Diagnostic labeling in juvenile court: how do descriptions of psychopathy and conduct disorder influence judges?

Proposed Specifiers for Conduct Disorder-Short Version (PSCD-SV): Psychometric Properties, Concurrent Correlates and Parenting Predictors

The present study aims to further examine the four-factor model of psychopathy in adolescence with a new alternate model for the assessment of psychopathic traits and conduct disorder (CD): The Proposed Specifiers for Conduct Disorder-Short version (PSCD-SV). Data were collected in a sample of 414 adolescents (49.2% females) aged 12-15 at the first assessment who were then followed-up 2 years later. Results supported the usefulness of the PSCD-SV to assess the broader construct of psychopathy showing good psychometric properties, including adequate reliability and validity, while accounting for all its dimensions. In addition, the study showed close associations between psychopathic traits and adolescent behavioral, emotional and psychosocial maladjustment. Finally, the findings elucidated the PSCD's connection to parental support and psychological control, and reinforced the potential role of parenting practices as predictors that can act as mechanisms of change in the development of psychopathy. Overall, current findings shed light on conceptual and developmental models of psychopathy that may have implications for assessment, diagnostic classification, prevention, and intervention.

Juvenile Psychopathy and Community Treatment Response in Youth Adjudicated for Sexual Offenses

The present study examined the association of juvenile psychopathy features and treatment response in a sample of 102 youth, court adjudicated for sexual offenses and followed up more than 11 years in the community. The Psychopathy Checklist: Youth Version (PCL: YV) was rated from comprehensive archival sources, along with a youth sexual offense risk assessment and treatment planning measure scored pre-and posttreatment. The PCL: YV converged with domains of sexual offense risk and change in conceptually meaningful ways, and significantly predicted nonsexual violent, general violent, and any recidivism; it did not significantly predict sexual recidivism. Higher levels of psychopathy-related personality features were significantly associated with noncompletion of youth sexual offense-specific treatment, while changes in risk were associated with decreased recidivism controlling for PCL: YV score and baseline risk at p < .10. The findings underscore the importance of intervention and support services for youth convicted of sexual offenses as well as the clinical and risk relevance of the juvenile psychopathy construct to decrease violent victimization to others.

Some critical considerations in applying the construct of psychopathy to research and classification of childhood disruptive behavior disorders

The recent inclusion of callous-unemotional traits in the diagnostic criteria for serious conduct problems has led to renewed interest in more comprehensive integrations of the construct of psychopathy into research and clinical classification of childhood disruptive behavior disorders. There have been a number of recent reviews of research focusing the many potential benefits for this integration. However, there are also a number of issues that could reduce these benefits and even potentially lead to harmful effects. The current paper focuses on several of these issues, some of which are common when attempting to integrate research findings across areas that have been conducted independently of each other. Other issues are more specific to the construct of psychopathy. Specifically, the current paper focuses on the lack of agreement on the necessary and sufficient dimensions needed to define psychopathy, the need to consider developmental relationships among these dimensions, the implications of the different associations among the dimensions of psychopathy with conduct problems in children and adolescents, the need to consider how these dimensions relate to existing constructs used in the classification of disruptive behavior disorders, and the potential harmful effects of labeling something "a dimension of psychopathy". These issues have several clear implications for using the construct of psychopathy to guide research on and diagnostic classification of childhood disruptive behavior disorders.

Psychopathic Personality Configurations in Early Childhood: A Response to Dvoskin et al. (2022)

Dvoskin et al. (2022) offered a cautionary comment on an article published in the Journal of Personality Disorders (López-Romero et al., 2021). This comment was focused on the scientific and policy grounds of our study, and cautioned against the use of the "putative psychopathic personality" label for applied purposes. While we agree with most of their concerns and cautions, we aim to provide additional clarification on the raised concerns, noting that the purpose of our study is purely exploratory, and that its findings are not intended for applied purposes. We do expect that our study and this commentary will further clarify the importance of examining psychopathic personality from a developmental perspective, opening new ways of discussion regarding how to best conceptualize and study a construct that, while waiting for additional longitudinal research, has been shown as relevant in identifying a group of children and adolescents at increased risk for maladjustment.

Labelling affects agreement with political statements of right-wing populist parties

In light of the recent rise of right-wing populist parties across Europe, it is an intriguing question under which conditions people agree with right-wing political statements. The present study investigates whether mere labelling of political statements as endorsed by a right-wing populist party influences people’s agreement with such statements. In the study (pre-registered; N = 221 German voters), it is shown than that supporters of the right-wing populist party indicated higher agreement with the statements when they were labelled as being endorsed by the party (vs. not labelled), whereas non-supporters indicated lower agreement with the labelled than with the non-labelled statements. We conclude that labelling of the very same political statements changes voters’ agreement with these statements. The results imply that rather than (dis)agreeing with the content of the statements per se, people may (dis)agree with right-wing populist statements because they come from a specific source (i.e., the right-wing populist party).

Perceptions of waived juvenile defendants across mental health diagnoses and demographic characteristics

Justice involved youth who present with diagnosable mental health issues are commonly prosecuted in criminal courts. Limited research has examined how jurors perceive and respond to transferred juveniles with mental health issues. For the current study, 252 mock jurors were randomly assigned to read one of six profiles (i.e., White male, White female, Black male, Black female, Latino, and Latina) and report culpability, deserved punishment, behavior regulation, and dangerousness for juveniles diagnosed with conduct disorder, major depressive disorder, attention deficit hyperactivity disorder, schizophrenia, and described with antisocial traits/behaviors. A schizophrenia diagnosis was associated with less blame, punishment, and capacity for behavior regulation. A description of antisocial traits/behaviors was associated with more blame, punishment, capacity for behavior regulation, and dangerousness. White juveniles described with antisocial traits were considered more blameworthy and deserving of punishment than Latinos. Considering the temporary nature of adolescent antisocial personality characteristics, jurors should have greater awareness of the maturation process.

Dangerous, depraved, and death-worthy: A meta-analysis of the correlates of perceived psychopathy in jury simulation studies

OBJECTIVES

Experimental research suggests that legal defendants described as psychopathic are generally, although not uniformly, judged more negatively and punitively. Understanding the correlates of perceived psychopathy, regardless of exposure to mental health evidence, is an important step towards clarifying divergent findings.

METHOD

We conducted a quantitative synthesis of ten juror simulation studies (combined N = 2,980) examining the meta-analytic association between perceived defendant psychopathy and various psychologically important and legally relevant outcomes.

RESULTS

Perceiving someone as being more psychopathic was associated with viewing that defendant as more dangerous (r _W  = 0.31) and evil ( r _W  = 0.44). Moreover, perceptions of defendant psychopathy predicted greater support for more adverse consequences in terms of capital sentencing ( r _W  = 0.22) and sentence length ( r _W  = 0.27), although not perceived treatment amenability ( r _W  = 0.09).

CONCLUSIONS

These findings highlight the importance of including ratings of perceived psychopathy in experimental designs to identify the circumstances under which psychopathy evidence might prejudicially impact case outcomes.

Alzheimer's disease and the law: positive and negative consequences of structural stigma and labeling in the legal system

OBJECTIVE

To explore the meaning and consequences of labeling on structural stigma in the context of Alzheimer's disease (AD) in the legal system.

METHOD

This qualitative study was made up of three focus groups including social workers and lawyers (n = 26). Participants were asked to report their experience in circumstances in which persons with AD and their family members engage with the legal system. Thematic analysis using the constant comparative method was used.

RESULTS

The discussions in the focus groups raised two overall themes. (1) The significance of the medical diagnostic labeling of AD in the legal system and (2) the consequences of labeling of AD within the legal system. This last theme included four sub-themes: (a) negative consequences of labeling; (b) reasons associated with negative consequences of labeling; (c) positive consequences of labeling; and (d) reasons associated with positive consequences of labeling.

CONCLUSION

Findings of the study provide a first foundation for future research on the meaning and consequences of labeling in legal cases involving persons with AD. They suggest that increasing judges' knowledge about AD and reforming the existing 'status-based' legal capacity legislation might benefit by limiting the legal weight given today to the medical diagnosis.

Psychopathy Checklist-Revised Use and Reporting Practices in Sexually Violent Predator Evaluations

We surveyed evaluators who conduct sexually violent predator evaluations ( N = 95) regarding the frequency with which they use the Psychopathy Checklist-Revised (PCL-R), their rationale for use, and scoring practices. Findings suggest that evaluators use the PCL-R in sexually violent predator cases because of its perceived versatility, providing information about both mental disorder and risk. Several findings suggested gaps between research and routine practice. For example, relatively few evaluators reported providing the factor and facet scores that may be the strongest predictors of future offending, and many assessed the combination of PCL-R scores and sexual deviance using deviance measures (e.g., paraphilia diagnoses) that have not been examined in available studies. There was evidence of adversarial allegiance in PCL-R score interpretation, as well as a "bias blind spot" in PCL-R and other risk measure (Static-99R) scoring; evaluators tended to acknowledge the possibility of bias in other evaluators but not in themselves. Findings suggest the need for evaluators to carefully consider the extent to which their practices are consistent with emerging research and to be attuned to the possibility that working in adversarial settings may influence their scoring and interpretation practices.

The Relationship Between Early Life Events, Parental Attachment, and Psychopathic Tendencies in Adolescent Detainees

Despite increasing interest in understanding psychopathic traits in youth, the role of early environmental factors in the development of psychopathic traits is not well understood. No prior studies have directly examined the relationship between early life events and psychopathic traits. We examined links between life events in the first 4 years of life and indices of the core affective and interpersonal components of psychopathy. Additionally, we examined relationships between early life events, psychopathic traits, and attachment to parents among 206 adjudicated adolescents. Results indicated that the total number of early life events was positively correlated with indices of the affective component of psychopathy. Moreover, psychopathic traits moderated the relationship between the number of early life events and later reports of attachment to parents. Findings suggest that early environmental factors could have important implications for the development of psychopathic traits and may impact attachment to parents for youth with psychopathic traits.

Effects of Mental Health and Neuroscience Evidence on Juror Perceptions of a Criminal Defendant: the Moderating Role of Political Orientation

Several recent studies have examined the effects of mental health and neuroscientific evidence on attitudes toward criminal defendants, suggesting that these factors may influence juror decision-making in meaningful ways. Few studies to date have manipulated both of these variables while also considering theoretically important individual difference variables (e.g., political orientation). Using a criminal case simulation, this study manipulated the presence of evidence concerning mental disorders (psychopathy and schizophrenia) and increasing levels of neuroscientific detail regarding a defendant's brain injury, and examined verdicts and sentencing recommendations in over 400 persons attending jury duty. Main effects were detected for mental health testimony and political orientation, although interactions were noted as well. More negative reactions to defendants labeled as psychopaths were relatively consistent, whereas participants who identified as liberal generally were less punitive towards a defendant identified as schizophrenic than were more conservative jurors. Consistent with other recent research, juror perceptions of the defendant's level of psychopathic traits (independent of the effects of the experimental manipulations) predicted guilty verdicts and longer sentencing recommendations. Copyright © 2016 John Wiley & Sons, Ltd.

A New Measure to Assess Psychopathic Personality in Children: The Child Problematic Traits Inventory

Understanding the development of psychopathic personality from childhood to adulthood is crucial for understanding the development and stability of severe and long-lasting conduct problems and criminal behavior. This paper describes the development of a new teacher rated instrument to assess psychopathic personality from age three to 12, the Child Problematic Traits Inventory (CPTI). The reliability and validity of the CPTI was tested in a Swedish general population sample of 2,056 3- to 5-year-olds (mean age = 3.86; SD = .86; 53 % boys). The CPTI items loaded distinctively on three theoretically proposed factors: a Grandiose-Deceitful Factor, a Callous-Unemotional factor, and an Impulsive-Need for Stimulation factor. The three CPTI factors showed reliability in internal consistency and external validity, in terms of expected correlations with theoretically relevant constructs (e.g., fearlessness). The interaction between the three CPTI factors was a stronger predictor of concurrent conduct problems than any of the three individual CPTI factors, showing that it is important to assess all three factors of the psychopathic personality construct in early childhood. In conclusion, the CPTI seems to reliably and validly assess a constellation of traits that is similar to psychopathic personality as manifested in adolescence and adulthood.

Interpersonal and affective dimensions of psychopathic traits in adolescents: development and validation of a self-report instrument

We report the development and psychometric evaluations of a self-report instrument designed to screen for psychopathic traits among mainstream community adolescents. Tests of item functioning were initially conducted with 26 adolescents. In a second study the new instrument was administered to 150 high school adolescents, 73 of who had school records of suspension for antisocial behavior. Exploratory factor analysis yielded a 4-factor structure (Impulsivity α = 0.73, Self-Centredness α = 0.70, Callous-Unemotional α = 0.69, and Manipulativeness α = 0.83). In a third study involving 328 high school adolescents, 130 with records of suspension for antisocial behavior, competing measurement models were evaluated using confirmatory factor analysis. The superiority of a measurement model represented by four correlated factors was supported, and this model was invariant across gender and age. The findings provide researchers and clinicians with a psychometrically strong, self-report instrument and a greater understanding of psychopathic traits in mainstream adolescents.

The effects of including a callous-unemotional specifier for the diagnosis of conduct disorder

BACKGROUND

'With Significant Callous-Unemotional Traits' has been proposed as a specifier for conduct disorder (CD) in the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The impact of this specifier on children diagnosed with CD should be considered.

METHODS

A multi-site cross-sectional design with volunteers (n = 1136) in the third-seventh grades and 566 consecutive referrals (ages 5-18) to a community mental health center were used to estimate the prevalence rates of CD with and without the proposed specifier. In addition, the degree of emotional and behavioral (especially physical aggression) disturbance and level of impairment in youth with and without CD and with and without the specifier was evaluated.

RESULTS

In the community sample, 10%-32% of those with CD and 2%-7% of those without CD met the callous-unemotional (CU) specifier threshold depending on informant. In the clinic-referred sample, 21%-50% of those with CD and 14%-32% without CD met the CU specifier threshold depending on informant. Those with CD and the specifier showed higher rates of aggression in both samples and higher rates of cruelty in the clinic-referred sample.

CONCLUSIONS

Results indicate between 10% and 50% of youth with CD would be designated with the proposed CU specifier. Those with CD and the specifier appear to be more severe on a number of indices, including aggression and cruelty.

Current issues in the diagnosis of attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder

This review evaluates the diagnostic criteria for three of the most common disorders for which children and adolescents are referred for mental health treatment: attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). Although research supports the validity and clinical utility of these disorders, several issues are highlighted that could enhance the current diagnostic criteria. For ADHD, defining the core features of the disorder and its fit with other disorders, enhancing the validity of the criteria through the lifespan, considering alternative ways to form subtypes of the disorder, and modifying the age-of-onset criterion are discussed relative to the current diagnostic criteria. For ODD, eliminating the exclusionary criteria of CD, recognizing important symptom domains within the disorder, and using the cross-situational pervasiveness of the disorder as an index of severity are highlighted as important issues for improving classification. Finally, for CD, enhancing the current subtypes related to age of onset and integrating callous-unemotional traits into the diagnostic criteria are identified as key issues for improving classification.

The relationship between juvenile psychopathic traits, delinquency and (violent) recidivism: a meta-analysis

A meta-analysis of k = 53 studies containing 60 non-overlapping samples and 10,073 participants was conducted to investigate whether psychopathy was associated with delinquency and (violent) recidivism in juveniles. The results showed that psychopathy was moderately associated with delinquency, general recidivism, and violent recidivism. Moderator effects revealed that various study and participant characteristics influenced the strength of the association between psychopathy, delinquency, and (violent) recidivism. It was concluded that screening for the (early) detection of psychopathy is important, as delinquent behavior and recidivism can be predicted from psychopathy as early as the transition from middle childhood to adolescence.

Predictive validity of callous-unemotional traits measured in early adolescence with respect to multiple antisocial outcomes

This study investigated the predictive validity of youth callous-unemotional (CU) traits, as measured in early adolescence (Grade 7) by the Antisocial Process Screening Device (APSD; Frick & Hare, 2001), in a longitudinal sample (N = 754). Antisocial outcomes, assessed in adolescence and early adulthood, included self-reported general delinquency from 7th grade through 2 years post-high school, self-reported serious crimes through 2 years post-high school, juvenile and adult arrest records through 1 year post-high school, and antisocial personality disorder symptoms and diagnosis at 2 years post-high school. CU traits measured in 7th grade were highly predictive of 5 of the 6 antisocial outcomes-general delinquency, juvenile and adult arrests, and early adult antisocial personality disorder criterion count and diagnosis-over and above prior and concurrent conduct problem behavior (i.e., criterion counts of oppositional defiant disorder and conduct disorder) and attention-deficit/hyperactivity disorder (criterion count). Incorporating a CU traits specifier for those with a diagnosis of conduct disorder improved the positive prediction of antisocial outcomes, with a very low false-positive rate. There was minimal evidence of moderation by sex, race, or urban/rural status. Urban/rural status moderated one finding, with being from an urban area associated with stronger relations between CU traits and adult arrests. Findings clearly support the inclusion of CU traits as a specifier for the diagnosis of conduct disorder, at least with respect to predictive validity.

Perceptions of diagnostic labels in forensic psychiatric practice: a survey of differences between nurses and other disciplines

This paper reports on a study of nurses' and non-nurses' perceptions of labels of mental illness and personality disorder in forensic services in the UK. The objectives of the study were to establish if differences in perceptions existed within, and between, the two groups of professionals. The research method was a survey design with 1,200 questionnaires distributed to nurses and 300 to other professionals in disciplines on forensic units in the UK, with response rates of 34.6% and 43%, respectively. The target population included clinical health care staff who had patient contact, including nurses, psychiatrists, psychologists, social workers, and occupational therapists. The results indicate that there are statistically significant differences within both nursing and non-nursing groups and also between the groups in relation to a "management" perspective for individuals labelled with a personality disorder and a "clinical" focus for individuals who are labelled as mentally ill. This paper adds research into the arena of forensic mental health in relation to the diagnostic labels of mental illness and personality disorders. It also adds evidence of a clinical response or a management response to such diagnostic labels which may impact on the practice of forensic psychiatry.

Assessing violence risk and psychopathy in juvenile and adult offenders: a survey of clinical practices

This study surveyed 199 forensic clinicians about the practices that they use in assessing violence risk in juvenile and adult offenders. Results indicated that the use of risk assessment and psychopathy tools was common. Although clinicians reported more routine use of psychopathy measures in adult risk assessments compared with juvenile risks assessments, 79% of clinicians reported using psychopathy measures at least once in a while in juvenile risk assessments. Extremely few clinicians, however, believe that juveniles should be labeled or referred to as psychopaths. Juvenile risk reports were more likely than adult reports to routinely discuss treatment and protective factors, and provide recommendations to reevaluate risk. The implications of these findings are discussed.

Describing, diagnosing, and naming psychopathy: how do youth psychopathy labels influence jurors?

Previous studies have reached opposing conclusions regarding how psychopathy assessment influences the court's response to a juvenile defendant. This study sought to clarify the apparent discrepancies across studies by distinguishing among three key variables: history of antisocial behavior (substantial versus minimal), psychopathic personality traits (present versus absent), and diagnostic label (no diagnosis, conduct disorder, psychopathy, or "is a psychopath"). We systematically manipulated these variables in vignettes describing expert testimony, and then distributed these vignettes to 891 jury-pool members. Descriptions of the antisocial behavior and psychopathic personality traits underlying diagnoses tended to have stronger effects than did the diagnostic labels (i.e. psychopathy or conduct disorder). However, labeling juvenile defendants with the colloquial term "psychopath" led jurors to believe that they posed greater risk for future crime and deserved greater punishment compared with juveniles described as meeting diagnostic criteria for psychopathy or conduct disorder. Results should influence the language forensic evaluators use in practice. Results should also inform research that investigates diagnostic labeling effects.

Juvenile psychopathy and judicial decision making: an empirical analysis of an ethical dilemma

In the burgeoning juvenile psychopathy literature, there is a debate on whether it is appropriate to apply this construct to youths. Some have suggested that labeling children/adolescents as psychopathic might result in negative consequences, such as being recommended for more restrictive placements. However, the scant evidence is equivocal. This study provides additional insights on this issue by assessing judicial perceptions and recommendations to a hypothetical case. Results indicate that psychopathy influenced perceptions of amenability (eta = .12) and dangerousness (eta = .25), and recommendations for placement (eta = .11). More specifically, youth who were both labeled as psychopathic and ascribed psychopathic traits were viewed as less amenable to treatment and more dangerous and were more likely to be recommended for a restrictive placement than youth who were neither labeled nor described as such. The effect of psychopathy on placement recommendations, however, was not significant after controlling for perceptions of dangerous. This suggests that the influence of psychopathy on judicial restrictiveness may operate through the perceived dangerousness of the youth.

Effect of psychopathy, abuse, and ethnicity on juvenile probation officers' decision-making and supervision strategies

Probation officers exercise substantial discretion in their daily work with troubled and troubling juvenile offenders. In this experiment, we examine the effect of psychopathic features, child abuse, and ethnicity on 204 officers' expectancies of, recommendations for, and approach to supervising, juvenile offenders. The results indicate that officers (a) have decision-making and supervision approaches that are affected by a youth's psychopathic traits and history of child abuse-but not ethnicity; (b) view both abused youth and psychopathic youth as highly challenging cases on a path toward adult criminality; and (c) have greater hope and sympathy for abused youth than psychopathic youth. For abused youth, officers are likely to recommend psychological services and "go the extra mile" by providing greater support, referrals, and networking than is typical for their caseload. For psychopathic youth, officers expect poor treatment outcomes and are" extra strict," enforcing rules that typically are not enforced for others on their caseload.