The Utility Of The Construct Of Psychopathy In Children Lorraine Johnstone

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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 [email protected] Or [email protected] 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: Arrogant & Deceitful Interpersonal Style Factor 2: Factor 3: Deficient Affective Experience 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 Criminality Institutional Misconduct Violence Psychopathy Personality disorders Substance Use Recidivism Poor 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 Interventions Treatment Social Interventions Therapies 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 •Narcissistic Injury •Dominance Impulsive and Irresponsible Behavioural Style Arrogant & Deceitful Interpersonal Style •Lacks emotional inhibitors to violence •No anticipatory guilt or empathy Deficient Affective Experience •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. 2. 3. 4. 5. 6. 7. Impression Management Grandiose Sense of Self-Worth Stimulation Seeking Pathological Lying Manipulation for Personal Gain Lack of Remorse 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: 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 “These results raise the prospect that 141 juveniles with high PLC:YV scores followed-up over 2 the violence potential of adolescents years and compared two groups of offenders – intensive treatment and treatment as usual with significant psychopathy features may beThose significantly reduced through who participated in the intensive treatment had lowertreatment” rates of recidivism (p. 593) intensive “Failure to consider theoftotality the Meta-analysis 15 samples of (N=1310) Institutional misconduct aggressive, extant research may lead to (total, inflated physically violent) perceptions of ES’s theranged predictive utility of from .24 to .28 (lower than published research) 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: Factor 3: Narcissism 7 items Callous-Unemotional Traits 6 items But…. Is concerned about schoolwork* ASPD Keeps Promises Emotions Seem Shallow Factor 1: Impulsivity Factor 2: Factor 3: 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 rewardoriented 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 Parenting Genetic 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