There Are No ‘Child Psychopaths’ Because We Can’t Diagnose Them. Yet. (Vice)

August 19, 2021

There Are No ‘Child Psychopaths’ Because We Can’t Diagnose Them. Yet.

A new wave in psychology research suggests people with psychopathy could be helped much earlier, if only we acknowledged the scope of their issues.

Most Americans are familiar with Ted Bundy, the infamous psychopathic serial killer who confessed to thirty murders. Fewer people are aware that the young Bundy liked to dig hidden holes in the ground that innocent passersby would fall into, an action that is now widely regarded as a sign of his mental health issues. Ted Bundy caused an incalculable amount of misery, not just for the people he killed, but the people who surrounded them, and the countless others he lied to, manipulated, and confused, until the moment of his execution by electric chair. 

But what if there had been a way to stop future Ted Bundys from embarking upon a lifetime of harm and crime? What if, after it became clear that he liked to torture innocent people but was not yet a murderer, he received targeted treatment that would get at the root of his misbehavior and compel him to live a life that caused no more pain than the average human?

Psychologists recognize psychopathy only as an adult disorder, and as a rule, don’t diagnose young children. Fear, stigma, and misunderstanding around the label means psychologists instead diagnose and treat kids for irrelevant issues, like anxiety or ADHD, which can actually make things worse. Furthermore, for years, the medical establishment assumed that people with psychopathic traits—derogatorily referred to as “psychopaths”—are untreatable. The only thing to do was lock them up for their crimes and hope you never came across one. 

But the tide against psychopathy treatment is beginning to turn, for kids in particular. The latest theory of some experts is that the best way to treat psychopathy is to identify the characteristic traits in children and adolescents, before the burgeoning issue becomes a full-blown problem. 

This means prescribing children—and their parents—with a taxing combination of emerging therapies and confronting the difficult possibility that the child will grow up to develop psychopathy. But the potential tradeoff is that catching the issue early could save countless lives and billions of dollars in incarceration costs. 

The word “emerging” is key here: The treatments available are in their infancy, and randomized trials are difficult to conduct in prison settings, where much of the research on psychopathy takes place. But the research is promising, and shows that with foresight, care, and considerable patience, a more peaceful life for people with psychopathy, their families, and their communities is possible.

The psychopathy trolley problem

Contrary to popular belief, psychopathy is not the same as antisocial personality disorder or sociopathy, though the conditions are related and sometimes overlap. Antisocial personality disorder (ASPD) represents a lifelong tendency to disregard and violate the rights of others, as well as traits like impulsivity, irritability, deceitfulness, a lack of remorse. People with psychopathy have many of these traits, but they’re also charming, manipulative, and unemotional. “This means that most people with psychopathy also have an anti-social diagnosis. But most people with antisocial personality do not have psychopathy,” said Arielle Baskin-Sommers, an associate professor of psychology and psychiatry at Yale University who studies disinhibition, including psychopathy. 

Sociopathy (blunt emotional affect, charm, callousness) appears to have a strong environmental component, such as abuse at a very early age. “It’s basically a response to their environment, not something that they were born with,” said Baskin-Sommers. Psychopathy, on the other hand, appears to be biological, based on neuroimaging and genetic analysis. 


Today, clinicians diagnose psychopathy in adults by reviewing their files and conducting an interview using psychologist Robert Hare’s Hare Psychopathy Checklist-Revised, which includes traits like grandiosity, impulsivity, pathological lying, and manipulation. . Each trait is assigned a score between 0 (doesn’t apply) to 3 (fully applies); in the United States, a score above 30 means the patient can be diagnosed as psychopathic. 

Psychopathy affects about 1% of the general United States population and up to 30% of the American prison population. But lawyers and clinical psychologists “are so afraid that these types of labels will be problematic for their clients, that they don’t end up using them. And I actually think that creates a huge problem,” said Baskin-Sommers.

Children, specifically, can’t be diagnosed with psychopathy, but they can be diagnosed with conduct disorder, which stipulates that a patient has a persistent pattern of breaking behavioral norms and violating the rights of others, including deceitfulness, property destruction, violence and aggression, and theft. Most children with conduct disorder grow out of it as adults, but one subtype, known as conduct disorder with callous and unemotional traits, is more stable from childhood to adulthood; in other words, it’s more likely to translate into psychopathy later on. In such cases, a child can receive treatment in case their condition worsens — but some psychologists are afraid to get anywhere close to a psychopathy diagnosis.

But clinicians resist it. “If you talk to your average child psychiatrist, they’ll be like, ‘Oh, my God, I would never diagnose the kid as callous and unemotional. There’s no known treatment,’” said Kent Kiehl, a professor of psychology and neuroscience at the University of New Mexico and the author of the book The Psychopath Whisperer.

Instead, said Kiehl, some psychiatrists will diagnose a child with ADHD or another disorder and medicate them accordingly. But this can worsen the problem. “Parents eventually come to me, after [their child has] been through three years of psychiatric care, where they’ve been just basically randomly prescribed various medicines to try to, you know, nuke them, and get them to calm down and not act out.” These parents are often desperate and in despair, worried about both the child with the callous and emotional traits as well as themselves and their other children and family members, who may be in danger. 

“There’s data for both youth and adults that if you do the wrong type of treatment, to individuals with psychopathy, or callous unemotional traits, you run the risk of making them worse.” 

Treating children as they begin to display psychopathic traits could be key to its successful treatment—in Ted Bundy’s case, at the time he was placing knives around his sleeping family member’s heads.

“It has to be caught early, in childhood, or at least by adolescence, before the full manifestation in adulthood,” said Craig Neumann, a professor of clinical psychology at the University of North Texas whose research focuses on personality disorders, particularly psychopathy, borderline personality disorder, and schizotypal personality disorder. “The family should also be involved, if possible — though sometimes the family is so toxic it is better to remove the individual from such contexts.” 

Yet many clinicians shy away from even coming close to associating a child with the term, because of the long-held belief that it’s essentially a life sentence. Because the general population stigmatizes people who commit immoral acts, it believes that these people — even if their behavior arises from a mental disorder — deserve to be punished. This has rolled into decades of fear, stigma, and misunderstanding that have contributed to the massive lack of research and treatment options for psychopathic people. “There’s just not a lot of people that want to treat these kids,” said Kiehl. “Not a lot of people who want to study them.”

What happens when you do treat a child as if they have psychopathy?

“Psychopathy” would be a heavy label for kids to bear generally. But experts theorize that treatment for psychopathy could even help make people with the disorder less psychopathic, similar to how treatment for anxiety makes people less anxious: the root feeling typically never disappears, but its internal and external effects lessened.

Preliminary research and case studies, much of it helmed by Kiehl, have shown heartening success at encouraging youth with callous and unemotional traits from going on to develop psychopathy and commit greater crimes. Kiehl, who has conducted thousands of interviews and copious research involving troubled and psychopathic youth, has witnessed this possible transformation first hand.

The Mendota Juvenile Treatment Center is a 29-bed treatment center for incarcerated youth whom two other juvenile correctional facilities couldn’t manage. These kids are, essentially, some of the most violent kids in the state of Wisconsin, with an average PCL-R Youth checklist score of 28.

The center has a high staff to inmate ratio, and are trained in what’s known as the Decompression Model. Instead of punishing inmates for bad behavior, which is how most prisons attempt to control their inmates, the Decompression Model rewards inmates for good behavior. Inmates regularly attend cognitive behavioral therapy with a therapist, psychiatrist, or social worker; attend group anger management therapy; and are additionally treated for substance abuse or sexual offenses. The rewards are graduated: the better the behavior, the greater the reward. 

“[Inmates] arrive, having just gotten into a fight with the correctional officer in another facility, and within a week, they can be watching movies in their cell, if they’re good, and if they engage with treatment,” said Kiehl. The success rate of this treatment method is nothing short of phenomenal; Kiehl wrote in his book that, while 98% of non-MJTC youth get arrested again within four years of release, only 64% of youth released from MJTC are arrested in four years. The MJTC reduces overall recidivism by 34%, and former inmates are 50% less likely than the general juvenile inmate population to be convicted for a violent crime after two years. 

Further, the cost of treatment is significantly less than the cost of incarceration, and this doesn’t even take into account how much money is saved on the part of potential victims for medical costs, replacing stolen properties, and other costs victims of crimes are forced to uphold.

The MJTC program is “far and away the best, most published, documented, re-documented, efficacious, successful program,” said Kiehl. In his book, he wrote about “Eric,” who by the age of thirteen had already been charged with battery, arson, auto theft, and weapons offenses. He set fire to the group home where he lived, didn’t form long term relationships, and had what one psychologist called “pathological” arrogance and narcissism. Two psychologists later scored him 34 out of 40 on the Hare Psychopathy Checklist-Youth Version, which tests developing psychopathic traits in teens. 

Eric was transferred to MJTC. Following his release, he has been crime-free, employed, and working on getting an education, according to Kiehl, who wrote in his book that Eric’s positive behavioral and life changes would warrant him a lower scale on the PCL-R checklist. Eric, he wrote, is just one example of how a well-executed treatment program can change lives — even kids with high PCL-R scores.

But the ability to treat people with psychopathic traits gets harder as patients get older. Where a 16-year-old might benefit from six months of treatment, said Kiehl, a 22-year-old might need two years of it. Which is to say: it’s not impossible. It just takes longer.

Other treatment methods appear promising. Josanne van Dongen, an associate professor of forensic psychology at Erasmus University Rotterdam, researches violence and psychopathy. She’s conducted research that shows that transcranial magnetic stimulation, which uses painless electrical currents to stimulate particular areas of the brain, can potentially increase empathy. “We recently showed that using [transcranial magnetic stimulation] during empathy tasks in violent forensic patients led to a reduction in aggression on a task one week later,” she said, “and also led to an increase in personal distress (arousal levels) when viewing pictures in which an aggression scene was displayed (including a victim of the aggressive act).” 

Despite promising treatments, however, psychopathic patients and their families face a long, arduous road. Getting kids into treatment at an early age, encouraging the criminal justice system to identify youth with psychopathic tendencies, increasing funding for treatment centers that cater to these kids, and decreasing clinical, legal, and public apprehension around the term “psychopathy” are all difficult tasks on their own; but to treat psychopathy, society needs to confront each issue.

“There’s no lobby for a psychopath,” said Kiehl. Unfortunately, psychopathic patients, their families, and their victims desperately need one.

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