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Psychopathy is often treated as a fixed identity: a person either has a conscience or does not, and little can be done about it. Maia Szalavitz’s July/August 2025 Scientific American article argues that this fatalism is especially dangerous when applied to children. Young people with severe callous-unemotional traits can be hard to reach, but early, carefully tailored treatment can reduce aggression, strengthen relationships and prevent those traits from hardening into adult psychopathy.

The article follows a young man called Alex, whose name was changed for privacy. From early childhood he seemed unusually indifferent to pain, punishment and other people’s distress. He hurt family members and classmates, stole from his parents and eventually committed armed robbery. Clinicians gave him a succession of diagnoses and treatments that did not fit. Only in adolescence was he diagnosed with conduct disorder, a condition that can precede adult psychopathy.

Alex’s history is disturbing, but it is not a simple story of an irredeemable child. By age 25 he was steadily employed, close to his parents and remorseful about what he had done. His experience illustrates the article’s central point: callousness is a serious developmental risk, not a predetermined moral destiny.

What Callous-Unemotional Traits Change

Conduct disorder involves persistent aggression, cruelty, rule-breaking and defiance. A smaller group of affected children also display callous-unemotional traits, including weak emotional responses, little remorse and low intuitive empathy. When these traits appear very early, genetics may play a large role, although abuse, neglect and other experiences can also cause or intensify them. Long-term studies suggest that roughly half of children with such traits do not develop adult psychopathy, especially when nurturing caregivers or other protective influences are present.

Psychopathy itself is not an official diagnosis in the main U.S. psychiatric manual. It overlaps with antisocial personality disorder, but the two are not identical. Someone with antisocial personality disorder may act violently because of impulsivity and later feel guilty. Psychopathy adds a distinctive combination of boldness, disinhibition, callousness and remorselessness. The imprecision of the labels matters because a mistaken diagnosis can direct a child toward ineffective care, while avoiding a stigmatizing diagnosis can leave a family without any useful treatment at all.

Research is beginning to explain why ordinary discipline works poorly for these children. They may have a higher threshold for physical pain and muted brain responses when seeing pain in others. Many struggle to recognize fear and sadness in faces and voices. Studies have found differences in regions involved in intuitive empathy, perspective-taking, fear and reward learning, including the insula, orbitofrontal cortex, amygdala and striatum. Their attention can also narrow intensely around a desired goal, leaving little awareness of the harm caused along the way.

These patterns do not mean that the children cannot understand another person’s point of view. Some are socially skilled and can read people well enough to charm or manipulate them. The missing piece is often the automatic emotional concern that would make another person’s suffering feel important. This also distinguishes callous-unemotional traits from autism. An autistic child may retreat from someone else’s distress because it is overwhelming or difficult to navigate; a callous child may register the situation without feeling motivated to help.

Treatment Has to Use a Different Lever

Fear of punishment normally discourages harmful behavior. For many children with callous-unemotional traits, it does not. Harsher penalties can therefore deepen conflict without teaching the intended lesson. Residential programs can make matters worse by grouping antisocial teenagers together, allowing them to normalize and teach one another destructive behavior.

More promising treatments build motivation through warmth, attention and reward. In an adapted form of parent-child interaction therapy, a clinician observes a parent and young child playing together and coaches the parent through a headset. Early sessions rebuild positive engagement: the child leads the play, and the parent learns to notice, praise and reward even small examples of cooperation or care. Later sessions add consistent limits and consequences, but rewards remain the main engine of change. Parents also help children identify distress in faces and voices, recognize triggers for aggression and practice safer responses.

In a study of 45 families with children ages three to seven, both children whose traits appeared largely genetic and those whose traits followed trauma improved. Three months after treatment, 58 percent of the children in the largely genetic group whose families completed the program no longer met the clinical threshold for callous-unemotional traits. The result is encouraging but preliminary: the sample was small, follow-up was short and children whose traits were associated with trauma did not maintain their gains as well.

A second experimental approach uses virtual reality to teach emotion recognition and regulation through reward-focused games. In pilot work, most participating children enjoyed the experience, an important advantage for those who resist talk therapy. They improved particularly at identifying sadness and fear, alongside reductions in aggression, rule-breaking and the severity of callous traits. Larger studies are still needed to show how durable those changes are.

A Capacity That Can Be Redirected

The article does not romanticize psychopathic traits, but it notes that some associated qualities can be useful. Low fear, calm under pressure and intense focus may suit demanding work if they are guided toward constructive goals. For Alex, a respected employer became the mentor who made honest work and accountability feel rewarding. Maturation also helped as the brain systems that restrain impulses continued developing into his twenties.

The deeper lesson is that empathy is not shaped by punishment alone. Children who respond weakly to fear may still respond to attachment, recognition, competence and reward. Effective care protects other people with firm boundaries while giving the child a practical reason to choose a different path. Psychopathy may be extremely difficult to treat once entrenched in adulthood, but childhood offers a period when relationships and specialized training can still redirect development. Treating these children early is therefore neither naive forgiveness nor an excuse for harm; it is a form of prevention grounded in how their minds actually work.