Despite debates surrounding juvenile psychopathy, we do not know how frequently psychopathy evidence is presented in adolescent court cases or how this information is used. To address this gap, we reviewed ill American and Canadian adolescent offender cases, which included 143 separate evaluations involving psychopathy. Results suggest that psychopathy evidence has been introduced in a sizable number of cases and is becoming increasingly common. While judges generally did not refer to psychopathy evidence in making ultimate legal decisions, psychopathy evidence appeared influential in some cases. In addition, consistent with concerns voiced by scholars, evidence of psychopathy was frequently used to infer that a youth would be difficult or impossible to treat. Conversely, the absence of psychopathy was occasionally interpreted as a sign of amenability and used to support more lenient sanctions. Whereas some cases appeared to attend to key issues that have been discussed in the research literature, such as the need for caution in applying psychopathy labels to youth and the importance of developmentally appropriate assessment strategies, other cases did not. The implications of these findings are discussed.