Psychopathy -- mostly as APD -- has been related to conduct problems in children, but there are so many overlapping conduct disorders that the concept gets muddled.  Specialists realize that, given a child’s developing and changing personality, it is difficult to diagnose mental disorders among adolescents.  Additionally, some common behavioral manifestations of youth, such as anger, mood instability, and defiance, match symptoms of disorders, and thus it is difficult to know when this behavior in a specific individual is a passing stage or a serious concern.

The real problem is a persistent pattern of antisocial behavior during childhood and adolescence, such as violating social rules, aggression toward animals or other children, destruction of property, deceitfulness, theft, and serious rule violations. The risk factors for repeat offenses are 50% from childhood to adolescence, and 40-75% continued from adolescence into adulthood.  There are six different diagnoses used in the DSM-IV for childhood antisocial behaviors:

1. Conduct Disorder (CD) - This is a vaguely-defined behavioral problem involving persistent violations of the rights of others or violation of age-appropriate social rules.  More specifically, conduct disorder involves a pattern of aggressive behavior toward people or animals, destruction of property, truancy, a pattern of deceitfulness, and/or serious violations of rules at home or at school.
2. Oppositional Defiant Disorder (ODD) - Such children and adolescents usually exhibit a pattern of defiant and disobedient behavior, including resistance to authority figures, albeit not as severe as CD. This includes recurrent temper problems, frequent arguments with adults, and evidence of anger and resentment.  Additionally, the defiant child/adolescent will often try to annoy others.
3. Disruptive Behavior Disorder Not Otherwise Specific (DBD-NOS) - This is a category for those who show ongoing CD and ODD but who fail to meet the criteria for either diagnosis.
4. Adjustment Disorder: With Mixed Disturbance of Emotions and Conduct -  This is an array of antisocial behaviors and emotional symptoms that set in within three months of a stressor and fail to meet the criteria of the previously mentioned disorders.
5. Adjustment Disorder: With Disturbance of Conduct - This is similar to the other adjustment disorder, but with antisocial behaviors only.
6. Child or Adolescent Antisocial Behavior - This category is for isolated antisocial behaviors not indicative of a mental disorder.

The DSM-IV also added Disruptive Behavior Disorder-Not Otherwise Specified (DBD-NOS), which allows clinicians to diagnose behavior problems that fail to meet criteria for CD or ODD.

If that is not sufficiently complicated, psychopathy has also been linked with Attention Deficit Hyperactive Disorder (ADHD or ADD).  This diagnosis has changed somewhat over the years and new research is continuing to refine it.  In many respects, it represents two separate problems, although they appear to be linked.  Children may have ADHD--primarily inattention, ADHD--primarily impulsive/hyperactive behavior, or a mixed type incorporating attributes of both.  Inattention is usually identified in children for whom almost anything will prove distracting.  Disorganization is common and the child may lose personal items regularly.  Even when spoken to directly, the child may not pay attention and will be unable to provide feedback when asked. Hyperactive children frequently get into minor difficulties in school.

It is not the case that a child diagnosed as conduct disordered will inevitably grow into an adult with APD.  The relationship between these two is more complicated.  As many as two-thirds stop their destructive behavior by the time they reach adulthood.  Conduct Disorder may be a precondition for APD but does not predict it.  Risk factors that a child displaying conduct disordered behavior will continue to behave in antisocial ways appear to be linked to 1) hyperactive and impulsive behaviors, 2) an early onset of antisocial behavior, 3) committing different types of antisocial behaviors, and 4) displaying antisocial behaviors in different settings.  Age of onset seems to be paramount.  In short, the relationship between APD and conduct disorders rests on an array of complicating factors.  Yet some researchers have taken a different tack, identifying most of these complicating factors as manifestations of a single construct: childhood psychopathy.

These researchers view psychopathy as an important clinical construct in the evaluation of adolescent offenders.  They found that among eighty-one boys in a residential treatment program, aggressive conduct disorder symptoms and deceit/theft symptoms are predictive of adolescent psychopathy in those aged 14 to 17.  Psychopathy and conduct problems are independent yet interacting constructs in children, similar to the way criminal behavior and psychopathic personality traits interact in adults (e.g., glibness and manipulation).  The salient childhood traits for psychopathy are grandiosity, irresponsibility, and susceptibility to boredom; these were also associated in children with conduct problems.

Donald R. Lynam seems to have done the most extensive work with this population.  He showed that psychopathy has much in common with ODD, CD, and hyperactivity.  He believes there is a neurological deficit that manifests as a lack of behavioral restraint, such as with hyperactive and impulsive children.  Those with psychopathic personalities were shown to be stable offenders who were prone to the most serious offenses.  Childhood psychopathy has also proven to be the best predictor of antisocial behavior in adolescence.  Lynam advocates the need to continue to work on the concept of childhood psychopathy because if there is a stable construct, then it can be measured reliably and can offer more predictive value.

Lynam also tested a hypothesis about the relationship between the adult psychopath and children with cluster symptoms of hyperactivity, attention deficit, and impulsivity (HIA), and concurrent conduct problems (CP).  He divided a population of adolescent boys into four groups: non-HIA-CP, HIA-only, CP only, and HIA-CP.  They were compared on measures thought to determine psychopathy.  As he predicted, the HIA-CP boys most closely compared with psychopathic adults.  Of the four groups, they were the most antisocial, disinhibited and neuropsychologically impaired.  In other words, those who had attention deficits and poor impulse control associated with conduct problems were more likely to manifest traits of psychopathy.

Attachment Theory

Many researchers in the field of child development support attachment theory as an explanation for why children become violent.  "Child development is fundamentally social," says Dr. James Garbarino, author of Lost Boys: Why Our Sons Turn Violent and How We Can Save Them.  "Children need to make connection through entering into a relationship."  He points out that most kids who kill are unable to connect.  A relationship with loving parents becomes an important mediation between the child and the outside world. 

Varieties of attachment were characterized as:

• secure
• insecure-avoidant
• insecure-ambivalent
• disorganized-disoriented

Children can become wary, distressed, distrustful, resistant, or angry if not securely attached by the first nine months of their lives.  Studies show that securely-attached children tend to be more competent and well-adjusted later in life.  It may be the case that childhood psychopathy forms at this crucial stage, especially if there is a neurological predisposition in terms of lack of behavioral inhibition and sensation-seeking.