Introduction
Identifying psychopathic traits in youth can lead to early prevention strategies including various forms of therapy and help in reducing their externalization. However, detection becomes increasingly difficult as adolescents naturally exhibit traits that are also linked to psychopathy including most commonly, narcissism, callous/unemotional traits, and impulsiveness. Psychopaths have in inability to form connections with others people, they in essence do not have a conscious. Their lack of a conscious results in them having no feelings of remorse in addition to lacking a connectedness with others. Preventative strategies have been implemented alongside various treatment methods. By looking at psychopathy as a development throughout an individual’s life-course, adolescents externalizing behaviors drastically differ from those of adults.
Possible Causes of Psychopathy
Psychopathy is a combination of affective, interpersonal and behavioral characteristics. Affective characteristics are defined as callousness, lacking empathy and remorse, and experiencing short-lived emotions. Interpersonal characteristics include “narcissism, good intelligence, verbal and manipulative abilities, superficial charm, egocentricity and glibness” (Feilhauer & Cima, 2013). Behavioral characteristics include impulsivity, irresponsibility, prone to boredom, novelty seeking and antisocial tendencies. There has been thought to be variety of genetic factors that can account for psychopathy development in the personality dimensions. Damage to the amygdala has been related to emotional deficits, leading to deficits in the interpretation of emotional stimuli like facial expressions, fear or sadness in others, and emotional learning in the form of stimulus- reinforcement associations (Feilhauer & Cima, 2013). Similarly, several links have been proposed between prenatal exposure to maternal stress to early infant outcomes. Changes in DNA methylation have also been documented in response to prenatal exposure to cigarettes or alcohol maternal drug abuse, and poor prenatal nutrition both genetically alter the development of psychopathy (Cicchetti, 2018; Moffit, 1993). However, equally, environmental factors including, “youth’s family background, past relationships, friendships, employment history, alcohol and drug use, school, delinquent behavior and future plans” also play a role (Feilhauer & Cima, 2013). The quality of mother and child interactions, may also lead to shifts in developmental trajectories (Cicchetti, 2018). Furthermore, often times parents of children who are demonstrating early signs of psychopathy are inadvertently providing their children with criminogenic environments (Moffit, 1993). Due to the combination of environmental influences and genetic contributions, it is hypothesized that psychopathy can develop over time for some while presenting itself particularly early in others.
Early Detection and Prevention
Early detection of psychopathic traits can be critical to the prevention and treatment of any remaining characteristic. It however is preferable to prevent the emergence of mental disorders and concomitant suffering, rather than waiting for a disorder to develop and then offer treatment (Cicchetti, 2018). Detecting psychopathology in youth is very difficult, but tests such as the Psychopathy Checklist Revised (PCL-R) have been developed to help predict violence and general recidivism (Seagrave & Grisso, 2002). The PCL-R is composed of two parts, the first taps interpersonal-affective features, while the second taps social deviance features. Although the PCL-R can give a definite answer, normal adolescent development can also express itself in a false positive. Due to this, it may be left up for clinicians to decide if a false positive has occurred. False positives however, may become common, as throughout normal adolescent development, youth display what can be viewed as psychopathic behaviors such as opposition towards authority, anti-social tendencies, impulsivity, and callous-unemtional traits (Moffit, 1993; Seagrave & Grisso, 2002). One way to try and minimize this problem is to test adolescents at various points across their development. Early detection of psychopathy could be successful if the juvenile displays high scores consistently across their development (Seagrave & Grisso, 2002).
To detect psychopathy as early as adolescences becomes increasingly difficult, as normal teenage development includes a period of deviant behavior indistinguishable from psychopathy. Grandiosity, lack of remorse, guilt and empathy, inability to accept responsibility or understand others reactions, poor anger control, lack of goals, and poor judgement, are all characteristics of psychopathic behaviors, but also can be displayed throughout typical adolescent development (Seagrave & Grisso, 2002). This makes it extremely difficult to deem an adolescent psychopathotic, as they may mature out of these traits, as most do (Seagrave & Grisso, 2002). Furthermore, a limited range of emotion can be a coping mechanism for a very stressful home environment while at the same time may risk being perceived as a sign of the shallow affect of psychopathy (Seagrave & Grisso, 2002).
Psychopathology can be viewed a a development, just as all of humankind develops. If pathology develops in an expected manner, then it is possible to identify precursors and pathways leading to disorder, as well as factors that lead individuals along such pathways or redirect them back toward more functional adaptation. Prevention and intervention is informed. At the same time, conjoint study of normal and abnormal development further illuminates developmental processes. One method proposed is to utilize “randomized prevention trials” (RPTs). RPTs are one method in which the course of psychopathology can be altered through experimental manipulation and those changes can be tested (Cicchetti, 2018). An RPT design furthermore permits researchers to determine whether a change in risk and protective factors is correlated to a change in the likelihood of developing psychopathology. From developmental perspective, RPTs can alter the progression of different expressions of psychopathology.
Critical to the expression of psychopathology, is epigenetic. Epigenetic processes play a dynamic role in regulating gene expression and are responsive to the environment (Cicchetti, 2018). Independent of DNA sequencing, epigenetic regulation of gene expression “operates primarily through changes in DNA methylation and chromatin structure” (Cicchetti, 2018). Epigenetically informed preventive interventions can include methylation assays in their measurement batteries to evaluate the effects of the interventions on these mechanisms and refine theory (Cicchetti, 2018). Epigenetic is a relatively new area of investigation and prevention scientists are just beginning to consider epigenetic mechanisms within the context of understanding the efficacy of interventions on complex outcomes (Cicchetti, 2018). The changes in methylation of DNA in response to experience, could lead to the design of prevention and intervention strategies that change the expression of genes to promote healthy physical and mental health outcomes.
The focus of the prevention trial is to alter risk factors or mediating processes in such a way as to reduce emergence of a disorder; therefore, components that will address those factors or processes need to be included in the intervention design. In order to successfully apply prevention strategies, more research must be done in substance abuse and mental health, and age development and expression. Genes could potentially affect how one’s environmental experience influences the developmental process. This may operate differently at various developmental periods, as the effects of genes and experience at a specific period may be influenced by the effects of prior development. Environments can influence the timing of gene expression, and genetic effects. However, with advances in technology throughout the fields of neuroimaging and molecular biology, the ability to ascertain how anomalies in brain structure and function may contribute to or be a consequence of the emergence of psychopathology has become increasingly applicable (Cicchetti, 2018).
Treatment
One treatment method for Psychopathy is Multisystemic Therapy (MST) in which antisocial behavior is neutralized. By targeting specifically the callous/unemotional traits and narcissism, MST can reduce delinquent behavior in juveniles. A study conducted by Manders (2013) observed psychopathy as a moderator and predictor of multisystemic therapy outcomes among adolescents treated for antisocial behavior. MST is a multi-faceted, intensive home- and community-based treatment for youth who show serious, violent and chronic antisocial behavior. Combined with treatment as usual (TAU) that includes social and mental health treatments, including juvenile justice services, child welfare services, and mental health center services, treatment can be effective in decreasing externalizing behaviors (Manders, 2013). The study found that MST was more effective than TAU in decreasing externalizing behavior, but we did not find MST to be more effective than TAU in reducing psychopathic traits, showing that treatment can induce improvement in psychopathic traits such as narcissism and impulsiveness. This study indicates that a combination of MST and TAU tailored to meet individual needs can increase the effectiveness of treatment for adolescents with antisocial behavior. Intervention strategies include strategic family therapy, structural family therapy, behavioral parent training, and cognitive therapy (Manders, 2013). Callous/unemotional traits did not decrease significantly in either treatment conditions, whereas impulsiveness decreased in both. However, these differences between conditions were small and non-significant, indicating that MST was not more effective than TAU in decreasing psychopathic traits. MST was found to be more effective than TAU in decreasing externalizing behavior, but MST was not found to be more effective than TAU in reducing psychopathic traits (Manders, 2013). Taken together, the findings indicated that psychopathic traits play an important, moderating role in treatment effectiveness for adolescents with antisocial behavior.