The Utility of the Construct of Psychopathy in Children Lorraine Johnstone

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:
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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