psychology case study

Case Study Final Paper – Cover Page Directions Students will conduct a case study pertaining to a fictional or nonfictional character in a book or movie. Please note that all characters and topics must receive prior approval from the instructor. The following information should be provided within the case study: demographic information, presenting issue, assessment methods utilized, diagnosis (or possible diagnosis), family history, social history, educational history, intellectual functioning, mental health history including treatment history, developmental history, medical history, and substance abuse history. Within the paper, students will conduct a two to three-page literature review of the presenting issue/disability related to the character utilizing a minimum of five (5) research-based references (only one reference may be from Google Scholar). The paper should also include multicultural considerations, treatment/rehabilitation recommendations, and/or academic and school recommendations depending on the nature of the issue. All citations should be in APA format. Students should print out this page and attach it as the cover page to their paper. Assignment Checklist Ö Was your character approved by the instructor? Ö Did you use the Case Study Template located on CANVAS? Ö Does your case study contain a two-page literature review with at least five (6) research-based Ö Is your paper in APA format? Ö Does your literature review contain a Works Cited page? Ö Did you print out this page, write your name, and attach it to your paper? Student Name: “Kimberly C.”

“Kimberly C.” RHS 302-???

Case Study

Demographic Information

Name: Kevin Khatchadourian (Movie: We Need to Talk About Kevin) Gender: Male Age: 17 Height: 5’9” Weight: 129 lbs. Race: Caucasian City/Hometown: Nyack, NY Presenting Issue At the age of 16, Kevin shot and killed his father, his sister, seven of his high school classmates, an English teacher, and a cafeteria worker. The weapon Kevin used was a crossbow. His mother, Eva Khatchadourian, describes Kevin as always having been callous, cunning, and manipulative, even as an extremely young child. She also characterizes his emotional response to others as shallow, and shares that Kevin has never displayed any feelings of guilt at any point in his life. A few weeks before Kevin committed the murders, his parents reportedly agreed to divorce. Family History It is reported that Kevin spent the first 16 years of his life growing up in an upper-middle class household, first in New York City, and then in Gladstone, a neighborhood of Nyack, NY. Notably, Nyack is an affluent and artsy village located 20 miles north of Manhattan, and the family enjoyed the benefits of having a significant amount of disposable income. Eva Khatchadourian is Armenian-American and was reportedly born in August 1945. She describes her own beginnings as “apocalyptic,” based solely on the chronological proximity to Hiroshima and Nagasaki. She also categorizes her son’s birth year, 1984, as ominous in its own right, feared by many as a result of George Orwell’s classic novel. Being of Armenian heritage comes up as a frequent theme in Ms. Khatchadourian’s conversation, and she shares that, generally speaking, Armenians never truly have a sense of safety and security as a result of their ancestors having been slaughtered by the Ottoman Empire. Though a native of Racine, Wisconsin, Ms. Khatchadourian indicated that she never felt a sense of belonging anywhere and relished the chance to leave the United States whenever possible and explore new cultures and countries. She expressed that she never felt that she belonged in the United States or had much interest in the country, due to its perceived lack of exoticism. In contrast, Kevin’s mother describes her husband, Franklin Plaskett, as being a “full-blooded” American, a person who brimmed over with idealism, happiness, and the drive for what she deemed to be an “imaginary” American Dream. He is said to have been blindly devoted to Kevin, and was known to regularly “triangulate” Ms. Khatchadourian, aligning himself and his son against whatever salient

concerns his wife had about Kevin’s behavior. This dynamic was reported to have continued up to the point of Mr. Plaskett’s death. Franklin Plaskett’s parents are reportedly described as upper- middle class and live in a custom-built house in Gloucester, Massachusetts. Their daughter-in- law describes them as refined, brittle, and formal, with a profound distaste for leisure time. Eva Khatchadourian reportedly owned her own business and worked as the head of an international travel guide franchise. When she was working full-time, she traveled several months out of the year to research travel destinations. Kevin’s father, Franklin Plaskett, was a film location scout and worked on a freelance basis. Ms. Khatchadourian states that, prior to becoming pregnant, she thought that she truly wanted a child. She describes her pre-parenthood relationship with her husband as solid and very loving, and she reports that she thought a child would be a positive addition to their lives. When she actually became pregnant, however, Ms. Khatchadourian reportdly felt dread rather than happiness, and no longer felt that having a child was a particularly appealing prospect. She expressed that she did not appreciate the re-organization of her life that having a baby would inevitably bring. Ms. Khatchadourian reports that she felt nothing for her son when he was born, apart from profound disappointment over not feeling anything. Bonding reportedly never took place, and Kevin is reported as having displayed a decidedly strong preference for his father versus his mother within moments of birth. It was reported that Kevin never took to nursing and consistently refused to breastfeed. Regarding extended family, Ms. Khatchadourian’s mother is reported to be severely agoraphobic and continues to live in Racine, Wisconsin. Her husband (Kevin’s maternal grandfather) was reportedly killed in WWII when his plane was shot down by Japanese fighter pilots. Ms. Khatchadourian reportedly has one brother to whom she is not close. Kevin had a sister, Celia, whom he shot and killed with a crossbow. When she was 6 years old, he was reported to have poured Liquid-Plumr in her eye, resulting in the loss of sight and a prosthetic replacement. As mentioned previously, a few weeks before Kevin committed multiple murders, his parents reportedly had agreed to divorce. Social History Kevin did not reportedly have any friends as a young child. Ms. Khatchadourian explained that children rarely asked him over to their houses more than once. In high school, he reportedly had a few acquaintances who are said to have been obsequious “followers” more than friends. Educational and Employment History While in Pre-K, Kevin was reportedly enrolled in an after-preschool playgroup. It was note dthat after a few weeks, all the mothers in the group pulled their children out and formed a separate group without telling Ms. Khatchadourian. Kevin attended a Montessori kindergarten, where his mother reports that many children quickly developed a deep-seated fear of him. Though he was never officially assessed as being a genius, Kevin is categorized by teachers and his mother as being disturbingly bright. In fact, he is noted for being calculatingly so.

Developmental History In terms of appearance, Ms. Khatchadourian describes her son as always having been underweight as a small child; a characteristic that gave him a “ferret-like sharpness from his earliest years” (E. Khatchadourian, personal communication, December 25, 2000). She also describes him as always having had a flat affect, disinterest in any activity that children normally enjoy (i.e. toys, games, and game playing), and a distinctive “sobersided wariness and disturbing self-possession” (E. Khatchadourian, personal communication, December 25, 2000). As an infant, Kevin’s mother reported that he regularly screamed for 6-8 hours straight while in her company during the day, only to stop immediately when in the presence of his father. She acknowledged that babies generally have a variety of dispositions and crying habits, but notes that Kevin’s always had distinct overtones of deliberateness, genuine outrage, and wrath. As a baby, he reportedly only ever slept after passing out from exhaustion. Kevin’s birth was reported to have caused marital strife, with each parent having a diametrically opposed view of Kevin’s habits, tendencies, and personality type. Two nannies reportedly quit taking care of Kevin in his early years, due to the child’s alarming behavior, and the family was blacklisted from at least one childcare agency. It was reported that Kevin promptly ceased his hours-long screaming habit once the second nanny left her post. In Ms. Khatchadourian’s words, he “stopped cold” prior to turning two years old. It was reported that he subsequently became mute, sitting in complete and utter silence for hours at a time. Throughout this period, Kevin’s mother and doctor describe him as being “floppy” and physically “slack.” It was reported that Kevin did not speak until he was nearly 3 years old, but when he did, he spoke in clearly discernible, full sentences. Everything he uttered was reportedly in the negative, i.e. “I don’t like that. I won’t do that. Not if I don’t feel like it, etc.” Kevin’s mother indicated that he had serious issues surrounding toilet training, and did not begin using the toilet until he was 6 years old. She stated that this only occurred after she used violence against him. Kevin, in turn, reportedly used the incident to gain leverage and power over his mother. Notably, both Kevin and Ms. Khatchadourian indicated that they are in agreement over what happened and how Kevin used the incident to his advantage. Client Medical History It was reported that as a young child, Kevin had a noticeable disinterest in nearly everything, and carried himself with an air of boredom and extreme apathy. Ms. Khatchadourian reportedly had him tested for various illnesses and spectrum disorders, but all results were negative. As mentioned previously, Kevin was reportedly resistant to toilet training and stayed in diapers until the age of 6. Then, following a changing table incident in which it was reported that his mother accidentally broke his arm, Kevin immediately began using the toilet. Aside from a flu-like illness he contracted for two weeks at the age of 10, Kevin was never reportedly sick. It was noted that food was never an interest, and his weight has always been on the low side of height/weight averages.

Family Medical History Ms. Khatchadourian was reportedly diagnosed with Postpartum Depression, a condition she categorizes as actually having an aversion to Kevin in particular, rather than to motherhood in general. It was reported that Kevin’s maternal grandmother is agoraphobic and lives on her own. When his sister was 6 years old, Kevin reportedly poured household cleaner into her eye, blinding her and causing permanent facial scarring. Mental Health Treatment History Prior to committing multiple murders, Kevin had no history of mental health treatment or diagnosed mental health issues. It was reported that Kevin asked to be placed on Prozac a few weeks before committing mass murder at 16. This was not due to any diagnosed or observable depression, but rather was a detail Kevin wanted used as part of his legal defense. In an interview, Kevin openly discussed his pleasure at the Prozac ploy’s effectiveness. Substance Abuse History There was no reported history of Kevin having engaged in substance abuse and he has never shown any indication of interest in alcohol or drug use. Intellectual Functioning Kevin has never reportedly underwent a psychoeducational evaluation or any kind of intelligence testing. That being said, his mother reported that a number of Kevin’s teachers always considered him to be quite smart, although manipulatively so. Ms. Khatchadourian also considers Kevin to be quite smart and extremely calculating. Any developmental delays that Kevin displayed as a child (see Developmental History) are considered to have been acts of will rather than ability. Multicultural Considerations Although Ms. Khatchadourian is proud of her Armenian heritage and tried to engage her son in multicultural pride, it was reported that he has historically abhorred that part of himself, claiming to be “American,” rather than Armenian. Kevin reportedly has a tendency to use racial derogatory terms with ease, including “gook” and “negro.” At one point shortly before the murders, Ms. Khatchadourian was reportedly called into school for a meeting with one of Kevin’s teachers. During the course of the conversation she commented that perhaps Kevin suffers from some form of “affluenza” because he lives very comfortably in a large, well- appointed custom-built home, where all his needs are met. The teacher surmised that he might be “bored” as a result and feel that he does not have much of a purpose. His solution, therefore, is to destroy his surroundings.

Suggested Methods of Assessment (or Methods of Assessment already used) Kevin appears to require a full mental health and forensic evaluation that includes a psychiatric evaluation to determine his overall treatment needs and risk of future violence and aggression towards others. The following instruments and methods of assessment would be appropriate for use with Kevin:

- Clinical Interview with Kevin as part of a forensic evaluation - Collateral interviews with Kevin’s mother, teachers, and other individuals who have

knowledge of him and his behavior - Hare Psychopathy Checklist-Revised (PCL-R) - Millon Adolescent Clinical Inventory (MACI) - Jesness Inventory – Revised (JI-R) - Personality Inventory for Children, 2nd Edition (PIC-2) - Parenting Stress Index (PSI) - Child Behavior Checklist (CBCL) - Youth Self-Report (YSR) - Cognitive testing (i.e. Wechsler Intelligence Scale for Children – V)

*Upon his arrival at Claverack, Kevin was screened by the psychiatric team for specific levels of psychopathy using the PCL-R. The PCL:YV was not introduced as a screening tool until four years after Kevin’s conviction and so was not used. The clinical interviews and inventories would be helpful in gathering information related to the extent of his antisocial thought processes and behaviors. The personality inventories, such as the MACI and JI-R, would be helpful to identify maladaptive personality patterns and determine the extent of Kevin’s psychopathology. The Parenting Stress Index (PSI) would be used with Kevin’s mother to obtain information about her own level of functioning. Finally, it would be helpful to use cognitive testing to identify Kevin’s overall IQ to further guide treatment planning. Diagnosis or Possible Diagnosis As mentioned previously, Kevin has never received mental health treatment and does not have a prior diagnosis. According to DSM-5, he does not appear to meet all of the criteria for Conduct Disorder despite exhibiting a history of callous behavior towards his sister. However, he does exhibit some symptoms associated with Oppositional Defiant Disorder (ODD). Additionally, he also appears to exhibit symptoms associated with psychopathy and Antisocial Personality Disorder. Case Conceptualization & International Classification of Functioning (ICF) Psychopathy is a psychological trait considered to be made up of four category facets (interpersonal, affective, lifestyle, and antisocial. On the Hare Psychopathy Checklist-Revised, facet scores can range from 0-10, and the higher the score, the higher an individual’s level of psychopathy.

If Kevin was to be administered the Hare Psychopathy Checklist-Revised (PCL-R) as a screening tool, he would likely score very highly in all four facets indicating a very high level of illness. He exhibits many of the following symptoms associated with the DSM-5 criteria for Antisocial Personality Disorders with psychopathic features:

1. Moderate or greater impairment in personality functioning, manifested by characteristic difficulties in two or more of the following four areas: 1. Identity: Egocentrism; self-esteem derived from personal gain, power, or

pleasure. 2. Self-direction: Goal setting based on personal gratification; absence of prosocial

internal standards, associated with failure to conform to lawful or culturally normative ethical behavior.

3. Empathy: Lack of concern for feelings, needs, or suffering of others; lack of remorse after hurting or mistreating another.

4. Intimacy: Incapacity for mutually intimate relationships, as exploitation is a primary means of relating to others, including by deceit and coercion; use of dominance or intimidation to control others.

2. Six or more of the following seven pathological personality traits:

1. Manipulativeness (an aspect of Antagonism): Frequent use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one’s ends.

2. Callousness (an aspect of Antagonism): Lack of concern for feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one’s actions on others; aggression; sadism.

3. Deceitfulness (an aspect of Antagonism): Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events.

4. Hostility (an aspect of Antagonism): Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior.

5. Risk taking (an aspect of Disinhibition): Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences; boredom proneness and thoughtless initiation of activities to counter boredom; lack of concern for one’s limitations and denial of the reality of personal danger.

6. Impulsivity (an aspect of Disinhibition): Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing and following plans.

7. Irresponsibility (an aspect of Disinhibition): Disregard for—and failure to honor—financial and other obligations or commitments; lack of respect for—and lack of follow-through on—agreements and promises (American Psychiatric Association, 2013).

According to the ICF model, Kevin is experiencing impairment in the following domains: Body Functions (mental functions): Kevin has engaged in antisocial behavior (mass murder) and has demonstrated callousness and a lack of empathy toward others. His mother, Eva Khatchadourian, describes Kevin as always having been callous, cunning, and manipulative, even as an extremely young child. She also characterizes his emotional response to others as shallow and reported that Kevin has never displayed any feelings of guilt at any point in his life. At a minimum, Kevin appears to exhibit symptoms of Oppositional Defiant Disorder (ODD) and antisocial thought processes and further assessment is needed to determine the full extent of his psychopathy and other mental health issues. Activities and Participation (learning and applying knowledge, interpersonal interactions and relationships, and community, social, and civic life): Kevin committed mass murder and will most likely be incarcerated for a substantial period of time (possibly life). He will not be able to participate in community activities and his relationship with his mother and others has been severely impacted by his crime. He will not be able to participate in meaningful and pro-social activities within the community. At the present time, Kevin possesses antisocial thought processes and tendencies and does not have the ability to empathize with others. The Environmental Factors that help to facilitate positive functioning for Kevin include his upbringing in an upper-middle class of socio-economic conditions and his parents’ support of him despite his negative behavior. Additionally, the highly structured environment associated with incarceration in conjunction with his lack of access of weapons will diminish the risk of him harming (or killing) others. The Personal Factors that help to facilitate positive functioning for Kevin include his high level of intelligence and overall good physical health. He does not have a reported history of abusing drugs or alcohol either. The Environmental Factors that serve as a barrier to positive functioning for Kevin include isolation from family and friends due to incarceration, inability to practice pro-social behavior within the community due to incarceration, lack of meaningful relationships with others, disruption in his education, and interaction with others in prison who have histories of antisocial and criminal behavior. The Personal Factors that serve as a barrier to positive functioning for Kevin include his antisocial thought processes, lack or regard for others, and lack of meaningful interpersonal relationships with others. Kevin’s mother has a history of mental illness (Postpartum Depression) and his maternal grandmother also has a history of mental illness (Agoraphobia). Kevin’s mother has also generally been aloof in their interactions and the two have never had a close, meaningful relationship. It is obvious that Kevin has significant capacity for success given that he comes from an upper- middle class family and has experienced little trauma or adversity during his childhood. He has no reported physical disabilities or cognitive deficits and presents as highly intelligent. However, the major areas affecting Kevin’s overall performance appears to be his high level of

psychopathy and antisocial thought processes. This has grossly affected his relationships with others, particularly his mother, and led to him engaging in mass murder. Kevin will be incarcerated for the remainder of his life and his ability to develop a family as well as engage in prosocial activities within the community will be severely impacted. Finally, assessment that includes an extensive clinical interview, interviews with collateral sources (such as teachers, parents, etc.), personality testing, intelligence testing, and especially testing for psychopathy is needed to determine Kevin’s level of risk for future violent acts as well as determining a comprehensive and appropriate treatment regimen for him. He should also be given a psychiatric evaluation to determine whether he could benefit from psychotropic medication. Treatment/Rehabilitation Recommendations

● The major presenting issues to address in Kevin’s rehabilitation are his psychopathic and antisocial tendencies that include a lack of empathy for others, his opinion that most everyone and everything is “boring and stupid,” and feelings of superiority while processing his belief system that led to him committing multiple murders.

● Kevin is recommended for intensive individual therapy to address his major presenting issues referenced above.

● Kevin is recommended for MST, or Multisystemic Therapy. As such, therapy will encompass close examination of Kevin’s personal systems, including his peer, family, school, and childhood environments prior to entering prison. Kevin’s mother regularly visits him at Claverack and has expressed noted interest in being involved in the therapeutic process. As part of the family systems aspect of therapy, Ms. Khatchadourian will be regularly included in sessions.

● Kevin is recommended for a psychiatric evaluation to determine whether he could benefit from psychotropic medication.

REVIEW OF LITERATURE

By current estimates, there are thought to be approximately 30 million psychopaths living throughout the world today. When limited to the United States, the number counts for about 1% of the population, or 3.09 million people. When broken down even further, it is estimated that nearly 1% of all non-imprisoned American males aged 18 and over are psychopaths (Kiehl & Hoffman, 2011). Historically speaking, psychopathy is a psychological disorder that many in the field of mental health view as having few effective treatment options. In the last 30 years, progress has been

made in terms of the adoption and implementation of effective screening tools, namely the PCL- R, or Psychopathy Checklist Revised, and its derivatives. According to psychologist Robert Hare, having such tools available can only aid in the development of effective treatment programs for psychopaths, ones in which “their propensity for offending and violence can be managed, without futile attempts to produce fundamental changes in their personality” (Hare, 2007, p. 22). In writing about psychopathy and criminality, FBI expert Mary O’Toole reports that this kind of disorder is best described in dimensions rather than categories. She goes on to state that the psychopathic personality can be broken down into four different facets. These include the interpersonal, affective, lifestyle, and antisocial facets. Facets are scored on a scale ranging from 0 to 10. The higher the score, the deeper the level of psychopathy (O’Toole, 2007). The interpersonal facet relates to how an individual interacts with others. A high score indicates that a person is manipulative, deceptive, dominant, and controlling (O’ Toole, 2007). The affective facet refers to a person’s emotional depth. A high score is an indicator that the subject is unable to experience feelings to a significant degree, nor is s/he able to consider the feelings of others, except in the abstract. The lifestyle facet is rather self-explanatory and relates to how the individual lives his or her life. A high score indicates a propensity towards boredom, a tendency to wander, and an inability to stay in jobs or relationships for very long. Finally, the antisocial facet describes the overall “rule-breaking” behaviors in which the subject might engage. A high score is an indication that the person regularly engages in social and legal violations (O’Toole, 2007). The PCL-R was first introduced to the field of psychology in 1980. It has been revised twice since then and is used to determine the course of treatment programs for adult psychopathic individuals. In recent years, more clinical attention has been given to the presentation of aggression and psychopathic traits in youth. In a study of adolescent and child psychopathy, psychology professors Ribeiro da Silva, Rijo, and Salekin write about the need for more reliable assessment tools for young people. In the early 2000s, the PCL-R was adapted for screening of child and adolescent psychopathy. In that iteration, it is known as the PCL: YV, or the Psychopathy Checklist: Youth Version (Ribeiro da Silva, Rijo, & Salekin, 2012). It is considered a full-scale assessment, replete with a structured interview and a comprehensive record review. Another youth-based screening method is the Antisocial Process Screening Device, or ASPD. It is considered “the most widely used and tested youth psychopathy screening measure” (Ribeiro da Silva et al., 2012, p. 72). Less frequently used tools include the Child Psychopathy Scale, the Youth Psychopathic Traits Inventory, and the Psychopathy Content Scale. Despite the significant growth in youth based measures, Ribeiro da Silva et al. point out that not all of them are precise in their findings, and many vary in what factors they are assessing. In their words, “the lack of agreement on the dimensionality of the psychopathy construct is a major issue that should be addressed in order to better compare results from different studies” (Ribeiro da Silva et al., 2012, p. 72). Not doing so most likely means continued “misunderstandings and mistakes” in clinical evaluations (Ribeiro da Silva et al., 2012, p. 74). Though it has proven to be an ineffective clinical intervention for psychopaths, “one of the most popular treatments for psychopathy has been the therapeutic community” (Harris & Rice, 2006,

p. 556). In the 1970s, it was thought that the social construct of a therapeutic community “might alter the basic personality” of psychopaths (Harris & Rice, 2006, p. 556). Based on this theory, an intensive study of a therapeutic community was conducted in the early 1990s, a community that was thought to be beneficial for patients with psychopathy. The program took place in a very high security psychiatric hospital and featured intensive group therapy for up to 80 hours per week. The study matched 146 treated offenders with 146 untreated offenders. Nearly all offenders had been convicted of violent crimes, and variables in the study were “related to recidivism (age, criminal history, and index offense)” (Harris & Rice, 2006, p. 556). All participants were given the PCL-R, but not all scored high enough to be considered a psychopath. The results of a study follow-up showed that 10.5 years after treatment in the therapeutic community, non-psychopaths demonstrated lower violent recidivism. However, psychopaths demonstrated higher violent recidivism. Since the program was psychoeducational in nature, and taught both psychopaths and non-psychopaths alike about the feelings of others, empathy, sympathy, social skills, and the importance of people’s perspectives, it is thought that psychopaths used this information to further harm others, but to a greater degree. Hecht, Latzman, and Lilienfeld of Georgia State, Emory, and University of Melbourne respectively, also write about the historical use of therapeutic communities to treat psychopathy. They state that, ideally, such communities should provide the client with a supportive and therapeutic atmosphere (Hecht, Latzman, & Lilienfeld, 2018). The daily group meeting is thought to be a key aspect to a strong supportive environment. When properly formatted, the group meeting is one in which all patients and staff are in attendance and a cooperative and democratic decision-making environment is created. In this context, rules can be made, therapy provided, and conflicts addressed (Hecht et al., 2018). To date, though, general treatment in a therapeutic community has not proven to be a clearly effective intervention for psychopaths. Cognitive Behavioral Therapy has historically been another intervention recommended for the treatment of psychopaths. However, it too, has not been proven to be particularly effective. To highlight this point, when a CBT and relapse prevention program for sex offenders was conducted in 1999, high psychopathy patients “were rated as having shown the most improvement (as measured by conduct during the treatment sessions, quality of homework, and therapists’ ratings of motivation and change)” (Harris & Rice, 2006, p. 557). However, not only were these same patients more likely than other participants to reoffend, their crimes were more likely to be violent. In 2018, a study was conducted in the Netherlands, exploring whether or not MST, or Multisystemic Therapy, is a viable treatment option for extremely violent youth. In the study, extremely violent youth were defined as individuals who had committed murder and/or used excessive violence towards others. MST is derived from Bronfenbrenner’s socio-ecological model, and it states that “the development of all behavior, and thus also the development of antisocial behavior, is the result of the interactions between individuals and the various systems in which they find themselves” (Aascher, Dekovic, Van den Akker, Prins, & Van der Lann, 2018, p. 959). The model draws heavily from both social and family systems theories, as well as research that has been done on the causes of antisocial behavior. The treatment addresses the various systems that make up adolescent daily life, including peer, family, school, and neighborhood (Aascher et al., 2018). The Dutch study included a group of 71 juvenile offenders

who are classified as extremely violent. During a 5-month treatment period, researchers found that psychopathic behaviors initially increased in the first month of treatment, but then decreased in months two and three. The same non-linear pattern was found in the quality of the parent/adolescent relationship. The study concluded that MST may be an effective treatment option for at least some violent juvenile offenders.

REFERENCES

Asscher, J. J., Deković, M., Akker, A. L., Prins, P. J., & Laan, P. H. (2016). Do Extremely Violent Juveniles Respond Differently to Treatment? International Journal of Offender Therapy and Comparative Criminology,62(4), 958-977. doi:10.1177/0306624x16670951

David, D., Lynn, S. J., & Montgomery, G. (2018). Evidence-based psychotherapy: The state of the science and practice. Chichester: Wiley Blackwell.

Diagnostic and statistical manual of mental disorders. (2013). Washington, D.C: American Psychiatric Association. doi:https://doi-org.ezp1.villanova.edu/ 10.1176/appi.books. 9780890425596.AlternatePersonalityDisorders.

Hare, R.D. (2007). Forty years aren’t enough: Recollections, prognostications, and random musings. In H. Hervé and J.C. Yuille (Eds.), The psychopath: Theory, research, and practice (pp. 3-28). Mahwah, NJ: Lawrence Erlbaum. Harris, G. T., & Rice, M. E. (2006). Treatment of Psychopathy: A Review of Empirical Findings.In C. J. Patrick (Ed.), Handbook of psychopathy (pp. 555-572). New York, NY, US: The Guilford Press. Hecht, L.K., Latzman, R.D., & S.O. Lilienfeld (2018). The psychological treatment of psychopathy: Theory and research. In D. David, S.J. Lynn, & G. Montgomery (Eds.). Evidence based psychotherapy: The state of the science and practice (pp. 271-298). Hoboken, NJ: John Wiley & Sons. Hervé, H., & Yuille, J. C. (2017). The psychopath: Theory, research, and practice. London: Routledge.

Kiehl, K. A., & Hoffman, M. B. (2011). The Criminal Psychopath: History, Neuroscience, Treatment, and Economics. Jurimetrics,51(Summer), 355-397. Retrieved March 28, 2019, from www.ncbi.nlm.nih.gov/pmc/articles/PMC4059069/.

O’Toole, M. (2007). Psychopathy as a behavior classification system for violent and serial crime scenes. In H. Hervé and J.C. Yuille (Eds.), The psychopath: Theory, research, and practice (pp. 301-325). Mahwah, NJ: Lawrence Erlbaum.

Shriver, L. (2005). We need to talk about Kevin. London: Serpents Tail.

Silva, D. R., Rijo, D., & Salekin, R. T. (2013). Child and adolescent psychopathy: Assessment issues and treatment needs. Aggression and Violent Behavior,18(1), 71-78. doi:10.1016/j.avb.2012.10.003