Are severely problematic children psychopaths?

Jason Brien.

There is a lot of talk about whether children can be diagnosed with antisocial personality disorder (ASPD) or psychopathy. Clinically speaking, children CANNOT be diagnosed with either ASPD or psychopathy as it is believed that children’s personalities are malleable and so capable of change. Come adulthood though, personality is believed to become fixed and rigid and so ‘severe’ diagnoses are ‘appropriate’.  

So when it comes to children, oppositional defiant disorder (ODD) and conduct disorder (CD) are considered potential precursors to the adult disorders of ASPD and psychopathy. Let’s start by looking at ODD. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) characterises Oppositional defiant disorder (ODD) as a childhood behavioural problem consisting primarily of disobedience and hostility in PRE-TEEN children.

The development of ODD may be linked to the following factors;

• Parental neglect and parental drug and alcohol abuse,
• marital conflict and interpersonal violence,
• physical, sexual and emotional abuse,
• low socio-economic status,
• lack of social, familial, religious and spiritual connections

Children diagnosed with ODD may exhibit the following behaviours;

• Low sensitivity to anger, annoyance and irritation,
• become easily frustrated and are more prone to frequent temper tantrums than the average child,
• strong tendency to argue with familiar adults (parents, teachers, caregivers, etc),
• frequent disobedience and disregard of rules,
• low self-esteem and poor self-image,
• inability to take responsibility and prone to blame shifting,
• frequent deliberate attempts to annoy and aggravate others,
• poor respect for personal boundaries.

Early intervention and treatment of ODD is critical as leaving this condition untreated can lead to the formation of the more serious condition known as Conduct Disorder (CD). Conduct disorder is diagnosable in TEENAGERS (remember that ODD is diagnosable in pre-teens). If conduct disorder is left undiagnosed or untreated it can lead to adult diagnosis of ASPD or psychopathy (more in just a bit).

Conduct disorder is the progression to more serious and harmful behaviours such as;

• Lying
• sadistic and cruel treatment of animals and people,
• physically or sexually abusing others,
• increased manipulativeness,
• frequent truancy and running away,
• law-breaking behaviours such as deliberately lighting fires, vandalism, stealing cars, armed robberies or shop lifting,
• increased lack of empathy and insight,
• Lack of respect for authority and morals

Some researchers estimate that between 25% and 40% of children diagnosed with Conduct disorder in childhood will later be diagnosed with Antisocial personality disorder (ASPD) in adulthood. In fact, according to the DSM-5, a diagnosis of Conduct Disorder in childhood (or a retrospective diagnosis of Conduct Disorder) is a pre-requisite for a diagnosis of ASPD in adulthood. 

Fortunately, not all children diagnosed with Conduct Disorder will experience the degree of dysfunctionality as those children who later become diagnosed with ASPD. Come adulthood though, children with a conduct disorder diagnosis (but not an ASPD diagnosis) are likely to exhibit a moderate to high degree of social dysfunction and they will inevitably struggle with day-to-day living and forming and maintaining healthy relationships.

Any diagnosis however is never a life sentence. Serious diagnoses such as ASPD, psychopathy and NPD are not terminal illness so to speak. Yes the disorders present significant challenges to society (these disorders are egosyntonic and so are not seen as a problem by the person with the disorder) but this does not mean that it is not possible to modify such persistent and pervasive problematic behaviours. It is extremely challenging to transform a diagnosis such as ASPD, etc from egosyntonic to egodystonic without the right therapeutic support.

Resources

Fraser, A., & Wray, J. (2008). Oppositional defiant disorder. health, 3, 7.

Jennifer W. Kaminski & Angelika H. Claussen (2017) Evidence Base Update for Psychosocial Treatments for Disruptive Behaviors in Children, Journal of Clinical Child & Adolescent Psychology, 46:4, 477-499, DOI: 10.1080/15374416.2017.1310044

Khadar, M. G., Babapour, J., & Sabourimoghaddam, H. (2013). The effect of art therapy based on painting therapy in reducing symptoms of oppositional defiant disorder (ODD) in elementary School Boys. Procedia-Social and Behavioral Sciences, 84, 1872-1878.

Scott S. (2007). Conduct disorders in children. BMJ (Clinical research ed.), 334(7595), 646. https://doi.org/10.1136/bmj.39161.370498.BE

Zocccolillo M.; Pickles A.; Quinton D.; Rutter M. (1992). "The outcome of conduct disorder: Implications for defining adult personality disorder and conduct disorder". Psychological Medicine. 22 (4): 971–986. doi:10.1017/s003329170003854x. PMID 1488492.