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The Utility of the Construct of Psychopathy in Children

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					The Utility of the Construct of
   Psychopathy in Children


             Lorraine Johnstone
Forensic Child and Adolescent Mental Health Service
                The Old School House
                 136 Stanley Street
                    Kinning Park
                      Glasgow
                 Tel 0141 276 3858

    Email Lorraine.johnstone@ggc.scot.nhs.uk
            Or johnstone573@aol.com
                     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.
Hare Psychopathy Checklist Revised


               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
                           Psychopathy in
                                Adults




      Factor 1:               Factor 2:               Factor 3:
      Arrogant &          Deficient Affective         Impulsive &
Deceitful Interpersonal      Experience         Irresponsible Behaviour
         Style
                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
                   Criminality

   Institutional
                                   Violence
   Misconduct



                   Psychopathy
Personality
                                      Recidivism
 disorders



                              Poor
         Substance Use
                           Responsivity
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


                     ODD


                           CD
                                Substance Use


                                                Serious Crimes
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




                             Educational
                                                         Treatment
                            Interventions




                        Social
                                                                Therapies
                    Interventions




                                            Monitoring
                         Risk Assessment




  “...psychopathy is such a robust and important risk
  factor for violence [in adults] that failure to consider it
  may constitute professional negligence...”



Hart, 1998, p.133


                        “However, it would also be negligent to base a risk
                        assessment on a single risk factor such as psychopathy”.



                    Hart, 1998, p.133
          Psychopathy might be causal...

•Sensitive to slights                               •Lacks emotional inhibitors to violence
•Narcissistic Injury               Arrogant &       •No anticipatory guilt or empathy
•Dominance                          Deceitful
                                  Interpersonal
                                       Style




                  Impulsive and                      Deficient
                  Irresponsible                      Affective
                  Behavioural                        Experience
                  Style
                                         •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


        Secure Care

        Forensic Mental Health


        Criminal Justice
    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)
                     Items
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
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:                     Factor 2:                   Factor 3:
      Arrogant &                                               Impulsive &
                                Deficient Affective
Deceitful Interpersonal                                  Irresponsible Behaviour
                                   Experience
         Style


 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
“These results raise the prospect that
       141 juveniles with high PLC:YV scores followed-up over 2
       years and potential of of offenders – intensive
the violence compared two groupsadolescents
       treatment and treatment as usual
with significant psychopathy features
                                 reduced through
may be significantly in the intensive treatment had
       Those who participated
intensive treatment” (p. 593)
       lower rates of recidivism
“Failure to consider the totality of the
                Meta-analysis of 15 samples (N=1310)
                Institutional misconduct inflated
extant research may lead to (total, aggressive,
                physically violent)
                 the predictive utility of
perceptions of ES’s ranged from .24 to .28 (lower than
juvenile psychopathy measures in
                published research)

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:             Factor 2:        Factor 3:
Impulsivity           Narcissism   Callous-Unemotional
  5 items              7 items             Traits
                                          6 items
                    But….

                          Is concerned about schoolwork*

                       ASPD       Keeps Promises

              Emotions Seem Shallow



Factor 1:            Factor 2:             Factor 3:
Impulsivity          Narcissism        Callous-Unemotional
                                               Traits
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


          Attachment



     Trauma            Genetic



           Parenting
        Differential Diagnoses
1) ADHD + Attachment Disorder + Conduct
   Disorder
2) Prodromal phase of psychosis
3) Developmental disorders (Autism, Asperger)
                                     Key differences with the
Potentially Useful
                                     adult literature and
Construct
                                     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

				
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posted:10/14/2011
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