Dr. Eva Kimonis is an Associate Professor in the School of Psychology at the University of New South Wales, Sydney, Australia. Dr. Kimonis is also a registered clinical psychologist and she is the latest expert to answer some questions for Aftermath. She answered several questions posed to her by Dr. Adelle Forth. In her answers, Dr. Kimonis discusses several interesting aspects of her research on psychopathic traits in youth, including how she got involved in psychopathy research, the ages at which psychopathic traits can be identified in children, challenges that parents face, and what we know about interventions for youth with callous and unemotional traits.
1. How did you get involved in the area of psychopathy research?
My first exposure to psychopathy and conduct problems was in an undergraduate lecture by James Blair at University College London. I was eager to learn more about the topic when I returned to Brandeis University after one year studying abroad in London, and was lucky to find Ray Knight in the Psychology department doing work on psychopathy in sexual offenders. He agreed to supervise me for an honors project where I used structural equation modeling to test the relationship between childhood maltreatment and dimensions of psychopathy using his Multidimensional Assessment of Sex and Aggression (MASA) sample. The experience solidified my interest in psychopathy and when applying for Psychology graduate programs I only applied to those where I had the opportunity to be supervised by a psychopathy researcher. My top choice was to study callous-unemotional traits with Paul Frick at the University of New Orleans, and I was fortunate enough to get accepted into the program.
2. Is it possible to identify psychopathic-like traits in young children? Can you give a brief description of these traits?
Yes, it is possible to identify callous-unemotional traits in young children. While in Cyprus for a Fulbright Scholar grant, I collaborated with Kostas Fanti to validate scores on the Inventory of Callous-Unemotional Traits (ICU) with children as young as 3 years old. The ICU measures traits including a lack of empathy and guilt, uncaring attitudes about one’s performance in structured activities and about others’ feelings, and shallow emotions. These features map onto the affective dimension of adult psychopathy. Paralleling findings with older children, adolescents and adults, young children who scored high on the ICU showed similar correlates including greater antisocial behavior and aggression, lower empathy and prosocial behavior, and were less accurate at identifying others’ emotions and less attentionally engaged by others’ distress cues. These children also scored higher on other commonly used measures of CU traits. This study and others support that CU traits can be identified in young children.
3. What type of interventions would you recommend for children with psychopathic-like traits?
The research base on interventions for children with callous-unemotional and psychopathic traits is quickly growing. So far, what we know is that the antisocial behaviors of children with CU traits respond less well to interventions designed for children with conduct problems alone, such as parent training programs, relative to antisocial children without CU traits. In my research lab, over the past several years we’ve been working on a targeted intervention for children with CU traits that aims to address three key risk factors thought to contribute to their development of antisocial behavior and CU traits: low parental warmth and responsivity; punishment insensitivity and reward dominance; and insensitivity to others’ emotions, primarily distress cues. The program was developed from a platform of Parent-Child Interaction Therapy (PCIT), which is a parent management training program that is unique in its in vivo coaching of parents using an earpiece with the therapist behind a one-way mirror. Results of our open trial study are promising in finding reductions in child conduct problems and CU traits, and increases in empathy. We are in the midst of two randomized controlled trial studies, one of which compares the PCIT-CU adaptation against standard PCIT, and the second tests whether PCIT matched to the child’s needs – PCIT-CU for children with CU traits and standard PCIT for children without CU traits – is more effective than non-matched treatment within a school setting where parents and teachers partner to address the child’s problems.
4. What are the challenges faced by parents with children with psychopathic-like traits?
Children with CU traits tend to show severe antisocial behaviors, and it is not uncommon for them to be aggressive towards parents and siblings. The more severe the problems, the harder they are to treat. Many parents also hold negative attributions about their child with CU traits that makes it difficult to engage in play, which is a central component of the PCIT-CU intervention that is designed for children ages seven and under. They often report attachment problems and a feeling that they never bonded with their child. Despite these damaged relationships, many of our parents showed marked changes in their feelings towards their child and their displays of warmth and affection from the beginning to the end of treatment.
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?
I’m excited about all of the research coming out on CU traits in young children as I believe early intervention has the best chances of addressing the problem of psychopathy. I would really like to see more work on the infant developmental period to understand what factors place a young child at risk for CU traits in later life. I’m particularly interested in how interactions between parents and babies contribute to emotional development and how chronic stressors occurring during the prenatal and postnatal periods interrupt these processes and increases risk for the later development of CU traits and antisocial behavior. As the question implies, it would be great to see more translation of the wealth of basic science findings on psychopathy to practice, particularly for adolescent and adult populations. I really enjoy seeing the increased interest in secondary psychopathy and hope this continues over the years to come. I think this will help us to better refine interventions for CU populations as there’s good reason to believe that the processes involved in the development of antisocial behavior and psychopathic traits for primary and secondary subtypes are different.
