ADOLESCENT BEHAVIOR DISORDERS
AND PSYCHOPATHY
The American Psychiatric Association’s diagnostic “bible,” DSM-IV, has no category that captures the full flavor of the psychopathic personality in children and adolescents. Rather, it describes a class of Disruptive Behavior Disorders characterized by behavior that is socially disruptive and is often more distressing to others than to the people with the disorders. Three overlapping subcategories are listed:
• attention-deficit hyperactivity disorder, characterized by de-velopmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity
• conduct disorder, a persistent pattern of conduct in which the basic rights of others and major age-appropriate societal norms or rules are violated
• oppositional defiant disorder, a pattern of negative, hostile, and defiant behavior without the serious violations of the basic rights of others that are seen in conduct disorder
None of these diagnostic categories quite hits the mark with young psychopaths. Conduct disorder comes closest, but it fails to capture the emotional, cognitive, and interpersonal personality traits—egocentricity, lack of empathy, guilt, and remorse, and so forth—that are so important in the diagnosis of psychopathy. Most adult psychopaths probably met the criteria for a diagnosis of conduct disorder when they were younger, but the reverse is not true—that is, most children with conduct disorder will not become adult psychopaths. But there is a subcategory of conduct disorder—with “poor social relatedness, little anxiety, high levels of aggression, and other ‘psychopathic’ characteristics”—that is virtually the same as the disorder defined and diagnosed by the Psychopathy Checklist in adults.3
More direct evidence of psychopathy in children comes from a recent study conducted at two child-guidance clinics, one in Alabama and the other in California.4 The children, mostly males aged six to thirteen, had been referred for a variety of emotional, learning, and behavioral problems. Basing their work on the Psychopathy Checklist, the researchers, headed by Paul Frick of the University of Alabama, assessed each child for the presence of the personality traits and behaviors described in chapters 3 and 4 of this book. The research teams identified a subgroup of children with much the same pattern of emotional/interpersonal features and socially deviant behaviors that characterizes adult psychopaths. For these researchers, and for countless numbers of bewildered and despairing parents, childhood psychopathy became a stark reality.
A DIFFICULT CHALLENGE:
HOW TO RESPOND
Most of the children who end up as adult psychopaths come to the attention of teachers and counselors at a very early age, and it is essential that these professionals understand the nature of the problem they are faced with. If intervention is to have any chance of succeeding, it will have to occur early in childhood. By adolescence, the chances of changing the behavioral patterns of the budding psychopath are slim.
Unfortunately, many of the professionals who deal with these children do not confront the problem head-on, for a variety of reasons. Some take a purely behavioral approach, preferring to treat specific behaviors—aggression, stealing, and so forth—rather than a personality disorder with its complex combination of traits and symptoms. Others feel uncomfortable with the potential long-term consequences to the child or adolescent who is diagnosed with a disorder widely believed to be untreatable. Still others find it difficult to imagine that the behaviors and symptoms they see in their young clients are not simply exaggerated forms of normal behavior, the result of inadequate parenting or poor social conditioning, and therefore treatable. All kids are egocentric, deceitful, and manipulative to a degree—a simple matter of immaturity, they argue—much to the dismay of the harried parents who daily must deal with a problem that refuses to go away and even worsens.
I agree that it is no light matter to apply psychological labels to children—or to adults. Perhaps the issue with the most pressing consequences for children is the “self-fulfilling prophecy,” whereby a child who has been labeled a troublemaker may indeed grow to fit the mold, while others—teachers, parents, friends—reinforce the process by subtly conveying their negative expectations.
Even if the procedures meet accepted scientific standards, no diagnosis is free from error or misapplication by careless or incompetent clinicians. For example, I read of a case in which a young girl was diagnosed as schizophrenic by a psychiatrist. It was later confirmed that she was actually being starved by her parents; once she received proper care her condition improved dramatically. In hundreds of other known cases, and probably countless unknown ones, incorrect psychiatric diagnoses have had a profound impact on patients’ lives. And it’s not hard to imagine these consequences being compounded if a misdiagnosis means that other, treatable problems are overlooked.
On the other hand, failing to recognize that a child has many or most of the personality traits that define psychopathy may doom the parents to unending consultations with school principals, psychiatrists, psychologists, and counselors in a vain attempt to discover what is wrong with their child and with themselves. It may also lead to a succession of inappropriate treatments and interventions—all at great financial and emotional cost.
If you are uncomfortable applying a formal diagnostic label to youngsters, then avoid doing so. However, do not lose sight of the problem: a distinct syndrome of personality traits and behaviors that spells long-term trouble, no matter how one refers to it.
JASON
We recently administered a version of the Psychopathy Checklist to a sample of young male offenders ranging in age from thirteen to eighteen. The average score on the checklist was higher than it was for adult male criminal populations, and more than 25 percent met our criteria for psychopathy. Particularly disturbing was our finding that the offender with one of the highest scores on the checklist was only thirteen years old. Jason had been involved in serious crime—including breaking and entering, thefts, assaults on younger children—by age 6. With one interesting exception, he was clinically and behaviorally indistinguishable from the violent adult psychopaths we have studied. The exception was that he was more open and forthright, less guarded and disingenuous, about his beliefs and attitudes than older psychopaths typically are. Listening to this boy talk was frightening.
Asked why he committed crimes, this product of a stable, professional family replied, “I like it. My fucking parents really freak out when I get in trouble, but I don’t give a shit as long as I’m having a good time. Yeah, I’ve always been wild.” About other people, including his victims, he had this to say: “You want the truth? They’d screw me if they could, only I get my shots in first.” He liked to rob homeless people, especially “faggots,” “bag ladies,” and street kids, because, “They’re used to it. They don’t whine to the police.... One guy I got in a fight with pulled a knife and I took it and I rammed [it] in his eye. He ran around screaming like a baby. What a jerk!”
By the time he started school he was used to stealing from his parents and local stores and bullying other children into giving him their candy and toys. Often, he was able to talk his way out of trouble. “I’d just look them straight in the eye and feed them shit. It was great. I still do it. My mother bought it for a long time.”
There can be no doubt that society is in for a very rough time from Jason. This is not a youngster whose motivations and behavior are readily understandable—he was not emotionally disturbed, neurologically damaged, or the product of a poor social or physical environment. Unfortunately, everyone who works in child guidance clinics, juvenile services, social agencies, youth detention centers, and the criminal justice system knows someone like him. The questions have remained the same for hundreds of years:
• How are we to understand such children?
• How is society to respond and protect itself while protecting as well the civil rights of these children?
As the signs of social breakdown grow more insistent, we no longer have the luxury o
f ignoring the presence of psychopathy in certain children. Half a century ago Hervey Cleckley and Robert Lindner warned us that our failure to acknowledge the psychopaths among us had already triggered a social crisis. Today our social institutions—our schools, courts, mental health clinics—confront the crisis every day in a thousand ways, and the blindfold against the reality of psychopathy is still in place. Our only hope is bringing to bear what we know about the disorder as early as possible. Otherwise, we will continue applying Band-Aids to a life-threatening disease, and the social crisis will worsen. (I’ll have more to say about this in a later chapter.)
CRIME AND VIOLENCE
The last decade has seen the emergence of an inescapable and terrifying reality: a dramatic surge of juvenile crime that threatens to overwhelm our social institutions. Particularly distressing is the staggering increase in drug use and crimes of violence—homicide, rape, robbery, aggravated assault—and the ever younger age at which these offenses are committed. We are constantly sickened and saddened—but no longer surprised—by reports of children under the age of ten who are capable of the sort of mindless violence that once was reserved for hardened adult criminals.
Psychologist Rolf Loeber5 draws our attention to the well-known fact that clinical practitioners have never had much luck in rehabilitating youngsters once their antisocial behavior has become entrenched, and that most treatment programs result in little more than short-term gains. Loeber then points to an issue that is often obscured by the sheer weight of the current data on delinquent behavior in our society: “The level of impairment that arose in the 1960s and 1970s in juveniles’ functioning should cause concern about the ability of a proportion of that generation to bring up the next generation. Impaired child rearing practices is one of the factors that influence how antisocial a next generation will be.” [p. 3] In other words, hold on to your hats—we ain’t seen nothing yet.
Loeber notes that there are several well-established pathways to criminality and that it would be illogical and foolish not to do everything in our power to disrupt these pathways as early as possible. The same reasoning applies, with even greater force, to psychopathy.
Ken Magid and Carole McKelvey use the concept of psychopathy to account, at least in part, for the burgeoning crime statistics among the young.6 To illustrate the point, they present a disturbing list of recent headlines from newspapers across the country:
• Teenage boy in Colorado waits patiently while two young friends hack and hammer his mother to death.
• Florida police try to determine if 5-year-old knew consequences when he threw 3-year-old off fifth-floor stairwell.
• Kansas City police are baffled by jealous 12-year-old who kills younger sister, mother over birthday party plans.
• Eleven-year-old from affluent St. Louis neighborhood orders 10-year-old out of her yard; when he doesn’t leave she shoots him with parents’ gun. Playmate dies after surgery.
• Girl, 4, kills twin baby brothers by throwing them to the floor after one of the 3-week-old infants accidentally scratches her during play.
I could add dozens of other cases to this list. For example, at this writing a small town in a western state is frantically searching for ways to deal with a nine-year-old who allegedly rapes and molests other children at knife point. He is too young to be charged and cannot be taken into care because “such action may only be taken when the child is in danger, not his victims,” according to a child protection official.7
These horrific events were not ordinary accidents or simple exaggerations of normal childhood behaviors that will correct themselves with time. Events of this sort begin to make sense when we accept the fact that the personality traits of psychopathy are present early in life. Disturbing as this may be, it paves the way for study of the disorder across the life span, a crucial task if we are to develop effective intervention procedures and to find out what leads one youngster with the disorder to become a con artist or swindler, another to become a violent criminal, another to become a shady or unethical businessperson, politician, or professional, and yet another—perhaps with a less potent mix of the characteristics described in chapters 3 and 4—to become a reasonably productive member of society.
ORIGINS
When we think about psychopathy in children we come very quickly to a single fundamental question: Why? As noted earlier, many adolescents go off track because of a poor social environment—abusive parents, poverty, lack of job opportunities, bad companions—but the psychopath seems off track from the start. Again: Why?
Unfortunately, the forces that produce a psychopath are still obscure to researchers. However, several rudimentary theories about the causes of psychopathy are worth considering. At one end of the spectrum are theories that view psychopathy as largely the product of genetic or biological factors (nature), whereas theories at the other end of the spectrum posit that psychopathy results entirely from a faulty early social environment (nurture). As with most controversies, the “truth” no doubt lies somewhere in between. That is, psychopathic attitudes and behaviors very likely are the result of a combination of biological factors and environmental forces.
NATURE
Evidence of the genetic and biological bases of temperament, the ability of some forms of brain damage to produce psychopathiclike symptoms, and the early appearance of psychopathic behaviors in children provide frameworks for several biological theories on the origins of psychopathy.
• The relatively new discipline of sociobiology argues that psychopathy is not so much a psychiatric disorder as an expression of a particular genetically based reproductive strategy.8 Simply, sociobiologists assert that one of our main roles in life is to reproduce, thereby passing on our genes to the next generation. We can do so in a number of ways. One reproductive “strategy” is to have only a few children and to nurture them carefully, thus ensuring that they have a good chance of survival. A different strategy is to have so many children that some are bound to survive, even if they are neglected or abandoned. Psychopaths supposedly adhere to an extreme version of the latter strategy: They reproduce as often as possible and waste little energy in worrying about the welfare of their offspring. In this way, they propagate their genes with little or no personal investment.
For male psychopaths, the most effective way to have lots of children is to mate with—and quickly abandon—a large number of women. Unless a psychopath is so attractive or charming that women actively pursue him, he can best accomplish his goal by deception, manipulation, cheating, and misrepresenting his status. One of our psychopathic subjects, a thirty-year-old fraud artist, has had dozens of common-law marriages, the first when he was age sixteen. He had a peripheral association with several rock stars and often passed himself off as their agent and personal confidant. He had little difficulty in convincing aspiring entertainers that he could give their careers a big boost. In eight cases that I know about, he moved in with such women, and as soon as they became pregnant he left them. Asked about his children, he said, “What’s there to tell? They’re kids, that’s all.”
TERRY IS TWENTY-ONE, the second of three boys born into a wealthy and highly respected family. His Older brother is a doctor and his younger brother is a scholarship student in his second year of college. Terry is a first-time offender, serving two years for a series of robberies committed a year ago. He is also a psychopath.
By all accounts, his family life was stable, his parents were warm and loving, and his opportunities for success were enormous. His brothers were honest and hardworking, whereas he simply “floated through life, taking whatever was offered.” His parents’ hopes and expectations were less important to him than having a good time. Still, they supported him emotionally and financially through an adolescence marked by wildness, testing the limits, and repeated brushes with the law—speeding, reckless driving, drunkenness—but no formal convictions. By age twenty he had fathered two children and was heavily involved in gambling and drugs. When he could no longer
obtain money from his family he turned to robbing banks, and was soon caught and sent to prison. “I wouldn’t be here if my parents had come across when I needed them,” he said. “What kind of parents would let their son rot in a place like this?” Asked about his children, he replied, “I’ve never seen them. I think they were given up for adoption. How the hell should I know!”
Sociobiologists don’t argue that the sexual behavior of people is consciously directed to passing on their gene pool, only that nature has provided us with various strategies for doing so, one of which happens to be the “cheating” strategy used by psychopaths. When asked if he was promiscuous because he wanted to have lots of children and thus attain a sort of “genetic immortality,” one of our psychopathic subjects laughed and said, “I just like to fuck.”
The behavior of female psychopaths also reflects a cheating strategy, one in which sexual relations are had with a large number of men and the welfare of the offspring is ignored. “I can always have another,” a female psychopath coldly replied when I questioned her about an incident in which her two-year-old daughter was beaten to death by one of her many lovers. (Two older children had previously been taken into protective custody.) When asked why she would want to have another child, given her obvious lack of concern for the fate of her first three, she said, “I love children.” Like most of the female psychopaths we study, her expressed affection for children was starkly contradicted by her behavior. Female psychopaths routinely physically or emotionally neglect their children or simply abandon them as they move from one sexual encounter to the next. A chilling illustration is provided by Diane Downs, who abused, neglected, and eventually shot her children, all the while having a prolonged series of affairs. She also became a “professional” surrogate mother, eager to become pregnant for a fee.9
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