Preventing Mental Health Epidemic for All

Prevention for Everyone
Averting America’s epidemic of mental, emotional, mental and related behavioral disorders

Dennis D. Embry, Ph.D. • President/Senior Scientist, PAXIS Institute
Presentation for ESD #113, Tumwater, WA, August 11, 2011

Friday, August 12, 11 1

Welcome
introductions and
housekeeping


What will we pack in
our young people’s
suitcases for their
whole lives?


What bricks—heavy objects of pain, injury, illness, or problems
—do you NOT want in young people’s suitcases for life?


Ask the suitcase questions of 30 people: some
republicans, some democrats, some independents
and some who are apolitical.


What do you want to happen and not happen for our elders?


Bi-directional Wealth and Wellbeing Transfer

5-Year 65-Year
Olds Olds



5-Year 65-Year
Olds Olds

Who are living
longer though get
progressively sicker…



Requiring more wealth transfer

5-Year 65-Year
Olds Olds

Who are living
longer though get




5-Year 65-Year
Olds Olds

Who are living
Who are less
longer though get
and less able…




5-Year 65-Year
Olds But elders voting to stop funds to kids Olds

Who are living
Who are less
longer though get
and less able…


Our Own Children’s Future


Our Own Children’s Future

ADHD

stealing aggression
asthma depression
learning disabilities
obesity cancer
bipolar
depression
hi-blood pressure heart-disease
violence tobacco
suicide diabetes alcohol
crime drugs
dangerous acts


Washington State’s Future

Children Children Children
Ages 0-5 Ages 6-18 Ages 0-18
457,269 1,129,723 1,586,991


What happens if we
pack every Washington
state ﬁrst grader’s life
suitcase well?
Universal
Behavioral
First Grad Vaccine Cost Net Economic
Cohort X ($150 each) = Beneﬁt for All
76,211 $11,431,718 $1,094,244,047


Why prevention for
everyone?
Shouldn’t we focus
on the people at risk?


The nation faced
a national
epidemic of polio.

Emergency wards
were ﬁlled with
iron lungs.
Children died or
crippled. The
nation was
terriﬁed.
Who should be given the
vaccine?

Only the frail or “at risk”?

Or, all children?


The Epidemic Today?
Mental, Emotional, Behavioral,
and Related Physical Illnesses


The Epidemic Today?
Mental, Emotional, Behavioral,
and Related Physical Illnesses
Do you know a
middle class
family with a
child with a
MEB?


Lifetime Prevalence of Disorders in US Adolescents (N=10,123)
Merikangas et al., 2010 40%

35%

30%

25%

20%

15%

10%

5%

0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years



35%
Anxiety
30%

25%

20%

15%

10%

5%

0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years



35%
Anxiety
30%

25%
Behavior
20%

15%

10%

5%

0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years



35%
Anxiety
30%

25%
Behavior
20%
Mood
15%

10%

5%

0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years



35%
Anxiety
30%

25%
Substance
Behavior
20%
Mood
15%

10%

5%

0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years


Youth MEB Prevalence Rate Comparison

4x
2x
USA United Kingdom OECD


Depression by Jobs


Nearly 3 out of 4 of the nation's 17- to 24-year-olds are
ineligible for military service for based on national
epidemiological data

• Medical/physical problems,
35 percent.

• Illegal drug use, 18 percent.
• Mental Category V (the
lowest 10 percent of the
population), 9 percent.

• Too many dependents under
age 18, 6 percent.

• Criminal record, 5 percent.

Army Times, Nov 5, 2009 • www.missionreadiness.org/PAEE0609.pd


Cumulative prevalence of psychiatric disorders by
young adulthood: a prospective cohort analysis from
the Great Smoky Mountains Study.
By 21 years of age, 61.1% of
participants had met criteria for a well-
speciﬁed psychiatric disorder. An
additional 21.4% had met criteria for a
not otherwise speciﬁed disorder only,
increasing the total cumulative
prevalence for any disorder to 82.5%.


The US has 75
million children
and teens.
40.4 million are
on psychotropic
medications

Wall Street
Journal,
12-28-2010


Why are these trends happening
in Washington State and the
United States?


What should the people
Why are these trends happening Washington State do to protect all
in Washington State and the of its children from the epidemic of
United States? mental, emotional, behavioral and
related physical disorders?


Major Ecologic Causes of the Dual Inﬂammatory Threats to Children & Youth

Reinforcement Antecedents Physiological Verbal Relations


Multi-Inﬂammatory Threat Reaction




Mood Reward Executive Behavioral
Attention
Stability Delay Function Competencies

Immune-
Motor Healing
Skills Multi-Inﬂammatory Threat Reaction Functions




Substance Work Obesity,
Early Mental Illness Violence Cancer School
Abuse Problems etc
Sex Failure

Mood Reward Executive Behavioral
Attention
Stability Delay Function Competencies

Immune-
STD’s Motor Healing Special
Skills Multi-Inﬂammatory Threat Reaction Functions Ed




Evolutionary Mismatch
How have the changes in modern
human ecology for which were were
evolved and adapted affected
Sleep
Eating
Mental health
Problem behaviors
Physical Health
Sexual maturity


What are the social rewards for these behaviors?

Billy Good Billy Bad

GGGCCGCCGCATTCGT-3 and 5 -
AGGGA-3 ; 661-nt product; ref. 20)
CGTACTGTGCGGCCTCAACGA-
CTGCGTGATGT-3 ; 705-nt product
r some amplifications of the VNTR, Fig. 3. Proposed o

were used (2). The alternative primers sity. A simpliﬁed m
repeat sequence

e VNTR to minimize out-of-register with only major re
indicated (Fig. 2). T

ation. PCRs were conducted in 25- l
7R alleles are show
minor 3R, 5R, and
in gray along with
f genomic DNA, 200 M dXTPs, 0.5 origins by unequa
arrows). Large red
buffer (Qiagen, Chatsworth, CA), 1 Text putative multistep
lele. The adjacent p

.625 units of Taq DNA polymerase S1), exon 1 (L2 S2)
A-C) polymorphism

s performed by using Perkin–Elmer strong linkage of
polymorphisms wit

c, 96°C hot start was used followed by
is noted.

nd 68°C for 1 min. After a 4-min chase Fig. 1. Diagrammatic representation of the human DRD4 gene region. Exon Standard methods of estimating coalescence time for these alleles
are not applicable, given the repetitive nature of the region and high
high fitness if almost everyone is meek but might r
when very common, because aggressive individua
e eliminated with 0.5 units of shrimp positions are indicated by blocks (yellow, noncoding; orange, coding). The recombination frequency. However, calculations of allele age based
on the relatively high worldwide population frequency of the DRD4
penalties of frequent conflict. This type of freq
selection might be expected to apply to many type
Amersham Pharmacia), 0.1 unit of approximate positions of a 120-bp promoter region duplication (blue trian- 4R and 7R alleles suggest that these alleles are ancient ( 300,000
years old; refs. 25 and 26; see Methods). On the other hand,
variation, including those associated with this part
gle), an exon 1 12-bp duplication (blue triangle), an exon 3 VNTR (blue mitter receptor (4–9).
ham Pharmacia), and 1 SAP buffer calculations of allele age based on the observed intraallelic vari- Alternative explanations to the proposed posit
triangle), and two intron 3 SNPs are indicated. 2R–11R variants of the VNTR are ability (refs. 26 and 27; see Methods) suggest that the 7R allele is as recent random bottlenecks, population expan
e SAP Exo I reaction was carried out 5–10-fold ‘‘younger’’ (30,000–50,000 years old). Such large discrep- ulation admixture (24) are less likely to account
indicated below exon 3 (blue) along with their worldwide population fre- ancies between allele ages calculated by these two methods usually
15-min heat inactivation at 72°C. The quencies determined by PCR analysis (3, 17).
are taken as evidence that selection has increased the frequency of
results. Bottlenecks certainly have occurred duri
tion and evolution (33–35) and undoubtedly ha
the allele to higher levels than expected by random genetic drift
reaction was used directly for DNA (26). The absolute values of these estimates are greatly affected by
current worldwide DRD4 allele frequency. Num
studies on other genes (24, 33, 35) have shown
the assumptions used in their computations, for example the
uals, the two allelic PCR products first assumed recombination frequency (26). We have used conservative
Africa’’ constriction of allele diversity (and an incr
occurred. In the present study, a greater diversit
estimates of recombination frequency based on the average ob-
rose gels. DNA cycle sequencing was majority of individuals were heterozygotes, and the two allelic PCR served for the terminal 20 megabases of 11p (31). Given the
was found for African DRD4 4R alleles in co
remainder of our population sample, which is co
observed high recombination at this locus (Table 1 and Fig. 3), it
niques using ABI 377 and 3700 auto- products could be separated by gel electrophoresis before sequenc- is likely that the actual age of the 7R allele is even younger, and
out-of-Africa hypothesis (24). Although one
the 7R allele frequency was increased by ch
further LD analysis will refine these estimates. The important
out-of-Africa expansion, this theory does not ex
ing, providing unambiguous haplotypes. Altogether, we screened conclusion, however, is that regardless of the parameters assumed,
the relative age differences for the 4R and 7R alleles calculated
lack of diversity in African 7R alleles. The mo
7R(1-2-6-5-2-5-4)-A-C haplotype (Fig. 3) is fou
over 450,000 bp of genomic DNA and 2,968 48-bp repeats. from intraallelic variability remains large, whereas their population
comparable to those found worldwide ( 85%)
ions. Ka Ks ratios were calculated by
frequency suggests they are both ancient.
imagine what type of bottleneck could produce
In the 600 chromosomes sequenced, 56 different haplotypes The simplest hypothesis to account for (i) the observed bias in
strong worldwide LD for a single allele (DRD4 7R
. Putative recombinant haplotypes were found (Table 1). These haplotypes were composed of 35
nucleotide changes (Ka Ks), (ii) the unusual sequence organization
of the DRD4 7R allele, and (iii) the strong LD surrounding this the remaining alleles. A model that is consistent
results is the ‘‘weak Garden of Eden’’ hypothesis
pendent events. Allele age calcula- distinct 48-bp variant motifs (Fig. 2), 19 of which were reported
allele is that the 7R allele arose as a rare mutational event (or
events) that nevertheless increased to high frequency by positive DRD4 4R allele would be hypothesized to be an
Friday, August 12, 11 selection. Advantageous alleles usually take a long time to reach a in indigenous populations, whereas the 7R 27 allele

Reinforcement Reinforcement Adult Behavior &
for “Good” for “Bad” coercion the Matching
In one hour of school, In one hour of school, Law
how often do peers how often do peers How often might adults
Example reinforce the “good” in reinforce the “bad” in in authority exert
The probability of human
behavioral choice
Evolutionary school? school? perceived threats of
“matches” this saturation
Mismatch How often by adults How often by adults coercion in school, at
formula in the classroom,
at school? at school? home, or in the
home and community,
How often at home or How often at home or community in a single
and Matching Law works
day?
community in a day? community in a day? for all vertebrate
creatures


What happens if you change the
Matching Law (the Good
Behavior Game) in a classroom?


CDC Nurses Office Study

60%

50%

Percentage Change
40%

30%

20%

10%

0%

-10%

-20%
All Visits Injury Viists Non-Injuries Fighting Non-Fighting
Injuries Injuries

Control/Wait List PeaceBuilders

What happens if you teach students to praise
each other for “peaceability”


DRI = Differential DRO = Differential
Reinforcement of Reinforcement of Other
Incompatible Behaviors Behaviors


Molecular Psychiatry (2000) 5, 467–475
 2000 Macmillan Publishers Ltd All rights reserved 1359-4184/00 $15.00
www.nature.com/mp

MILLENNIUM ARTICLE

Is there an evolutionary mismatch between the normal
physiology of the human dopaminergic system and
current environmental conditions in industrialized
countries?
L Pani
CNR Center for Neuropharmacology, ‘BB Brodie’ Department of Neuroscience, University of Cagliari and Neuroscienze
Scarl, Cagliari, Italy

A large body of evidence has recently defined a field theory known as ‘evolutionary mismatch’,
which derives its attributes largely from the fact that current environmental conditions are
completely different from those in which the human central nervous system evolved. Current
views on the evolutionary mismatch theory lack, however, any attempts to define which brain
areas or neuronal circuits should be mostly involved in coding such misevolved traits and to
what extent our neurobiological knowledge can be applied to the topographical localization
of a specific psychopathology. In this respect the mesocorticolimbic dopaminergic circuits
have long been misconceptualized as simple reward or reinforcement systems. Instead, they
motivate and coordinate the functions of the higher brain areas that mediate planning and
foresight and direct finalized movement in both animals and humans. These systems make
animals intensely interested in exploring the world around them, but by the same means they
also make them susceptible to the environmental stimuli that have been sought and con-
sumed. It is has been speculated that the cortical dopamine targets that developed most
recently in phylogeny are of particular functional value, and that the mesocorticolimbic dopa-
minergic system is involved in more complex integrative functions than previously assumed.
In the present paper I will argue that some mental disorders may have their deep roots in the
evolutionary mismatch between the normal physiology of the mesocorticolimbic dopami-
nergic system and the current environmental conditions in affluent societies. Molecular Psy-
chiatry (2000) 5, 467–475.
Keywords: evolution; limbic system; dopamine; stress; depression; emotions; Darwinian medicine

Friday, August 12, 11 Introduction Table 1 Steps in brain evolution with increasing environ-
32

Changes in
antecedents of life?

TV’s in bedrooms
Text Electronic games
Computers, social media


Social Network & Sleep Deprivation
Text

Social Network & Marijuana Use


Apparent consumption o inoleic acid (% of dietary energy) among
Australia, Canada, UK and USA for the years 1961–2000

10 Australia Canada UK USA

Apparent consumption of linoleic acid
9

8

7

(% energy)
6

5

4

3

2

1

0
1960 1965 1970 1975 1980 1985 1990 1995 2000

“Risky” Beh.
Evolution Neonates Breast Milk
& Mismatch
In the Rife Valley, the Successful human American infants have
human brain evolution neonates born with been getting steadily less Theory
the result of eating fish 60-day supply of omega-3 (n3) and more Almost all adolescent
pro-inflammatory risky behaviors have now
Example high in omega-3 not omega-3 in
omega-6 (n6) in breast been documented to be
savannah animals subcutaneous fat from
Evolutionary milk related to low n3 and
mother’s diet high n6 in US diet
Physiology See Broadhurst, Cunnane, & change in last 50 years
Mismatch
See HIbbeln et al. (2007).Maternal seafood
Crawford (1998). Rift Valley lake fish See Ailhaud et al. (2006).Temporal changes
consumption in pregnancy and
in dietary fats: Role of n6
and shellfish provided brain-specific neurodevelopmental outcomes in childhood Hibbeln et al. (2006). Healthy intakes of n-3
polyunsaturated fatty acids in excessive
nutrition for (ALSPAC study): an observational cohort
adipose tissue and n-6 fatty acids: estimations considering
early Homo study worldwide diversity.
development and relationship to obesity


30%

Percentage with Psychosis at 12 months
27.5%
24%

18%

12%

6%
4.9%
0%
Omega-3 Placeo
Psychosis


Evolutionary Mismatch
Language of belonging and danger


K R R
Path Path
Path

Evolutionary Path
of a Child’s Life

Probability of long-life and Probability of short-life and
reproductive success doubtful reproductive success


K R R
Path Path
Path

Evolutionary Path
of a Child’s Life

Probability of long-life and Probability of short-life and
reproductive success doubtful reproductive success
R-Path can be triggered by
evolutionary mismatch in social or
physical environment.


Human Infectious/Biological Threats Human Predatory Threats



Evolutionary Adaptive Responses
(Simplified)

Generalized Localized
Inflammatory Inflammatory
Response Response

Anti-Inflammatory Regulators



Evolutionary Adaptive Responses Evolutionary Adaptive Responses
(Simplified) (Simplified)

Intra-Group Threat Attributional
Generalized Localized Affiliation Bias (Inflammatory)
Inflammatory Inflammatory (Anti-Inflammatory)
Out-Group
Response Response
Aggress. (Inflammatory)
Intra-Group
Cooperation Tit-for-Tat Beh. Bias
Anti-Inflammatory Regulators (Anti-Inflammatory)
(Inflammatory)



(Simplified) Neuro-Hormones (Simplified)

Mood
Modulators

Reward Delay Intra-Group Threat Attributional
Generalized Localized Modulators
Affiliation Bias (Inflammatory)
Out-Group
Response Response Stress
Modulators Intra-Group
Anti-Inflammatory Regulators Puberty/Sex (Anti-Inflammatory)
Modulators (Inflammatory)



(Simplified) Neuro-Hormones (Simplified)

Mood
Modulators

Reward Delay Intra-Group Threat Attributional
Generalized Localized Modulators
Affiliation Bias (Inflammatory)
Out-Group
Response Response Stress
Modulators Intra-Group
Anti-Inflammatory Regulators Puberty/Sex (Anti-Inflammatory)
Modulators (Inflammatory)

Modern culture commonly produces multiple evolutionary mismatches triggering multiple inflammatory responses.


Obesity
Conduct
Disorders

Homicide &
Suicide

Depression

Oppositional/
Addictions ADHD

Aggression

Self
harm

ANXIETY

R PATH = Risky behaviors or health

How many of you know a regular
American family with a child with…
a mental, emotional or behavioral disorder?


How many of you know a regular
American family with a child with…
a mental, emotional or behavioral disorder?

Like a more
Like ADHD or Like learning or serious mental Like a serious
behavior developmental illness like addictions
problems? disorder? bipolar or problem?
suicidal actions?


Key messages about mental, emotional & behavioral disorders…



MEB’s are
preventable.



MEB’s are Break-even for
preventable. MEB prevention
is one year.



MEB’s are Break-even for MEB prevention
preventable. MEB prevention balances
is one year. budgets.



MEB’s are Break-even for MEB prevention MEB prevention
preventable. MEB prevention balances improves US
is one year. budgets. business.




Effective MEB
prevention helps
national security.




Effective MEB MEB prevention
prevention helps helps US global
national security. success.




MEB prevention
Effective MEB MEB prevention saves Social
prevention helps helps US global Security &
national security. success. Medicare.




MEB prevention
Effective MEB MEB prevention saves Social MEB prevention
prevention helps helps US global Security & heals past
national security. success. Medicare. inequities.


Mental, emotional, behavioral and health
disorders are preventable by our own
hands—right here in Washington State.


Increase nurturance of prosociality for
persons of all ages
This can be individual, family, school and/or community action

Reduce toxic inﬂuences of all ages
This can be at an individual, family, school and/or community level

Increase psychological ﬂexibility among
people of all ages
This can be achieved across settings, as the above.

From Biglan, Flay and Embry. Nurturing Environments and the Next Generation of Prevention Research and Practice for the American Psychologist


Clin Child Fam Psychol Rev
DOI 10.1007/s10567-008-0036-x

Evidence-based Kernels: Fundamental Units of Behavioral
Influence
Basic understanding of kernels
Embry, D. D. and A. Biglan (2008). "Evidence-Based Kernels:
Dennis D. Embry Æ Anthony Biglan

Fundamental Units of Behavioral Influence." Clinical Child & Family
Psychology Review 11(3): 75-113.
Ó The Author(s) 2008. This article is published with open access at Springerlink.com

Abstract This paper describes evidence-based kernels, This paper presents an analysis of fundamental units of
fundamental units of behavioral influence that appear to behavioral influence that underlie effective prevention and
underlie effective prevention and treatment for children, treatment. We call these units kernels. They have two
adults, and families. A kernel is a behavior–influence defining features. First, in experimental analysis,
procedure shown through experimental analysis to affect a researchers have found them to have a reliable effect on

Using kernels for population change
A R T I C L E

COMMUNITY-BASED
PREVENTION USING SIMPLE,
LOW-COST, EVIDENCE-BASED Embry, D. D. (2004). "Community-Based Prevention Using Simple,
KERNELS AND BEHAVIOR
VACCINES Low-Cost, Evidence-Based Kernels and Behavior Vaccines."
Dennis D. Embry
PAXIS Institute
Journal of Community Psychology 32(5): 575.
A paradox exists in community prevention of violence and drugs. Good

B e h a v i o r a l Vac c i n e s an d
Evidence-Based Kernels:
Nonpharmaceutical Behavioral vaccines for disease control
A p p ro a c h e s f o r th e
P re v e n t i o n o f M e n t a l , Embry, D. D. 2011. Behavioral vaccines and evidence-based kernels:
Emotional, and
B e h a v i o r a l D i s o rd e r s
non-pharmaceutical approaches for the prevention of mental, emotional,
Dennis D. Embry, PhD
and behavioral disorders. Psychiatr Clin North Am 34 (1):1-34.
KEYWORDS


What is a kernel?
Is the smallest unit of scientiﬁcally proven behavioral
inﬂuence.

• Is indivisible; that is, removing any part makes it
inactive.

Produces quick easily measured change that can
grow much bigger change over time.

Can be be used alone OR combined with other
kernels to create new programs, strategies or
policies.

• Are the active ingredients of evidence-based
programs

• Can be spread by word-of-mouth, by modeling, by
non professionals.

• Can address historic disparities without stigma, in
part because they are also found in cultural wisdom.


Relational
Antecedent Reinforcement Physiological
Frame
Kernel Kernel Kernel
Kernel

Changes Creates verbal
Happens BEFORE Happens AFTER the
biochemistry of relations for the
the behavior behavior
behavior behavior

Embry, D. D., & Biglan, A.
(2008). Evidence-Based

Four Types of Kernels
Kernels: Fundamental Units of
Behavioral Inﬂuence. Clinical
Child & Family Psychology
Review, 39.


Kernel Description Behaviors Affected References
Combinations of visual, kinesthetic and/or auditory
Non-verbal cues that single shifting attention or task in Reduces dawdling, increases time on task or Rosenkoetter, & Fowler, 1986; Krantz, & Risley, 1977; Abbott et al., 1998;
transition cues patterned way, coupled with praise or occasional engaged learning; gives more time for instruction Embry et al., 1996
rewards.

Antecedent Stop lights in Trafﬁc light signals when behavior is appropriate/
(Cox, Cox, & Cox, 2000; Jason & Liotta, 1982; Jason, Neal, & Marinakis,
desirable or inappropriate/undesirable in real time, Decreases noise, off task behavior, or increases
Kernel school settings or
trafﬁc settings
and connected to some kind of occasional stopping in dangerous intersections
1985; Lawshe, 1940; Medland & Stachnik, 1972; Van Houten & Malenfant,
1992; Van Houten & Retting, 2001; Wasserman, 1977)
reinforcement.

These may be lines or other cues such as ropes or Decreases dangerous behavior; decreases
Boundary cues and (Carlsson & Lundkvist, 1992; Erkal & Safak, 2006; Marshall, et al., 2005;
rails that signal where behavior is safe, acceptable pushing and shoving; increases waiting behavior
railings or desired in a queue; reduces falls
Nedas, Balcar, & Macy, 1982; Sorock, 1988)

Happens Cooperative, Planned activities happen during children play time
Decreases aggression and increases social
competence; also affects body mass index, and (Bay-Hinitz, Peterson, & Quilitch, 1994; Leff, Costigan, & Power, 2004;
BEFORE the Structured peer
play
that involve rules, turn taking, social competencies,
and cooperation with or without “soft competition.”
appears to reduce ADHD symptoms, and increase
academics afterwards; reduces social rejection in
Mikami, Boucher, & Humphreys, 2005; Murphy, et al., 1983; Ridgway,
Northup, Pellegrin, LaRue, & Hightsoe, 2003)
behavior middle school
(Barker & Jones, 2006; Ben Shalom, 2000; Bray & Kehle, 2001; Buggey, 2005; Clare,
Drawn, photographic or video model viewer/listener Increases academic engagement; increases attention; Jenson, Kehle, & Bray, 2000; Clark, Beck, Sloane, Goldsmith, & et al., 1993; Clark, Kehle,
increases recall and long term memory; improves behavior; Jenson, & Beck, 1992; Clement, 1986; R. A. Davis, 1979; Dowrick, 1999; Dowrick, Kim-
Self-modeling engaging targeted behavior, receiving rewards or reduces dangerous behavior; increases social competence; Rupnow, & Power, 2006; Elegbeleye, 1994; Hartley, Bray, & Kehle, 1998; Hartley, Kehle, &
recognition. improved sports performance; reduced health problems Bray, 2002; Hitchcock, Prater, & Dowrick, 2004; Houlihan, Miltenberger, Trench, Larson, & et
al., 1995; Kahn, Kehle, Jenson, & Clark, 1990; Kehle, Bray, Margiano, Theodore, & Zhou,
2002; Law & Ste-Marie, 2005; Lonnecker, Brady, McPherson, & Hawkins, 1994; Meharg &
(Agran, et al., 2005; Blick & & Woltersdorf, 1990; Owusu-Bempah& Frank, 1990; Buggey, 1995;
Lipsker, 1991; Meharg Test, 1987; Boyle & Hughes, 1994; Brown & Howitt, 1985; Owusu-
Reductions in alcohol, tobacco use; reductions in illness Buggey, Toombs, Gardener, & Cervetti, 1999; Burch, Clegg, & Bailey, 1987; Carr & Punzo, 1993; Cavalier,
Coding target behavior with a relational frame, which symptoms from diabetes; increased school achievement; changes Bempah & Hodges, 1983;Clare, et al., 2000;McLoughlin,Kehle, & Truscott, 2001; Dalton, Martella, &
Ferretti, &
Howitt, 1997; Possell, Kehle, Clarke, Bray, & Bray, 1999; Ram & McCullagh, 2003;
Reamer, Brady, & Hawkins, 1998; Rickards-Schlichting, Kehle, & Bray, 2004; Rickel & Fields,
Self-monitoring is often charted or graphed for public or semi-public in other social competencies or health behaviors; reductions in Marchand-Martella, 1999; de Haas-Warner, 1991; R. M. Foxx & Axelroth, 1983; Glasgow, Klesges,
Godding, & Gegelman, 1983; Glasgow, Klesges, & Vasey, 1983; Gray & & Simon, 1997; Walker &
1983; Schunk & Hanson, 1989; Schwartz, Houlihan, Krueger, Shelton, 1992; Hall & Zentall,
display, occasioning verbal praise from others ADHD, Tourettes and other DSM-IV disorder; improvement in 2000; K. R. Harris, Friedlander, 1992; Wedel & Fowler, 1984; Woltersdorf, 1992) 1990; Hitchcock,
Clement, Saddler, Frizzelle, & Graham, 2005; Hertz & McLaughlin,
brain injured persons et al., 2004; Hughes, et al., 2002; Kern, Dunlap, Childs, & Clarke, 1994; Martella, Leonard, Marchand-
Martella, & Agran, 1993; M. Y. Mathes & Bender, 1997; McCarl, Svobodny, & Beare, 1991; McDougall &
Brady, 1995; McLaughlin, Krappman, & Welsh, 1985; Nakano, 1990; O'Reilly, et al., 2002; Petscher &
Bailey, 2006; Possell, et al., 1999; Rock, 2005; Selznick & Savage, 2000; Shabani, Wilder, & Flood, 2001;
After hearing or seeing some content, person is told Shimabukuro, Prater, Jenkins, & Edelen-Smith, 1999; Stecker, Whinnery, & Fuchs, 1996; Thomas,
Paragraph Abrams, & Johnson, 1971; Todd, Horner, &G. Mathes, Fuchs, Fuchs, Henley,Winn, Skinner,
(Bean & Steenwyk, 1984; P. Sugai, 1999; Trammel, Schloss, & Alper, 1994; & et al.,
to “shrink” meaning to 8-10 words, full sentence; Improved reading responses and retention Allin, & Hawkins, 2004; Wood, Murdock, & Cronin, 2002; Wood, Murdock, Cronin, Dawson, & Kirby, 1998)
Shrinking praise typically happens for good summaries.
1994; Spencer, Scruggs, & Mastropieri, 2003)


= Public Posting Kernel
Antecedent
Kernel

Happens
BEFORE the
behavior

= radar


Kernel Description Behaviors Affected References
Person or group receives spoken (or Examples: Cooperation, social competence, academic (Leblanc, Ricciardi, & Luiselli, 2005; Lowe & McLaughlin, 1974; Marchant
engagement, academic achievement, positive-parent child
signed) recognition for engagement in & Young, 2001; Marchant, Young, & West, 2004; Martens, Hiralall, &
Verbal Praise target acts, which may be descriptive or
interactions, positive marital relations, better sales Bradley, 1997; Matheson & Shriver, 2005; C. M. Robinson & Robinson,
performance; reduced disruptive or aggressive behavior; 1979; S. Scott, Spender, Doolan, Jacobs, & Aspland, 2001)
simple acknowledgements reduced DSM-IV symptoms

Reinforcement Peer-to-peer written A pad or display of decorative notes are
Examples: social competence, academic (Cabello & Terrell, 1994; Embry, Flannery, Vazsonyi, Powell, & Atha, 1996;
praise--“Tootle” Notes, posted on a wall, read aloud, or placed in a
Kernel compliments books/ photo type album in which behaviors
achievement, work performance, violence,
Farber & Mayer, 1972; Heap & Emerson, 1989; Mayer, Butterworth,
Nafpaktitis, & Sulzer-Azaroff, 1983; Mayer, Mitchell, Clementi, Clement-
aggression, physical health, vandalism Robertson, & et al., 1993; Skinner, Cashwell, & Skinner, 2000)
praise notes receive written praise from peers
Tokens or symbolic rewards for positive
behavior result in random rewards from Academic achievement, disruptive behavior, (Thorpe, Darch, & Drecktrah, 1978; Thorpe,
Principal Lottery status person (e.g., principal, authority aggression Drecktrah, & Darch, 1979)
ﬁgures) such as positive phone calls home

Happens AFTER Safety or Tokens or reward tickets given out for
Safety behaviors, accident reduction,
(Geller, Johnson, & Pelton, 1982; Putnam, Handler, Ramirez-
Performance observed safety or performance behavior, Platt, & Luiselli, 2003; Roberts & Fanurik, 1986; Saari &
the behavior Lottery which are entered into lottery
improved sales or work performance Latham, 1982)

Music is played or stopped in real time, Increased weight gain of babies, improved baby (Allen & Bryant, 1985; Barmann & Croyle-Barmann, 1980; Barmann, Croyle-Barmann, & McLain, 1980;
Bellamy & Sontag, 1973; Blumenfeld & Eisenfeld, 2006; Cevasco & Grant, 2005; Cook & Freethy, 1973;
development possibly, work performance, academic
Contingent music Cotter, 1971; W. B. Davis, Wieseler, & Hanzel, 1980; Dellatan, 2003; Deutsch, Parks, & Aylesworth, 1976;
based on observed behavior of the achievement, attention and focus (ADHD symptoms Eisenstein, 1974; Harding & Ballard, 1982; Hill, Brantner, & Spreat, 1989; Holloway, 1980; Hume &
Crossman, 1992; Jorgenson, 1974; Larson & Ayllon, 1990; Madsen, 1982; McCarty, McElfresh, Rice, &
individual or group. down); reduced aggression Wilson, 1978; McLaughlin & Helm, 1993; Standley, 1996, 1999; Wilson, 1976; D. E. Wolfe, 1982)

Improved academic engagement and achievement, (Beersma, et al., 2003; Hoigaard, S?fvenbom, &
Soft Team Groups compete on some task, reduced disruptive behavior, increased sales,
increased funding raising, increased safety; reduced
Tonnessen, 2006; Kivlighan & Granger, 2006; Koffman,
competition performance, or game. smoking; changed brain chemistry favoring attention Lee, Hopp, & Emont, 1998; Neave & Wolfson, 2003;
and endurance Tingstrom, Sterling-Turner, & Wilczynski, 2006)

Peer-to-peer Increased academic achievement; reduced (Allsopp, 1997; Delquadri, Greenwood, Stretton, & Hall, 1983;
Dyad or triad take turns asking questions,
ADHD and conduct problems; long-term DuPaul, Ervin, Hook, & McGoey, 1998; Fantuzzo & Ginsburg-Block,
tutoring give praise or points and corrective
effects on school engagement; decreased 1998; Greenwood, 1991a, 1991b; Maheady, Harper, & Sacca,
feedback 1988; Maheady, Sacca, & Harper, 1988; Sideridis, et al., 1997)
special education needs.


Survival analysis to show long-term advantage of
prize bowl kernel

Standard Community Treatment
Prize Bowl for Recovery


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Preventing Mental Health Epidemic for All

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