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Psychopathy in childhood: is it a meaningful diagnosis?

  • Michael Rutter (a1)
Summary

Psychopathy is not included in either of the main classification systems (ICD-10 or DSM-IV). Research has now extended the concept of psychopathy to childhood and has produced evidence that it is meaningfully distinct from antisocial behaviour. It is proposed that psychopathy should be accepted as a meaningful diagnosis in childhood.

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References
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1 Blair, RJR, Viding, E. Psychopathy. In Rutter's Child and Adolescent Psychiatry, 5th Edition (eds Rutter, M, Bishop, D, Pine, D, Scott, S, Stevenson, J, Taylor, E, et al): 852–63. Blackwell, 2008.
2 Frick, PJ, O'Brien, BS, Wootton, JM, McBurnett, K. Psychopathy and conduct problems in children. J Abnorm Psychol 1994; 103: 700–7.
3 Viding, E, Jones, AP, Pual, JF, Moffitt, TE, Plomin, R. Heritability of antisocial behaviour at 9: do callous–unemotional traits matter? Dev Sci 2008; 11: 1722.
4 Hawes, DJ, Dadds, MR. The treatment of conduct problems in children with callous–unemotional traits. J Consult Clin Psychol 2005; 73: 737–41.
5 Lynam, DR, Caspi, A, Moffitt, TE, Loeber, R, Stouthamer–Loeber, M. Longitudinal evidence that psychopathy scores in early adolescence predict adult psychopathy. J Abnorm Psychol 2007; 116: 155–65.
6 Dadds, MR, Allen, JL, Oliver, BR, Faulkner, N, Legge, K, Moul, C, et al. Love, eye contact and the developmental origins of empathy v. psychopathy. Br J Psychiatry 2012; 200: 191–6.
7 Kumsta, R, Sonuga–Barke, E, Rutter, M. Adolescent callous–unemotional traits and conduct disorder in adoptees exposed to severe early deprivation. Br J Psychiatry 2012; 200: 197201.
8 Rowe, R, Maughan, B, Moran, P, Ford, T, Briskman, J, Goodman, R. The role of callous and unemotional traits in the diagnosis of conduct disorder. J Child Psychol Psychiatry 2010; 51: 688–95.
9 Skeem, JL, Cooke, DJ. Is criminal behavior a central component of psychopathy? Conceptual directions for resolving the debate. Psychol Assess 2010; 22: 433–45.
10 Jones, AP, Happé, FGE, Gilbert, F, Burnett, S, Viding, E. Feeling, caring, knowing: different types of empathy deficit in boys with psychopathic tendencies and autism spectrum disorder. J Child Psychol Psychiatry 2010; 51: 1188–97.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Psychopathy in childhood: is it a meaningful diagnosis?

  • Michael Rutter (a1)
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eLetters

Psychopathy in Childhood: Is it a meaningful diagnosis?

Michael Fitzgerald, Psychiatrist
10 October 2012

Rutter accepts Jones et al suggestions that callous/unemotional traits in psychopathy are different from Autism ('cold and uncaring') because "psychopathic features are associated with difficulties in resonating with other people's distress, whereas Autism is characterised by difficulties in knowing what people think". While this might be correctfor over 99% of persons with Autism it is too neat and too specific and does not explain the tiny numbers of persons with Autism who are serial killers and described in the book Young Violent and Dangerous to Know. I have resurrected Asperger's phrase Autistic Psychopathy to describe them and other persons with Autism in prison and engaging in serious criminality. Blair and Viding point out that "individuals with psychopathy show impairment in processing the fearful and sad expressions of others and are poor at feeling for others". This precisely describes the situation with serial killers with Autistic Psychopathy or dual diagnosis of Autism and Psychopathy. What is being described here is the very small sub group of persons with Autism and criminality. It is not satisfactory to lump all ASD's together. Eventually it is likely there maybe many sub types based on genotype but we are not close to this yet. As far as the rest of persons with Autism high moral standards are very common. This is another example of the heterogeneity of psychiatric disorders.

Yours sincerely,

Professor Michael Fitzgerald, M.C.004541 Consultant Child and Adult Psychiatrist

Rutter M. Psychopathy in Childhood: Is it a Meangingful Diagnosis? British Journal of Psychiatry 2012; 200: 175/176

Jones A. P. Happe F.G.E. Gilbert F. Burnett S. Viding E. Feeling, Caring, Knowing: different types of empathy deficit in boys with psychopathic tendancies and Autism Spectrum Disorder. Journal Child Psychol. Psychiatry 2010, 51: 1188/97

Fitzgerald M. Young, Violent and Dangerous to Know. Nova Science: NewYork 2010

Asperger H. Autistic Psychopathy in Childhood. Trans U. Frith (ED) In Autism and Asperger's Syndrome. Cambridge University Press: Cambridge 1991 (1944)

Blair R. J. Viding E. Psychopathy in Rutter's Child and Adolescent Psychiatry 5th Ed. (Eds Rutter M. Bishop D. Pine D. Scott S. Stephenson J.Taylor E. 852/63. Blackwell 2008

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Conflict of interest: None declared

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Psychopathy in Childhood: Is it a meaningful diagnosis?

Michael Fitzgerald, Consultant Child & Adult Psychiatrist
21 July 2012

Rutter [1] accepts Jones et al [2] suggestions that callous/unemotional traits in psychopathy are different from Autism ('coldand uncaring') because "psychopathic features are associated with difficulties in resonating with other people's distress, whereas Autism ischaracterised by difficulties in knowing what people think". While this might be correct for over 99% of persons with Autism it is too neat and too specific and does not explain the tiny numbers of persons with Autism who are serial killers and described in the book Young Violent and Dangerous to Know. [3] I have resurrected Asperger's phrase Autistic Psychopathy [4] to describe them and other persons with Autism in prison and engaging in serious criminality. Blair and Viding [5] point out that "individuals with psychopathy show impairment in processing the fearful and sad expressions of others and are poor at feeling for others". This precisely describes the situation with serial killers [6] with Autistic Psychopathy or dual diagnosis of Autism and Psychopathy. What is being described here is the very small sub group of persons with Autism and criminality. It is not satisfactory to lump all ASD's together. Eventually it is likely there may be many sub types based on genotype but we are not close to this yet. As far as the rest of persons with Autism high moral standards are very common. This is another example of the heterogeneity of psychiatric disorders.

References:

1. Rutter M. Psychopathy in Childhood: Is it a Meangingful Diagnosis? British Journal of Psychiatry 2012; 200: 175/176

2. Jones A. P. Happe F.G.E. Gilbert F. Burnett S. Viding E. Feeling,Caring, Knowing: different types of empathy deficit in boys with psychopathic tendancies and Autism Spectrum Disorder. Journal Child Psychol. Psychiatry 2010, 51: 1188/97

3. Fitzgerald M. Young, Violent and Dangerous to Know. Nova Science: New York 2010

4. Asperger H. Autistic Psychopathy in Childhood. Trans U. Frith (ED) In Autism and Asperger's Syndrome. Cambridge University Press: Cambridge 1991 (1944)

5. Blair R. J. Viding E. Psychopathy in Rutter's Child and AdolescentPsychiatry 5th Ed. (Eds Rutter M. Bishop D. Pine D. Scott S. Stephenson J.Taylor E. 852/63. Blackwell 2008

6.

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Conflict of interest: None declared

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