Juvenile Psychopathy

Despite disagreement about its exact contours, most conceptualizations of psychopathic personality disorder emphasize traits of emotional detachment, including callousness, failure to form close emotional bonds, low anxiety proneness, remorselessness, and deceitfulness. Nevertheless, most measures of psychopathy go beyond these interpersonal and affective features to assess repeated involvement in antisocial behavior, which many scholars view as peripheral to the construct. Chiefly, this is because most measures are based on the Psychopathy Checklist-Revised (PCL-R), which weighs past violent and antisocial behavior as strongly as traits of emotional detachment. Over the past decade, researchers have extended this adult measure of psychopathy downward to adolescents and children, with the goal of assessing “juvenile psychopathy.” This research has gained considerable momentum, despite ongoing controversy about the appropriateness of diagnosing psychopathy before youths’ personalities have reached a period of relative developmental stability. Most contemporary research and virtually all practical interest revolve around the reliability and utility of measures of juvenile psychopathy in forecasting youthful offenders’ violent and antisocial behavior. In this entry, this movement is noted, but research on the validity of extending this construct to youths is emphasized. Theoretically driven research on the potential mechanisms that underpin psychopathy reveals the importance of emotional detachment as a likely manifestation of psychopathy in youths. However, there is no compelling evidence that the purported traits of psychopathy (a) remain stable during the transition to adulthood or (b) do not respond to treatment. This limits the utility of measures of psychopathy for informing legal decisions with long-term consequences concerning youth. Although relevant measures have been developed for children as young as 3 years, the focus of this entry is on preteens and adolescents.

Extending Psychopathy from Adults to Youths

Several factors have encouraged the extension of psychopathy from adults to youth. Foremost among them are (a) the recognition that the chief tools for diagnosing psychopathy predict violence and criminal recidivism and (b) the juvenile justice system’s increasingly punitive policies, which have created a demand for identifying inalterably dangerous youths. Although researchers hoped that psychopathy assessments would be used to identify a subgroup of at-risk youths to target for intervention, recent legal reviews suggest that the youths identified are likely to be excluded from treatment and set up for harsh sanctions.

Most measures of juvenile psychopathy modify the PCL-R items and scoring criteria to reference youths’ peer, family, and school experiences. They are built on the assumption that the features of psychopathy manifested by adult psychopaths will, when exhibited in youths, identify a small subgroup of offenders who are maturing into psychopaths. That is, psychopathy is manifested similarly, whether one is 13 or 33 years old. This assumption is challenged by a study of clinical psychologists’ conceptions of juvenile psychopathy. Clinicians viewed some of the features of adult PCL-R psychopathy (e.g., impulsivity, the failure to accept responsibility, a parasitic lifestyle, criminal versatility) as nonprototypic of juvenile psychopathy. Although this raises the possibility that the manifestations of psychopathy differ as a function of developmental stage, no “bottom-up” measures of juvenile psychopathy have been developed.

Reliability and Predictive Utility of Juvenile Psychopathy Measures

The most widely validated measures of juvenile psychopathy were derived from the PCL-R, including the Psychopathy Checklist: Youth Version (PCL:YV), the Antisocial Process Screening Device (APSD), and the Child Psychopathy Scale (CPS). Like its parent measure, the PCL:YV is based on a clinical interview and file review; the other measures are based on self- or collateral report. Perhaps, given these method differences, the PCL:YV correlates only moderately with the remaining measures.

These measures share two general strengths. First, each has been shown to be reliable (interrater, internal consistency, and/or short-term test-retest). Second, each has demonstrated some utility in predicting youths’ violent or antisocial behavior. The typical degree of association with these behavioral outcomes is similar to that observed in adults (i.e., r ^ .25). Although most prospective studies follow youths for only 1 to 2 years, one retrospective study indicates that youths’ (mean age = 16) file-based PCL:YV scores moderately predict violent recidivism over an average 10-year follow-up period. Most of the PCL:YV’s predictive utility in this study, however, was attributable to its assessment of an impulsive, antisocial lifestyle rather than traits of emotional detachment. This finding is consistent with much of the adult literature and challenges the assumption that the measure’s association with violence is an indication that emotionally detached psychopaths use violence to prey on others. Instead, the measures may tap traits of aggression or externalizing features that predict violence but are not specific to psychopathy.

Construct Validity of Juvenile Psychopathy: Potential Mechanisms and Etiology

For such reasons, predictive utility (which seeks clinical utility) cannot be mistaken for construct validity (which seeks construct identification). To determine whether psychopathy is a valid construct when applied to youths, juvenile psychopathy must be (a) evaluated against a validation hierarchy dictated by a theory of the disorder and (b) shown to be a stable personality disorder that does not dissipate as youths become adults.

Despite the differences among them, most theories describe psychopathy as a largely inherited affective or cognitive processing deficit. These theories dictate a validation hierarchy that places pathophysiologic and etiologic mechanisms at the top, as they offer the greatest potential for explaining the disorder and potentially altering its course. The question is whether diagnostic criteria for juvenile psychopathy identify a homogeneous group of youths with clearly delineated deficits and largely genetic pathophysiology.

Paul Frick and his students have begun to address this question. Their work highlights the importance of features of emotional detachment, or “callous/ unemotional” (C/U) traits, in defining juvenile psychopathy. Theoretically, traits of emotional detachment are underpinned by a fearless temperament and deficient processing of emotionally distressing stimuli, which causes insensitivity to socializing agents and interferes with the typical development of conscience. At the symptomatic level, Frick and his colleagues have found that youths with traits of emotional detachment tend to be fearless, thrill and adventure seeking, and low in anxiety. At the pathophysiological level, they have found that emotionally detached traits identify— among a pool of youths with early and persistent antisocial behavior—those who possess information-processing and emotional deficits similar to those found among psychopathic adults. These include reduced sensitivity to cues of punishment when a reward-oriented response set is primed and diminished reactivity to threatening and emotionally distressing stimuli. Although such results might be interpreted as evidence that psychopathy is genetically influenced, caution should be exercised in drawing premature inferences because the heritability of these laboratory variables is unclear.

Only one behavioral-genetic study of psychopathy has been conducted with youths to date. In this study, psychopathy was operationalized using teachers’ ratings of C/U traits on an unvalidated but internally consistent scale. Based on a selection of 661 7-year-old probands with extreme C/U traits (>1.3 SD), the authors found concordance rates of 39% and 73% for dizygotic and monozygotic twins, respectively, yielding an estimate of moderate heritability for C/U traits (h = .67). Although observational studies suggest that childhood maltreatment relates more strongly to antisocial behavior than features of emotional detachment per se, more research is needed to determine whether features of emotional detachment are more highly heritable.

In summary, existing research provides some support for the validity of emotional detachment or C/U traits in defining juvenile psychopathy. The importance of these traits is bolstered by psychometric studies. Studies that apply item response theory indicate that interpersonal and affective items convey more information about the underlying juvenile psychopathy construct than items that tap aggressive and antisocial conduct. Some of the recently developed measures of juvenile psychopathy (e.g., the Youth Psychopathic Traits Inventory; the Inventory of Callous Unemotional Traits) focus on emotional detachment, deemphasizing antisocial behavior. It remains for future research to determine whether these measures more “cleanly” assess the construct than their predecessors.

Malleability of Juvenile Psychopathy

The fact that we can reliably assess features of emotional detachment in youths that relate in a theoretically coherent manner to cognitive and affective deficits provides some support for extending psychopathy measures downward from adults to youth. Presently, however, we lack the necessary collateral evidence that what we are assessing in youths is psychopathy, a personality disorder that will remain stable into adulthood.

Scholars have expressed two main concerns about the stability of juvenile psychopathy. First, downward translations of the PCL-R include normative and temporary features of adolescence such as impulsivity, stimulation seeking/proneness to boredom, poor behavior controls, and irresponsibility. At least one study indicates that measures of juvenile psychopathy correlate moderately with measures of psychosocial maturity. To the extent that measures of juvenile psychopathy tap construct-irrelevant variance related to psychosocial maturity, a youth’s score will gradually decrease as he or she matures. It is possible that recent measures of juvenile psychopathy that focus specifically on emotional detachment may capture less construct-irrelevant variance related to psychosocial maturity. Indeed, a cross-sectional item-response theory study indicates that PCL:YV items that assess emotional detachment are more defining of psychopathy across age groups than items that tap impulsive, antisocial behavior.

The second concern is that there is no compelling evidence that youths assessed as psychopathic will mature into psychopathic adults. Because personality and identity may not be well formed until adulthood, our nosological systems generally forbid applying diagnoses of personality disorders to children and adolescents. Although psychopathic adults probably manifested similar traits when they were younger, relatively few youths with psychopathic features may mature into psychopathic adults. Reasoning by analogy, the majority of children with conduct disorder desist acting out and do not mature into adults with antisocial personality disorder.

Three relevant studies have been conducted. In the first, the APSD was repeatedly administered to 100 nonreferred fourth graders. Across a 4-year period, the stability of APSD scores and rank order was excellent (interclass correlation [ICC] = .80), suggesting that parent ratings change little from late childhood to early adolescence. The two remaining studies focused on the transition from adolescence to adulthood. In the second study, more than 200 youths were administered the CPS at age 13 and a screening version of the PCL at age 24. Over this 10-year period, there was relatively poor stability (ICC = .27), and most of the shared variance was between the CPS and PCL’s antisocial scale. Of the adolescents who obtained extremely high CPS scores (i.e., the top 5%) at age 13, less than one-third (29%) were classified as psychopathic at age 24. In the third study, PCL measures were repeatedly administered to approximately 200 adolescents and 100 adults. Over a 2-year period, the stability of adolescents’ PCL:YV scores was limited (ICC = .34). Adolescents’ PCL:YV scores decreased significantly more than adults’ PCL-R scores, indicating that psychopathy assessed during adolescence is less stable than that assessed during adulthood.

The apparent features of psychopathy can change not only as a function of maturity but also as a function of intervention. The results of recent research challenge the long-standing therapeutic pessimism about psychopathy. Although three studies of youth have been conducted, only one is prospective and includes a control group. In this study, of approximately 150 youths with pronounced PCL:YV scores and long histories of acting out, those who participated in an intensive treatment program were 2.4 times less likely to recidivate violently the year after release than those who participated in treatment as usual.

Legal Implications of Juvenile Psychopathy

Although juvenile psychopathy is a promising construct, the available evidence cannot support its application to legal decisions about youth that have long-term consequences. First, given the lack of evidence that these measures identify inalterably dangerous youths who will mature into adult psychopaths, it is inappropriate to apply these measures to determine whether a youth should be tried in the adult court system. Second, these measures should not be used as an exclusion criterion for treatment programs. Indeed, juveniles with high psychopathy scores should be reframed as high-risk cases in need of intensive treatment rather than hopeless cases to incapacitate.

What legal uses of these measures might be appropriate? Given their predictive utility, one might use a measure of juvenile psychopathy as a risk assessment tool to inform short-term decisions about placement (particularly levels of security). However, risk assessment tools that have been designed and validated for youth are available. Before selecting a diagnostic measure of psychopathy over a validated risk assessment tool, one must consider the potential for stigmatizing a child or an adolescent with the unsavory label “psychopath.” Studies of juvenile justice professionals and mock juries alike indicate that this label invites assumptions that the youth is inalterably dangerous. Although this assumption does not enjoy empirical support, it pushes decision makers away from rehabilitative efforts toward harsh sanctions and incapacitation. Because adolescence is a time of significant developmental change, it is imperative to learn more about the stability, nature, and manifestations of psychopathy before embracing this construct as a component in the evaluation of juvenile offenders.

References:

  1. Edens, J. F., Skeem, J. L., Cruise, K. R., & Cauffman, E. (2001). Assessment of “juvenile psychopathy” and its association with violence: A critical review. Behavioral Sciences and the Law, 19, 53-80.
  2. Frick, P. J., & Dickens, C. (2006). Current perspectives on conduct disorder. Current Psychiatry Reports, 8, 59-72.
  3. Salekin, R. T. (2006). Psychopathy in children and adolescents. In C. J. Patrick (Eds.), Handbook of psychopathic traits (pp. 389-H4). New York: Guilford Press.

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