Revised by Shannon and Taffy and the North American Research Committee
While there are tools that are used to identify psychopathic traits in youth, individual children and adolescents are not labelled as psychopathic. The Psychopathy Checklist: Youth Version (PCL-YV) and the Youth Psychopathic Traits Inventory (YPI) are two reliable, valid tools that are used to identify children and adolescents with psychopathic traits. These tools act to differentiate those youth with psychopathic traits from their peers and to predict their likely future courses of behaviour. Frick proposed that children who exhibit both conduct problems and callous and unemotional traits (that is, low empathy, lack of guilt, and lack of emotional expression) are similar to psychopathic adults (Frick & Marsee, 2018). Research by Lyman (1996) found that a subset of children with conduct problems that also exhibit hyperactive/impulsive/attention problems are more like psychopathic adults than children with conduct problems alone. Although these two theories differ, both researchers agree that conduct problems alone do not predict adult psychopathy. Many youth develop conduct problems (or behavior problems), and most of them do not grow up to develop psychopathy. Psychopathy also requires a personality component.
Even though clinicians can identify a subset of youth who may be on the path to adult psychopathy, they are reluctant to label these individuals as psychopathic. One of the reasons we do not label children and adolescents as psychopathic is to avoid the potential negative consequences of the ‘psychopath’ label. This term has many negative connotations, and there is evidence that labels like “psychopath” or “mentally ill” can hurt the way that youth are treated by parents, by teachers, and even by peers. Psychopathy also comes with the stigma of being considered an ‘untreatable’ disorder. Being labelled psychopathic could be harmful by causing someone to be denied treatment because of a belief that he/she/they cannot be treated, or to lead to sending an adolescent to adult court. Another kind of harm occurs if people misuse this label to attempt to influence a judge to administer a more severe punishment (including capital punishment) on the grounds that someone is untreatable. The stigma associated with the psychopathy label is particularly damaging in youth as many young people with psychopathic traits may be capable of significant change from childhood to adolescence to adulthood, particularly if they receive intensive intervention. This means that not all youth who display psychopathic features will go on to display psychopathic features as adults.
It is also not true that people with psychopathic traits cannot be treated. There are a few interventions that have demonstrated success at helping youth with psychopathic traits (e.g., Fleming et al., 2022). These approaches are also discussed in a summary about the research on treating people with psychopathic traits on this website (see The Treatability of Psychopathy).
Another reason this label is avoided in adolescents is that, without the use of proper diagnostic tools, there is the risk of mistaking short-term teenage behaviours (e.g. impulsivity, underdeveloped empathy, and delinquent behaviours) for the kinds of lasting psychopathic traits observed in adults (even though some of the tools for assessing psychopathic traits are designed to ensure that normative behaviors of youth (such as impulsivity and thrill seeking) are not labelled as psychopathic). So even when research studies report poor outcomes for children and adolescents who exhibit psychopathic traits and conduct problems, it is important to keep in mind that, even without specialized treatments, there are many who do change for the better over time. Studies of outcomes present only snapshots of part of the prognosis, or likely course, for youth with psychopathic traits.
The important thing to remember is that we simply cannot predict what the outcome will be for any individual child or adolescent. If a child or adolescent is displaying psychopathic traits, it is advisable to make intensive treatment available to them and their families. Treatments often involve empathy training, where, among other things, the child or adolescent is taught to pay more attention to emotional facial cues, improve their emotional understanding, and practice prosocial and empathic behaviour.
References
Fleming, G. E., Neo, B., Briggs, N. E., Kaouar, S., Frick, P. J., & Kimonis, E. R. (2022). Parent training adapted to the needs of children with callous-unemotional traits: A randomized controlled trial. Behavior Therapy, 53(6), 1265–1281. https://doi.org/10.1016/j.beth.2022.07.001
Frick, P. J., & Marsee, M. A. (2018). Psychopathy and developmental pathways to antisocial behavior in youth. In C. J. Patrick (Ed.), Handbook of psychopathy (2nd ed., pp. 456–475). The Guilford Press.
Lynam, D. R. (1996). Early identification of chronic offenders: Who is the fledgling psychopath? Psychological Bulletin, 120(2), 209–234. https://doi.org/10.1037/0033-2909.120.2.209
