Dr. Paul Frick is a Professor and holds the Roy Crumpler Memorial Chair in the Department of Psychology at Louisiana State University in Baton Rouge, LA. He is a former president of the Society for the Scientific Study of Psychopathy and a recipient of the R.D. Hare Lifetime Achievement Award. His research focuses on the causes, assessment, and treatment of disruptive behavior problems in children and adolescents, with a specific focus on how callous and unemotional traits enhances our understanding of these problems. For more information about Dr. Frick, click here
Question 1. How did you get involved in the area of psychopathy research?
As a graduate student, I started out being very interested in treating victims of abuse and violence. However, I had a conversation with a researcher who worked with people who abused children .I said I didn’t know how he could work with these people who caused so much harm to others. I asked him, “Shouldn’t you be focusing on the victims? He told me something that has really stuck with me. He said, “Frick, if you only work with the victims, you will always have victims. If you find a way to successfully treat the perpetrators, you will keep people from being victimized”.
So, this led me to want to treat children and adolescents who were at most risk for being aggressive and violent. However, it became clear that we were not successful in treating many of these children, especially those who were causing the most harm to others. Also, there was the view held by many, that these children were “all budding psychopaths, who couldn’t be treated”. This was wrong to me for a number of reasons. First, even in adults, certain treatments could be effective for treating those with psychopathic traits and it is highly likely that they could be even more effective earlier in development. Second, the majority of the children who I was working with were very upset by their behavior and the problems it was causing to them and others. They just had trouble controlling their behavior in many situations. This did not seem to fit the definition of “being psychopathic”. Third, it seemed to me that it wasn’t that children and adolescents with serious behavior problems were untreatable, it just seemed that we didn’t know enough about the causes of their behavior problems to effectively intervene, leading most children to get unproven treatments.
As a result, our research started by developing assessment methods to show which children and adolescents with behavior problems did and did not seem to show problems in their conscience development that would be similar to what is found for adults with psychopathy. Through our research we showed that it was only a minority of youth with serious behavior problems. Then, we began to investigate how children who showed these problems in conscience development differed from other children with behavior problems, so that interventions could be tailored to address the distinct needs of children who may develop their behavior problems for very different reasons.
Question 2. Is it possible to identify psychopathic-like traits in children? Can you give a brief description of these traits?
We have found that there are certain characteristics that differentiate some children with serious conduct problems from others and which identify a group with significant problems in conscience development. In fact this group shows a number of characteristics similar to adults with psychopathy, such as showing more instrumental and premeditated aggression and being less emotionally responsive to certain things, most notably signs of distress in others. These characteristics, which can be identified as early as ages 3 and 4 years of age include:
Deficient guilt or remorse.
Callous-lack of empathy.
Failure to put forth sufficient effort in important activities.
Shallow or deficient display of emotions.
These characteristics have been labelled as “callous-unemotional (CU) traits” in research and they have recently been included in the diagnostic criteria for conduct disorder (labeled as “limited prosocial emotions”).
Importantly, many of the other features that are often associated with psychopathy, such as being impulsive and deceitful, are also often displayed by these children with elevated CU traits. However, many children without CU traits also show these other features of psychopathy. Thus, it is the presence of the CU traits that designates a distinct subgroup of children with conduct problems.
Question 3. How does psychopathy relate to other disruptive disorders in youth?
Children with disruptive behavior disorders can be divided into those who start showing their behavior problems early in childhood and whose behavior tends to get worse across childhood (i.e., childhood-onset) and those whose problem behavior starts around the onset of puberty (i.e., adolescent onset). About 20 to 30 percent of those in the childhood-onset group seem to show elevated levels of CU traits. This group with elevated CU traits shows more severe aggression (e.g., that leads to more severe harm in others including gun use), shows both reactive and instrumental aggression, are less distressed by their behavior, shows abnormalities in how they response to punishment, and are less reactive to cues of distress in others. In treatment, while these youths with elevated CU traits often do respond to some evidence-based approaches to treatment, they often start treatment with more severe behavior problems and, despite improving over treatment, still end treatment with more severe behavior problems.
Question 4. What are the challenges faced with providing intervention to youth with psychopathic-like traits?
One of the main challenges is how to accurately identify those children with CU traits early and to clearly delineate their need for treatment, so that intervention can be initiated early in development, before the behavior problems become severe and when interventions tend to be more successful. However, we have to be careful that we don’t label these children in a way that suggests that their behavior is “unchangeable” or “untreatable”.
Question 5. Considering research is generally ahead of application in the field, what is one improvement in the field of psychopathy that you hope to see take place over the next five to ten years?
As I noted previously, my entire career has focused on identifying the developmental processes that can lead to serious behavior problems, so that this research can lead to more effective interventions that are tailored to the child’s individual needs. Our research has made clear that many of the existing treatments were not developed with the unique characteristics of children who show elevated CU traits in mind. Over the past 3 decades, I feel we finally have a number of clues as to what more effective interventions may look like for these children (e.g., increasing warmth in the parent-child relationship, emphasizing rewards for changing behavior, coaching and motivating children to recognize and respond appropriately to others). A former student of mine, Eva Kimonis at the University of New South Wales, has modified an existing intervention for children with behavior problems that she has enhanced to address these components. It has shown to be highly effective for young children (between the ages of 4 and 8) with behavior problems and CU traits in young children. This intervention now needs to be tested in randomized controlled trials and other similar interventions based on existing research need to be developed and tested.
