While there has been an exponential increase in brain imaging research on psychopathy in the past two decades, knowledge on the brain basis to child and adolescent psychopathic-like behavior is relatively new. This adult and child research has potential future implications for the development of new interventions, prediction of future offending, and punishment. This review examines both adult and child literatures on the neural basis of psychopathy, together with implications for the criminal justice system. The adult imaging literature provides growing evidence for amygdala structural and functional impairments in psychopaths, and more variable evidence for prefrontal deficits. The emerging child and adolescent imaging literature with notable exceptions broadly parallels these adult findings and may help explain the development of fearlessness, disinhibition, and lack of empathy. This knowledge places policy makers at a crossroads. Should new biological interventions be developed to remediate these brain abnormalities? Would imaging be used in the future to predict offending? Could imaging findings help excuse psychopathic behavior or alternatively argue for longer sentences for public protection? This review attempts to address these issues at the child and adult levels and provides directions for future research that include the incorporation of biological measures into treatment programs.