This weekend, The New York Times Magazine's powerful cover story, "Can You Call a 9-Year-Old a Psychopath?," explored the experience of a Florida family whose son, Michael, was found to be "two standard deviations outside the normal range for callous-unemotional behavior" -- possibly “prepsychopathic.”
But as the piece, written by Jennifer Kahn, illustrates, treatments for -- and even definitions of -- child psychopathy ("essentially identical” to sociopathy, according to Kahn) are still largely experimental rather than clear-cut.
For parents, though, the piece raises chilling questions, including the most basic: How would I know if my child was a psychopath? HuffPost Parents went to the Child Mind Institute's Senior Director of Forensic Psychiatry and Senior Pediatric Psychopharmacologist Dr. Alan Ravitz, with some of the biggest questions about child psychopathy; what follows is an edited transcript of our conversation.
What’s your initial reaction to the New York Times Magazine article?
They were describing a group of very difficult, very disturbed kids. I was surprised that they were able to find that many of them in one place, because I’ve been doing this for 35 years; I used to run an in-patient hospital; I’ve seen literally thousands of adolescents and children -- and I just don’t run into the problem as frequently as the investigator in the article. ...
I’ve seen people who have the callous-unemotional personality, meaning that they have difficulty empathizing with other people. They talk about these kids as being slick, but they’re not that slick, because if they were really slick they probably wouldn’t have been identified as being in need of treatment. Really good sociopaths escape our scrutiny.
Have you treated children who could have been diagnosed as psychopathic?
Sure. I’ve treated some kids, I think, who are psychopathic.
This isn’t an all-or-nothing phenomenon; it probably exists on a continuum, and all of us have a few sociopathic characteristics. … Once in a while, people make up excuses that are not entirely honest, which doesn’t turn them into terrible human beings -- but it kind of makes them human. That’s what sociopaths do all the time. They lie all the time. The difference between you and a sociopath is that the physiological response that you interpret as anxiety/fear doesn’t exist for a psychopath. So the less of that physiological response you have, the more likely it is that you will be psychopathic or sociopathic.
So, how can a parent tell if he or she is dealing with a psychopathic child, rather than a child with ADHD or another disorder? Is it that lack of empathy and anxiety?
It’s a lack of empathy in addition to a lack of anxiety. There are some people who are unempathic, who are still very anxious. It’s really a combination of no anxiety along with lack of empathy, along with a self-centeredness, along with a predisposition to tell everybody exactly what they want to hear, even if the kid doesn’t believe it at all. So it’s a kind of self-interestedness that’s probably three standard deviations above the mean.
I don’t think parents should be looking to figure out whether their kids are sociopaths, because we don’t have very good treatments for sociopathy. What we should be looking for is to determine whether what appears to be antisocial, insensitive behavior is really a manifestation of some kind of mental health problem for which there is effective treatment.
How is sociopathy’s stigma different from, or similar to, the stigma attached to other mental health disorders?
There is stigma attached to mental health issues, period. We live in a crazy kind of country where people are embarrassed to suffer from depression, from anxiety, from schizophrenia, whatever. It makes us nervous, because we’re all a little bit anxious, and we all tend to get depressed every once in a while, and so when we see somebody else who’s like that, we want to say: “That isn’t me.”
The stigma that’s associated with sociopathy is a kind of implication that there is no treatment for this, so we might as well give up. So it’s like after you’ve tried every diagnosis, and you’ve tried to treat every problem, and the problem continues to exist, and you’re really frustrated, and you’re angry at the patient or you’re angry at the family for not following through with your recommendations, then you might use the label of sociopathy. But three-standard-deviation-above-the-mean sociopathy is really quite rare. … We should be slow to diagnose sociopathy, because sometimes it’s just a stand-in for our frustration at not being able to treat somebody.
In her article, Jennifer Kahn wrote, "A small but growing number of psychologists ... say that confronting the problem earlier may present an opportunity to help these children change course." What do you think? Can this diagnosis ever be positive?
The best that we can do for everybody who we treat is to try to figure out exactly what the problem is, so that we can try to apply a treatment to that problem. The difficulty with sociopathy is that, as far as I know, nobody has identified effective treatments for it. I think that that’s what the article says, too -- we’re just beginning to appreciate the genetic and neuro-physiological aspects of this problem, and until we do more investigation, we’re not going to figure out where to put the lever.
Why has it taken so long for people to start researching potential treatments?
Sociopathy really isn’t all that common. It seems like every time there’s a sociopath, somebody writes a book about them. The same thing happens with airplane crashes. They happen so rarely that every time one happens, it’s news. So part of the reason [we haven’t been researching treatments] is that the frequency of sociopathy is not that high.
A second reason is that if you are a “successful” sociopath, you’re not going to be identified as sociopathic, except by your friends and family. But you’re not generally thought to be identified as sociopathic.
A third reason is that sociopathy doesn’t generate sympathy. People want to look at sociopaths as criminals -- which many of them are. And there is a huge debate in our society right now about the medicalization of criminal behavior. … Do we treat evil? Or do we not treat evil? Can we treat evil medically? I’m not going to weigh in on one side or the other of this debate, because I don’t know the answer to that one.
We’ve had thousands of years of incarcerating criminals, and only a very few years of trying to treat them, and even now when we try to treat criminals, there are a lot of people who reject that approach.
Is there anything else you would add -- particularly for readers who are parents of young children?
Yes. Number one: What the article talked about was that the two parents were not on the same page in regards to treating the child. It’s very difficult to treat oppositional and defiant behavior if the parents are not on the same page. It’s difficult, if not impossible, to generate a good behavior management plan without a great deal of professional help. And the way that we fund mental health treatment these days makes it very difficult for people to gain access to those resources. Because most of the third-party payers and most of the managed care companies will say, “This is just a bad kid, and there are no evidence-based treatments for being bad, therefore we’re not going to pay for this.” So people have limited resources.
At the Child Mind Institute, we have something called Parent-Child Interaction Therapy, which is a treatment that’s been developed for oppositional defiant kids who are age 7 or below, where you’ve got the mental health professional sitting behind a one-way mirror, and there’s a little bug in the ear of the parent, and these people are given intensive coaching in how to manage these types of difficult children. And I can tell you, because I have witnessed these sessions myself (because I sometimes do medication management for some of these kids), that we’ve taken kids who looked to be absolutely cold-blooded and impossible, and we have turned them into functioning little members of society.
You want to try to address these problems early; you don’t want to look at this as a phase or something that’s just going to go away. Yes, it’s true that there is such a thing as sibling rivalry, but if you want to kill your younger sibling, and you engage in behavior the objective of which is to actually commit murder, that’s, again, several standard deviations above the mean.