Even though the parents of the gunman who took the lives of 20 children and six adults at Sandy Hook Elementary School allowed doctors from Yale to share information with the school system, not all of the information was transmitted, according to a new report Friday from the Office of the Child Advocate.

“We can say that a copy of the Yale Child Study Center psychiatric evaluation and accompanying recommendations for treatment and education were not contained in the educational record that we obtained,” Child Advocate Sarah Healy Eagan said Friday. “Nor are they specifically referenced or embedded in Adam Lanza’s Individualized Education Plan.”

But the parents did sign releases allowing the information to be shared and there was at least one phone call between Yale and the Newtown system.

“We cannot know exactly what was discussed and we do not know the scope of what was transmitted,” Eagan said.

For almost two years now, the victims families and the state have been searching for answers to why this horrific tragedy occurred.

In October 2006, Lanza was evaluated by Dr. Robert King at the Yale Child Studies Center and later by Advanced Practice Registered Nurse Kathleen Koenig, who met with the youth four times through February 2007, according to the state police report released last December.

He was diagnosed with “profound Autism Spectrum Disorder, with a secondary diagnosis of Obsessive Compulsive Disorder.” Koenig prescribed Celexa, an anti-depressant/anti-anxiety medication and follow-up visits, but Nancy Lanza, Adam’s mother, told Koenig her son was “unable to raise his arm” after taking the medication.

“Nancy Lanza stated due to her son’s symptoms, he would be discontinuing the use of the medication,” according to the interview Koenig gave police.

Does that mean his parents, Peter and Nancy Lanza, were in denial?

“In this case it doesn’t really appear that the parents were in denial,” Dr. Julian Ford of the University of Connecticut’s Department of Psychiatry, said Friday. “In fact both of the parents, Mr. and Mrs. Lanza, repeatedly tried to get help for Adam in a variety of ways.”

He said the finding is more that they recognized Adam had serious problems and was becoming more and more isolated and was having difficulties in relationships with other people.

“But Mrs. Lanza’s approach to trying to help him was to actually protect him and shelter him and pull him further away from the world and that proved to be a very tragic mistake,” Ford said.

Ford said it wasn’t denial, they simply didn’t know which path to take to help their son.

Dr. Hank Schwartz of the Institute of Living said they also were unaware of the magnitude of Adam Lanza’s condition, especially during the last few years of his life.

“It’s not clear the depths of the issues were recognized,” Schwartz said. “So the response of Mrs. Lanza could appear like denial . . . it is possible there were some elements of denial with regard to the depth of Adam Lanza’s pathology.”

Ford said parents have to view the mental health system as not trying to take away their ability to parent their children, but as a partner supporting them. If the Lanzas had worked with the mental health system at that point, it could have provided help for the whole family and not just for Adam, he said.

But Adam’s problems weren’t typical for someone with his diagnosis.

The severe mental health problems were combined with an “atypical preoccupation with violence that had been evident at least since he authored the Big Book of Granny and that appeared to be exacerbated by access to a segment of the cyber-world in which mass violence was a dominant theme of intellectualized speculation and debate, and horribly, fascination and celebration,” according to the report.

The report goes on to say that online atmosphere, combined with easy access to assault weapons, “proved a recipe for mass murder.”

“It is fair to surmise that, had AL’s mental illness been adequately treated in the last years of his life, one predisposing factor to the tragedy of Sandy Hook might have been mitigated,” according to the report — which refers to Adam Lanza only as “AL” throughout the entire narrative.

Schwartz said there is still no evidence that the school system or Lanza’s parents ever responded to evidence that he was prone to violence, evidence like the Big Book of Granny, which was a fictional story Lanza wrote about a spree of violence perpetrated by a grandmother and her son.

“We are faced with a lack of evidence with response to this rage,” Schwartz said. “There is no evidence that it ever was addressed by anyone.”

But despite Lanza’s writings, Ford said there was no evidence that Lanza was a “violent young boy or man” before the shooting.

“In fact, there’s no evidence at all that anyone observed him doing anything that appeared to be violent,” Ford said. “He wasn’t obviously the victim of any violence.”

But there are two features of the preoccupation he had with violence that stand out.

According to Ford, Lanza was preoccupied with violence between people in close relationships and his feelings of violence were completely disconnected from an awareness of other people, as people.

“He was losing a sense of contact with other people as human beings,” Ford said. “And as he became more isolated in an actual physical sense, that increased his sense of disconnection.”

The 114-page report didn’t include any recommendations about changing the law to address some of the issues about information sharing between clinicians, parents, and schools. However, it’s something lawmakers may consider during the next legislative session.

Eagan said sometimes it’s not so much about the privacy laws that prevent the sharing of this information, but about making sure all the interested parties are on the same page with a treatment plan for an individual.

“I think more commonly in this case and other cases we see in our work, it’s not the consent issue that’s always the problem. It’s really the lack of coordinated protocol,” Eagan said.