Predictors of treatment outcome in dually-diagnosed antisocial youth: an initial study of forensic inpatients

The safe and effective management of adolescent offenders is a top priority for inpatient forensic programs. Treatment successes were examined for adolescent offenders on four parameters, specifically hospital course, level of improvement, time to discharge, and rapidity of improvement. Hospital course was predicted primarily by the breadth of polysubstance abuse with modest but independent contributions by psychopathic characteristics, and aggressive conduct-disorder symptoms. An important finding for treatment was that level of improvement at discharge was only marginally affected by psychopathic traits. In addition, rapidity of improvement was predicted only by decreased polysubstance abuse. Approximately one-fourth of the adolescent offenders experienced a substantial decrease in psychopathic characteristics. This finding was unexpected because the generic treatment program did not target the core elements of psychopathy. Even in the absence of nontreatment controls, this diminution of psychopathic traits in 25% of adolescent offenders raises important questions about the temporal stability of these traits and their potential amenability to generic interventions.