Journal of Personality Disorders, 24(2), 258-271.

2010 2010 The Guilford Press

ANTISOCIAL PERSONALITY DISORDER WITH AND WITHOUT ANTECEDENT CHILDHOOD CONDUCT DISORDER: DOES IT MAKE A DIFFERENCE?
Glenn D. Walters, PhD, and Raymond A. Knight, PhD
The purpose of this study was to test whether prior conduct disorder increased deviance in persons diagnosed with antisocial personality disorder. One hundred and three male inmates satisfying adult antisocial and conduct disorder criteria for antisocial personality disorder achieved significantly higher scores on self-report measures of criminal thinking and antisocial attitudes than 137 male inmates satisfying only the adult criteria for antisocial personality disorder and 87 male nonantisocial inmates. Inmates satisfying adult antisocial and conduct disorder criteria for antisocial personality disorder were also more likely to receive disciplinary infractions for misconduct than inmates in the other two conditions. The theoretical, diagnostic, and practical implications of these results are discussed.

The Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition (DSM-IV; American Psychiatric Association, 2000) requires something of antisocial personality disorder that it does not demand of any other personality disorder. Taking a page from Robins' (1966) classic book on childhood conduct problems and adult antisocial behavior, DSM-IV stipulates that an Axis I disorderchildhood conduct disordermust be present before an Axis II disorderantisocial personality disordercan be diagnosed. The DSM-IV approach to antisocial personality raises at least three questions. First, given the well-documented continuity in behavioral problems from childhood to adulthood (Glueck & Glueck, 1950), is childhood conduct disorder redundant with adult antisociality in diagnosing antisocial personality disorder? Second, if assessing conduct disorder before the age of 15 in someone eligible for a diagnosis of antisocial personality disorder (>18 years old) requires retrospective accounts that may not coincide with contemporaneous reports of conduct disorder from childhood (Rueter,

From Federal Correctional Institution, Schuylkill. Pennsylvania (G, D. W.); and Brandeis University (R, A. K,). The assertions and opinions contained herein are the private views of the authors and should not be construed as official or as reflecting the views of the Federal Bureau of Prisons or the United States Department of Justice, Address all correspondence to Glenn D. Walters. Psychology Services. FCI-SchuylklU. P, O, Box 700. Minersville. Pennsylvania 17954-0700; E-mail: gwalters@bop.gov 258

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Choo, & Conger, 2000), how useful is a retrospective diagnosis of conduct disorder? Third, in the event antisocial personality disorder without antecedent conduct disorder is a meaningful clinical entity, how should we diagnose and treat the not insignificant number of people who fall under this classification (Tweed, George, Blazer, Swartz, & MacMillan, 1994)? Constructing diagnoses from a file review. Black and Braun (1998) compared 32 psychiatric patients who met the adult antisocial and childhood conduct disorder criteria for antisocial personality and 23 patients who met only the adult antisocial criteria and discovered few if any sociodemographic, criminal history. Axis I, or current antisocial behavior differences between the two groups. Using a structured interview instead of a file review and community volunteers instead of psychiatric patients, Perdikouri, Rathbone, Huband, and Duggan (2007) found no evidence of sociodemographic, criminal history, substance abuse, or adult antisocial differences between 30 individuals who satisfied both the adult antisocial and conduct disorder criteria for antisocial personality disorder and 39 individuals who satisfied only the adult antisocial criteria. One of the few significant differences between the groups was greater trait and expressed anger on the part of individuals satisfying both the adult antisocial and conduct disorder criteria for antisocial personality disorder. Marmorstein (2006) also failed to uncover a significant group difference between individuals from a large population-based sample satisfying the adult Jintisocial and conduct disorder criteria for antisocial personality disorder ind those satisfying only the adult antisocial criteria on a number of sociodemographic, historical, and diagnostic variables. Research indicates that genetic factors play a role in early onset antisocial beha'vior (Jacobson, Neale, Prescott, & Kendler, 2001) but when comparisons are made between adult antisocial patients with and without a history of conduct disorder there are few if any clinically significant between-group differences (Langbehn & Cadoret, 2001). DiLalla and Gottesman (1989) classify as late bloomers individuals who satisfy the adult criteria for antisocial personality disorder but not the conduct disorder criteria. Such individuals purportedly either experienced relatively few environmental pressures during childhood or had fewer opportunities to engage in conduct disorder because of strong parental controls. Before we can assume that this group of late bloomers is comparable to DiLalla and Gottesman's (1989) continuous antisocials (i.e., adult antisocial individuals with a clear background of childhood conduct disorder), however, studies with more participants, more reliable diagnoses, and more diverse groups of correlates, including behavioral outcome measures, are required. There are practical, conceptual, and clinical advantages to knowing whether antecedent conduct disorder contributes to a diagnosis of adult antisocial personality disorder. From a practical standpoint, if, on the one hand, conduct disorder is unnecessary in making a diagnosis of antisocial personality disorder, time can be saved by skipping a retrospective and potentially unreliable review of prior conduct disorder sjmiptomatology. If,

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on the other hand, prior conduct disorder is associated with more severe forms of adult antisocial behavior, including retrospective accounts of prior conduct disorder symptomatology may be justified. Nowhere is the answer to this question more important than in civil commitment proceedings for sex offenders where a diagnosis of antisocial personality disorder often serves as an indicator of current mental disorder or abnormality (Jackson & Hess, 2007). An early age of onset of criminality has consistently been found to be a reliable predictor of chronic or persistent offending as well as criminal versatility (McGloin, Sullivan, Piquero, & Pratt, 2007; Patterson, Forgatch, Yoerger, & Stoolmiller, 1998; Piquero, Paternoster, MazeroUe, Brame, & Dean, 1999; Smallbone, Marshall, &Wortley, 2008). Consistent with these data, Moffitfs (1993) Life Course Persistence (LCP) model proposes that early conduct disorder constitutes a vital link in the series of developmental events that can lead to severe adult antisocial behavior. In a recent paper, Moffitt and several colleagues (2008) concluded that the age at which a conduct disorder first appears is a strong indicator of the severity of adult antisocial behavior. Hence, determining whether childhood conduct disorder predicts more serious behavioral outcomes in adults is central to testing and validating Moffitfs LCP model. Clinically, if prior conduct disorder symptomatology portends more serious subsequent adult antisocial behavior, this information would be helpful in assigning individuals to interventions because program intensity often correlates positively with treatment gains in high risk individuals but has been found to have a detrimental effect on low risk individuals (Bonta, Wallace-Capretta, & Rooney, 2000). Hence, there are practical, theoretical, and clinical reasons why it is important to ascertain whether prior conduct disorder sjmiptomatology adds anything to an adult diagnosis of antisocial personality disorder. In this study a series of anedyses were conducted on recent admissions to a federal prison to determine the contribution of childhood conduct disorder symptomatology to diagnoses of adult antisocial personality disorder. It was hypothesized that on measures of criminal history, criminal/ antisocial attitudes, and institutional misconduct, participants satisfying adult antisocial and childhood conduct disorder criteria for antisocial personality disorder would score significantly higher than participants fulfilling only the adult antisocial criteria, who in turn would score significantly higher than nonantisocial participants. METHOD PARTICIPANTS Participants were 327 male inmates housed in a medium security federal prison located in the northeastern United States. The mean age of participants was 36.26 years (SD= 10.13; range = 20-71) and the mean educational level was 11.54 years (SD= 1.55). African-Americans comprised

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71.6% of the sample, with 16.5% of the sample being Caucasian, 10.4% Hispanic, and 1.5% Asian. Approximately three-quarters of the sample (74.6%) listed their marital status as single, with 18.7%, 5.8%, and 0.9% describing themselves as married, divorced, and widowed, respectively. The most common instant offense was a drug crime (42.5%), followed by weapons violations (19.0%), robbery (13.1%), miscellaneous offenses (10.1%), violent crimes (9.2%), and property offenses (6.1%). Ninety-six percent of these participants had one or more prior convictions and nearly two-thirds of participants (63.3%) had at least one prior conviction for a violent crime (e.g., assault, rape, robbery). MEASURES The Antisocial Personality Disorder (ASPD) module of the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997) was administered to all participants. The ASPD is a semi-structured interview modeled after the DSM-IV (American Psychiatric Association, 2000) criteria for antisocial personality disorder and consists of 15 conduct disorder items and 7 adult antisocial items. Each item is rated on a three-point scale (1 = absent or false, 2 = subthreshold, 3 = threshold or true). To qualify for a diagnosis of iintisocial personality disorder (APD) the person must be at least 18 years of age, satisfy two or more of the 15 conduct disorder items at the threshold level (before age 15), and satisfy three or more of the seven adult antisocial items at the threshold level. The first author conducted all of the ASPD interviews for this study. A random sample of 33 participants (10% of the total sample) was independently interviewed by a second mental health professional within a week of the original interview. Interrater reliability was adequate to good as evidenced by a weighted kappa coefficient of .66 for diagnosis (antisocial personality with conduct disorder, ASP; antisocial personality without conduct disorder, AAB; nonantisocial, NA) and intraclass correlation coefficients (ICC: single measures, absolute agreement) of .91 for the total ASPD symptom count, .77 for the adult antisocial symptom count, and .91 for the conduct disorder symptom count. The Psychological Inventory of Criminal Thinking Styles (PICTS; Walters, 1995) is an 80-item self-report measure designed to assess criminal thinking. Each PICTS item is rated on a four-point Likert-type scale with strongly agree responses earning respondents 4 points, agree responses 3 points, uncertain responses 2 points, and disagree responses 1 point on all scales except for Defensiveness-revised (Df-r), where the point assignments are reversed. Three PICTS scores were included in the present investigation: the General Criminal Thinking (GCT) score, the Proactive Criminal Thinking (P) composite score, and the Reactive Criminal Thinking (R) composite score. The 64-item GCT score is the summed raw score of the eight thinking style scales on which the PICTS is based, the 18-item P score is designed to assess the proactive or instrumental aspects of criminal thinking, and the 18-item R score is designed to assess the reactive or

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hostile aspects of criminal thinking. Test-retest reliability (2-12 weeks: GCT= .81-.93; P = .78-.96; R = .70-.88) and predictive validity (correlations with disciplinary adjustment: GCT= .18-.38; P = .13-.29; R = . 2 0 .35; correlations with recidivism: GCT = .23-.26; P = .20; R = . 18-.26) data on the GCT, P, and R are adequate (Walters, 2002, 2006) and internal consistency, as measured by Cronbach's alpha (a), was good in the current sample of participants (GCT = .92, P = .78, R = .88). The Antisocial Features (ANT) scale of the Personality Assessment Inventory (PAI; Morey, 2007) also served as a dependent measure in this study. Each item on the 344-item PAI is rated on a four-point scale (1 - very true, 2 = mainly true, 3 = slightly true, 4 = false). The ANT is composed of three 8-item nonoverlapping subscales. Antisocial Behaviors (ANT-A), Egocentricity (ANT-E), and Stimulus Seeking (ANT-S). Because of time constraints imposed by the intake screening process, these 24 items were administered as a standalone inventory rather than as part of the full 344-item PAI. In the current study the standalone ANT correlated .53 with the PICTS GCT scale, which compares favorably with the correlation Walters and Geyer (2005) obtained (r= .51) when the embedded ANT and PICTS GCT were correlated. Furthermore, the correlation obtained in the present study between the standalone ANT and SCID-II ASPD symptom count (r = .49) is comparable to what Guy, Poythress, Douglas, Skeem, and Edens (2008) found when they correlated the embedded ANT with the SCID-II ASPD symptom count (r= .51). Test-retest reliability (r) after 2 4 - 2 8 days was adequate (ANT = .84-.86; ANT-A = .80-.86; ANT-E = .70-.79; ANT-S = .78-.84) in the normative sample (Morey, 2007) and internal consistency (a) was fair in the current sample (ANT= .73; ANT-A = .49; ANT-E = .62; ANT-S = .59). PROCEDURE The ASPD, PICTS, and ANT were administered within two weeks of an inmate's arrival at the federal prison where this study took place. All admissions from J a n u a r y 2008 through May 2008 were inciuded in this study except for 32 inmates excluded for multiple reasons. Of those excluded, 24 inmates had been transferred or released prior to taking part in the intake, 3 inmates left more than 10 items blank on the PICTS, 2 inmates achieved a T-score of 100 or more on the PICTS Cf-r scale, and 3 inmates left more than two items blank on the ANT. The ASPD was administered by a staff psychologist (first author, who was aware of the study hj^otheses) as part of the intake screening interview, whereas the PICTS and ANT were administered by a psychology technician responsible for the psychological testing portion of the psychology intake process. The psychologist who administered the ASPD had no knowledge of the PICTS/ANT assessment until elfter the ASPD had been administered and the psychology technician who administered the PICTS/ANT had no knowledge of the ASPD until after the PICTS and ANT had been scored. Although the psychology

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technician was unaware of the study hypotheses, correlations between the ASPD, PICTS, and ANT may have been inflated by shared method variance in that all three measures are based on offender self-report. After completing the ASPD the staff psychologist reviewed an electronic file compiled by the U.S. Probation Department and computed the number of prior delinquency adjudications and adult convictions and age at flrst adjudication/ conviction. Informed consent was not obtained because the ASPD, PICTS, and ANT were administered for routine clinical purposes. Permission to use these data for research purposes was granted by the Bureau of Prisons' national institutional review board. Participants were assigned to one of three conditions based on the results of the ASPD. The antisocial personality disorder (APD) condition comprised inmates who satisfied both the adult antisocial and conduct disorder criteria for antisocial personality disorder as dened by the ASPD. The adult antisocial behavior (AAB) condition included inmates who met the ASPD adult antisocial criteria but not the conduct disorder criteria. The nonantisocial (NA) condition contained inmates who failed to meet the ASPD adult antisocial criteria.' The dependent variables for this study w^ere derived from demographic, criminal background, psychometric, and behavioral data. Demographic variables included age, education, race, marital status, and instant offense. Criminal background variables included the number of prior delinquency adjudications and adult convictions and age at first adjudication/conviction. Psychometric variables examined in this study included the PICTS GCT, P, and R scores and the PAI ANT, ANT-A, ANT-E, and ANT-S scales. The beha\'ioral outcome measure for this study was receipt of an incident report for a disciplinary infraction during the follow-up period that ended twenty weeks after the last intake and ranged from 1.0 to 9.5 months in participants who did not receive an incident report during the follow-up and from 0.1 to 8.8 months in participants who received an incident report during the follow-up. Omnibus tests for all three groups (APD, AAB, NA) were conducted first, followed by individual planned comparisons (APD vs. AAB, AAB vs. NA) to determine whether the results supported the study hypotheses (APD > AAB, AAB > NA).

RESULTS

There were no significant omnibus group differences in age, F (2, 324) = 2.13, p > .05, education, F (2, 324) = 0.59, p > .05, race, x^ (6) = 5.13, p > .05, marital status, x^ (6) = 6.48, p > .05, or instant offense, x^ (10) = 3.73,

1. There were two members of the nonantisocial (NA) condition who satisfied the conduct disorder criteria (>2 reported sjmiptoms) but not the adult antisocial criteria (>3 reported symptoms) for an ASPD diagnosis of antisocial personality disorder. When these participants were removed from the NA group there were no significant changes in outcome on any of the criminal history, psychometric, or behavioral measures included in this study.

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p > .05, although criminal history, the PICTS, and ANT achieved a significant multivariate analysis of variance (MANOVA) effect, F (16, 636) = 5.91, p< .001. There were significant omnibus group differences on criminal history variables and planned comparisons revealed that APD and AAB had more prior adjudications and convictions than NA, and APD had an earlier age of onset than AAB and NA (see Table 1).^ Significant omnibus group differences were also noted for all seven PICTS and ANT scales and six of the seven scales displayed the predicted pattern of planned comparison results (APD > AAB > NA). The lone exception was ANT-S, where APD > AAB, but AAB was not greater than NA. Seventy-eight participants (23.9%) received a disciplinary report during the follow-up period (APD = 33.0%; AAB = 19.7%; NA= 19.5%). A Cox semi-parametric duration (survival) regression analysis of the disciplinary report measure disclosed a significant effect for diagnosis (APD, AAB, NA), X^ (2) = 7.22, p < .05. Planned comparisons (simple contrasts) revealed a significant APD-AAB effect (p< .05) but no AAB-NA effect (p> .05). A meaningful Cox regression einalysis could not be conducted on violent disciplinary infractions because only 14 participants (4.3% of the sample) received a disciplinary report for assault or fighting during the follow-up: APD (7.8%), AAB (2.9%), NA (2.3%). Because APD participants achieved significantly higher ASPD adult antisocial scores than AAB or NA participants, F (2, 324) = 392.51, p< .001, it

TABLE 1. MANOVA Between-Subject Effects and Post Hoc Results Variable APD(n = 103) AAB (n = 137) NA(n = 87) F (2, 324) Prior Adj/Convict 3.41 (2.34), 4.55 (2.65)a 4.09 (2.00)a 5.75* Age Adj/Convict 18.58 (4.24L 21.64 (6.43), 21.25 (6.03), 9.19" PICTS GCT 121.16 (25.79)a 107.26 (24.18), 98.69 (21.70)e 21.42"' PICTS P 78.98 (22.30)a 68.32 (19.09), 60.46 (15.78)c 20.03*' PICTS R 84.17 (27.97)a 71.22 (24.25), 61.91 19.97)e 20.03*' ANT Total 23.48 (8.33), 18.82 (6.55), 16.32 (6.86), 24.52*' ANT-A 13.00 (3.65), 11.43 (3.23), 10.36 (3.44)c 14.51*' ANT-E 3.60 (3.39)a 2.69 (2.74), 1.56 (2.37), 11.86*' ANT-S 6.87 (4.20), 4.69 (2.98), 4.40 (3.50), 14.98** Note. Prior Adj/Convict = number of prior delinquency adjudications and/or adult convictions; Age Adj/Convict = age at first delinquency adjudication or adult conviction; PICTS = Psychological Inventory of Criminal Thinking Styles; GCT = General Criminal Thinking score; P = Proactive composite score; R = Reactive composite score; ANT Total = total score for the Personality Assessment Inventory Antisocial Features scale; ANT-A = ANT Antisocial Behaviors subscale; ANT-E = ANT Egocentricity subscale; ANT-S = ANT Stimulus Seeking subscale; APD = antisocial personality disorder condition; AAB = adult antisocial behavior condition; NA = nonantisocial condition; first number in each column is the group mean and second number, in parentheses, is the standard deviation; means with different subscript letters are significantly different from one another (p < .05); F (2. 324) = omnibus F test with 2 and 324 degrees of freedom. *p< .01; **p< .001.

2. An earlier age of onset (rp5 = -. 14, p < .01) but not prior adjudications/convictions (fp, .04, p > .05) predicted the presence of a subsequent disciplinary infraction in this sample.

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could be argued that many of the significant effects observed in this study were the result of group differences in adult antisocial symptoms rather than group differences in conduct disorder symptomatology. This possibility was evaluated by computing a series of two-step multiple regression and Cox regression analyses with adult antisocial symptoms entered at Step/Block 1 and conduct disorder symptoms entered at Step/Block 2. With the exception of the prior conviction variable, all of the criminal history, psychometric, and behavioral variables examined in this study exhibited a significant effect for conduct disorder at Step/Block 2 of the regression equation after adult antisocial S3rmptoms had already been entered at Step/Block 1 (see Table 2).^ CoUinearity between predictor variables was not a problem in this study (Tolerance = .741; Variance Infiation Factor = 1.349).
DISCUSSION

A two-part hypothesis was evaluated in this study; Part 1 (APD > AAB) and Part 2 (AAB > NA). The results showed consistent support for Part 1 and
TABLE 2. Two-Step Multiple Regression and Cox Regression Results Multiple Regression Cox Regression

Step 1

Step 2

Block 1

Block 2

Ait' F (1,325) AR' F (1,324) df p df P Any Disciplinary Report 1.82 1 .178 7.70 1 .006 Prior Adj/Convict .043 14.73** .000 0.00 Age Adj/Convict .030 9.96* .026 8.93* PICTS GCT .108 39.45' .050 19.22** .078 30.65** PICTS P .100 36.04' .024 PICTS R .128 47.90*' 9.36* .087 37.06** ANT Total .151 57.96' .035 13.28** ANT-A .104 37.55*' .024 ANT-E .119 44.07* 9.17* .098 37.18** ANT-S .052 17.69* Note. Prior Adj/Convict = number of prior delinquency adjudications and/or adult convictions; Age Adj/Convict = age at first delinquency adjudication or adult conviction; PICTS = Psychological Inventory of Criminal Thinking Styles; GCT = General Criminal Thinking score; P = Proactive composite score; R = Reactive composite score; ANT Total = total score for the Personality Assessment Inventory Antisocial Features scale; ANT-A = ANT Antisocial Behaviors subscale; ANT-E = ANT Egocentricity subscale; ANT-S = ANT Stimulus Seeking subscale; Step/Block 1 = step or block in which ASPD adult antisocial items entered; Step/ Block 2 = step or block in which ASPD conduct disorder items entered; AR^ = change in R square from previous model (R^ of current modelR^ of previous model); F [I, 325) = F test of change with 1 and 325 degrees of freedom; F [I, 324) = F test of change with 1 and 324 degrees of freedom; x^ = Chi-square change from previous step; df= degrees of freedom; p = signiflcance of chi square change. *p< .01; **p< .001.

3. The number of conduct disorder symptoms displayed incremental validity relative to the number of adult antisocial symptoms in Cox regression analyses of institutional infractions. When variable order was reversed and conduct disorder symptoms were entered at Block 1 and adult antisocial symptoms were entered at Block 2. adult antisocial symptoms failed to demonstrate incremental validity relative to conduct disorder symptoms in a Co.x regression analysis of the institutional infraction measure (p > .05).

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mixed support for Part 2. That adult antisocial behavior was associated with greater levels of criminal thinking, antisocial attitudes, and behavioral adjustment difficulties when accompanied by two or more sjrmptoms of conduct disorder before age 15 is inconsistent with much of the previous research conducted on this subject (cf. Black & Braun, 1998; Langbehn & Cadoret, 2001; Marmorstein, 2006; Perdikouri et al., 2007). It should be noted, however, that the focus of much of the prior research had been on criminal history and psychiatric symptomatology. In the present study the one variable that failed to distinguish between the APD and AAB groups was the number of prior delinquency adjudications/adult convictions, whereas one of the few significant differences separating emtisocial adults with and without antecedent childhood conduct disorder in the Perdikouri et al. (2007) study was self-reported trait and expressed anger. Although the AAB group scored significantly higher than the NA group on most of the self-report measures of criminal thinking and antisocial attitudes, the two groups failed to differ in their subsequent disciplinary reports. Hence, the results of this study furnish only mixed support for the possibility of a meaningful distinction between offenders with and without a history of adult antisocial behavior in the absence of prior conduct disorder. According to the results of the current investigation, offender age at first documented delinquent adjudication or criminal conviction successfully discriminated between participants in the APD and AAB conditions but failed to distinguish between participants in the AAB and NA conditions. This is important for several reasons. First, age of onset was one of the few variables included in this study that was not based on offender self-report. Consequently, the relationship between age of onset and ASPD, unlike the relationships between the PICTS, ANT, and ASPD, cannot be attributed to shared method variance. Second, these results confirm the role of age of onset in ASPD (Farrington, 2003) and highlight this variable's ability to predict future problem behavior (Lahey et al., 1999). Age at time of first delinquency adjudication or adult conviction but not total number of delinquency adjudications and/or adult convictions successfully predicted future disciplinary infractions in this study. Third, these results indicate that self-report may be vital in gaining a fuller understanding of an individual's offending history. The average age of first adjudication/conviction in the APD group was 18 years (range = 11-34 years); hence, there were a number of serious conduct disorder acts that preceded the first adjudication/conviction that could only be identified through offender self-report, an approach that has produced reliable and valid results in research conducted in the criminology and criminal justice fields (Thomberry & Krohn, 2000). Juvenile delinquency and conduct disorder may derive from different theoretical and clinical traditions but they overlap extensively. Teplin et al. (2006) note that conduct disorder is the most frequent psychiatric diagnosis in detained juvenile delinquents, with prevalence rates exceeding

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90% in several samples. The relationship between early conduct disorder and juvenile delinquency and later adult antisocial and criminal behavior is also well documented. What we now need is research on the transition from conduct disorder to antisocial personality in order to clarify the nature of this relationship. It is well known that many conduct disordered children and adolescents suffer from weak empathy (Eisenberg, 2000). Less well known, but equally important, is research showing that socioeconomic status interacts with conduct disorder to increase risk for adult antisocial behavior (Lahey, Loeber, Burke, & Applegate, 2005). One conceptual possibility is that lack of empathy and living in an environment where opportunities for conventional success are limited but criminal role models and associations abound sets up a situation in which prosocial avenues of interaction become increasingly remote and antisocial avenues of interaction increasingly accessible. Alternatively, earlier onset could be associated with increased genetic risk that interacts with abusive and stressful environments. Longitudinal panel studies and appropriate paradigms to unravel genetic and environmentai contributions (e.g., Moffltt, 2005) will, of course, be required to unravel these Gordian knots. The chief diagnostic implication of this study is that it may, in fact, matter whether an individual who displays adult antisocial sjonptoms also reports a history of childhood conduct disorder. Concerns about the unreliability of a person's recall of years- or decades-old symptoms (Rueter et al., 2000) aside, the total number of conduct disorder symptoms displayed greater reliability and validity than the total number of adult antisocial sjnnptoms in this study, even though the conduct disorder sjrmptoms preceded the adult antisocial symptoms by three or more years. Whereas the results of this study confirm the existence of a clinically meaningful distinction between antisocial adults with and without antecedent childhood conduct disorder, it does not necessarily support the presence of a taxonic boundary between the two groups. In fact, taxometric research on antisocial personality disorder (Marcus, Lilienfeld, Edens, & Poythress, 2006; Walters, Diamond, Magaletta, Geyer, & Duncan, 2007), psychopathy in adults (Edens, Marcus, Lilienfeld, & Poythress, 2006; Guay, Ruscio, Knight, & Hare, 2007; Walters, Gray et al., 2007), and psychopathy in children (Murrie et al., 2007) suggest that these constructs possess an underlying dimensional structure. Moreover, a taxometric analysis of the ASPD module of the SCID-II using the same sample of participants as the current study also showed evidence of dimensional latent structure (Walters & Ruscio, 2009). The results of this study highlight the role childhood conduct disorder plays in serious adult antisociality. As such, our results support the early work of Robins (1966) on childhood precursors of adult antisocial behavior and Moffltt's (1993) more recent work on early onset or life course persistent delinquency. Despite evidence of dimensional latent structure, the early onset or life course persistent pattern may carry with it a greater magnitude of developmental deficits than Moffltt's (1993) adolescent-

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limited pattern or DiLalla and Gottesman's (1989) late bloomers. Data show, in fact, that life course persistent or early onset delinquency is associated with moderate to high levels of neurocognitive impairment (Raine et al., 2005). The form and intensity of intervention may accordingly need to vary depending on whether an adult antisocial client reports a history of childhood conduct disorder. Criminal justice clients who are at elevated risk for reoffense, in part because of a history of early and persistent antisociality, tend to respond better to more intense interventions, whereas lower risk individuals often display diminished or even negative treatment effects with increased intervention intensity (Bonta et al., 2000). The advantage the present study has over previous research on the antisocial personality-conduct disorder controversy is that it assessed a relatively large sample of criminal justice clients on a range of historical, psychometric, and behavioral variables. One notable limitation of this study is that the criterion diagnoses (structured interview) and many of the dependent variables (e.g., PICTS, ANT) were based on self-report. Shared method variance and criterion contamination may therefore have artificially inflated the relationship between antisocial personality disorder and several of the self-report inventories included in this study. Whereas a meaningful relationship was also observed between these diagnoses and a behavioral outcome measure, the behavioral measure was restricted to relatively minor infractions taking place over a relatively brief period of time. It could even be argued that the second part of the h5q5othesis for this study (AAB > NA) would have received support had the follow-up period been longer and the infractions more severe. Although the vEiriable effect sizes and patterns observed in research on prison misconduct are similar to the variable effect sizes and patterns found in research on community recidivism (French & Gendreau, 2006), one could still question the relevance and generalizability of the current results to disruptive behavior outside of a correctional facility. The current findings are inconsistent with previous research comparing antisocial adults with and without antecedent conduct disorder (Black and Braun, 1998; Langbehn & Cadoret, 2001; Marmorstein, 2006; Perdikouri et al., 2007). Much of the previous research, however, focused on family, psychiatric, and criminal history variables. The current study also failed to find substantial criminal history differences between the three conditions, with the exception of an earlier onset of delinquency/criminality in the APD condition, and did not analyze psychiatric or family history variables. By contrast, when crime-relevant variables like criminal thinking, antisocial attitudes, and institutional adjustment were examined, a clear difference was observed between antisocial adults with and without antecedent childhood conduct disorder. Taxometric studies denote that antisocial personality disorder may possess a dimensional latent structure, whereas the present study demonstrates that the essential content of antisocial personality disorderantisocial attitudes, emotional impulsivity, behavioral deviancehas its roots in childhood conduct disorder. Contin-

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ued development of the antisocial personality disorder construct consequently demands that we pay close attention to structure and content when it comes to conceptualizing antisocial personality.

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