Preventing Mental, Emotional and Behavioral Disorders - Part 1

Mental, Emotional and Behavioral Disorders are
Preventable - Part 1
Dennis D. Embry, Ph.D., Senior Scientist and President, PAXIS Institute
Co-Investigator, Promise Neighborhood Research Consortium, ORI

Objectives today
Identify what kernels are or are not and the types
of kernels What behavior would you like to change?
Work through several examples of applying kernels
to common problems
Make a plan to use a kernel to inﬂuence a behavior
of concern to the participants

Darwin Meets Mendel
Darwin documented the big picture.
Mendel documented the two types of genes—
qualitative and quantitative. Nobody paid any
attention to quantitative genes until the early
1990s. Now, we know them as polygenetics
and epigenesis.

Biology has the genome and proteinomics.
Physics has periodic table.
What does behavioral science have?

Homo influencer?
Do humans influence each other?

Why do we influence each other?

How long have we been influencing each other?

Is there a science of influencing other humans?

What are the tools that we influence each other?

Other Humans are principal source of safety. Other Humans are principal vertebrate predator.

The Unique Human Evolutionary Niche

How do humans inﬂuence each other to be How do humans inﬂuence each other for
more protective of one another? harm to other?

What are the fundamental units of behavioral
inﬂuence used by modern humans?

What were the fundamental
units of behavioral inﬂuence
used by humans 40,000
years ago?
About 40,000 years ago, with the appearance of the Cro-
Magnon culture, tools became markedly more sophisticated,
incorporating a wider variety of raw materials such as bone and
antler. They also included new implements for making clothing,
engravings, and sculptures. Fine artwork, in the form of
decorated tools, beads, ivory carvings of humans and animals,
clay ﬁgurines, musical instruments, and cave paintings,
appeared over the next 20,000 years.

FREE DOWNLOAD

Embry, D. D., & Biglan, A. (2008).
Evidence-Based Kernels: Fundamental
Units of Behavioral Inﬂuence. Clinical
Child & Family Psychology Review, 39.

Download at:

www.pubmed.gov
Described in the 2009 IOM Report, p. 210

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 often 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.

What are these? What are these?

What are these? What are these?
How might these be selected by consequences?

Reinforcement
Kernel
One of these Unagax men is a better “catch” to have as a mate.
How might these be selected by consequences?

52 Examples of Kernels
Antecedents
Reinforcements
Physiological
Relational frames

= Public Posting Kernel
Antecedent
Kernel

Happens
BEFORE the
behavior

= radar

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)

Prize Bowl/Mystery
Motivator Kernel
Reinforcement
Kernel

Happens AFTER
the behavior

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.

Omega 3 kernel
30%
Physiological
Percentage with Psychosis at 12 months

Kernel 27.5%
24%

18%

Changes 12%
biochemistry of
behavior 6%
4.9%
0%
Omega-3 Placeo
Psychosis

Amminger, G. P., M. R. Schafer, et al. (2010). "Long-Chain {omega}-3 Fatty Acids for Indicated
Prevention of Psychotic Disorders: A Randomized, Placebo-Controlled Trial." Arch Gen
Psychiatry 67(2): 146-154.

Reduced Felony Violent Oﬀences Among Prisoners 
with recommended daily amounts of vitamins, minerals and essen=al fa>y acids
Ratio of Disciplinary Incidents Supplementation/Baseline

1.00

Ac=ve ‐37.0% Placebo ‐10.1%
0.75  p ‹ 0.005  p = ns

0.50

Active
0.25 Placebo

0
Before supplementation During supplementation

UK maximum security prison ‐ 338 oﬀences among 172 prisoners over 9 months treatment in a compared to 9 
months baseline. 
Gesch et al.  Br J Psychiatry 2002, 181:22‐28

Consilience Issues (pardon a digression)
Parsimony or Occams’ Razor:
"Pluralitas non est ponenda sine neccesitate" or
"plurality should not be posited without necessity."
The words are those of the medieval English
philosopher and Franciscan monk William of
Ockham (ca. 1285-1349).
Links to meta theories versus depending on
mezzo-theories—e.g., “selection by consequences
that embraces evolution, neural plasticity, and
principles of reinforcement.”

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

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“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
high in omega-3 not omega-3 in
omega-6 (n6) in breast been documented to be
savannah animals subcutaneous fat from milk related to low n3 and
mother’s diet high n6 in US diet
See Broadhurst, Cunnane, & See HIbbeln et al. (2007).Maternal seafood
change in last 50 years
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


Pleasant greeting with Affects donations; social status an
Friendly physical and verbal perceptions of safety or harm; affects (Edwards & Johnston, 1977; Ferguson, 1976; T. Field, 1999; Fry,
or without positive 1987; Howard, 1990; la Greca & Santogrossi, 1980; Schloss,
gestures, on a frequent basis. behavior streams of aggression, hostility or Schloss, & Harris, 1984)
physical touch politeness
Physiological (Diego, et al., 2002; T. Field, N. Grizzle, et al., 1996; T. Field, Kilmer,
Massage, Any method of rubbing, stroking Reduces aggression, arousal, cortisol,
Kernel brushing or and therapeutic touch applied to depressive symptoms, PTSD
Hernandez-Reif, & Burman, 1996; T. Field, Seligman, Scafidi, &
Schanberg, 1996; T. M. Field, 1998; T. M. Field, Grizzle, Scafidi, &
Schanberg, 1996; Jones, Field, & Davalos, 1998; Scafidi & Field,
stroking the body symptoms, and pain 1996)

Using a turtle metaphor, child holds self,
Turtle verbal frame, breaths through nose, and Reduces arousal and aggression (Heffner, Greco, & Eifert, 2003; Robin,
engage in sub-verbal or verbal self- against peers or adults Schneider, & Dolnick, 1976)
Technique coaching, with peer or adult reinforcement
Changes “Rough and Tumble” Several times per week child or adolescent Reduces aggression, teaches self-control, may improve status
among same-sex peers; changes c-fos gene expression in
(Boulton & Smith, 1989; Gordon, Kollack-Walker, Akil, &
engages in rough and tumble play, causing Panksepp, 2002; Hines & Kaufman, 1994; Jacklin, DiPietro, &
biochemistry of Free Play with higher
status conspecific
increased arousal and self-control mediated
laboratory animals; the behavior may be especially important to
the development of positive behavior among boys and unique Maccoby, 1984; Paquette, 2004; Pellegrini & Smith, 1998;
by status adult or peer contribution of fathering Reed & Brown, 2001; E. Scott & Panksepp, 2003)
behavior (Antunes, Stella, Santos, Bueno, & de Mello, 2005; Atlantis, Chow, Kirby, & Singh, 2004;

Aerobic play Daily or many times per week child or adult Reduces ADHD symptoms, reduces depression;
engage running or similar aerobic solitary reduces stress hormones; may increase cognitive
Berlin, Kop, & Deuster, 2006; Blue, 1979; Blumenthal, et al., 2005; Crews, Lochbaum, &
Landers, 2004; Doyne, Chambless, & Beutler, 1983; Dunn, Trivedi, Kampert, Clark, &
Chambliss, 2005; Dunn, Trivedi, & O'Neal, 2001; Dustman & et al., 1984; Khatri, et al., 2001;
or behavior activities, game, or food gathering behavior function; decreases PTSD Kubesch, et al., 2003; Manger & Motta, 2005; Marin & Menza, 2005; Phillips, Kiernan, &
King, 2003; M. B. Stein, 2005; Stella, et al., 2005)

Progressive Person tenses and relaxes sequence of Reduces panic, fear, anxiety; decreases negative (Larsson, Carlsson, Fichtel, & Melin, 2005; Norlander, Mo?s,
muscles in combination with anxiety attributions; decreases phobic responses with & Archer, 2005; Pawlow & Jones, 2005; Wencai, Xinhu, Kele,
muscle relaxation evoking stimulus paired with evoking stimuli & Yiyuan, 2005)

Zinc Evolving evidence shows that the addition of zinc (Akhondzadeh, Mohammadi, & Khademi, 2004; Arnold, et al.,
15 mg per day eaten or to the diet or by supplementation increases the 2005; Arnold & DiSilvestro, 2005; Bilici, et al., 2004; McGee,
supplementation or effectiveness of drug treatment and/or may Williams, Anderson, McKenzie-Parnell, & Silva, 1990;
dietary consumption supplemented prevent ADHD symptoms. Sandyk, 1990)

Motivational (values expression) kernel
A Simple Gift Example: My Values1
Relational Please provide responses to questions about your ideas, your beliefs, and your life. Please bear in mind that,
Frame there are no right or wrong answers. There are just answers important to you.
Please circle the 1st, 2nd and 3rd most important value from this list
Kernel Athletic ability 1 2 3
Being good at art 1 2 3
Being smart or getting good grades 1 2 3
Creativity 1 2 3
Independence 1 2 3
Living in the moment 1 2 3
Membership in a social group (such as your community, racial group or club) 1 2 3
Music 1 2 3
Creates verbal Politics
Relationships with friends or family
1
1
2
2
3
3
relations for the Religious values
Sense of humor
1
1
2
2
3
3
behavior Please look at the values you picked as most important to you, and to think about times when these values were important to you. Please describe
in a few sentences why the selected values are important to you. Focus on your thoughts and feelings, and don’t worry about spelling, grammar,
or how well written it is. Please list the top two reasons why the values you selected are important to you:

Reason #1:

Cohen, G. L., J. Garcia, et al. (2009). "Recursive Processes in Self-Afﬁrmation:
Intervening to Close the Minority Achievement Gap." Science 324(5925): 400-403.


Increased rule governed behavior; (Choenarom, Williams, & Hagerty, 2005;
Adjectival Noun for Verbal phrase “I am/we _____” is paired
increases behavior associated with the
Relational Belonging to Status with status, belonging, protection or
named group; decreases aggression Embry, et al., 1996; Gaskell & Smith,
Group safety
Frame within group; may affect physical health 1986; Ju?rez, 2002; Mishima, 2003)
Kernel
Public Individuals sign or pledge self to Voting, contributing money,
collective behavior (Burns & Oskamp, 1986)
Commitment recycling,

Individuals or groups are divided into Increase aggression and (Roos, 2005; Sherif, 1958, 1968, 1970;
“US” and “THEM” two groups, with differences highlighted
Creates verbal framed around clothing, adornment, violence by each group toward Sherif, Hogg, & Abrams, 2001; Sherif,
Role Framing
language, social position, etc. each other White, & Harvey, 1955)
relations for the
(Collier, Czuchry, Dansereau, & Pitre, 2001; Czuchry & Dansereau, 1996, 1999, 2003;
behavior Graphic/ node A graphic organizer for goal-based Increased sobriety and goal Czuchry, Dansereau, Dees, & Simpson, 1995; Dansereau, Dees, Greener, & Simpson, 1995;
Dansereau, Joe, & Simpson, 1993; Dees, Dansereau, & Simpson, 1994; Joe, Dansereau,
maps behavior, guided by other status completion; increased treatment Pitre, & Simpson, 1997; Joe, Dansereau, & Simpson, 1994; Melville, Davis, Matzenbacher, &
Clayborne, 2004; Newbern, Dansereau, Czuchry, & Simpson, 2005; Newbern, Dansereau, &
individuals compliance Pitre, 1999; Pitre, Dansereau, & Joe, 1996; Pitre, Dansereau, Newbern, & Simpson, 1998;
Pitre, Dansereau, & Simpson, 1997)

Verbal questioning by status individual Reduction in substance abuse, increase in social (Bernstein, et al., 2005; Burke, Arkowitz, &
Motivational around major goals of target person, competences and related goals; reduction in Menchola, 2003; Resnicow, et al., 2001; Rusch &
Interviewing with clarifying questions about injuries or antisocial behaviors; increase in Corrigan, 2002; D. K. Smith, 2004; Sobell, et al.,
interferring behaviors. healthy behaviors (Monti, et al., 1999) 2003; L. A. R. Stein, et al., 2006)
Media associating Reduces sexually transmitted (Beyth-Marom, Austin, Fischhoff, Palmgren, & et
Media (TV, video, radio) showing
behavior with al., 1993; Downs, et al., 2004; Pechmann, 2001;
“immediate” negative behavior results in social rejection or diseases; reduces alcohol, Pechmann & Ratneshwar, 1994; Pechmann,
escape from social rejection
social outcomes tobacco and other drug use Zhao, Goldberg, & Reibling, 2003)

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What is a behavioral vaccine?
It is a simple procedure (a kernel or a recipe of kernels)
that, when used repeatedly, reduce morbidity and mortality
and/or increase wellbeing or health.
Behavioral vaccines can be used by individuals, families,
schools, businesses, organizations to produce rapid
population level change.

Embry, D. D. (2004). "Community-Based Prevention Using
Simple, Low-Cost, Evidence-Based Kernels and Behavior
Vaccines." Journal of Community Psychology 32(5): 575.

“Behavioral health could learn from public
health in endorsing a population health
perspective”—(IOM, page 19).

“Families and children have ready access to
the best available evidence-based prevention
interventions, delivered in their own
communities…in a respectful non-stigmatizing
The story of the Broad
Street water pump during
way”—(IOM, page 387).
the cholera epidemic in
London.

What is a public-health
approach?
Potential harm is universal,
Personal or Group Risk is Common,
Stigmatizing Persons or Groups At Risk Reduces
Prevention Results, and/or
More Cost Efﬁcient to Reach All Above “Case
Finding.”

Community reinforcement case study

PeaceBuilders School-Community Reinforcement Study

Positive Peer-to-Peer Social
Home Notes Notes Competence Violence

Injury Prevention Study Using Positive Reinforcement

Change in Nurses’
Ofﬁce Visits from
Year to Year

Control/Wait List Intervention

Krug, E. G., N. D. Brener, et al. (1997). "The impact of an elementary school-based violence prevention program on visits to
the school nurse." American Journal of Preventive Medicine 13(6): 459-463.

Injury Prevention Study Using Positive Reinforcement
60%

50%
Change in Nurses’
40% Ofﬁce Visits from
30% Year to Year

20%

10%

0%

-10%

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

Control/Wait List Intervention

Krug, E. G., N. D. Brener, et al. (1997). "The impact of an elementary school-based violence prevention program on visits to
the school nurse." American Journal of Preventive Medicine 13(6): 459-463.

Reward & Reminder case study on tobacco

Reward &
Reminder:
Logic
model

Baseline After Reward and Reminder
60%
Wyoming

Percentage of Illegal or Non-Compliant Tobacco Sales to Minors
50%

40%

Reward &
30%

20%

Reminder Impact 10%

on Access 0%

60%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Wisconsin
50%

40%

30%

20%

10%

0%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Data Source: Synar Report, SAMSA

Reward &
Reminder:
Impact on
prevalence

Source: Youth Risk Behavior Survey (YRBS), Centers for Disease Control

Why not turn about the lives of high risk primary
grade children using a teacher invented procedure?

Muriel Saunders,
the teacher

Kernel or Useful Component of PAX Good Behavior Game Kernel or Component Rationale

Response cost for negative behavior (e.g., Conyers et al., 2004) Easier to use and effective for ADHD like behaviors

Team competition (e.g., Beersma et al., 2003) Creates positive peer pressure, and reduces negative peer attention

Public posting of results (e.g., Parsons, 1982) Increases performance and peer pressure

Team Rotations (deemed critical but no study) Reduces bullying and peer rejection

Low emotional response to negative behaviors (e.g., Abromowitz et al., 1987) Reduces accidental attention to negative behavior by adult

Three games per day (deemed critical but no study) Improves maintenance of skill

Use of timer (e.g., Adams & Drabman, 1995) Creates pressure to succeed and excitement

Secret Game (unannounced) – indescriminable contingency – (Freeland & Noel, 2002) Increases generalization to non-game times

Lower points to win (e.g., Harris & Sherman, 1973) Causes more rapid improvement

Student help design game rules (e.g., Fishbein & Wasik, 1981) Improves acceptance by students and occasions correspondence

Relational frame language correspondence training (e.g., “I’m a PAX Leader) (Embry et al., 1996) Improves generalization of rule governed behavior

Use of Premack Principle for prizes (e.g., Browder et al., 1984) Improves acceptability of game by students and adults

Non-verbal cues (e.g., Rosenkoetter & Fowler, 1986; Cox, Cox, & Cox, 2000) Accelerates generalization and adoption of the game

Meaningful roles as DRO (e.g., Rutter, 1981) Increases attention to positive behavior; reduces problem actions
Setting generalization — recipe for carrying over the Game to hallways, restrooms, cafeteria, etc.
Improves generalization by students and acceptability of game by adults
(e.g., Fishbein & Wasik, 1981)
Symbolic self-modeling (e.g., Embry et al., 1996) Improves imitation of behavior
School-home note (e.g., Kelley et al., 1988) Prompts family reinforcement and generalization of behavior to home
Peer-to-peer praise notes (e.g., Embry et al., 1996; Skinner et al., 2000) Improves social competence and reduces negative peer attention

Self-monitoring by teacher (e.g., Agran et al., 2005) Improves mastery of skill and results by teacher

Good behavior lottery (e.g.. Putman et all, 2003 Improves generalization when not playing the game

PAX GBG Implementation Rubric
PAX Game Coaching Observation
Kernel or Component Highest Score High Score Moderate Score Poor No Use
for Success 4 3 2 1 0
Preparing the All of the following: Four of the following: Three of the following: Less than Three of the Teacher does not attempt
Students for the -Teacher gets the children’s -Teacher gets the -Teacher gets the following: to prepare the students
Game attention before starting the children’s attention before children’s attention before -Teacher gets the children’s for the game
game (e.g. uses PAX Quiet) starting the game (e.g. starting the game (e.g. attention before starting the -or-
- Gives clear directions for uses PAX Quiet) uses PAX Quiet) game (e.g. uses PAX Quiet) Teacher does not play
(PAX Quiet Kernel) the activity the children will be - Gives clear directions for - Gives clear directions for - Gives clear directions for the game during the
completing during the game. the activity the children will the activity the children will the activity the children will be scheduled observation
- Identifies/references the be completing during the be completing during the completing during the game.
spleems that will be counted game. game. - Identifies/references the
during this game. - Identifies/references the - Identifies/references the spleems that will be counted
- Sets timer in full view of spleems that will be spleems that will be during this game.
children and announces that counted during this game. counted during this game. - Sets timer in full view of
they will be playing the game - Sets timer in full view of - Sets timer in full view of children and announces that
for _____ minutes. children and announces children and announces they will be playing the game
-Announces that “the game that they will be playing the that they will be playing the for _____ minutes.
starts NOW.” game for _____ minutes. game for _____ minutes. -Announces that “the game
-Announces that “the game -Announces that “the game starts NOW.”
starts NOW.” starts NOW.”
Choice of Activity Teacher has chosen an Teacher has chosen a Teacher has chosen a Teacher has chosen a No activity chosen-
appropriate activity for the semi-appropriate activity for partially-appropriate activity inappropriate activity for the students are not given a
(Appropriateness of students to complete while the students to complete for the students to students to complete while task to complete while
task setting for playing the game while playing the game complete while playing the playing the game playing the game
All of the following: Two of the following: game None of the following: -or-
Game) -teacher is able to be an -teacher is able to be an One of the following: -teacher is able to be an Teacher does not play
observer observer (does not need to -teacher is able to be an observer (does not need to the game during the
-Appropriate skill level; not interact with students) observer (does not need to interact with students) scheduled observation
too easy or difficult for -Appropriate skill level; not interact with students) -Appropriate skill level; not
students too easy or difficult for -Appropriate skill level; not too easy or difficult for
-Educational purpose tied to students too easy or difficult for students
curriculum (not just -Educational purpose tied students -Educational purpose tied to
busywork) to curriculum (not just -Educational purpose tied curriculum (not just
busywork) to curriculum (not just busywork)
busywork)
Timing the Game Timer is used to time the Timer is used to time the Timer is used to time the Teacher attempts to use the No timer used
game game game timer but does not follow -or-
(Beat the Timer And both of the following: And one of the following: And neither of the through (i.e. sets the timer Teacher does not play
Kernel) -Timer is placed in a -Timer is placed in a following: but never acknowledges the game during the
visible/auditory location visible/auditory location -Timer is placed in a when it goes off) scheduled observation
where it can be heard by all where it can be heard by all visible/auditory location -or-
-Time is referred to during the -Time is referred to during where it can be heard by all Teacher times the game
game (i.e. 3 minutes left or the game (i.e. 3 minutes -Time is referred to during using another device (e.g.

!"#$%&#'()*)*)+(+' ,$-&'('

Her invention immediately increases time to learn

Why not turn about the lives of high risk primary
grade children using a teacher invented procedure?

A environmental policy case
study in reducing early
rebelliousness, risk taking
and sensation seeking
This risk factor can be easily measured in early-childhood, and it
predicts lifetime injuries, delinquency, alcohol/drug abuse
abuse, and school difﬁculties.

Contextual example of such risk

Oh,prior prevention efforts in Sweden had resulted
in more fatalities…

Safe Playing Self-Modeling Books

Safe Playing Verbal Praise/Stickers

Safe Playing Sit and Watch

Sit and Watch

Conduct small single subject
studies ﬁrst to test tools
Use the ﬁrst
studies to
identify sources
of variation

Let’s apply kernels to some behaviors you are concerned about,
discuss research agendas, and experimental designs?

For more information
Contact:
Dennis D. Embry, Ph.D.
PAXIS Institute
PO 31205
Tucson, AZ 85751
Ph: 520-299-6770
dde@paxis.org
See www.slideshare.net/drdennisembry for more
presentations, papers and videos

Preventing Mental, Emotional and Behavioral Disorders - Part 1

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