The influence of extra-clinical factors on "successful" and "unsuccessful" Atkins cases were examined. Sixty-two judicial opinions were included in this study, 31 successful and 31 unsuccessful cases. Extra-clinical factors (e.g. Briseno Factors, activities typical of most adults, behavior in prison) served as the independent variables, and the final outcome of the hearings served as the dependent variable. The influence of Antisocial Personality Disorder on case outcome was examined. Differences in the rate of successful and unsuccessful claims as a function of the state where the case was heard was compared to state trends in the rate of executions. In addition, the rate of deficits in functional academics was also examined. Analyses indicated that opinions were not influenced by extra-clinical factors to the extent hypothesized, and a history of Antisocial Personality Disorder did not predict final case outcome. The rate of successful and unsuccessful claims did not follow state trends in the rate of execution as expected. As hypothesized, functional academics was the most often cited area of deficits in successful and unsuccessful cases. It should be noted that a number of analyses in this study contained few participants across groups, which likely contributed to non-significant findings. Additional limitations of this study and recommendations for future research are discussed.