Severe Conduct Disorder (Juvenile Psychopathy)
A model of early assessment and intervention

High Risk?

Edited Version First Published In Community Care Magazine,

Often one only needs to press the remote control switch of the television to on to find the media commenting on the devastation and harm, which has been caused by children. This harm is to individuals, animals and property and the comments are frequently around disbelief and confusion as to why the children of our society would do such a thing. This paper attempts to stimulate discussion on the need to implement a strategy of support and intervention for the children who are discussed so frequently in the media, who are responsible for a high percentage of the harm and offences committed within our society.

It also attempts to encourage reflection as too a move to a greater awareness of the factors which interplay in the development of high risk behaviour. As a reader you are encouraged to make sense of the behaviour presented by of the young people and to try and understand why at the start of their early life the scales were tipped away from a life with the qualities of love and trust to one of mistrust and hate.

Attachment: A Critical Time

When looking at this area, the concept of attachment can be beneficial in understanding the behaviour of the children, I am not advocating this element to the exclusion of other explanations but purely on the basis of where we may have an opportunity to do something and provide effective interventions.

I think it is appropriate to pose a question:

What Makes The Normal Process That Causes Attachment And Thus A Social Conscience To Occur To Be Short Circuited?

You just have to observe a new mother cuddling her baby, you can sense the attunment in the interactions, gazing into each other’s eyes in an effectional bond that joins them emotionally.

By understanding the development of a child in a nurturing and warm care environment, it provides an ability to understand the potential for experiences which are characterised as fragmented, neglectful and abusive to change the trajectory of a child in their life.

This crucial process which occurs in the first three years of life provides the child the formation of social attachments, but also a template for future emotional joining of others in meaningful and healthy relationships. I believe we all need a to have an ability to create an sense of understanding of a child’s behaviour and by being able to look back. at the early developmental cycle we can not only gain a sense of understanding but can give a point where informed interventions can be proposed.

Much is known about the biological and emotional effects of trauma upon the mind and the crucial importance of the primary caregiver in enabling the young child to develop the ability to be reflective and mentalize experience (Fonagy, 2002).

Therefore the failing of the attachment process brings difficulties in emotional awareness, perceiving and understanding the emotions of others and difficulties in regulating levels of arousal. This is why I firmly believe that the characteristics of those attempting to do meaningful work with such children need to be able to provide for these deficits by themselves being emotional aware and self aware of others.

I would therefore encourage interested professionals to explore the great deal that is now know about the possible effects on personality of physical, sexual and emotional abuse.

In my work with adults who would have scored high on the Revised Psychopathy Checklist - the PCL-R, although they are perceived as the most dangerous hard men. may be vulnerable to psychic trauma. They may have learned in childhood to create a psychopathic defence as they are too vulnerable to deal with the traumas of everyday life. For although others in the same social environment may feel "contained and safe", they may perceive the world as a continuous war zone. This understanding and insight has assisted me in developing more appropriate interventions for children who have came from homes which have been described as war zones to assist in helping them understand themselves better and hopefully make better choices.

It provides a potential space where it is safe to think about the trauma, experience feelings about it and create the correct holding environment where healing can take place (Miller, 1993; Ward, 1998). This means that the adults responsible for the child’s care have a huge responsibility to be there to care for them, not just some of the time but all of time. In effect, the staff become part of the therapeutic parenting team.

In this way the milieu or life space in a group living environment becomes a focus for the staff to use daily events and processes as part of therapeutic work. The care staff can provide a responsive environment which manages the boundaries within which the child behaves. This will ultimately assist the child to manage and regulate their internal affect. As we have seen, dissociation is utilised to protect the individual from overwhelming anxiety. Without realizing it, I fought to keep my two worlds separate. Without ever knowing why, I made sure, whenever possible, that nothing passed between the compartmentalization I had created between the day child and the night child (Marlyn Van Derbur (2004, p26)

An alternative reframing environment should be created by staff to help the child to alter their perception of the world and of self. In this way trust in the outside world becomes the foundation for self-trust and self-care as the child or young person grows and develops.

It is essential that staff strive to create a safe place in the real world so the child doesn’t need to retreat to their inner world. The C.A.R.E. approach embodies the notion proposed by Heard and Lake (1997) about supportive companionable. relating within a safe environment.

The importance of understanding the child’s behaviour a child who has been abused carries around a set of habitual expectations and responses specifically designed for survival. The child has developed mechanisms and behaviours to provide themselves with a sense of safety and control in situations where they had none. Staff continually strive to make sense of the child’s behaviour. This pattern is called a trauma bond (Herman, 1992; James, 1994).

Staff need to be supported do not take any of the behaviour personally (e.g. angry acting out). This can be particularly difficult when the child is violent, damages the carer’s property and attempts to test the messages provided by the adult. By reframing the child’s behaviours, one can see these as opportunities to undertake meaningful work and to question where the behaviour fits into an old pattern. In this way, staff arrive at a better understanding of why the child copes in a certain way.

By reframing, staff learn to view the behaviour as the child’s way of communicating, and are then able to use this understanding to help inform formal therapeutic interventions. If behaviour is seen as a type of communication, it may be asserted that some behaviours only occur if formal communication breaks down. This can be a challenging concept, but by looking at violence as communication, for instance, it provides an opportunity for reflective practice that staff can harness to improve inter-relational understanding and outcomes for the child.

For staff to be able to make sense of the extreme transference and chaos within the child’s inner world, they must remain grounded and self-aware. In doing so they are able to react calmly and non-punitively in the face of a child’s anger and anxiety. Support structures are utilised by all staff (e.g. supervision and team meetings) where the focus is on processing, and ensuring understanding of, dynamics, feelings, and how best to meet the child’s needs (Tomlinson, 2004).

Share