Cho was referred to the school's educational screening committee because teachers believed his communication problems stemmed more from emotional issues than from language barriers. When Cho was in sixth grade, his parents bought a townhouse next to the school so he could easily commute to his classes. (Virginia Tech 2009, s. 33, alaotsikko: "Elementary school in Virginia")

The doctor diagnosed Cho with "selective mutism" and "major depression: single episode." He prescribed the antidepressant Paroxetine 20 mg, which Cho took from June 1999 to July 2000. Cho did quite well on this regimen; he seemed to be in a good mood, looked brighter, and smiled more. The doctor stopped the medication because Cho improved and no longer needed the antidepressant. (s. 35, alaotsikko: "Middle school years")

About 1 month after classes began at Westfield, one of Cho's teachers reported to the guidance office that Cho's speech was barely audible and he did not respond in complete sentences. The teacher wrote that he was not verbally interactive at all and was shy and shut down. There was practically no communication with teachers or peers. Those failings aside, teachers also praised Cho for his qualities as a student. He achieved high grades, was always on time for class, and was diligent in submitting well-done homework assignments. Other than failing to speak, he did not exhibit any other unusual behaviors and did not cause problems. When the teacher asked Cho if he would like help with communicating, he nodded yes. (Virginia Tech2009, s. 36, alaotsikko: "High school years")

Cho were concerned about his move away from home and the stress of the new environment, especially when they learned he was unhappy with his roommate. His parents visited him every weekend on Sundays during that first semester, which was a major time commitment since they both worked the other 6 days of the week. They noted that the dorm room trash can was full of beer cans (allegedly, from the interview with Cho's parents, the roommate was drinking) and the room was quite dirty. Cho, in contrast, had kept his room neat at home and had good hygiene. He requested a room change—a move that his parents and sister saw as a positive sign that he was being proactive and taking care of his own affairs. (Virginia Tech 2009, s. 40, alaotsikko: College years")

Mr. and Mrs. Cho said that he never asked for extra money and would not accept any. He was very mindful of the family's financial situation and lived frugally. He would not buy things even though his parents encouraged him occasionally to purchase new clothes or other items. (Virginia Tech 2009, s. 40, alaotsikko: College years")

Cho's sophomore year (2004–2005) brought some changes. Cho made arrangements to share the rent on a condominium with a senior at Virginia Tech who worked long hours and was rarely home. His courses that fall leaned more heavily toward science and math. His grades slipped that term. At the same time, he became enthusiastic about writing and decided he would switch his major to English beginning the fall semester of 2005. It is unclear why he made this choice as he disliked using words in school or at home. Moreover, English had not been one of his strongest subjects in high school. (Virginia Tech 2009, s. 40, alaotsikko: College years")

Cho had moved back to the dormitories that semester. He had a roommate and two suitemates who lived in another room connected by a bathroom—a typical layout in the residence halls. The panel interviewed his roommate and one suitemate who related some events from that year. They described Cho in the same way as he is described throughout this report: very quiet, short responses to questions, and rarely initiating any communication. At the beginning of the school year, the roommate and the other suitemates took Cho to several parties. He would always end up sitting in the corner by himself. One time they all went back to a female student's room. Cho took out a knife (“lock blade, not real large”) and started stabbing the carpet. They stopped taking him out with them after that incident. (Virginia Tech 2009, s. 42, alaotsikko: College years")

In the paper, Cho accused the other students in the class of eating animals, “I don't know which uncouth, low-life planet you come from but you disgust me. In fact, you all disgust me.” He made up gruesome quotes from the classmates, then wrote, “You low-life barbarians make me sick to the stomach that I wanna barf over my new shoes. If you despicable human beings who are all disgraces to [the] human race keep this up, before you know it you will turn into cannibals—eating little babies, your friends,. I hope y'all burn in hell for mass murdering and eating all those little animals.” (Virginia Tech 2009, s. 43, alaotsikko: College years")