They've been condemned. Now they must be understood

How do you prevent the perpetrators of these crimes from turning into adult psychopaths? Paul Vallely finds out how tough love can turn their lives around

Saturday 23 January 2010 01:00 GMT

The public wants violent criminals to be locked up. When the criminal is a child who has perpetrated a coldly sadistic act, many people's first instinct is to want that evil banished from the public gaze for a very long time, if not indefinitely.

But when our heads overrule our hearts we want something more. We want children – like the two young brothers from Edlington, near Doncaster, who were sentenced yesterday to indefinite detention for shocking acts of gratuitous violence against two young children – to understand and acknowledge the impact of their actions. We want them to demonstrate genuine contrition. We want them to be changed.

Yet is that possible for the 11- and 12-year-olds who were described by the trial judge Mr Justice Keith as posing "a very high risk of serious harm to others"?

They had spent 90 minutes engaged in "prolonged sadistic violence for no reason other than that [they] got a real kick out of hurting and humiliating" their victims.

One of the UK's most experienced child psychiatrists, Dr Eileen Vizard, told the court she felt "intimidated" while interviewing the younger boy, who had no apparent capacity for empathy or remorse. Without treatment, she said, he could well become an adult psychopath.

Can a child like that be changed? Now that the pair have been locked up, what will happen to them?

"There is always an impatience in the outside world to address the crime," says Professor Sue Bailey, a consultant child and adolescent forensic psychiatrist who has studied more than 250 child murderers in her 30-year career – and was an expert witness at the trial almost two decades ago in which two 10-year-olds tortured and murdered the toddler James Bulger. "But if you do that too soon children like this will close down."

So that is not where mental health experts start when they get such children into custody. "Psychiatry and psychotherapy do not produce a magic bullet inside secure units," says the criminologist Tim Bateman of the University of Bedford, who is also youth crime policy officer for the crime reduction charity Nacro. "It's first of all about providing a structured and nurturing environment to compensate for the normal childhood they never had."

Dr Vizard, who also worked with the young Bulger killers – Robert Thompson and Jon Venables – agrees. "One of the main therapeutic agents is the stability of the place," she says. "These children are taken away from disrupted backgrounds, with no boundaries, and dangerous adults, and are put somewhere where they are safe, fed and housed and told No by people who understand how to set limits. It's tough love. It's a great skill, creating an experience that approximates to a proper family life."

One professional who did that at Red Bank secure children's unit on Merseyside, where Jon Venables was detained, was Pam Hibbert. "Children whose lives have been lives in chaos feel profoundly unsafe," she says. "Their offence is often a mask for their own vulnerability; if you get in first, they think, you won't get hurt."

So first you make them feel safe. "You give them someone they feel is interested in them," she says. "For some it's their first proper relationship with an adults and that milieu is as important as any therapy. And they can shift from being kids who are difficult to handle to kids who on the whole respond very quickly."

It is difficult for those of us with more normal upbringings to understand how radical a shift this is for many of these problem children. "You have to start with socialisation," says the criminologist Professor Gwyneth Boswell of the University of East Anglia, who studied 200 children convicted of extreme offences throughout the Nineties.

"Just getting up at the same time every day and eating regular meals is a big change for a lot of them," she says. "Some have to be taught how to use a knife and fork. Many have never eaten at a table."

"Many have to be taught something as basic as taking turns," says Professor Bailey, who works with the Greater Manchester West Mental Health NHS Foundation Trust treating extremely disturbed children. "You have to do all that, developing various social skills and life skills, before you can get to a point where they can begin to engage."

That can mean spelling out what might be obvious to a normal child. "Sometimes they don't even understand what they have done wrong, within the unit, how they have broken the rules," she says. "You have to explain: if you do this then this is what will happen to you."

The biggest single factor, outside normalising the young offender's relationships with the unit's staff and their fellow inmates, is education.

"It is the tool which opens up a young person's confidence in themselves and awakens them to the possibility that they can achieve something while they are detained," says Roy Walker, who ran Sutton Place, the secure unit in Hull, until it was closed, like many others, to cut costs. He is the outgoing chair of the units' umbrella group, the Secure Accommodation Network.

Inside the secure units, high-quality education is provided continuously apart from a fortnight over Christmas and New Year. It is not easy work. "These kids often begin with a very negative attitude saying they can't do schoolwork and won't try," says Tim Bateman. But the staff remain relentlessly positive. "Our students have a lot of catching up to do, particularly on literacy and numeracy," Roy Walker says.

Professionals and researchers have no doubt of the value of this work. "These children often begin to respond very quickly to education," says Professor Boswell. From being the barely literate underdog in a family of seven brothers, where his older siblings picked on him brutally, Robert Thompson passed five GCSEs and several A-levels and developed a strong interest in design and fashion. Jon Venables passed seven GCSEs and did A-levels too – a level of attainment that neither could have achieved before their arrest.

But it is not simply learning for learning's sake. Nor it is done purely to help the youngsters find a job when they are eventually released. Literacy and numeracy skills are central to the therapy these units provide.

Locking up dangerous delinquents protects the public in the short term. But if the risk is to be permanently removed, child offenders have to change. The key to this, says Roy Walker, who has worked for 17 years with such children, is to get them to focus on their offence and the impact it has had on others. "To help them to ensure that they won't offend again as soon as they get out," he says, "they need to develop a greater awareness."

But, as Pam Hibbert explains, "you have to get them to develop an awareness of how they feel about themselves before you can move on to dealing with how they think their victim might have felt. Whatever crime they have committed you always have before you an extremely damaged and vulnerable child and you have to focus on them."

Professor Bailey agrees. "You have to start from where they are," she says. "What they think their life is about. What they think their needs are. What they want out of life. It gives you a common point from which you can gradually introduce other concerns and points of view. But what you must do first is build trust and engagement."

And yet this must not be a process which indulges the child. "You set boundaries, you don't stand for cheek," says Pam Hibbert. "But you have to treat them with respect and listen to what they say," says Roy Walker. "You have to inculcate in them a confidence that adults are going to deliver for them. But that doesn't mean agreeing with them." Rather it means realigning their concepts of fairness and right and wrong with those of the rest of society.

The detained children start in very different places. "Some are traumatised by the experience of the courtroom," says Professor Bailey. "Some have depression which was never diagnosed before. Some get hostile, some go quiet and withdrawn. Some have problems with their hearing or eyesight. Some are dealing with their own abuse. Some had been living with inappropriate roles, parenting their siblings or caring for a parent."

Some are unresponsive to the most basic tool of therapy – speech. "Quite often for these kids words have become meaningless," says Professor Bailey. "They have lived lives where they have been ignored and left to their own devices and now suddenly everyone is talking at them and asking question. It's all words, words, words." Many of them just switch off. Psychiatrists then have to resort to indirect means like art therapy.

And when they do begin to make progress children can be disturbed by that. "They can get very worked up doing it," says the psychiatrist. "You do your best to calm them down [but] in the end you have to negotiate with the secure unit staff so the child doesn't get over-penalised if there is a spill-over from the session."

Units operate points-based systems which allow their residents to earn privileges by good behaviour. Staff have to strike a delicate balance between discipline and incentive. "It's a tough job," Professor Bailey says. "To use a medical analogy, we are not asking staff to monitor these young people's blood pressure, we are asking them to do heart transplants."

Some of the work can be done in groups. "Group work, if it's done well, is particularly effective for children entering their teens," says Professor Boswell, "because they identify much more with their peers than with any adult. They can learn very powerfully in a group, though it has to be led by a skilled adult to steer the focus away from members expressing negative antisocial views."

But the approach poses extra risks. The units, which range in size from just a dozen inmates to as many as 36, have a wide mix of residents. Some have been sentenced for very serious crimes, others are on remand, others put there to protect them from themselves – there has been a big increase in the number of protective welfare orders since the Baby P case.

"They are not friends; they have been put together," says Roy Walker. "They can be here for 24 hours or eight years. And the group dynamic changes every time someone comes in or goes out. These kids are in some respect loners; they may hang around in groups but they are not really socialised."

Sex offenders are particularly responsive to group therapy. It is heavily used in units like Red Bank, which specialises in children who have committed sex offences. "They can deconstruct why things which are not good for other people are also not good for themselves," says Professor Boswell. "It encourages them to work that out for themselves rather than someone else telling them."

But for others group work is unsuitable. "Some just wouldn't understand what was going on," says Professor Bailey. "Some would try to manipulate the group. Some may just not be ready educationally and might not understand the nuances – they'll just think it's people talking sex to them."

Most work is driven by the principles of cognitive behavioural therapy which aims to modify dysfunctional thinking by changing patterns of behaviour and teaching the offender to avoid the early signs of temptation and trouble. "There is good evidence that many children in secure units respond well to vigorous input from trained supervised therapists," says Dr Vizard.

The range of programmes ranges through anger management, family relationship therapy, drug abuse and diet interventions, occupational therapy, and music, speech and language therapy.

Part of the treatment is to change offenders' masturbatory fantasies from unhealthy to healthy ones. The strategy operates by rewarding good behaviour, withdrawing privileges for bad behaviour and introducing time-out sanctions, which are a more sophisticated version of the naughty step for small children.

But there are some offenders for whom this approach does not work. They are the children with emerging severe personality disorder (ESPD) traits who could grow up to become psychopaths. Dr Vizard estimates that there are between one and two thousand children in this category in the UK. She suggested in court that the younger Edlington boy may be one of these.

"One of the characteristics of these children is that they can't interpret certain facial expressions," she says. Research has shown that they over-interpret hostility in other people. They mistakenly rate neutral faces as angry. "They can't tell the difference between fear and sadness in another person's face."

They can describe what they see but, because they lack empathy, they can't understand it. One told Dr Vizard about someone he had raped: " 'She was crying, yeah, there were tears on her face. Her face was screwed up.' But he couldn't work out what was in the mind of the other person. He didn't know what all that meant, and he didn't care."

Psychologists theorise that the ability to recognise fear in others comes from a childhood developmental stage that is critical for learning that other people are sentient, feeling organisms. Such children have not developed this "theory of mind".

There is something else that is critical. Professor Mark Dadds, a psychologist at the University of New South Wales, has been investigating this callous unemotional trait in children. He has discovered that most problem children have high emotional states. "They'll be anxious, they'll be emotionally reactive, so things upset them; they react aggressively to frustrating situations," he says.

But the ESPD sub-group do not react emotionally. Rather, their aggression is predatory and cold. "Predatory aggression is different, it's someone who's on the lookout for an opportunity to be aggressive in order to further their own ends."

And such children, being low in emotion, are not very susceptible to the disapproval of others. Parents' attempts to correct their behaviour are routinely frustrated. They are difficult to discipline. "Attempts to punish them become escalating and quickly move into very extreme levels," Professor Dadds says.

In a study of 56 such boys, aged 4 to 9, he discovered that the more callous and unemotional a boy was, the less likely he was to respond well to punishments for misbehaviour. Rewards and encouragement were far more productive, which may explain why, to the disgust of the tabloid press, the Edlington brothers were given treats while they were on remand – they were taken to watch a Doncaster Rovers football match and to the seaside – to encourage an improvement in their behaviour.

Mark Dadds has discovered another technique. He remembered that the ability to recognise fear is also impaired in people with damage to the amygdala – nuclei deep inside the medial temporal lobes of the brain which play a role in forming and storing memories associated with emotional events. Doctors had discovered that this deficit can be temporarily corrected by simply asking such patients to focus on the eyes of other people.

Professor Dadds has pioneered the technique with ESPD children. "You just say to them: 'Would you mind looking at me while I'm speaking," says Dr Vizard. "It is not a reprimand but a request and it seems to work."

They still might not be able to line up other people's experiences with their own. But therapists can use this to appeal to their self-interest to motivate them to take part in treatment. Dr Vizard adds: "You say: 'If you do this then you'll get a lesser sentence; if you do you will have fewer bad things to tell a future girlfriend about your self.' "

Doing the right thing, its advocates insist, will turn into wanting to do the right thing. "There's a chance that, if that continued over many years, their brain might right itself because they are living in an environment where appropriate responses are encouraged," Dr Vizard says. "It's a measure of how plastic the child and adolescent brain is."

There is more to this than pious hope. Researchers have a number of techniques for assessing whether any change has occurred in the attitudes and thinking of these young people. Psychological tests can be used at the early, middle and later stages of the child's detention. They might, for example, be asked whether they strongly agree, agree, disagree or strongly disagree with statements such as:

*I don't owe the world anything;

*If you back down from a fight people will think you're a coward;

*It makes me feel big when I push someone around;

*It's OK to hit someone if you just go crazy with anger;

*It's hard to get ahead without breaking the law now and again;

*I really care about how my actions affect others.

"Of course some children learn how to give the 'right' answers," says Professor Boswell. But therapists use in-depth interviews to reveal inconsistencies and calculate the risk of the young person committing a similar offence in the future. Psychiatrists have found that change can come and it can be thorough-going, especially in those under the age of 18, whose brains and personalities are still developing.

The younger the children are, the more quickly the change can come. "A complete transformation can happen within four years, because of the speed at which children develop," says Pam Hibbert.

The two boys from Edlington have been told that they must serve a minimum of five years before they can even apply for parole. They may well need longer than that.

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