These neuropsychological deficits, particularly in the early developmental years of the child and adolescent, could have significant detrimental effects in regard to the functional, emotional, and cognitive adaptive abilities of the individual with such brain dysfunction. Thus high risk individuals who evolve into persistent criminal offenders may be those who have acquired significant neural impairment or brain damage and have the misfortune to be born into an impoverished environment, which typically lacks adequate attention for medical, educational, psychiatric, and legal problems. In contrast, it is hypothesized that those individuals born into a similar impoverished environment without significant neural impairments would have a dramatically increased probability of coping with their adverse environment, as well as the biological potential to develop normal inhibitory controls. The importance of primary prevention in regard to the socioeconomic effects on the developing fetus and child has been made. However, the consequence of sociogenic brain damage and dysfunction will continue to be felt. The accumulating evidence of a high incidence of brain dysfunction in persistent juvenile and adult criminal populations has implications not only for the possible identification of high risk individuals, but also for alternative approaches to treatment and rehabilitation. In conclusion, the emerging relationships between adverse environments, genetic factors, brain damage, altered brain function or dysfunction, male gender, and behavioral disorders in high risk subpopulations strongly suggest that biological factors interacting with the environment play a significant role in the genesis of persistent juvenile delinquency and criminal behavior. A multidisciplinary, multimodal approach is needed to effectively deal with the prevention and treatment of high risk offenders. Thirty-nine references are appended. (Author abstract modified).