What are adolescent antecedents to antisocial personality disorder?

BACKGROUND: This paper fills a gap because there are very few studies that prospectively predict antisocial personality disorder (APD) from psychopathology earlier in life in clinic-referred samples of young males. METHOD: The paper addresses the continuity between conduct disorder (CD) and other forms of psychopathology during ages 13 17 and modified APD at ages 18 and 19 (modified to remove the DSM-IV requirement of pre-existing CD by age 15) in the Developmental Trends Study. RESULTS: The results show that 82 90% of APD cases met criteria for CD at least once during ages 13 17, and very few youths who met criteria for ODD during this period progressed to APD without intermediate CD. While CD is a strong predictor of modified APD, when other factors were accounted for in regression analyses, the best predictors were callous/unemotional behaviour, depression and marijuana use. ADHD during ages 13 17 was not significant in the final model. Males with CD during adolescence who progressed to APD tended to commit more violence, as evident from their court records. CONCLUSIONS: Implications are discussed for the conceptualization of developmental models leading to APD, the strengthening of relevant symptoms of CD predictive of APD, and preventive and remedial interventions.