Understanding the Downward Extension of Psychopathy to Youth: Implications for Risk Assessment and Juvenile Justice

Psychopathy is an important construct in adult risk assessment resulting from strong associations to antisocial behavior and criminal recidivism. A recent trend is the downward extension of psychopathic traits to explain juvenile violence. Applying the concept of psychopathy to youthful offenders has great potential; however, its application to adolescence is fraught with uncertainty. This article discusses how the search for causes of violence along with the changing juvenile justice system have encouraged psychopathy to be used for informing policies related to the assessment and treatment of juvenile offenders. Based on established research and clinical practice, we make the case that if applied judiciously, psychopathy can be a critical component in identifying youth most at-risk for short-term violence

Construct Validity of Psychopathy in Mentally Disordered Offenders: A Multi-trait Multi-method Approach

Psychopathy continues to receive increased attention due to the negative outcomes, including recidivism, violence, and poor treatment amenability. Despite the vast amount of attention psychopathy has received, research on its applications to mentally disordered offenders remains sparse. The current study explored the relationship between psychopathy, depression, anxiety, and psychotic disorders. It also investigated the comparative fits of two and three-factor models of the PCL-R with mentally disordered offenders. Participants consisted of 96 inmates placed in the mental health pod at Tarrant County Jail. A Confirmatory Factor Analysis (CFA) with testlets found the three-factor PCL-R model had excellent fit (Robust Comparative Fit Index = 1.00). Psychopathy was found to be a construct independent of mental disorders. Two exceptions were (a) a modest correlation between anxiety and Impulsive and the Irresponsible Lifestyle factor of the PCL-R (r = 0.20) and (b) a modest negative correlation between Deficient Affective Experience of the PCL-R and mania (r = -.37). Based on the current data, treatment programs for mentally disordered offenders are suggested that focus on both behavioral and personality aspects of psychopathy

Adolescent Psychopathy in an Adjudicated Male Population: The Role of Sensation Seeking, Impulsivity, and Externalizing Disorders

Psychopathy, as conceptualized by Cleckley (1941), describes a constellation of psychological and behavioral correlates including superficial charm, untruthfulness, lack of remorse or shame, poor judgment, and failure to learn from experience. Based on Cleckley's initial work, Hare (1991) developed a two-factor model of psychopathy. The purpose of this study was to investigate the roles that sensation seeking, impulsivity, ADHD, conduct disorder, and oppositional defiant disorder have on adolescents classified as psychopaths. The participants consisted of 79 adjudicated male adolescents in a maximum-security facility. As hypothesized, adolescent male psychopaths had higher levels of sensation seeking, impulsivity, conduct disorder and oppositional defiant disorder. A discriminant function analysis found that sensation seeking, impulsivity, ADHD, Conduct Disorder, and Oppositional Defiant Disorder was moderately useful in classifying adolescent psychopathy. The results suggest that behavioral dysregulation is an important aspect of adolescent psychopathy. The relationship of these data to theories of adolescent psychopathy is discussed

Legal and Clinical Issues Regarding the Pro Se Defendant: Guidance for Practitioners and Policy Makers

Defendants who attempt to represent themselves, or proceed pro se, make up less than 1% of felony cases. However, when the issue of competency to proceed pro se arises, it can present interesting questions and challenges not only for the defendant, but also for others involved with the trial process. In Indiana v. Edwards (2008), the U.S. Supreme Court permitted states to impose a higher standard of competency for defendants who wish to proceed to trial without an attorney than for defendants who stand trial with representation. States have responded by adopting a patchwork of different, and often vague, competency standards. The current paper describes states’ differing responses to Edwards, courts’ efforts to ensure the constitutionality of those standards, and extant research on the legal standards and guidelines that should apply to forensic evaluators. Drawing upon this body of law and commentary, this paper distills principles to guide evaluations of defendants’ pro se competency. To facilitate discussion, this paper utilizes three case studies involving defendants with severe mental illness, antisocial personality disorder, and communication impediments unrelated to mental illness. The analysis of these case studies illustrates the application of guiding principles and demonstrates how to distinguish impairments relevant to pro se competence from those that may be legally irrelevant yet still present significant fairness or efficiency concerns

The desire for healthy limb amputation: structural brain correlates and clinical features of xenomelia

Xenomelia is the oppressive feeling that one or more limbs of one's body do not belong to one's self. We present the results of a thorough examination of the characteristics of the disorder in 15 males with a strong desire for amputation of one or both legs. The feeling of estrangement had been present since early childhood and was limited to a precisely demarcated part of the leg in all individuals. Neurological status examination and neuropsychological testing were normal in all participants, and psychiatric evaluation ruled out the presence of a psychotic disorder. In 13 individuals and in 13 pair-matched control participants, magnetic resonance imaging was performed, and surface-based morphometry revealed significant group differences in cortical architecture. In the right hemisphere, participants with xenomelia showed reduced cortical thickness in the superior parietal lobule and reduced cortical surface area in the primary and secondary somatosensory cortices, in the inferior parietal lobule, as well as in the anterior insular cortex. A cluster of increased thickness was located in the central sulcus. In the left hemisphere, affected individuals evinced a larger cortical surface area in the inferior parietal lobule and secondary somatosensory cortex. Although of modest size, these structural correlates of xenomelia appear meaningful when discussed against the background of some key clinical features of the disorder. Thus, the predominantly right-sided cortical abnormalities are in line with a strong bias for left-sided limbs as the target of the amputation desire, evident both in our sample and in previously described populations with xenomelia. We also propose that the higher incidence of lower compared with upper limbs (∼80% according to previous investigations) may explain the erotic connotations typically associated with xenomelia, also in the present sample. These may have their roots in the proximity of primary somatosensory cortex for leg representation, whose surface area was reduced in the participants with xenomelia, with that of the genitals. Alternatively, the spatial adjacency of secondary somatosensory cortex for leg representation and the anterior insula, the latter known to mediate sexual arousal beyond that induced by direct tactile stimulation of the genital area, might play a role. Although the right hemisphere regions of significant neuroarchitectural correlates of xenomelia are part of a network reportedly subserving body ownership, it remains unclear whether the structural alterations are the cause or rather the consequence of the long-standing and pervasive mismatch between body and sel

Structural, item, and test generalizability of the psychopathology checklist - revised to offenders with intellectual disabilities

The Psychopathy Checklist–Revised (PCL-R) is the most widely used measure of psychopathy in forensic clinical practice, but the generalizability of the measure to offenders with intellectual disabilities (ID) has not been clearly established. This study examined the structural equivalence and scalar equivalence of the PCL-R in a sample of 185 male offenders with ID in forensic mental health settings, as compared with a sample of 1,212 male prisoners without ID. Three models of the PCL-R’s factor structure were evaluated with confirmatory factor analysis. The 3-factor hierarchical model of psychopathy was found to be a good fit to the ID PCL-R data, whereas neither the 4-factor model nor the traditional 2-factor model fitted. There were no cross-group differences in the factor structure, providing evidence of structural equivalence. However, item response theory analyses indicated metric differences in the ratings of psychopathy symptoms between the ID group and the comparison prisoner group. This finding has potential implications for the interpretation of PCL-R scores obtained with people with ID in forensic psychiatric settings

Mindfulness-based interventions for young offenders: a scoping review

Youth offending is a problem worldwide. Young people in the criminal justice system have frequently experienced adverse childhood circumstances, mental health problems, difficulties regulating emotions and poor quality of life. Mindfulness-based interventions can help people manage problems resulting from these experiences, but their usefulness for youth offending populations is not clear. This review evaluated existing evidence for mindfulness-based interventions among such populations. To be included, each study used an intervention with at least one of the three core components of mindfulness-based stress reduction (breath awareness, body awareness, mindful movement) that was delivered to young people in prison or community rehabilitation programs. No restrictions were placed on methods used. Thirteen studies were included: three randomized controlled trials, one controlled trial, three pre-post study designs, three mixed-methods approaches and three qualitative studies. Pooled numbers (n = 842) comprised 99% males aged between 14 and 23. Interventions varied so it was not possible to identify an optimal approach in terms of content, dose or intensity. Studies found some improvement in various measures of mental health, self-regulation, problematic behaviour, substance use, quality of life and criminal propensity. In those studies measuring mindfulness, changes did not reach statistical significance. Qualitative studies reported participants feeling less stressed, better able to concentrate, manage emotions and behaviour, improved social skills and that the interventions were acceptable. Generally low study quality limits the generalizability of these findings. Greater clarity on intervention components and robust mixed-methods evaluation would improve clarity of reporting and better guide future youth offending prevention programs

Dynamic and static factors associated with discharge dispositions : the national trajectory project of individuals found not criminally responsible on account of mental disorder (NCRMD) in Canada

The majority of individuals found not criminally responsible on account of mental disorder (NCRMD) in Canada spend some time in hospital before they are conditionally or absolutely (no conditions) discharged to the community by a legally mandated review board. By law, the decision to conditionally discharge an individual found NCRMD should be guided by the need to protect the public, the mental condition of the accused, and the other needs of the accused, especially regarding his/her community reintegration. At the time of this study, Canadian legislation and case law required that the review board disposition should be the "least onerous and least restrictive" possible for the accused. This means that, if there is no evidence that the person poses a significant risk to public safety, he/she must be released. However, the Canadian Criminal Code does not specify the criteria that must be considered when making this risk assessment. This leads to two questions. (1) What predicts review board dispositions? (2) To what extent do disposition determinations reflect evidence-based practices? The present study examined dynamic and static predictors of detention in custody, conditional discharge (CD), and absolute discharge (AD) dispositions among persons found NCRMD across the three largest provinces in Canada. The National Trajectory Project (NTP) examined men and women found NCRMD in British Columbia (BC), Québec (QC), and Ontario (ON) between May 2000 and April 2005, followed until December 2008. For the purposes of this study, individuals who had at least one hearing with a review board were extracted from the NTP dataset (N = 1794: QC = 1089, ON = 483, BC = 222). Over the course of the study, 6743 review board hearings were examined (QC = 3505, ON = 2185, BC = 1053). Despite advances in the risk assessment field, presentation of a comprehensive structured risk assessment to the review board was not the norm. Yet our findings suggest that review boards were taking into account a combination of empirically validated static and dynamic risk factors, as represented by the items of the HCR-20 risk assessment scheme. Particular attention was being paid to the behavior of the patient between hearings (e.g., violent acts, compliance with conditions). Severity of index offense was associated with review board decisions; though index severity is not related to recidivism, it is an important consideration in terms of public perceptions of the justice system and can be related to better established risk factors (i.e., criminal history and prior violence). Historical factors had more influence on the decision to detain someone, while clinical factors were more influential on an AD decision. Disposition stability was the most common trajectory, meaning that a patient with a prior CD disposition was most likely to receive another CD disposition at the next hearing. Static and dynamic risk factors found in the HCR-20 influenced review board determinations, although presentation of a complete structured risk assessment is the exception, not the norm. Results suggest that clinicians recommending less restrictive dispositions are more likely to include a comprehensive risk assessment with their recommendation. An alternative explanation is that, when there is no comprehensive assessment of risk, the review board tends to be more cautious and apply more restrictive dispositions. The practice seems to be contrary to the legislation at the time of the study, given that there should be a presumption that the patient is not a significant threat