| Summary: | Background: Antisocial personality is characterised by impulsive behaviour and a pervasive disregard for the rights of others. Its consequences are often debilitating and its presentation poses considerable treatment challenges. While it may be associated with a range of neuropsychological deficits, the literature is often contradictory and no research has examined their effect on treatment. Method: A systematic review of the neuropsychological literature on male adults with antisocial personality was conducted to facilitate generation of hypotheses. Pooled evidence from 132 studies suggested robust cognitive deficits in motor regulation, affect recognition, and concept formation. Findings were less consistent for other functions and differences between operationalisations of the antisocial personality were present. To further investigate the neurocognitive deficits and examine their effect on treatment, the Cambridge Neuropsychological Assessment Battery (CANTAB) was administered on 102 adult male offenders (divided into those with antisocial vs. other personality disorders) and on 20 healthy controls in a between-subjects design. Two operationalisations were examined in parallel for the first time: Antisocial Personality Disorder (ASPD) and psychopathy. Progress in treatment was measured using a two-part, standardised instrument – the Progress Rating Schedule (PRS) – developed systematically via thematic analysis as part of the project. Results: ASPD demonstrated impairments in executive, memory, attentional, and visual processing functions while psychopathy showed primarily executive but overall milder deficits. Impairments in motor regulation, set-shifting, working memory, and visual perception appeared present in the antisocial personality (ASPD and psychopathy) but not offenders with other personality disorders. Regarding progress in treatment, the PRS showed good reliability (intra-class correlations: 0.63-0.92; internal consistency: 0.77-0.87) and concurrent and predictive validity. However, cognitive difficulties predicted outcomes only to a limited extent. In ASPD, fronto-temporal deficits predicted poorer progress through the forensic pathway. However, higher risk-taking (Cambridge Gambling Task) predicted better outcomes while intellectual functioning and presence of psychopathy mediated some effects. In psychopathy, only visual short-term memory and planning predicted progress; impairments in the former predicted slower progress but there were inconsistencies for the latter. Conclusions: A range of neuropsychological deficits appeared to characterise the antisocial personality and some may have adverse effects on progress in treatment. Further research is required in other, larger samples and cognitive functions not included in the CANTAB to confirm and extend these findings.
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