DIFFERENTIATING EMOTIONAL DISTURBANCE FROM SOCIAL MALADJUSTMENT:

ASSESSING PSYCHOPATHY IN AGGRESSIVE YOUTH

CARL B. GACONO
Austin, Texas
TAMMY L. HUGHES
Duquesne University
The Individuals with Disabilities Education Act (1997) requires identication of emotional dis-
turbance by special education criteria. It also requires that emotional disturbance be distin-
guished from social maladjustment. In some cases, a thorough evaluation of the childs character
pathology can aid in this determination. While methods such as the Rorschach, BASC, and
MMPI-A are useful in understanding behavior and personality, psychopathy assessment may be
particularly useful for organizing opinions in this matter. In this article we discuss the relevance
of psychopathys two-factor structure in formulating a schema for making the differentiation
between emotional disturbance and social maladjustment and review methods for gathering infor-
mation about this troublesome aspect of character pathology. 2004 Wiley Periodicals, Inc.
The Individuals with Disabilities Education Act (IDEA 1997) mandates identication of
emotional disturbance by specic special education criteria [ 300.7(c)(4)(ii)], and requires that
emotional disturbance and social maladjustment be differentiated [ 300.7(c)(4)(ii)]. While this
difference is essential to various decisions regarding special education eligibility and service pro-
vision, it can be a daunting task for the evaluation team. However, in some cases evaluating the
character pathology of the child can aid the evaluator in making this determination. Specically,
evaluating one aspect of character pathology, psychopathy, may be useful in differentiating the
child with an emotional disturbance from the child with social maladjustment.
The importance of assessing psychopathy in children and adolescents is twofold. First, ele-
vated psychopathy levels alert clinicians to individuals who are at high risk for preying upon
others (Rutter, Giller, & Hagell, 1998). This is a serious concern when both groups are placed in
the same educational settings. Although common in some school systems, when groups are placed
together the child with a social maladjustment (psychopathic traits) is afforded access and oppor-
tunity to exploit the child with an emotional disturbance. Second, elevated psychopathy levels are
associated with disruptive patients for whom more traditional treatment approaches tend to be
ineffective (Fisher & Blair, 1998; Samenow, 1998). In fact, traditional treatment approaches may
make the socially maladjusted worse (Hare, 1999; Sherman, 2000). Indeed, for the more psycho-
pathic youth, behavior management strategies within a secure setting, rather than treatment, may
be the recommended mode of intervention (Gacono, Nieberding, Owen, Rubel, & Bodholdt, 2001).
Understanding Psychopathy
While emotional disturbance encompasses a range of DSM Axis I mental disorders and clin-
ical syndromes such as anxiety and depression, psychopathy is a distinct personality syndrome. As
noted in Table 1, personality characteristics such as supercial charm, shallow affect, egocentric-
ity, impulsiveness, and lack of guilt or anxiety, make it more akin to a personality disorder than an
Axis I syndrome.
The authors wish to thank Dr. Jamie Loving for his comments and suggestions. The views expressed in this article are
solely the authors and may not reect the views of any of the authors past, present, or future afliations.
Correspondence to: Carl B. Gacono, P.O. Box 140633, Austin, TX 78714. E-mail: DrCarl14@aol.com
Psychology in the Schools, Vol. 41(8), 2004 2004 Wiley Periodicals, Inc.
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pits.20041
849
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850 Gacono and Hughes
Psychopathy also differs from the Conduct Disorder (CD) and Antisocial Personality Disor-
der (ASPD) designations (DSM-IV-TR; American Psychiatric Association, 2000). These disorders
rely primarily on behavioral criteria (social deviancy model; Robins, 1966), while psychopathy
(traditional psychiatric model; Cleckley, 1976) includes both traits and behaviors. As can be seen
in Table 1, the psychopath (Cleckley, 1976) bears only a passing resemblance to the Conduct and
Antisocial Personality Disorder (APA, 2000) diagnostic classications.
The DSM disorders (e.g., CD andASPD) include a heterogeneous group of individuals diverse
in personality functioning and behavior (Rogers, Duncan, Lynett, & Sewell, 1994). In fact, Rogers
et al. (1994) suggested that there are over a half-million criterion combinations that allow for a
diagnosis of ASPD. The number of criterion combinations for CD is even more. The prevalence of
these disorders is also very high among any populations with behavioral problems. For example,
in forensic or correctional settings 50 to 80% of individuals may meet these criteria. Since both
emotionally disturbed and socially maladjusted youth exhibit behavioral problems, the DSM cri-
teria fail to distinguish between them (Bodholdt, Richards, & Gacono, 2000; Loving & Gacono,
2002). Psychopathy is different. As can be seen in Table 1, it is composed of both personality traits
and behaviors. The constructs two-factor structure (traits and behaviors) results in a syndrome
(elevations on many of the variables) that is much more homogeneous than the DSM diagnosis.
Elevated psychopathy levels are also predictive. They are associated with a variety of prob-
lematic outcomes, including institutional misbehavior, re-offending, violent re-offending, and treat-
ment failure (Gretton, McBride, Hare, OShaughnessy, & Kumka, 2001; Hare, 2003). The same
prediction should not be assumed for the more heterogeneous CD and ASPD diagnoses (Gacono,
2000a). The relationship between psychopathy and the DSM-IV diagnoses can be summarized
as follows:
1. Psychopathy is dened in terms of both personality traits and behaviors. Conduct Dis-
order and Antisocial Personality Disorder are based largely on a social deviance model
dened predominantly in terms of antisocial and criminal behaviors.
2. While most psychopaths meet criteria for CD or ASPD, most individuals with CD or
ASPD are not psychopaths.
3. In forensic or correctional settings, base rates for CD and ASPD are high and perhaps
three times greater than base rates for psychopathy.
4. The CD and ASPD diagnoses apply to a diverse group of individuals who may have little
in common other than the presence of criminal or antisocial behavior.
5. Conceptually, psychopathy is a combination of traits and behaviors from paranoid, bor-
derline, narcissistic, histrionic, and antisocial personality disorders.
6. The presence of CD or ASPD does not have the same association with risk for offending
or for violence as psychopathy does. Psychopaths comprise one extreme subset that
demonstrates the highest levels of risk for problematic behaviors (also see Loving &
Gacono, 2002; Gacono, 2000a).
The Psychopathy Checklists
The Psychopathy Checklists (Hare, 2003; Forth, Kosson, & Hare, in press; Hart, Cox, &
Hare, 1995; Frick & Hare, 2001) were developed, in part, due to the limitations in the DSM
diagnosis. This family of instruments includes the Antisocial Process Screening Device (APSD;
Frick & Hare, 2001), the Psychopathy Checklist: Youth Version (PCL:YV; Forth et al., in press),
the Psychopathy Checklist-Revised (PCL-R; Hare, 1991, 2003), and the Psychopathy Checklist:
Screening Version (PCL:SV; Hart et al., 1995). The APSD is a 20-item rating scale used with
children between the ages of 6 and 13 years old. Both the APSD and its predecessor the PSD
(Psychopathy Screening Device) are scored based on parent and teacher ratings. The PCL:YV and
Assessing Psychopathy in Aggressive Youth 851
PCL-R are 20-item, 40-point scales scored from record review and semi-structured interview.
1
The PCL:YV is used with young offenders from 12 to 18 years of age; the PCL-R with adult
offenders. The 12-item PCL:SV is a screening tool for use in both offender and nonoffender
populations.
Psychopathy Checklist items reect specic traits that are theorized to be present in psychop-
athy. The PCL:YV, PCL-R, and PCL:SV are scored 0, 1, or 2. When insufcient information exists
for scoring, items are omitted and the score is prorated. Items are scored from record review and
semistructured interview data.
The PCL:YV and PCL-R consist of two separate but related factors (Hare, 1991, 2003). In
addition to including behavioral features that are highly correlated with CD and ASPD criteria, the
PCL:YV and PCL-R assess certain interpersonal or affective features that theoretically underlie
those behaviors. Factor 1 items (e.g., glibness and supercial charm, grandiose sense of self
worth, shallow affect) collectively reect the longstanding interpersonal and affective traits, and
correlate with Narcissistic and Histrionic Personality Disorders. Factor 2 items (e.g., need for
stimulation, juvenile delinquency, criminal versatility) are largely behavioral in nature and corre-
late mostly with CD or ASPD. Additionally, most self-report scales, such as those of the MMPI-2
and MMPI-A [e.g., Scales 4 (Psychopathic Deviant) and 9 (Hypomania)], CPI [e.g., So (Social-
ization Scale)] and MCMI-III (e.g., Antisocial), correlate more with Factor 2 than Factor 1. Stud-
ies that use a self-report measure scale or score as the independent measure of psychopathy
frequently have few if any actual psychopaths in them. They often include antisocial or conduct-
disordered subjects, so that what is being assessed is a behavioral dimension of criminality akin to
the PCL-R Factor 2.
Psychopathy can be viewed either categorically (i.e., a discrete taxon that is either present or
absent [Harris et al., 1994]) or dimensionally (i.e., existing along a continuum of severity). In
research, psychopathy is usually treated categorically (psychopathic/nonpsychopathic). In applied
contexts, the condition is treated dimensionallythe relevant score becomes more important than
whether or not the patient is psychopathic (see Gacono, Loving, & Bodholdt, 2001). To be high in
psychopathy (e.g., PCL-R total score 30), items from both factors must be endorsed. In other
words, unlike CD or ASPD, a psychopathic designation is never considered due to the presence of
persistent antisocial behavior alone, but must also include personality traits (e.g., Factor 1).
An impressive body of research supports the reliability and internal consistency of these
instruments, and particularly with the PCL-R, its concurrent and predictive validity. In adult
offender samples (Hare, 2003), high PCL-R scores have been associated with higher rates
and a wider variety of offenses committed, higher frequency of violent offenses, higher rates
of re-offending, poor response to traditional treatment interventions (Ogloff, Wong, & Green-
wood, 1990; Rice, Harris, & Cormier, 1992), and more serious and persistent institu-
tional misbehavior (Gacono, Meloy, Sheppard, Speth, & Roske, 1995; Gacono, Meloy, Speth,
& Roske, 1997; Heilbrun et al., 1998). High psychopathy levels have been shown to be one
of the most robust predictors of violence. Consequently, PCL-R scores have been incor-
porated into certain adult actuarial risk assessment instruments (e.g., Quinsey, Rice, Harris, &
Cormier, 1998) and psychopathy assessment has been considered an essential component of
forensic practice (Bodholdt et al., 2000; Gacono, 2000b, Gacono & Bodholdt, 2001, 2002;
Hart, 1998).
1
The PCL-R may be scored reliably from records (Grann, Langstrom, Tengstrom, & Stalenheim, 1998; Wong, 1988)
but never from interview alone (see Gacono, 2000b; see Gacono 2000c for the PCL-R Clinical and Forensic Interview
Schedule). Additionally, the reliance on historical data for completing these instruments drastically reduces the effects of
response style (see Bannatyne, Gacono, & Greene, 1999).
852 Gacono and Hughes
The Psychopathy Checklist for Youth (PCL:YV)
The empirical assessment of youthful psychopathy began in the late 1980s (Forth, Hart, &
Hare, 1990) with the PCL-R research (see Loving & Gacono, 2002). The discovery that some of
the original PCL-R items (e.g., parasitic lifestyle, many short-term marital relationships) were not
appropriate for younger offenders resulted in the development of an 18-item modied version of
the PCL-R for adolescents (Brandt, Kennedy, Patrick, & Curtin, 1997; Forth t al., 1990; Smith,
Gacono, & Kaufman, 1997), and eventually, to the development of the 20-item PCL:YV.
While the PCL:YV is similar to the PCL-R, there are two important differences. First, several
PCL:YVitems have been renamed to reect somewhat different content coverage (e.g., the PCL-R
many short-term marital relationships was renamed to unstable interpersonal relationships).
Second, scoring criteria have been adjusted to make them more applicable to younger examinees
(i.e., fewer criminal acts are required to earn points on relevant items).
Preliminary studies have found the PCL:YV to be reliable and internally consistent (Forth,
1995; Forth & Burke, 1998; Gretton et al., 2001; Sheruda et al., 2001; Whalen, 1999). Its two-
factor structure is highly similar to the PCL-R (Forth, 1995; Sheruda, Loving, & Russell, 2001).
High scores on the PCL:YV or the modied PCL-R (for adolescents) are associated with earlier
onset of delinquent and violence acts, higher frequency and variety of criminal and violent acts,
more severe criminal behavior, and higher rates of institutional misconduct (Brandt et al., 1997;
Forth & Burke, 1998; Forth, Hart, & Hare, 1990; Forth & Mailloux, 2000; Gretton, 1998; Gretton
et al., 2001; Rogers, Johansen, Chang, & Salekin, 1997; Whalen, 1999). While preliminary infor-
mation suggests the PCL:YV is equally applicable to African American and Caucasian examinees
(Sheruda et al., 2001), further study is needed with other ethnic minority groups and females
(Loving, Lipkin, Patapis, & Russell, 2001).
Two other instruments, which do not involve the extensive examiner training, collateral record
review, and interviewing required for use of the PCL:YV have been developed for studying psy-
chopathy in children and adolescents. The APSD (Frick & Hare, 1995; predecessorthe Psychop-
athy Screening Device, PSD; Frick, OBrien, Wotton, & McBurnett, 1994) is a 20-item rating
scale completed based on parent or teacher observations that can be applied to children as young
as age six. The APSD measures three dimensions: callousness and unemotionallity, narcissism,
and impulsivity. PSD limitations have included low inter-rater reliability between teacher and
parent ratings and only weak evidence to support the instruments predictive validity (Frick,
Barry, & Bodin, 2000). A second instrument, the Childhood Psychopathy Scale (CPS; Lynam,
1997), is a parent rating scale that draws 41 items from existing items of the Child Behavior
Checklist (CBCL; Achenbach, 1991) and the Common Language California Child Q-Sort (Caspi
et al., 1992). Some support has been reported for the construct validity of the CPS, including the
presence of two highly correlated factors and the correlation of CPS scores with measures of
impulsivity and externalizing disorders (Lynam, 1997).
When considering assessment of psychopathy in children and adolescents, practitioners must
consider three things: (a) the development of these instruments has occurred only over the past
decade; (b) there has been limited use of these instruments in an applied school context; and, (c)
results describe the level of disturbance assessed; children are not labeled as psychopaths (Gacono,
2000b; Gacono, Loving, Evans, & Jumes, 2002). Despite these limitations the understanding of
psychopathy and these instruments provides the clinician with a useful basis for organizing their
thinking concerning the differences between emotional disturbance and social maladjustment.
Differentiating Among Juvenile Delinquents
Whereas the heterogeneity of the ASPD and CD diagnoses make them of limited use when
a clinician is interested in understanding or distinguishing among juvenile delinquents, the
Assessing Psychopathy in Aggressive Youth 853
two-factor structure of psychopathy (Harpur et al., 1989) lends itself to this differentiation. Con-
sider the following two case examples from Loving and Gacono (2002):
Andy, age fourteen, was recently arrested for armed robbery of a convenience store. He has two prior
arrests (stolen vehicle and assaulting a police ofcer). Although he admits to committing many addi-
tional criminal acts for which he eluded arrest, his rst arrest occurred at age twelve. His violence
history includes frequent ghting, intentional re setting, and harming animals. Bill, also age fourteen,
was recently arrested for breaking and entering after he attempted to sleep overnight in a house he had
thought was abandoned. During the past eighteen months, he has engaged in an increasingly conicted
relationship with his mother, and following numerous verbal altercations with her, he has run away
from home for hours or days at a time. Often, following an argument, he has stayed out late at night, and
then returned home after his mother was asleep. During this same time period, Bills attendance at
school has begun to drop off, and his absenteeism has become another area of conict at home.
Andy and Bill both meet the criteria for Conduct Disorder and hence would elevate on the
PCL:YV behavioral items (Factor 2). Investigation of the boys respective histories, however,
revealed that Andy was more narcissistic and detached (PCL:YVFactor 1socially maladjusted),
while Bill was inadequate and impulsive (emotionally disturbed). Bill lacked many of the PCL:YV
trait-based Factor 1 items. He was not glib or grandiose, nor did he display shallow affect, a
callous lack of empathy, or pathological lying. Because CD correlates with the PCL:YV Factor 2,
most juvenile delinquents will receive mild to moderate scores for these items. However, when
everything else is equal, it is the trait-based items (Factor 1) that will aid in differentiating between
the emotionally disturbed (low Factor 1, moderate-to-high Factor 2) from the socially maladjusted
(moderate-to-high Factor 1; moderate-to-high Factor 2).
2
Keep in mind that mental illness can
coexist with psychopathy. These dual-diagnosed individuals are likely to be extremely difcult to
manage and resistant to treatment even within secure settings (Gacono & Meloy, 1994; Young,
Justice, Erdberg, & Gacono, 2000).
Psychopathy Assessment in Context
Making a CD diagnosis
3
is only the starting point for an evaluation that continues with
assessing psychopathy level and the use of other evaluation methods to understand the individuals
psychological functioning, treatability, and risk levels (Gacono & Bodholdt, 2001, 2002). As
noted by Grisso (1998), . . . The job [of the evaluator] is not to nd a diagnosis but to discover
and describe the youths psychological condition (p. 33). As previously noted by Gacono (2002a,
2002b) the work of Monahan et al. (2001) provides a useful model for the evaluation process by
suggesting the need to gather assessment data from the following four domains:
1. Dispositional factors (including anger, impulsiveness, psychopathy, and personality
disorders);
2. Clinical or psychopathological factors (including diagnosis of mental disorder, alcohol
or substance abuse, and the presence of delusions, hallucinations, or violent fantasies);
2
Psychopathy can be viewed either categorically (i.e., a discrete taxon that is either present or absent) or dimension-
ally (i.e., existing along a continuum of severity). In research, psychopathy is usually treated categorically (psychopathic/
nonpsychopathic). In applied contexts, the condition is treated dimensionally, the relevant score becomes more important
that whether or not the patient is psychopathic (cf. Gacono, Loving, & Bodholdt, 2001).
3
Some modiers have been recommended for CD. DSM-III (APA, 1980) allowed for assessing socialized versus
under-socialized subtypes and/or presence or absence of aggressive behavior. DSM-IV (APA, 1994) included age of onset
(i.e., childhood onset vs. adolescent onset) and severity (i.e., mild, moderate, or severe). These modiers are potentially
useful in discriminating among CD subjects because each have empirically demonstrated links to the severity of psychop-
athy (Forth & Mailloux, 2000; Frick et al., 2000).
854 Gacono and Hughes
3. Historical or case history variables (including previous violence, arrest history, treatment
history, history of self-harm, as well as social, work, and family history);
4. Contextual factors (including perceived stress, social support, and means for violence).
Depending on the referral context, referral question, and setting, assessment necessitates
gathering data from each of these domains. The use of multiple assessment methods, such as
review of collateral materials and records, clinical and semistructured interviewing, standardized
psychological testing and so forth, aids the clinician in assessing specic domains of functioning.
The clinician must identify reliable and valid methods for assessing specic components of each
domain. While the PCL:YV and other psychopathy assessment instruments may prove useful for
collecting and quantifying certain relevant dispositional and historical variables, other methods
are needed (Gacono, Evans, & Viglione, 2002).
Psychopathy has been identied as an essential component for making determinations as to
the risk of future violence and/or re-offending (Gacono & Bodholdt, 2001, 2002; Hart, 1998).
High levels of psychopathy predict elevated risk of re-offending and/or violence, although low
levels do not immediately imply low risk. Violence, however, expresses itself in many ways, and
even nonpsychopaths can pose a threat of violence or recidivism due to other features such as
impulsivity, separate personality disorder diagnosis, sexually deviant arousal pattern, and so on.
Aggression that stems solely from an emotional disturbance typically occurs due to emotional
dysregulation (e.g., decits or distortions in identication, expression, and/or regulation of emo-
tion). This type of aggression is linked to real or perceived threats. Aggression that results from
character pathology, such as psychopathy, may exhibit some of the same patterns as the emotion-
ally disturbed, but typically also includes purposeful, unprovoked, predatory behavior (indicative
of social maladjustment).
High psychopathy levels have consistently shown a moderate association with subsequent
criminal violence in adolescents (Edens, Skeem, Cruise, & Cauffman, 2001; Gretton et al., 2001).
Although additional research is needed before youthful psychopathy may be considered predictive
of long-term or adult violence or criminality, there is support for the use of PCL:YV as a predictor
of short-term violence risk with adolescents. As such, when clinicians are required to make deter-
minations of risk regarding violence or recidivism, PCL:YV assessment can contribute meaning-
fully to the data collection process. The following two cases illustrate this point (from Loving &
Gacono, 2002):
Craig and Donald, both age 15, were co-defendants implicated in the brutal beating of two males. For
Craig and Donald, this arrest was their rst formal contact with authorities. They both faced identical
charges, including Aggravated Assault. Despite highly similar and mostly unremarkable behavioral
backgrounds, clinical interviews with the boys and collateral contacts with their respective parents
resulted in strikingly different data with respect to interpersonal and affective features. Both claimed to
experience remorse, but in response to in-depth questioning, it became clear that Donalds negative
feelings were tied more closely with having been caught than inicting pain or suffering on the com-
plainants. By contrast, Craig presented as genuinely embarrassed and remorseful about the incident and
showed considerable sympathy toward the complainants. Donald appeared aloof and indifferent about
harm he had inicted; at one point, he blamed the complainants for instigating the dispute and com-
mented that they shouldnt have started something they werent able to nish. When asked about
possible outcomes for their ongoing legal involvement, Craig appeared at a loss and expressed a will-
ingness to take whatever I got coming to me, but Donald showed a cavalier attitude as he condently
explained how he expected to beat his case.
Although the above description provides only a small sampling of each adolescents attitudes
and behaviors, their family relationships, sexual experiences, and school histories also varied.
Based solely on their instant offense, Craig and Donald might have been seen as posing similar
Assessing Psychopathy in Aggressive Youth 855
levels of risk for re-offending despite their character differences. PCL:YV scores for Craig and
Donald, would reveal similar scores on the behaviorally oriented Factor 2, but differences on
Factor 1 (interpersonal/affective). However, Donalds mild grandiosity, callous disregard for oth-
ers, and failure to take responsibility for his negative actions (higher Factor 1 scores) speak to a
failure to learn from or be impacted by this incident and, consequently, represent a higher risk of
repeating similar behaviors in the future.
Conclusions
The majority of CD youth do not develop lifelong patterns of antisocial behavior (Moftt,
1993). Discriminating among them has important prevention, management, and treatment consid-
erations. There have been numerous efforts to subtype among children with conduct disorder and
to identify those at high risk (Frick et al., 2000). One group of children who display a combination
of hyperactive, impulsive, and inattentive symptoms (HIA) and conduct problems (CP) represent
a particularly high-risk group (Farrington et al., 1990; Lynam, 1996, 1997, 1998). This combina-
tion of HIA and CP has been associated with more noncompliance, aggression, egocentricity, and
frequency of conduct problems (August, Stewart, & Holmes, 1983), more police contacts, more
offenses, self-reported delinquency, aggression, and/or theft, parent-reported doctor visits, temper
tantrums (Loeber, Brinthaupt, & Green, 1990), earlier onset of and higher frequency of ASPD
symptoms (Walker, Lahey, Hynd, & Frame, 1987), lower measures of physiological arousal (Dela-
mater & Lahey, 1983; Pelham et al., 1991), and higher rates of antisocial behaviors among family
members (Faraone, Biederman, Keenan, & Tsuang, 1991; Lahey et al., 1987). Fledgling psycho-
paths who exhibit this unique combination, have repeatedly shown a signicantly higher risk for
various negative outcomes than children with only one of the symptoms (Lynam, 1996).
Other children with conduct disorder who pose the highest risk for later antisocial or criminal
conduct include undersocialized youths (Quay, 1987), those with low anxiety (McBurnett et al.,
1991; Quay & Love, 1977; Walker et al., 1991), and those whose disruptive behavior includes not
only covert but also overt acting out (Fergusson, Horwood, & Lynskey, 1994; Frick et al., 1993).
Quite likely, these groups represent overlapping yet different types of youthful offenders who
share some, but not all, features associated with psychopathy.
Despite the reluctance to discuss childhood and adolescent psychopathy, it does exist (Forth
& Mailloux, 2000; Frick et al., 2000). The development of psychopathy begins early and follows
a predictable, persistent course across the lifespan (Hare, Forth, & Strachan, 1992; Harpur &
Hare, 1994; Loeber & Hay, 1997). The specic etiology of psychopathy stems from multiple
factors, including biochemical, temperamental, familial, and other psychosocial elements.
Extending the psychopathy construct to youth aids in differentiating among the diverse range
of individuals diagnosed with CD. All things being equal, those who are behaviorally disturbed,
but low in the more trait-based features (low on Factor 1, moderate-to-high on Factor 2) are more
likely to t into the category of emotional disturbance. For them, treatment prognosis is most
likely underestimated. Juveniles who are high in psychopathy (high on both Factor 1 and 2;
socially maladjusted) are likely to be more problematic in traditional treatment settings, with less
positive outcome related to traditional treatment methods.
For many reasons (Gacono, 1998; Gacono, Loving, Evans, & James, 2002) applied usage
dictates that the Psychopathy Checklists are used as a method for organizing the historical and
clinical data (dimensional usage) rather than labeling someone as a psychopath (categorical usage).
When applying the construct of psychopathy to children and youth, clinical issues do not center on
labeling the student as a psychopath, but rather, how these traits relate to prevention, management,
and treatment. It is our hope that the psychopathy construct will be useful to school psychologists
in differentiating the socially maladjusted fromthe emotionally disturbed, and ultimately, facilitating
856 Gacono and Hughes
IDEA compliance and the goal of matching treatment services to the childs treatment and educa-
tional needs.
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