It’s important to learn from the rare cases of children who murder

When any ‘child’ carries out in public a very violent, totally unprovoked act that results in the death of a highly respected and caring person the reaction is one of shock, horror and mystification.

The question asked is: what drives a young person to behave in this way? And were there any signs that could have been picked up by professionals to predict this behaviour?

Most professionals working in child mental health, social care, justice, and education are used to dealing with young people with a conduct disorder on a day-to-day basis. However, both practitioners and researchers are beginning to realise there is a small subgroup who are of higher intelligence, who do not have a very notable history of criminal behaviour, but who present with cold, callous, unemotional traits.

Personality disorders, including psychopathic personality disorders, have been seen as conditions that emerge in adolescence, but diagnosis is not made before the age of 18.

In addition, more recent work on understanding the nature of personality disorder has shifted from the concept of it being a fixed condition to one of it being dynamic and changing over both time and circumstances.

In the past, personality disorder has been measured by what is observable ‘bad’ behaviour. But what often seems to happen in some cases is an event, or series of events in an already possibly biologically vulnerable brain that leads to the young person experiencing intense anxiety.  Anxiety that must be controlled at all costs.

Coping mechanisms come into play that deliver immediate relief, but are in the medium to long-term, maladaptive – storing up trouble for the future.

In turn, some children as they enter adolescence discover that there is an increasing sense of pleasure to be gained from the domination and control of others in both fantasy and fact. This is the path to ongoing and escalating sadistic thoughts and subsequently behaviours.

What started them onto the pathway to murder may appear to us to be a trivial event in their lives. But for them that event was critical. This could be anything from being ‘put down’ by a significant person in their life, facing the onset of a chronic illness or believing the only way they can have any sense of self is through destroying another person.

Not uncommonly, the young person does not hide their intentions from others.  But what triggers the final act – the final place, time, and victim choice – often does not emerge in therapy for months or indeed years after the offence.

The majority of young people who have murdered – even the group with cold, callous and unemotional traits – are able to make some tacit acknowledgment of what this might mean for the victim’s family.

It is important for these young people to move on from needing a sense of domination and power and wanting to denigrate others, towards pro-social thinking where they can cope with whatever has set them on a path to murder.

Over many years, working with other professionals, I have seen, assessed, and been part of a team intervening with young people who have killed. Many serve what, compared to other countries, are long sentences in detention. But carefully risk managed, these young people do eventually gain parole (often when they are adults) and go on to lead pro-social lives under conditions of license. Like the victim’s family, and their own family, their lives are changed forever.

A very small number remain ‘untouchable’ and spend their lives in prison where the staff have the task of delivering humane care.

In society the debate on what should happen to such young people continues as does discussion about whose fault it is –parents, the impact of social media and whether some  people are just ‘born bad ‘.

But what’s really important is to learn from these ‘rare cases’ and feed that knowledge back into the system so that together we can better prevent any child setting off on the path to murder.

To do that we need society as a whole to realise that a child’s mental health matters as much as their physical health.

Professor Dame Sue Bailey is the chair of children and young people’s mental health coalition, and past president of the Royal College of Psychiatrists