The idea of child psychopaths sparks an unreasonable backlash – Dr John J Marshall

Critics of his call to identify children showing the early warning signs of psychopathy reacted swiftly, overwhelming reasonable debate about the issue, writes psychologist Dr John J Marshall.

Children with early signs of psychopathy can be helped (picture posed by model) (Picture: Phil Wilkinson)

In the wake of the conviction of Aaron Campbell for six-year-old Alesha MacPhail’s murder, I suggested in this newspaper last week that when it comes to psychopathic traits, childhood prevention is better than tragedy or a lifelong offending ‘career’.

Some surveys have found psychopathic individuals are responsible for half of all serious crime. They are also far more likely to kill.

If a psychopath is particularly narcissistic and entitled, in my experience, in court they may try and cross-examine victims, pathologically lie, deny offending in the face of overwhelming evidence, try to play games with the legal system, and feel they can persuade others of their innocence by appealing.. Psychopaths have a profound indifference to the suffering their actions cause others.

In adulthood, there is as yet no well-proven treatment for psychopathy. But psychopathic traits and their precursors not only can be measured in early childhood, as researchers from Sweden and the Netherlands have shown, but can predict the development of later anti-social conduct problems. As Dr Suzanne Zeedyk highlighted in her Scotland on Sunday article about my column, warm parental attachments for children at risk of psychopathy are critical and, for younger children, there is emerging evidence about the benefits of specialist family therapy.

Some argue that many psychopaths don’t commit crime, but psychopaths in the workplace can also be nasty toxic leaders, bullying and manipulating their way through organisations. The idea of helping children at risk of developing psychopathic traits to divert them from this path seems obvious, yet has proved controversial.

I have received messages of support from professionals who told me they are working with children with callous-unemotional or psychopathic traits but cannot raise this with other colleagues for fear of complaint. Some tell me that causal trauma and adverse childhood experiences (ACEs) conversations dominate clinical discussions at the expense of identifying neuro-developmental problems like ADHD or autism spectrum disorder.

Yet every genetically informed study on the small number of children affected shows psychopathic or callous-unemotional traits are strongly or substantially heritable.

Some parents tell me they can feel judged when it comes to ACEs narratives and genetic research removes that culpability. It could also lead to novel treatments in future. It’s not that long ago that mothers were blamed for their child’s autism despite it being highly heritable.

Dr Zeedyk stated I was rehashing the tired nature-nurture debate, but instead, I am simply stating the research evidence in this field. In reality, as Harvard University psychologist Steven Pinker has said “genes are affected by their environments, and learning requires the expression of genes, so the nature-nurture distinction is meaningless”.

I fully support the ACEs agenda, but for this small number of at-risk children, we cannot ignore genetic drivers. Dr Zeedyk rightly points out the critical importance of good relationships at all stages of life, but in the case of this group of children, they are preloaded with temperaments that parents (who are not cold and callous) and adoptive parents struggle with. Some parents feel defeated.

Colleagues such as Dr Lorraine Johnstone have confidently asserted there is no empirical research in this area or even question whether the concept of psychopathy traits exists in children or adolescents. Bizarrely, Dr Sarah Armstrong, director of the Scottish Centre for Crime and Justice Research, implied I wish to criminalise children and label them as super-predators, and that the scientific study of examining pathways to adult psychopathy is pseudoscience.

I am perplexed yet curious as to how a reasonable position about prevention for those at risk for adult psychopathy, involving family support and specialist therapies, not criminalisation, is highjacked by sensational rebuttal. And critics of my preventive position reacted swiftly, overwhelming reasonable debate.

Questioning whether the concept of psychopathy traits or its precursors even exist is one way to close down debate and smacks of authoritarian social constructionism.

The notion of super-predatory children is deeply unpleasant. I would never use such language, but perhaps it captures something of some victims’ lived experiences at the hands of those with psychopathic traits.

In every forensic risk assessment I have carried out, where there are psychopathic traits clearly identified, after a detailed exploration of childhood background, there have always been obvious early warning signs.

Parents in research studies report children with callous-unemotional traits as cold and uncaring, not concerned about right or wrong, not learning from rewards or consequences and not caring about hurting others. With psychopathic traits, they additionally report a superior and arrogant attitude, with lying being the norm and a constant need of thrill and excitement.

If there are high levels of aggression, destructiveness, hyperactivity and impulsiveness added to this potent mix, then such a child might be referred to child and adolescent mental health or social work services.

All I am proposing is that these children are carefully considered as potentially being at risk of future psychopathy trait trajectories. It would be absurd to screen the whole population including children who are kind and altruistic or display no behavioural difficulties, but children referred for severe or chronic anti-social behaviour problems should be screened for psychopathy traits.

Higher risk children and their families should then receive the intense and longer-term therapeutic support they deserve.

Children with psychopathic traits or at risk of developing them require more complex clinical formulations and different interventions might be needed compared to typical approaches, such as parenting programmes, hence the need to know what the early risk indicators are.

Surely reasonable-minded people would consider it reckless to ignore such potential pathways.

No professional wants to label a child as a psychopath but at the same time if psychopathy exists in adulthood then professionals objecting to the notion of earlier psychopathy traits need to explain how psychopathy magically appears later in life.

They have to answer this question: do childhood precursors to adult psychopathy exist and if so, what do we do with that knowledge? Of course, not all of these children will become psychopathic as adults.

Some professionals appear to be suggesting we should irresponsibly wait and see what happens and feel happy we have not used any labels. If labels are the problem, then change the labels.

Surely, it’s better to identify and support children with callous-unemotional, psychopathic traits or at-risk pathways early than wait for another tragedy like poor Alesha?

Imagine the positive impact on society by systematically diverting psychopathy trajectories. Doing nothing about this problem is not an option.