Journal of Consulting and Clinical Psychology 2005 Vol 73 No 3 389 399 Copyright 2005 by the American Psychological Association 0022 006X 05 12 00 DOI 10 1037 0022 006X 73 3 389 Predicting Future Antisocial Personality Disorder in Males From a Clinical Assessment in Childhood Benjamin B Lahey Rolf Loeber and Jeffrey D Burke University of Chicago University of Pittsburgh Brooks Applegate Western Michigan University It is essential to identify childhood predictors of adult antisocial personality disorder APD to target early prevention It has variously been hypothesized that APD is predicted by childhood conduct disorder CD attention deficit hyperactivity disorder ADHD or both disorders To test these competing hypotheses the authors used data from a single childhood diagnostic assessment of 163 clinic referred boys to predict future APD during early adulthood Childhood Diagnostic and Statistical Manual of Mental Disorders 3rd ed rev American Psychiatric Association 1987 CD but not ADHD significantly predicted the boys subsequent APD An interaction between socioeconomic status SES and CD indicated that CD predicted APD only in lower SES families however Among children who met criteria for CD their number of covert but not overt CD symptoms improved prediction of future APD controlling for SES Keywords conduct disorder ADHD antisocial personality disorder covert antisocial behavior aggression adulthood Maughan Rutter 2001 For example in a seminal study that helped set the stage for modern developmental psychopathology Robins 1966 interviewed adults who had been child guidance outpatients as children or adolescents during the 1920s Two psychiatrists made the diagnosis of sociopathy in the adults after reading the interviews and reviewing records Retrospective review of the child guidance clinic charts showed that 36 of youth with high levels of child or adolescent conduct problems noted in their charts were diagnosed with sociopathy Conversely 82 of the adults with sociopathy had high levels of early conduct problems noted in their charts Robins Robins Murphy Woodruff King 1971 later replicated the findings of her 1966 study using the school records of 235 African American males who had attended school during the 1940s It is important to note however that Robins influential early studies used a much broader definition of both childhood conduct problems and adult antisocial personality than contemporary Diagnostic and Statistical Manual of Mental Disorders 3rd ed rev DSM III R American Psychiatric Association 1987 and DSM IV definitions of conduct disorder CD and APD Although some DSM CD behaviors were included in her list of child behavior problems fighting lying running away from home vandalism rape and truancy her list also included childhood psychopathic characteristics absence of guilt recklessness impulsivity and use of aliases other problem behaviors bad language substance use and promiscuous sexual intercourse consequences and correlates of problem behavior expulsions from school and arrests poor school grades and dropping out of school and a behavior no longer considered to be problematic in most cases masturbation Thus although children who meet contemporary DSM criteria for CD would have been considered to have conduct problems in Robins studies children without any DSM symptoms of CD also Antisocial personality disorder APD is a profoundly impairing disorder characterized by individuals engaging in irresponsible and antisocial behavior without remorse Because APD is refractive to treatment in adulthood understanding the childhood predictors of later APD to inform research on preventive intervention is a pressing priority for both the public health and criminal justice systems Childhood Conduct Problems as a Predictor of Adult Antisocial Personality Many studies of clinic and population based samples in several countries have shown that childhood conduct problems predict serious adult antisocial behavior Hill 2003 Kratzer Hodgins 1997 Robins 1978 The accuracy of prediction of which children will not become antisocial adults is greater than the prediction of which children will become antisocial adults however That is although the great majority of antisocial adults had a childhood history of conduct problems many children with serious conduct problems do not go on to exhibit serious antisocial behavior in Benjamin B Lahey Department of Psychiatry University of Chicago Rolf Loeber and Jeffrey D Burke Department of Psychology University of Pittsburgh Brooks Applegate Department of Psychology Western Michigan University This study was supported by Grant R01 MH42529 from the National Institute of Mental Health We appreciate the helpful comments of Kate Keenan on a draft of this article Correspondence concerning this article should be addressed to Benjamin B Lahey who is now at the Departments of Health Studies and Psychiatry MC 2007 University of Chicago 5841 South Maryland Avenue Chicago IL 60637 E mail blahey yoda bsd uchicago edu 389 390 LAHEY LOEBER BURKE AND APPLEGATE could have been said to have multiple conduct problems according to Robins broader definition In a follow back study of a British sample of boys many of whom were reared in group foster homes Zoccolillo Pickles Quinton Rutter 1992 40 of boys given ad hoc retrospective chart review diagnoses of CD met DSM III criteria for APD in adulthood In a similar British study 60 of a group of children who had attended a psychiatry clinic in the past were located and interviewed in adulthood Fombonne Wostear Cooper Harrington Rutter 2001 On the basis of retrospective chart reviews all selected children had met an unspecified ad hoc definition for childhood major depression with about half of the selected children also meeting an ad hoc definition for childhood CD In adulthood 45 of the children who were said to exhibit both childhood depression and CD met criteria for APD according to research diagnostic criteria that antedated DSM III compared with 1 of the children with only childhood depression These follow back studies provide highly useful information but they are limited because the information recorded in even the most systematic medical charts in the past rarely map well onto contemporary diagnostic criteria The association between childhood CD and adult APD also has been examined in studies of adults with current APD who retrospectively recall their childhood CD symptoms Robins Price 1991 Although the results of