he didn't want to go uh to the bathroom in school he only wanted to produce his own bathroom at home [2:04:35] uh and so consequently he would be he became constipated uh there was a and and his mother and [2:04:42] grandmother uh did indicate that he had some trouble they were kind of vague with constipation [2:04:50] and smearing that that's a problem with with kids who hold their stool they end up having some leakage [2:04:57] from around the the hard stool and also there was a medical record um when he was about 19 that uh [2:05:06] indicated that he had significant bleeding from hemorrhoids and had gone to um to the uh emergency [2:05:14] department for this now you know constipation is a major you know you've got to think in a 19 year [2:05:21] old what would be the cause of that significant uh hemorrhoid and rectal bleeding um hemorrhoids would [2:05:28] be one there are much more serious uh disorders like cancers whatever um that were ruled out [2:05:35] and dr ryan i want to switch gears again during your interview with uh or let me back up in [2:05:47] preparation for your interview with tanner did you review the interrogation videos yes i think we can [2:05:58] agree that uh during those interrogation videos there were a lot of lies that tanner told yes um he he [2:06:11] lied to the fbi officers um he lied about not knowing anything about the abduction um lied about [2:06:22] where he hid athena's body and he lied about several other things would you agree with that yes based on [2:06:31] your training and your experience as a forensic psychiatrist why do you think why do you think he [2:06:41] lied to stay out of trouble is that uncommon yes now um i want to talk to you about what we see in some [2:06:58] of those interrogations there was no just going to come right out and ask that i'm going to talk to [2:07:06] you about zero okay did does tanner meet the criteria for multiple personality disorder well it's called [2:07:17] associate of identity disorder now um but uh no he does not in my opinion so how do you reconcile [2:07:26] this with the interrogation where he's claiming to have this alter ego named zero in my opinion um you [2:07:36] know i think that the um police did a an excellent job of making him more comfortable i think that he [2:07:45] wanted in my opinion i think he wanted to confess and this made it easier to do so as sort of a third [2:07:54] person uh rather than you know himself dr ryan did you hear the testimony of dr fritz regarding her [2:08:05] experience with level one autism patients and you know speaking about themselves in the third person [2:08:11] uh i think i you know i'm not sure that i did about that i i tried to watch some of it but i had some [2:08:20] connectivity issues and i didn't see all of it well in your practice and based upon uh the patients that [2:08:29] you have observed do you find that it's easier for them to speak about themselves in the third person [2:08:37] sometimes it is sometimes it's easier to to do that and kind of distance yourself from it what do you [2:08:48] mean by distancing yourself from it distancing yourself from uh what happened it's kind of moving [2:08:58] closer and closer to you know taking some responsibility do you think that tanner actually believed that the [2:09:10] officers were buying his act yes i think he believed that they were because of his deficits in perspective [2:09:19] thinking i mean i think that anybody who would have seen that video would have known that it was not [2:09:26] legitimate but uh if they knew anything about dissociative identity disorder and pd but i think he [2:09:32] believed that they believed him does this go into what we were referring to as the theory of mind yes how so [2:09:44] well his um he has an impaired ability to um recognize what other people are thinking and feeling um and that [2:09:57] is related to the autism spectrum disorder many individuals with autism have that problem in your [2:10:09] experience do you ever find that when someone who was on the autism spectrum is being questioned or pressured [2:10:19] into giving an answer do they ever just give an answer to make it stop yes i mean not even you don't [2:10:29] have to be have an autistic autism spectrum disorder to do that um people can do it who are neurotypical [2:10:37] during your evaluation of tanner did you find this to be true with him times um i'm trying to think of [2:10:51] specific times and i'm i'm at this point but yes um you know if there were times particularly around the [2:11:01] offense that you that i ended up pressuring him i'm sure um and then you know the the question comes up [2:11:08] then you know how how comfortable was i with the fact that what i pressured him into potentially saying was [2:11:16] actually act reliable and accurate and then that that comes up with putting it together with the [2:11:25] totality of everything else that i had in terms of the evidence that i saw and you know the other [2:11:33] event the rest of the evaluation as a part of the reference that you reviewed in this case did you [2:11:41] have the opportunity to review the letter that tanner wrote to athena's transparency yes i want to talk [2:11:50] to you a little bit about that letter um you had mentioned before that about autism and people on the [2:12:03] spectrum being able to show their emotions explain to me and explain for the jury you know can someone [2:12:14] of autism feel emotions yes do people that are on the spectrum have difficulty expressing those emotions [2:12:26] that they feel yes they can and is is that kind of what we call alexithymia yes what uh explain what [2:12:41] alexithymia is it's a a trait that um uh of being in about 50 percent or more of individuals [2:12:53] with autism spectrum disorder have this of being unable to understand and express your own emotions [2:13:04] based upon your evaluation of tanner do you believe that he also dealt with alexithymia yes when you made [2:13:18] that observation at the time did you have the report from dr fritz who also noted alexithymia no [2:13:30] so your conclusions were independent of each other yes i didn't get her report until after my [2:13:39] evaluation and prepared my report so how might someone with alexithymia present to another in [2:13:50] what situation well what i'm getting at is you said that they had difficulty expressing their emotions [2:13:58] when someone has difficulty expressing their emotions is it possible for the emotions that [2:14:06] they do express to be misconception oh yes how so well you know throughout mr horner's life and i [2:14:16] observed this during the evaluation um he uh interacts with people in ways that are off-putting uh in [2:14:29] ways that um can be perceived as for example arrogant as a know-it-all uh that's just a couple of examples um but [2:14:40] his ability to um perceive what others are thinking of him is is very uh disturbed uh now i want to [2:14:53] explain that this alexithymia is not an all-or-none thing right and and his ability to um recognize his [2:15:04] emotions uh and express them would be improved under conditions that are more structured for example and [2:15:15] less uh emotionally dysregulating so getting back to the letter that tanner had written to his parents [2:15:28] in reading that letter how can you gauge what is a true expression of emotion you know i think um when [2:15:45] you read that letter when i read that letter um i wrote it kind of in two ways right um as a non-psychiatrist [2:15:54] and as a psychiatrist who has a lot of experience with individuals with autism spectrum disorder [2:16:03] um as a regular person there's elements of it that are pretty kind of infuriating in some ways [2:16:12] it seems like he's making excuses for himself and you know you say like what in the world you know [2:16:19] this isn't the place for this um on the other hand having spent so many hours with him and recognizing [2:16:27] how he moves through the world i in my opinion he was expressing remorse um he felt genuinely awful [2:16:39] about what he had done he recognized as much as he could um that he had brought pain to parents um [2:16:49] because he is a parent himself and i i in my opinion that was as far as he could go and it was genuine that [2:16:58] he felt terrible about what he had done and wanted to express that was that feeling consistent [2:17:07] throughout your interviews with him when he spoke about the event when he spoke about athena and the [2:17:12] event yes and dr ryan i promise i'm almost done i just have one other issue area that i want to get [2:17:22] into with you okay what is the aapl that is the american academy of psychiatry and the law what do they [2:17:35] do well it's it's an organization um basically uh of forensic psychiatrists and uh it you know forensic [2:17:46] psychiatry is the um you know is the clinical and scientific application of psychiatry to legal [2:17:55] questions and and issues so this is an organization of forensic psychiatrists and they um are involved [2:18:03] in teaching education their mission is to one of their missions uh is to promote um a high standard [2:18:15] of forensic evaluation do they publish guidelines related to forensic evaluations yes are these mandates [2:18:24] mandates they're not mandates no they're guidelines uh recommendations to assist uh psychiatrists in [2:18:35] performing a variety of types of forensic evaluations insanity competency to stand trial civil evaluations [2:18:44] capital evaluations so are these basically just a set of best practices for forensic psychiatrists to [2:18:51] use when doing these enumerated evaluations typically yes and typically should a person or should a doctor [2:19:00] who is doing one of these evaluations follow those guidelines yes i mean you there there certainly can [2:19:07] be deviations right because every um uh evaluation can be somewhat different because individuals are [2:19:14] different but if you deviate substantially from the guideline you should have a very good reason for doing so [2:19:22] should someone practicing forensic you know psychiatry for 20 or 30 years should they at least be aware [2:19:28] of these guidelines yes when you conducted your forensic psychiatric evaluation of tanner in this case [2:19:36] did you follow the guidelines set forth by the aapl yes i i i hesitate because i've gone over them so [2:19:45] many times with fellows that i'm teaching that i didn't read it before i went in to talk to mr horner but [2:19:51] yes i'm very familiar with them and dr right i want to talk to you a little bit about how tanner has [2:19:58] adjusted to his time in jail counsel dr ryan how well has tanner adjusted to his time in jail [2:21:05] he appears to have just adjusted well when he was in wise county jail did he have any disciplinary [2:21:15] infractions did he have any write-ups i believe that there was an incident where he was um hitting a wall [2:21:23] i don't know if it was with his head or with his fist or whatever and didn't stop when told and so [2:21:28] was placed in the restraint chair for a few minutes i'm not sure if that was wise or tarrant county [2:21:33] actually so that was it during your time that you saw him in tarrant county did you review the records [2:21:46] yes and um did he have any disciplinary write-ups and i did not see any [2:21:57] do you believe based upon your based upon your evaluation and what you have reviewed [2:22:07] do you believe that that tanner poses a threat to other inmates if sentenced to prison in this case [2:22:17] i don't believe that he has a high potential for but why is that any dangerousness um why would be [2:23:09] compatible with being a uh major violence uh risk in a prison environment and also you know for example [2:23:19] his mental health his depression anxiety that can be treated also in a prison environment he is not [2:23:27] going to have access to substances uh that's just those are just a few you mentioned prey not predator [2:23:35] what did that mean i think that he's much more likely to be uh assaulted than to assault prisoners [2:23:43] you also mentioned structure how important is a um a structure to someone who is on the autism spectrum [2:23:56] it's very important and that lack of structure was part of what kind of brought him to the point [2:24:03] um that he was at lack of routine lack of structure structure is very important and prison is a very [2:24:12] structured environment he'll know there'll be routines and he'll know what those are do you feel [2:24:20] that someone who is on the autism spectrum would be able to function properly in a structured environment [2:24:30] such as prison yes you had mentioned that you looked at his history did tanner have a history of violence [2:24:43] he had a history of some assaults they were more um you know kind of uh flailing out um in response to [2:24:53] uh bullying for example uh there was an incident where i believe he got into an altercation um and spit on [2:25:04] someone's car uh there there were you know fights in in high school of course in in in school he was [2:25:12] very badly bullied uh but they they were not major uh violent episodes where he harmed seriously harmed [2:25:21] anybody well dr ryan um what i'm getting at is when tanner had these episodes or incidents were they [2:25:31] instances of him being aggressive or were the instances of him being reactive more reactive [2:25:38] and his aggression has been mostly toward himself the last thing i want to talk to you about are some [2:25:45] of the other diagnoses that uh that may or may not be at issue in this case first of all what is [2:25:56] psychopathology if some people consider it to be the study of mental disorders other people just see it [2:26:04] as mental disorders mental disorders mental pathology so is psychopathology the same as [2:26:12] psychopathy no is there a diagnosis in the dsm for psychopathy no i want to talk to you about [2:26:25] antisocial personality disorder based upon your review of the records and your evaluation of tanner [2:26:33] does he meet the criteria for antisocial personality disorder he does not why do you say that well in [2:26:41] terms of what the criteria for antisocial personality disorder is a persistent pattern of uh violating [2:26:49] the rights of others you have to at least you don't have to be diagnosed with conduct disorder uh before [2:26:55] the age of 15 but you have to meet those criteria for conduct disorder and he does not explain to [2:27:05] the jury what a paraphilic disorder is a paraphilic disorder is a um disorder in which an individual [2:27:14] has a persistent um sexual arousal to something or someone other than consenting mature individuals [2:27:26] was there any indication in tanner corner of a paraphilic disorder no does sexual sadism fall under a [2:27:37] paraphilic disorder yes you mentioned earlier that um what we saw in the video did not constitute sadism [2:27:53] what about sexual sadism in my opinion it did not no why not well i had i in my opinion he was not [2:28:04] aroused in any way um by her suffering um by athena's suffering uh he in my opinion the the um multiple [2:28:17] attempts were more as i mentioned before related to his ambivalence um and his incompetence at at doing [2:28:27] what he was trying to do and last the doctor i want to ask you about pedophilic disorder what is that [2:28:34] that that is a paraphilia one of the paraphilias uh persistent um uh sexual fantasies urges interests [2:28:45] lasting at least six months or more toward prepubescent children did tanner meet the criteria for [2:28:54] pedophilic disorder no why not well there's no indication from anything that i read that he had a [2:29:02] sexual attraction to there was no child pornography in any of the discovery um this in my opinion was a [2:29:13] horrible an aberrant event um and he did not have a history of an attraction to to children i'll pass away [2:29:26] so uh we'll come back in the morning to finish uh with dr brian he uh fans on its way they're saying [2:29:45] probably around five o'clock so i think i'm going to get you out of here then in time okay so enjoy [2:29:51] you guys for the afternoon stay safe we'll see you in the morning [2:30:01] you