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Though definitions vary, psychological experts typically agree there are no child psychopaths. Mental health categorization doesn’t, generally speaking, even allow for that possibility.
“Especially when we’re talking about younger people, we don’t use the term psychopathy,” says psychiatrist Dr. Jeffrey Borenstein, president and CEO of the Brain & Behavior Research Foundation in New York City. Borenstein served on the editorial advisory board of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders guide for consumers, based on the manual’s latest, fifth edition, called “Understanding Mental Disorders: Your Guide to DSM-5.”
Instead, Borenstein says, mental health experts speak about an issue called conduct disorder, in which individuals consistently, repeatedly disregard the rights of peers, significant social norms for their age or rules. “A child who has a diagnosis of conduct disorder may be showing … aggression towards other people – for instance, being a bully, threatening or intimidating others, engaging in physical fights,” he says. “It could be using a weapon to cause [or] that could cause harm to another person, being cruel to other people or to animals, stealing, destruction of property and often lying – those would be some of the types of things that would be a warning sign for a parent.”
Left unchecked, children with conduct disorder may get in major trouble at school, commit criminal offenses and set a course for their life that alienates them from much of society and could – particularly in cases where they exhibit troubling violent tendencies – endanger others. Those children and adolescents who also exhibit callousness, such as appearing entirely insensitive or unsympathetic to other people, may, some experts say, be at risk for developing psychopathy as adults.
Definitions of psychopathy vary. Some clinicians, Borenstein included, prefer not to use the word at all – and most certainly not the shorter version that cuts deep through pop-culture and Hollywood horror: psychopath. Instead, Borenstein defers to a broader categorization, antisocial personality disorder, to describe adults who persist in exhibiting issues that are similar to those of children with conduct disorder. However, though not in the DSM-5, psychopathy is sometimes broken out – including by researchers and in forensic settings – from this broader description for a smaller group individuals, based on what’s called the Hare Psychopathy Checklist Revised, or PCL-R, which was developed in 2003. As part of an assessment, a specially trained mental health expert evaluates an individual for 20 traits “that measure central elements of the psychopathic character,” ranging from glib and superficial charm, grandiose estimation of self and pathological lying to cunning and manipulativeness, parasitic lifestyle, early behavior problems and juvenile delinquency.
Research finds differences in brain structure and areas of activation in adults with antisocial personality disorder and psychopathy versus those who have antisocial personality disorder, but not psychopathy. A 2012 study in the Archives of General Psychiatry found that reduced gray matter in areas of the brain that are “implicated in empathic processing, moral reasoning, and processing of prosocial emotions such as guilt and embarrassment may contribute to the profound abnormalities of social behavior observed in psychopathy.” And more recent research finds differences in the brains of boys with conduct disorder who also exhibit callousness from their counterparts who don’t exhibit callousness.
All this, plus a still-evolving understanding of how nature – genetics – and nurture – including a child’s home life, such as whether a child was abused versus having a relatively healthy upbringing – can also contribute to the likelihood a child will develop conduct disorder or psychopathic tendencies later. “It’s kind of a progression, or stages, that a child goes through,” says Dr. David Blackburn, a psychologist at Baylor Scott & White Health, a health care system in Texas.
“First of all, there may be some conflicts that are going on at home,” he says. “Sometimes the child gets identified as the problem child, and so you see the child acting out, usually in school – if they’re in school at that time. Sometimes the acting out occurs at home.” Blackburn says some kids may be diagnosed with oppositional defiant disorder. That’s usually characterized by an angry or irritable mood, a short temper, being easily annoyed and often resentful. “In addition, the person can be argumentative and quite defiant in behavior. He or she will often argue with authority figures, including parents and teachers, Blackburn says. "The person often actively refuses to comply with requests from authority figures such as parents and teachers, not doing chores around the house or homework assignments … [and] will deliberately annoy others with a tendency to blame others for his own misbehavior.” If not properly addressed, some children may eventually develop the much more severe conduct disorder.
Just as a troubled home can increase the likelihood of such issues, experts say, positive or improved caregiver-child relations can help prevent problems or potentially improve circumstances, particularly the earlier changes are made. “What we find with some of these kids who have oppositional defiant disorder, is the parent-child interaction is very, very poor,“ Blackburn says. “They get to where they don’t like their children, and so the interaction – if you see the interaction between the parent and the defiant child – it’s very hostile, it’s very argumentative, it’s very demeaning, and so the child just digs in his heals or her heals and is very oppositional, very defiant – and so you go back and forth, back and forth.”
In addition to providing therapy, Blackburn says parenting classes can be helpful. “So basically if I could get mom and dad on the same page to be as consistent as possible in their discipline to their oppositional defiant child, it makes a big difference,” he says.
Notably, kids with conduct disorder and adults who display psychopathic tendencies don’t tend to respond to punishment in the same way as their peers – including in how they process the information and translate that to future behavior – which can make it increasingly difficult to treat as a child gets older. “Some [individuals] with conduct disorder have a chip on their shoulders and they are not the ones who have the problem – it’s everybody else,” Blackburn says.
Fortunately, psychopathy is rare – it’s estimated to affect less than 1 percent of the population, and far fewer women than men, though data is limited, and actual numbers are unclear.
For parents who have concerns about their children, talk therapy may help, including by teaching a child or adolescent how to properly express and control their anger, Borenstein says. “There’s also family therapy to help the family better work with the child around these behaviors and these issues,” he says.
He emphasizes treating the whole person as well, including the other mental health concerns a child may be dealing with concurrently. “The issue for kids who are troubled is to make sure that any concordant conditions are being treated, whether it be ADHD, symptoms of depression, symptoms of anxiety disorders, early onset of bipolar disorder – or some symptoms of impending bipolar disorder,” he says.
Furthermore, as researchers and clinicians continue to work toward improving treatment, experts stress that a troubled childhood doesn’t have to follow children around for the rest of their lives. “We want to be very careful about putting a label on a child, who – with proper treatment – may be able to outgrow that particular condition,” Borenstein says. “Early intervention can have a tremendous impact.” To concerned parents, he adds, seek professional help – don’t go it alone, and: “Don’t give up.”
By Michael O. Schroeder, U.S. News