Visiting ProfessorClinical Lead IVY Head of Child and Family Clinical Psychology Associate Fellow of the British Psychological Society Aims and Overview And a picture paints a thousand words The problem of youth violence ID: 634538
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Slide1
Dr
Lorraine Johnstone
Consultant Clinical Forensic Psychologist
Visiting Professor/Clinical Lead, IVY
Head of Child and Family Clinical Psychology
Associate Fellow of the British Psychological SocietySlide2
Aims and Overview
And a picture paints a thousand words
The problem of youth violence
The Billion Dollar QuestionWill they do it again?The whole is greater than the sum of the parts
Risk factors for youth violence
Fitting a square peg into a round whole
Youth Psychopathy AKA the Holy Grail
‘The chicken or the egg’
Attachment, complex trauma or psychopathy
‘Don’t throw the baby out with the bath water’
Using Formulation to Make Sense of Psychopathic-Like TraitsSlide3
And
a picture paints a thousand words… Slide4
The Billion Dollar Question: Will they do it again? Slide5
Age Crime Curve Slide6
Persistent and Serious
Conduct Problems Slide7
Psychopathy
Antisocial Personality Slide8
What is
psychopathy
? Slide9
Early conceptualisations
"
Likeable," "Charming," "Intelligent,"
"Alert," "Impressive," "Confidence-inspiring”
“unreliability”
“Untruthfulness”
“Lack of remorse and shame”
“Pathological Egocentricity”
“Incapacity for love”Slide10Slide11
Criminality
Violence
Poor institutional adjustment
Poor treatment
responsivity
Substance misuse
Cluster B Personality
Impaired
neurocognitive
and affective functioning Slide12
Etiological Basis
A
biological disorderSlide13
“psychopathy does not suddenly spring, unannounced, into existence in adulthood. The precursors…first reveal themselves early in life”
Hare (1994) Slide14
BenjaminSlide15
ColleenSlide16
Hare Psychopathy Checklist Youth Version: PCL-YV, Forth, Kosson & Hare, (2003)
“from the school yard to the prison yard” (MHS)Slide17
Antisocial Process
Screening
Device
(ASPD; Frick & Hare, 2001)
“the APSD screens for Antisocial Personality Disorder or psychopathy. The child is rated on a dimensional scale that probes the characteristic psychopathic pattern”Slide18Slide19
In 2013, the DSM-IV made it permissible for clinicians to include a CU
specifier
when diagnosing conduct disorderWhat that means is identifying those children that are, according to some, showing precursors, if not actual, characteristics of psychopathy - there are important implications of this! Slide20
1.
Lack of Remorse or Guilt
:
Does not feel bad or guilty when he/she does something wrong (exclude remorse when expressed only when caught and/or facing punishment). The individual shows a general lack of concern about the negative consequences of his or her actions. For example, the individual is not remorseful after hurting someone or does not care about the consequences of breaking rules. The person rarely admits to being wrong and typically blames others for any negative consequences which result from his or her actions.
2.
Callous-Lack of Empathy
:
Disregards and is unconcerned about the feelings of others. The individual is described as cold and uncaring. The person appears more concerned about the effects of his or her actions on him or herself, rather than their effects on others, even when they result in substantial harm to others.
3. Unconcerned about Performance
: Does not show concern about poor/problematic performance at school, work, or in other important activities. The individual does not put forth the effort necessary to perform well, even when expectations are clear, and typically blames others for his or her poor performance.4. Shallow or Deficient Affect: Does not express feelings or show emotions to others, except in ways that seem shallow, insincere, or superficial (e.g., actions contradict the emotion displayed; can turn emotions “on” or “off” quickly) or when emotional expressions are used for gain (e.g., emotions displayed to manipulate or intimidate others).Slide21
More severe conduct problems (Christian et al., 1997)
Higher scores on measures of thrill and adventure seeking (Frick et al., 2003; Frick et al., 1999)
Lower sensitivity to cues to punishment when a reward-oriented response set is primed (O’Brien and Frick, 1996; Frick et al., 2003)
Lower levels of reactivity to threatening and emotionally distressing stimuli (Blair, 1999)Less distress to negative effects of their behaviour on others (Blair, 1997)Impaired ability to recognize fearful and sad facial expressions and sad vocal tones (Blair et al., 2001; Stevens et al., 2001)Impairments in moral reasoning and empathic concerns towards others (Blair, 1999)Maladaptive dimensions of narcissism (Barry et al., 2003)Support for the biological basis of the disorder
A valid
contstructSlide22
Voila! Slide23
Richter (1997)Slide24Slide25
Brief Illustrations
“John” – referred by consultant psychiatrist and clinical psychologist – has threatened to perpetrated a sexual homicide; has entered unknown females premises; has history of cruelty to animals including decapitation (multiple protocols – SAVRY, RSVP, THREAT, sexual homicide literatures
)
“Gemma” – referred by social worker. Complex presentation with multiple risks including fire-raising, self-harm, indecent exposure, thoughts of sexually assaulting younger sibling, extreme aggression towards staff and others (multiple protocols SAVRY, Northgate and RSVP but note limited data for girls)
.
“Harry” – referred by police; distributing right wing and violent extremism materials; attempting to purchase bomb making materials via internet; openly endorses the use of violence for political ends; advocates Nazism and other extremist philosophies; attempting to form networks (SAVRY and VERA
)
“Jake” – referred by secure estate; convictions x3 rape; ongoing violence towards staff and peers; aggressive towards family; highly negative attitudes towards females and past victims; due for return to local community. (RSVP and SAVRY
)
“Lenny” –
hx
of raping x2 toddlers (sodomy) and sexual assault of vulnerable peer; had constant supervision since (around 3 years), due to exit childcare system; remains preoccupied with sexually explicit and pornographic materials and openly admits that would take an opportunity to offend against a child. Slide26
Historical Risk Factors
Historical Risk Factors
High
Moderate
Low
Not Rated
1. History of violence
38
4
0
0
2. History of nonviolent offending
2687
13. Early initiation of violence
23134
24. Past supervision/intervention failures
2113
4
4
5. History of self-harm or suicide attempts
9
17
15
1
6. Exposure to violence in the home
28
4
6
4
7. Childhood history of maltreatment
28
4
7
3
8. Parental/caregiver criminality
21
6
12
3
9. Early caregiver disruption
28
11
2
1
10. Poor school achievement
29
8
2
3Slide27
Social/Contextual Factors
Social/Contextual Risk Factors
H
M
L
Not Rated
11. Peer delinquency
2289
312. Peer rejection28
94113. Stress and poor coping
383
01
14. Poor parental management317
2
2
15. Lack of personal/social support
20
17
4
1
16. Community disorganisation
13
6
16
7Slide28
Individual Factors
Individual/Clinical Risk factors
17. Negative attitudes
33
7
1
1
18. Risk taking/impulsivity
343
3219. Substance use difficulties17
4192
20. Anger management problems34
42
2
21. Low empathy/remorse
29
3
1
9
22. Attention deficit hyperactivity difficulties
13
4
23
2
23. Poor compliance
31
9
0
2
24. Low interest/commitment to school
20
14
5
3Slide29Slide30
Attachment Theory Slide31
Trauma, abuse and neglectSlide32
Impact of trauma and neglectSlide33
Attachment StylesSlide34
Models of Developmental Trauma Slide35
Hypervigilant
to threat and preparedness to act…
Poor
behavioural controls ImpulsivityAggressivity Slide36
False Affect
Inconsistent emotions
Use of charm
Manipulation Slide37
Dissociation
Shallow affect
Lack of empathy
Lack of remorse As a ‘disconnect’ as opposed to absence of emotion
Divorce between event and emotion
Driving
behavioural
reenactmentsSlide38
Poor self-concept
‘The best defense is offence’
Narcissism develops as a defense against early experiences of ineptness, shame and guilt experienced via abuseSlide39
Impaired world view
Foreshortened future
Lack of
planfulnessRisk taking Slide40Slide41
Beth Thomas
https://
www.youtube.com
/watch?v=ME2wmFunCjUSlide42
Square peg, round hole
But, don’t throw the baby out with the bathwater
An either or position is futileSlide43
Making sense of this complexity
Formulation: tell the story…
Analysis and description of the problem
Temporal sequencing of the problem development mapped with significant attachment or trauma events Pragmatic formulation – 4 PsNarrative with postulated mechamismsReliability and validity check Slide44