The Utility of the Construct ofPsychopathy in Children
Lorraine JohnstoneForensic Child and Adolescent Mental Health Service
The Old School House136 Stanley Street
Kinning ParkGlasgow
Tel 0141 276 3858
Overview
Part 1: What is psychopathy, why is it important?
Part 2: Conceptualisations of Youth Psychopathy (PCL:YV and ASPD)
Part 3: Developmental Issues
Part 4: Discussion
What is Psychopathy
A personality disorder...
“…an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individuals culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment” (DSM-IV, APA, 1994, p. 629)
Manie sans delire (Pinel, 1800s)
…individuals engaging in deviant behavior but exhibiting no signs of a mental illness or disorder…
The Mask of Sanity (Clecley 1971)
• 16 behavioral characteristics of a psychopath:– Superficial charm and good intelligence – Absence of delusions and other signs of irrational thinking – Absence of nervousness or psychoneurotic manifestations – Unreliability – Untruthfulness and insincerity – Lack of remorse or shame – Inadequately motivated antisocial behaviour – Poor judgment and failure to learn by experience – Pathologic egocentricity and incapacity for love – General poverty in major affective reactions – Specific loss of insight – Unresponsiveness in general interpersonal relations – Fantastic and uninviting behavior with drink and sometimes without – Suicide threats rarely carried out – Sex life impersonal, trivial, and poorly integrated – Failure to follow any life plan.
20 Items
Scored on a 3 point scale (2 = present, 1 = possibly/partially, 0= not present)
Trained Rater
Multiple Information Sources (Interviews, Files/Collaterals, etc.)
Can take several hours of interviewing and file review
Hare Psychopathy Checklist Revised
Psychopathy in
Adults
Factor 1: Arrogant &
Deceitful Interpersonal Style
Factor 2:Deficient Affective
Experience
Factor 3: Impulsive &
Irresponsible Behaviour
Factor 1:
Arrogant and Deceitful Interpersonal Style
Glibness/Superficial Charm
Grandiose Sense of Self Worth
Pathological Lying
Conning/Manipulative
Factor 2:
Deficient Affective Experience
Lack of remorse or guilt
Failure to Accept Responsibility
Shallow Affect
Callous Lack of Empathy
Factor 3:
Impulsive and Irresponsible Behavioural Style
Lack of realistic, long-term goals
Parasitic Lifestyle
Impulsivity
Irresponsibility
Need for stimulation/proneness to boredom
Psychopathy
Criminality
Violence
Recidivism
Poor Responsivity
Substance Use
Personality disorders
Institutional Misconduct
A prototype...
Why extend the construct downward
“psychopathy does not
suddenly spring, unannounced,
into existence in adulthood.
The precursors…first reveal
themselves early in life”
Hare (1994)
Difficult
temperament
ADHD
CD
Substance Use
Serious Crimes
ODD
Test key hypothesis about development
III. ETIOLOGICAL MECHANISMS
11. Genetic and Environmental Influences on
Psychopathy and Antisocial Behaviour
IRWIN D. WALDMAN and SOO HYUN RHEE
14. Neuroanatomical Bases of Psychopathy: A
review of Brain Imaging Findings
ADRIAN RAINE and YALING YANG
15. Subcortical Brain Systems in Psychopathy: The
Amygdala and Associated Structures
R.J.R. BLAIR
“we can conclude that there is
a genetic contribution to the
Emotional dysfunction seen in
Psychopathy” (p. 45)
Early Identification, Intervention and Prevention
Treatment
Therapies
Monitoring
Social Interventions
Educational Interventions
Risk Assessment
“...psychopathy is such a robust and important risk factor for violence [in adults] that failure to consider it may constitute professional negligence...”
“However, it would also be negligent to base a risk assessment on a single risk factor such as psychopathy”.
Hart, 1998, p.133
Hart, 1998, p.133
Psychopathy might be causal...
Arrogant &
Deceitful
Interpersonal
Style
Impulsive and
Irresponsible
Behavioural
Style
Deficient
Affective
Experience
•Sensitive to slights•Narcissistic Injury•Dominance
•Lacks emotional inhibitors to violence•No anticipatory guilt or empathy
•Opportunistic crimes•Poor temper control
“...it is a reasonable assumption that the socially deviant behaviour of many offenders is a function of personality disorder...”
Blackburn, 1992, p.70
Decisions regarding disposal and management
Residential Care
Criminal Justice
Secure Care
Forensic Mental Health
Prevent Misuse
“Psychopath” “Asperger”
Models of Juvenile Psychopathy
Hare Psychopathy
Checklist Youth
Version: PCL-YV, Forth,
Kosson & Hare, (2003)
“from the school
yard to the prison
yard” (MHS)
Downward extension of PCL-R
20 developmentally appropriate
items
Procedure: 3 point rating scale,
interviews, files and collateral
information
Dimensional (no cut-off scores)
1. Impression Management
2. Grandiose Sense of Self-Worth
3. Stimulation Seeking
4. Pathological Lying
5. Manipulation for Personal Gain
6. Lack of Remorse
7. Shallow Affect
Items
8. Callous/Lack of Empathy
9. Parasitic Orientation
10. Poor Anger Control
11. Impersonal Sexual Behaviour
12. Early Behaviour Problems
13. Lacks Goals
14. Impulsivity
15. Irresponsibility
16. Failure to Accept Responsibility
17. Unstable Interpersonal Relationships
18. Serious Criminal Behaviour
19. Serious Violations of Conditional Release
20. Criminal Versatility
Utility of PCL:YV
Reliability: “good” (Forth et al., 2003)
Prevalence: 20-30% of institutionalized
adolescent males and 10% of those on
probation show significant traits (Forth et
al., 2003; Salekin et al, 2004
Psychometric Structure
Psychopathy in Adolescents
Factor 1: Arrogant &
Deceitful Interpersonal Style
Factor 2:Deficient Affective
Experience
Factor 3: Impulsive &
Irresponsible Behaviour
Dolan & Rennie (2006); Salekin et al., 2006; Neumann, et al., 2006)
Construct Validity
Meta-analysis of recidivism data across 21
samples of juvenile offenders
P significantly associated with general and
violent recidivism (r=.24 and r = .25) but
negligibly with sexual recidivism
Considerable heterogeneity with some
variance explained by gender and ethnicity of
samples
‘Associated but ES’s low’
10 year follow-up of 75 male offenders
Neither total nor factor scores predicted
general or violent reconvictions
141 juveniles with high PLC:YV scores followed-up over 2
years and compared two groups of offenders – intensive
treatment and treatment as usual
Those who participated in the intensive treatment had
lower rates of recidivism
“These results raise the prospect that
the violence potential of adolescents
with significant psychopathy features
may be significantly reduced through
intensive treatment” (p. 593)
Meta-analysis of 15 samples (N=1310)
Institutional misconduct (total, aggressive,
physically violent)
ES’s ranged from .24 to .28 (lower than
published research)
“Failure to consider the totality of the
extant research may lead to inflated
perceptions of the predictive utility of
juvenile psychopathy measures in
institutional settings” (p. 13)
Mental Disorders
• substance misuse problems (Murrie et al., 2004; Corrado et al., 2004)
• Personality disorders(Myers et al., 1995)
• Axis 1 disorders*(Schmidt et al., 2006)
Antisocial Process
Screening Device
(ASPD; Frick & Hare,
2001)
“the APSD screens for
Antisocial Personality
Disorder or psychopathy.
The child is rated on a
dimensional scale that
probes the characteristic
psychopathic pattern”
APSD
• 20 Items
• Parent rating scale
• Teacher rating scale (must have known the child for 2 months)
• Both completed in under 10 minutes
• Clinician time required approx. 10 minutes
Interpretation T scores
Above 70 – Markedly Atypical – Highly Antisocial
66 to 70 – Moderately Atypical
61 to 65 – Mildly Atypical
56 to 60 – Slightly Atypical
45 to 55 – Average
Below 45 – Below Average – Good/low antisocial
Items: ASPD Parent
1. Blames others for his/her mistakes
2. Engages in illegal activities
3. Is concerned about how well she/he does at school or work
4. Acts without thinking of the consequences
5. His/Her emotions seem shallow and not genuine
6. Lies easily and skillfully
7. Is good at keeping promises
8. Brags excessively about her/his abilities
9. Gets bored easily
10. Uses or cons other people to get what he/she wants
11. Teases, makes fun of other people
12. Feels bad or guilty when she/he does something wrong
13. Engages in risky or dangerous activities
14. Can be charming but in ways that seem insincere or superficial
15. Becomes angry when corrected or punished
16. Seems to thing that he/she is better than other people
17. Does not plan ahead or leaves things until the “last minute”
18. Is concerned about the feelings of others
19. Does not show feelings or emotions
20. Keeps the same friends
Utility of ASPD
Psychometric Structure (Frick et al., 2000)
ASPD
Factor 1: Impulsivity
5 items
Factor 2:Narcissism
7 items
Factor 3: Callous-Unemotional
Traits 6 items
But….
ASPD
Factor 1: Impulsivity
Factor 2:Narcissism
Factor 3: Callous-Unemotional
Traits
Emotions Seem Shallow
Is concerned about schoolwork*
Keeps Promises
CU was associated with more
severe conduct problems in
community and clinic referred
children
• Thrill and Adventure Seeking (Frick et al., 2003; Frick et al. 1999)
• Lower sensitivity to cues to punishment when a reward-oriented response set is primed (O’Brien & Frick, 1996; Frick et al., 2003)
• Lower levels of reactivity to threatening and emotionally distressing stimuli (Blair, 1999)
• Less distressed by the negative effects of their behaviour on others (Blair, 1997)
• Impaired ability to recognize fearful and sad facial expressions and sad vocal tones (Blair et al., 2001; Stevens et al., 2001)
• Impairments in moral reasoning and empathic concern (Blair, 1999)
Stability
• ASPD showing reasonable stability over 4 years (Frick et al. 2003)
APSD is highly correlated with
other measures of Disruptive
Behaviour Disorders of
Childhood
Non-laboratory measures of emotion
Developmental indices of emotion
Socialisation of moral affect and
inductive parenting
Reliability has been poor
Developmental Challenges
Homotypic and Heterotypic Continuity
Homotypic Continuity: Identical behavioural
expression of an underlying process across
different developmental stages - this is rare
(Kagan, 1971)
Heterotypic Continuity: Changing
behavioural manifestation of the same
developmental process – more likely
Caspi (2000) illustrated this concept:
The undercontrolled child who has daily temper tantrums in
early childhood may refrain from this behaviour as an adult. But
if he emerged into adulthood as a man who is irritable and
moody, we may grant that the surface behaviour has changed
but claim that the underlying personality type has not. Although
the form of behaviour changes over time, the course of
personality is said to evidence coherence if the qualities of
behaviour are preserved over time (p. 168)
Transient Developmental Phenomena
(Seagrave and Grisso, 2002)
Arrogant and Deceitful.......or..... Immature theory of mind,
egocentricism common
to youth (Piaget, 1972,
1973)
Irresponsible/Impulsive......or.......”normal “ sensation seeking
and lack of consequential thinking
Deficient Affective Experience...or.....Egocentricism
Aetiology
• Assumed biological primacy
• What about Inductive parenting??
• Direction of effects
– Transactional
– Interactional
– Unidirectional
– Bi-directional
• Absence of empirical data providing conclusive evidence
Equifinality and Multifinality
GeneticTrauma
Attachment
Parenting
Differential Diagnoses
1) ADHD + Attachment Disorder + Conduct Disorder
2) Prodromal phase of psychosis
3) Developmental disorders (Autism, Asperger)
Potentially Useful
Construct
Key differences with the
adult literature and
developmental concerns
Priority for Research
Implications for the practitioner
• How can the construct be meaningfully applied in forensic child and adolescent settings?
Clinical use should be for speculation, not
diagnosis or decision making
