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Upstream Prevention of
                                                              Alcohol and Related
                                                              Problems among America’s
                                                              Young People: Reclaiming
                                                              America’s Promise

                             An	
  inquiry	
  into	
  possibili/es               Dennis D. Embry, Ph.D.
                                                                                 President/Senior Scientist
                             West	
  Windsor,	
  NJ	
  •	
  Nov	
  14,	
  2012
                                                                                 PAXIS Institute



Wednesday, November 14, 12
A recent
                             webinar
                             experience
                             on prevention




Wednesday, November 14, 12
Wednesday, November 14, 12
How early is
                             this prevention?




Wednesday, November 14, 12
Wednesday, November 14, 12
Is this early
                             prevention?




Wednesday, November 14, 12
Wednesday, November 14, 12
Is this early
                             prevention?




Wednesday, November 14, 12
Wednesday, November 14, 12
Is this early
                             prevention?




Wednesday, November 14, 12
Thinking way upstream
                             What might be the early malleable predictors?




                                           What if universities
                                             started here
                                              with early
                                             prevention?




Wednesday, November 14, 12
Thinking way upstream
                             What might be the early malleable predictors?
                             Could we actually change those predictors easily
                             and reliably?
                             And what else might change as a consequence
                             of the prevention or protection strategies? That
                             is, how and why are these human problems
                             so deeply connected?




Wednesday, November 14, 12
Wednesday, November 14, 12
15 Will have
                       Eating
                          Disorders


                              Sexual
                                           Weapons
                                                        28
                              Violence                    Will have
                                   Sexual Crimes
                           Out of 100
                          Violent Physical Weapons Substance
                               Bullying
                         Assaults Violence Fighting
                          Felonies Abuse
                          SexualViolent
                                                          Abuse
                                                 Crimes Disorder
          20               Antisocial
                          Violence
                                     Bullying
                    Bullying Assaults Weapons Fighting
                                Felonies
                                            Physical
                                Fighting Abuse
                                       Crimes
          Will have        Bullying Violent
                            youth will…
          Depression Assaults Assaults Fighting
                                      Felonies
                                           Crimes
                                                 Physical
                                           Weapons
                                                 Abuse
                            Violent
                                 Sexual Physical
                            Felonies
                                        Abuse
                                 Violence



                              37 Will engage in
                                 Risky Sexual
                                         37%
                                       Behavior




Wednesday, November 14, 12
15 Will have
                       Eating                                                   14 Will have
                                                                                   Eating
                          Disorders                                                   Disorders

                                                        28
                                                                                                                   33
                              Sexual
                              Violence     Weapons        Will have                        Unprotected Sex
                                   Sexual Crimes
                           Out of 100
                          Violent Physical Weapons Substance
                               Bullying
                         Assaults Violence Fighting
                          Felonies Abuse
                          SexualViolent
                                                          Abuse
                                                 Crimes Disorder                     Out of 100
                                                                                    Teen Pregnancy Multiple Partners Will have
                                                                                    Unprotected Sex AIDS
                                                                                                     HIV
                                                                                          EarlyUnprotected Sex
                                                                                                Sex
                                                                                                                     Substance

          20               Antisocial
                          Violence
                                     Bullying
                    Bullying Assaults Weapons Fighting
                                Felonies
                                            Physical
                                Fighting Abuse
                                       Crimes                         23            Youth doing
                                                                            Teen Pregnancy Multiple Partners
                                                                                                                     Abuse
                                                                                                                     Disorder
                                                                                      Teen Pregnancy Multiple Partners
          Will have        Bullying Violent                                                 HIV AIDS
                                                                      Will have Early Sex Unprotected Sex
                            youth will…
          Depression Assaults Assaults Fighting
                                      Felonies
                                           Crimes
                                                 Physical
                                           Weapons
                                                 Abuse                Depression
                                                                                     Risky Sex
                                                                                             Early Sex
                                                                                                       HIV AIDS
                            Violent                                                  Teen Pregnancy Multiple Partners
                                 Sexual Physical
                            Felonies                                                                  HIV AIDS
                                        Abuse                                              Early Sex
                                 Violence



                              37 Will engage in
                                 Risky Sexual
                                                                                           30 Will have
                                         37%                                                  Antisocial
                                       Behavior
                                                                                                  Behavior




Wednesday, November 14, 12
15 Will have
                       Eating                                                                                 14 Will have
                                                                                                                 Eating
                          Disorders                                                                               Disorders

                                                        28
                                                                                                                                               33
                              Sexual
                              Violence     Weapons        Will have                                                    Unprotected Sex
                                   Sexual Crimes
                           Out of 100
                          Violent Physical Weapons Substance
                               Bullying
                         Assaults Violence Fighting
                          Felonies Abuse
                          SexualViolent
                                                          Abuse
                                                 Crimes Disorder                                                  Out of 100
                                                                                                                Teen Pregnancy Multiple Partners Will have
                                                                                                                Unprotected Sex AIDS
                                                                                                                                 HIV
                                                                                                                      EarlyUnprotected Sex
                                                                                                                            Sex
                                                                                                                                                 Substance

          20               Antisocial
                          Violence
                                     Bullying
                    Bullying Assaults Weapons Fighting
                                Felonies
                                            Physical
                                Fighting Abuse
                                       Crimes                                                     23             Youth doing
                                                                                                        Teen Pregnancy Multiple Partners
                                                                                                                                                 Abuse
                                                                                                                                                 Disorder
                                                                                                                  Teen Pregnancy Multiple Partners
          Will have        Bullying Violent                                                                             HIV AIDS
                                                                                                  Will have Early Sex Unprotected Sex
                            youth will…
          Depression Assaults Assaults Fighting
                                      Felonies
                                           Crimes
                                                 Physical
                                           Weapons
                                                 Abuse                                            Depression
                                                                                                                  Risky Sex
                                                                                                                         Early Sex
                                                                                                                                   HIV AIDS
                            Violent                                                                              Teen Pregnancy Multiple Partners
                                 Sexual Physical
                            Felonies                                                                                              HIV AIDS
                                        Abuse                                                                          Early Sex
                                 Violence



                              37 Will engage in                14 will have                                            30 Will have
                                 Risky Sexual
                                         37%
                                       Behavior
                                                                  Eating
                                                                       Disorders           30Will have                    Antisocial
                                                                                                                              Behavior
                                                                                                 Antisocial
                                                                     Poly Drug Addiction         Behavior

                                                  18                         Poly Drug Addiction
                                                                         Tobacco Addiction
                                                                          Alcohol Abuse
                                                               Prescription Drug Abuse
                                                                     Out of 100
                                                            Poly Drug Addiction
                                                                           Prescription Drug Abuse
                                                                   Tobacco Addiction 100e
                                                                      Illegal Drug Abus
                                                           Prescription Drug Abuse Drug Abuse
                                                                                 Illegal
                                                  Will have      Alcohol Abuse Addiction
                                                  Depression
                                                                     Substance
                                                                       Poly Drug
                                                                               Tobacco Addiction
                                                                Illegal DrugTobacco Addiction
                                                                               Abuse

                                                                        Users…
                                                            Alcohol Abuse
                                                                     Prescription Drug Abuse

                                                                  Poly Drug Illegal Drug Abuse
                                                                            Addiction
                                                                        Alcohol Abuse



                                                                      38 Will engage in
                                                                            Risky Sexual
                                                                              Behavior




Wednesday, November 14, 12
15 Will have
                       Eating                                                                                 14 Will have
                                                                                                                 Eating
                          Disorders                                                                               Disorders

                                                        28
                                                                                                                                               33
                              Sexual
                              Violence     Weapons        Will have                                                    Unprotected Sex
                                   Sexual Crimes
                           Out of 100
                          Violent Physical Weapons Substance
                               Bullying
                         Assaults Violence Fighting
                          Felonies Abuse
                          SexualViolent
                                                          Abuse
                                                 Crimes Disorder                                                  Out of 100
                                                                                                                Teen Pregnancy Multiple Partners Will have
                                                                                                                Unprotected Sex AIDS
                                                                                                                                 HIV
                                                                                                                      EarlyUnprotected Sex
                                                                                                                            Sex
                                                                                                                                                 Substance

          20               Antisocial
                          Violence
                                     Bullying
                    Bullying Assaults Weapons Fighting
                                Felonies
                                            Physical
                                Fighting Abuse
                                       Crimes                                                     23             Youth doing
                                                                                                        Teen Pregnancy Multiple Partners
                                                                                                                                                 Abuse
                                                                                                                                                 Disorder
                                                                                                                  Teen Pregnancy Multiple Partners
          Will have        Bullying Violent                                                                             HIV AIDS
                                                                                                  Will have Early Sex Unprotected Sex
                            youth will…
          Depression Assaults Assaults Fighting
                                      Felonies
                                           Crimes
                                                 Physical
                                           Weapons
                                                 Abuse                                            Depression
                                                                                                                  Risky Sex
                                                                                                                         Early Sex
                                                                                                                                   HIV AIDS
                            Violent                                                                              Teen Pregnancy Multiple Partners
                                 Sexual Physical
                            Felonies                                                                                              HIV AIDS
                                        Abuse                                                                          Early Sex
                                 Violence



                              37      Will engage in           14      will have
                                                                                                                       30 Will have                   23 Will have
                                                                                                                                                         Antisocial              20 Will have
                                                                                                                                                                                    Substance
                                      Risky Sexual
                                            37%
                                        Behavior
                                                                       Eating
                                                                       Disorders           30Will have                    Antisocial
                                                                                                                              Behavior
                                                                                                                                                             Behavior                      Abuse
                                                                                                                                                                                           Disorder
                                                                                                 Antisocial                                                  Eating Disorders
                                                                      Poly Drug Addiction        Behavior

                                                                                                                                                               Out of 100
                                                                                                                                                             Eating Disorders Eating Disorders
                                                   18                         Poly Drug Addiction
                                                                          Tobacco Addiction
                                                                           Alcohol Abuse
                                                                Prescription Drug Abuse
                                                                                                                                                             Eating disorders Eating Disorders
                                                                                                                                                                    Eating Disorders
                                                                                                                                                                         Eating Disorders
                                                                     Out of 100
                                                             Poly Drug Addiction
                                                                            Prescription Drug Abuse
                                                                    Tobacco Addiction 100e
                                                                       Illegal Drug Abus                                                                       YouthDisorders 26
                                                                                                                                                    Eating DisordersEating
                                                                                                                                                                             with
                                                                                                                                                              Eating Disorders Eating DIsorders
                                                                                                                                                                   Eating Disorders
                                                            Prescription Drug Abuse Drug Abuse
                                                                                  Illegal
                                                   Will have      Alcohol Abuse Addiction
                                                                     Substance
                                                                        Poly Drug                                                                         Eating Disorders S
                                                                                                                                                                        Eating Disorders
                                                   Depression                   Tobacco Addiction
                                                                 Illegal DrugTobacco Addiction
                                                                                Abuse                                                                                 eating Disorders Risky
                                                                                                                                                                      Eating Disorders
                                                                                                                                                              Eating Disorders Eating
                                                                                                                                                                                       Will engage
                                                                                                                                                                                       in

                                                                        Users…
                                                             Alcohol Abuse
                                                                      Prescription Drug Abuse                                                                        disorders DisordersSexual
                                                                                                                                                                              Eating
                                                                                                                                                                    Eating Disorders    behavior
                                                                  Poly Drug Illegal Drug Abuse
                                                                            Addiction
                                                                        Alcohol Abuse
                                                                                                                                                       31 Will have
                                                                                                                                                             Depression

                                                                      38 Will engage in
                                                                            Risky Sexual
                                                                              Behavior




Wednesday, November 14, 12
15 Will have
                       Eating                                                                                 14 Will have
                                                                                                                 Eating
                          Disorders

                                                                                                                                                                   And, how are
                                                                                                                  Disorders

                                                        28
                                                                                                                                               33
                              Sexual
                                           Weapons                                                                     Unprotected Sex
                                                                                                                                                                 these connected?
                              Violence                    Will have
                                   Sexual Crimes
                           Out of 100
                          Violent Physical Weapons Substance
                               Bullying
                         Assaults Violence Fighting
                          Felonies Abuse
                          SexualViolent
                                                          Abuse
                                                 Crimes Disorder                                                  Out of 100
                                                                                                                Teen Pregnancy Multiple Partners Will have
                                                                                                                Unprotected Sex AIDS
                                                                                                                                 HIV
                                                                                                                      EarlyUnprotected Sex
                                                                                                                            Sex
                                                                                                                                                 Substance

          20               Antisocial
                          Violence
                                     Bullying
                    Bullying Assaults Weapons Fighting
                                Felonies
                                            Physical
                                Fighting Abuse
                                       Crimes                                                     23             Youth doing
                                                                                                        Teen Pregnancy Multiple Partners
                                                                                                                                                 Abuse
                                                                                                                                                 Disorder
                                                                                                                  Teen Pregnancy Multiple Partners
          Will have        Bullying Violent                                                                             HIV AIDS
                                                                                                  Will have Early Sex Unprotected Sex
                            youth will…
          Depression Assaults Assaults Fighting
                                      Felonies
                                           Crimes
                                                 Physical
                                           Weapons
                                                 Abuse                                            Depression
                                                                                                                  Risky Sex
                                                                                                                         Early Sex
                                                                                                                                   HIV AIDS
                            Violent                                                                              Teen Pregnancy Multiple Partners
                                 Sexual Physical
                            Felonies                                                                                              HIV AIDS
                                        Abuse                                                                          Early Sex
                                 Violence



                              37      Will engage in           14      will have
                                                                                                                       30 Will have                   23 Will have
                                                                                                                                                         Antisocial              20 Will have
                                                                                                                                                                                    Substance
                                      Risky Sexual
                                            37%
                                        Behavior
                                                                       Eating
                                                                       Disorders           30Will have                    Antisocial
                                                                                                                              Behavior
                                                                                                                                                             Behavior                      Abuse
                                                                                                                                                                                           Disorder
                                                                                                 Antisocial                                                  Eating Disorders
                                                                      Poly Drug Addiction        Behavior

                                                                                                                                                               Out of 100
                                                                                                                                                             Eating Disorders Eating Disorders
                                                   18                         Poly Drug Addiction
                                                                          Tobacco Addiction
                                                                           Alcohol Abuse
                                                                Prescription Drug Abuse
                                                                                                                                                             Eating disorders Eating Disorders
                                                                                                                                                                    Eating Disorders
                                                                                                                                                                         Eating Disorders
                                                                     Out of 100
                                                             Poly Drug Addiction
                                                                            Prescription Drug Abuse
                                                                    Tobacco Addiction 100e
                                                                       Illegal Drug Abus                                                                       YouthDisorders 26
                                                                                                                                                    Eating DisordersEating
                                                                                                                                                                             with
                                                                                                                                                              Eating Disorders Eating DIsorders
                                                                                                                                                                   Eating Disorders
                                                            Prescription Drug Abuse Drug Abuse
                                                                                  Illegal
                                                   Will have      Alcohol Abuse Addiction
                                                                     Substance
                                                                        Poly Drug                                                                         Eating Disorders S
                                                                                                                                                                        Eating Disorders
                                                   Depression                   Tobacco Addiction
                                                                 Illegal DrugTobacco Addiction
                                                                                Abuse                                                                                 eating Disorders Risky
                                                                                                                                                                      Eating Disorders
                                                                                                                                                              Eating Disorders Eating
                                                                                                                                                                                       Will engage
                                                                                                                                                                                       in

                                                                        Users…
                                                             Alcohol Abuse
                                                                      Prescription Drug Abuse                                                                        disorders DisordersSexual
                                                                                                                                                                              Eating
                                                                                                                                                                    Eating Disorders    behavior
                                                                  Poly Drug Illegal Drug Abuse
                                                                            Addiction
                                                                        Alcohol Abuse
                                                                                                                                                       31 Will have
                                                                                                                                                             Depression

                                                                      38 Will engage in
                                                                            Risky Sexual
                                                                              Behavior




Wednesday, November 14, 12
15 Will have
                       Eating                                                                                 14 Will have
                                                                                                                 Eating
                          Disorders

                                                                                                                                                                   And, how are
                                                                                                                  Disorders

                                                        28
                                                                                                                                               33
                              Sexual
                                           Weapons                                                                     Unprotected Sex
                                                                                                                                                                 these connected?
                              Violence                    Will have
                                   Sexual Crimes
                           Out of 100
                          Violent Physical Weapons Substance
                               Bullying
                         Assaults Violence Fighting
                          Felonies Abuse
                          SexualViolent
                                                          Abuse
                                                 Crimes Disorder                                                  Out of 100
                                                                                                                Teen Pregnancy Multiple Partners Will have
                                                                                                                Unprotected Sex AIDS
                                                                                                                                 HIV
                                                                                                                      EarlyUnprotected Sex
                                                                                                                            Sex
                                                                                                                                                 Substance

          20               Antisocial
                          Violence
                                     Bullying
                    Bullying Assaults Weapons Fighting
                                Felonies
                                            Physical
                                Fighting Abuse
                                       Crimes                                                     23             Youth doing
                                                                                                        Teen Pregnancy Multiple Partners
                                                                                                                                                 Abuse
                                                                                                                                                 Disorder
                                                                                                                  Teen Pregnancy Multiple Partners
          Will have        Bullying Violent                                                                             HIV AIDS
                                                                                                  Will have Early Sex Unprotected Sex
                            youth will…
          Depression Assaults Assaults Fighting
                                      Felonies
                                           Crimes
                                                 Physical
                                           Weapons
                                                 Abuse                                            Depression
                                                                                                                  Risky Sex
                                                                                                                         Early Sex
                                                                                                                                   HIV AIDS
                            Violent                                                                              Teen Pregnancy Multiple Partners
                                 Sexual Physical
                            Felonies                                                                                              HIV AIDS
                                        Abuse                                                                          Early Sex
                                 Violence



                              37      Will engage in           14      will have
                                                                                                                       30 Will have                   23 Will have
                                                                                                                                                         Antisocial             20 Will have
                                                                                                                                                                                   Substance

                                          These are examples 30Will have
                                                             of interrelated multi-problem behaviors.
                                      Risky Sexual                     Eating
                                            37%                                         Behavior  Abuse                   Antisocial
                                        Behavior                       Disorders
                                                                                                  Disorder                    Behavior
                                                                                                 Antisocial                                                  Eating Disorders
                                                                      Poly Drug Addiction        Behavior

                                                                                                                                                               Out of 100
                                                                                                                                                             Eating Disorders Eating Disorders
                                                   18                         Poly Drug Addiction
                                                                          Tobacco Addiction
                                                                           Alcohol Abuse
                                                                Prescription Drug Abuse
                                                                                                                                                             Eating disorders Eating Disorders
                                                                                                                                                                    Eating Disorders
                                                                                                                                                                         Eating Disorders
                                                                     Out of 100
                                                             Poly Drug Addiction
                                                                            Prescription Drug Abuse
                                                                    Tobacco Addiction 100e
                                                                       Illegal Drug Abus                                                                       YouthDisorders 26
                                                                                                                                                    Eating DisordersEating
                                                                                                                                                                             with
                                                                                                                                                              Eating Disorders Eating DIsorders
                                                                                                                                                                   Eating Disorders
                                                            Prescription Drug Abuse Drug Abuse
                                                                                  Illegal
                                                   Will have      Alcohol Abuse Addiction
                                                                     Substance
                                                                        Poly Drug                                                                         Eating Disorders S
                                                                                                                                                                      Eating Disorders
                                                   Depression                   Tobacco Addiction
                                                                 Illegal DrugTobacco Addiction
                                                                                Abuse                                                                                 eating Disorders Risky
                                                                                                                                                                      Eating Disorders
                                                                                                                                                              Eating Disorders Eating
                                                                                                                                                                                       Will engage
                                                                                                                                                                                       in

                                                                        Users…
                                                             Alcohol Abuse
                                                                      Prescription Drug Abuse                                                                        disorders DisordersSexual
                                                                                                                                                                              Eating
                                                                                                                                                                    Eating Disorders    behavior
                                                                  Poly Drug Illegal Drug Abuse
                                                                            Addiction
                                                                        Alcohol Abuse
                                                                                                                                                       31 Will have
                                                                                                                                                             Depression

                                                                      38 Will engage in
                                                                            Risky Sexual
                                                                              Behavior




Wednesday, November 14, 12
A question about genes
                             (biology) and jeans
                             (environment)?
                             How much evidence is there for genes predicting risk of
                             mental, emotional, and behavioral disorders?




Wednesday, November 14, 12
A question about genes
                             (biology) and jeans
                             (environment)?
                             How much evidence is there for genes predicting risk of
                             mental, emotional, and behavioral disorders?


                              A lot       Some       A little    None




Wednesday, November 14, 12
A question about genes
                             (biology) and jeans
                             (environment)?
                             How much evidence is there for genes predicting risk of
                             mental, emotional, and behavioral disorders?


                              A lot       Some       A little    None

                             How much evidence is there for environmental prediction
                             risk of mental, emotional, & behavioral disorders?


                               A lot      Some        A little    None




Wednesday, November 14, 12
Wednesday, November 14, 12
What became the principal
                             vertebrate predator of humans
                             after the invention of stone tools?
   My hypothesis
   emerges from a            What became the principal
                             source of safety for humans after
   series of questions?      that fierce predator appeared of
                             humans?

                             What are the unique, innate
                             (evolutionarily selected) “tool kits”
                             that humans have to cooperate
                             with other humans?



Wednesday, November 14, 12
Some example evolutionary “tool kits”:
                              Use of arbitrary sounds and symbols to influence each others’
                              behavior.
                              Bi-directional “wealth” transfer between generations.
                              Ability to form “teams” of non-related humans for group
                              advantage and reinforcers.
                              Ability to plan modifications of environment for common gain.




Wednesday, November 14, 12
Social Biological
        Epigenesis                    Environmental Inputs                                         Genesis
                                           Nurturing or Toxic
         Epigenetics are                    Environments,                           These
         heritable                            Disease, or                         polygenes
                                                Threats
         changes in                                                                 can be
         gene expression                                                           “added”,
         caused by                                                              “subtracted”,




                                                               M
         mechanisms                   g                                          “divided”, or




                                                                or
                                    lin
                                              Phosphorlyation




                                                                  ph
         other than                                                              “multiplied.”
                                  na




                                                                     og
                                                Acetylation
                               Sig




                                                                          en
         changes in the                         Methylation




                                                                           sis
         underlying DNA                  Histone Remodeling
                                     Chromatin Stucture Changes
         sequence.
                             Development   Immunity   Stem Cell Changes   Imprinting

         These changes                                                       Parent,
         can pass            Three                                           1st Generation

         through multiple    Generation                                      Baby,
                                                                             2nd Generation
                             Effects
         generations.
                                                                             Reproductive Cells,
                                                                             3rd Generation




Wednesday, November 14, 12
Evolutionary Path
                              of a Child’s Life




Wednesday, November 14, 12
K                                                                       R
                         Path                                                                    Path



                                                  Evolutionary Path
                                                   of a Child’s Life




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




Wednesday, November 14, 12
Multi-Inflammatory Brain & Body Response




                                  Toxic Influences of the Adverse Trends Predicting MEBs & Related Illnesses

                             Toxic Reinforcement Toxic Antecedents Toxic Physiological Toxic Verbal Relations
                              more for anti-social  cue anti-social influences trigger    occasion perceived
                                than prosocial     acts and threats adverse biological   threats and related
                                   behaviors                          mechanisms              reactions

                             The Same Toxic Conditions Predict Multiple Disorders
Wednesday, November 14, 12
Mood                           Lo Reward      Lo Executive   Lo Behavioral
                                                    Inattention                    Function
                                  Instability                        Delay                       Competencies
                                   Poor                                                           Immune-
                                   Motor                                                           Healing
                                   Skills        Multi-Inflammatory Brain & Body Response         Dysfunction




                                  Toxic Influences of the Adverse Trends Predicting MEBs & Related Illnesses

                             Toxic Reinforcement Toxic Antecedents Toxic Physiological Toxic Verbal Relations
                              more for anti-social  cue anti-social influences trigger    occasion perceived
                                than prosocial     acts and threats adverse biological   threats and related
                                   behaviors                          mechanisms              reactions

                             The Same Toxic Conditions Predict Multiple Disorders
Wednesday, November 14, 12
Substance                       Work       Obesity,
                             Early   Mental Illness                    Violence                             Cancer     School
                                                       Abuse                        Problems       etc
                             Sex                                                                                       Failure

                                       Mood                             Lo Reward      Lo Executive    Lo Behavioral
                                                         Inattention                    Function
                                     Instability                          Delay                        Competencies
                                      Poor                                                             Immune-
                             STD’s    Motor                                                             Healing         Special
                                      Skills          Multi-Inflammatory Brain & Body Response         Dysfunction         Ed




                                     Toxic Influences of the Adverse Trends Predicting MEBs & Related Illnesses

                                Toxic Reinforcement Toxic Antecedents Toxic Physiological Toxic Verbal Relations
                                 more for anti-social  cue anti-social influences trigger    occasion perceived
                                   than prosocial     acts and threats adverse biological   threats and related
                                      behaviors                          mechanisms              reactions

                                The Same Toxic Conditions Predict Multiple Disorders
Wednesday, November 14, 12
Multi Anti-Inflammatory Brain & Body Response




                                 Nurturing Environments Protecting the Futures of Children, Youth and Adults

                             Nur. Reinforcement     Nur. Antecedents            Nur. Physiological      Nur. Verbal Relations
                              more for prosocial      cue prosocial              influences trigger       occasion perceived
                                  behaviors             behaviors               protective biological    efficacy, safety and
                                                                                    mechanisms                affiliation


                             The Same Nurturing Conditions Protect and Prevent
Wednesday, November 14, 12
Mood                                Hi Reward       Hi Executive    Hi Behavioral
                                                        Attention         Delay
                                   Stability                                              Function      Competencies
                                    Good                                                                Immune-
                                    Motor                                                                Healing
                                    Skills         Multi Anti-Inflammatory Brain & Body Response         Efficiency




                                 Nurturing Environments Protecting the Futures of Children, Youth and Adults

                             Nur. Reinforcement     Nur. Antecedents            Nur. Physiological      Nur. Verbal Relations
                              more for prosocial      cue prosocial              influences trigger       occasion perceived
                                  behaviors             behaviors               protective biological    efficacy, safety and
                                                                                    mechanisms                affiliation


                             The Same Nurturing Conditions Protect and Prevent
Wednesday, November 14, 12
Heart
                                                            Low                                 Work                          Low
                              Delayed    Mental health                     Prosociality        Success
                                                                                                                Health
                                                                                                                                          Hi Sch.
                                                          Addictions                                             etc         Cancer
                               Sex                                                                                                         Grad

                                          Mood                                Hi Reward          Hi Executive            Hi Behavioral
                                                              Attention         Delay
                                         Stability                                                 Function              Competencies
                                          Good                                                                           Immune-
                               Low        Motor                                                                           Healing          Higher
                             Injuries     Skills         Multi Anti-Inflammatory Brain & Body Response                    Efficiency           Ed




                                        Nurturing Environments Protecting the Futures of Children, Youth and Adults

                                  Nur. Reinforcement      Nur. Antecedents                Nur. Physiological             Nur. Verbal Relations
                                   more for prosocial       cue prosocial                  influences trigger              occasion perceived
                                       behaviors              behaviors                   protective biological           efficacy, safety and
                                                                                              mechanisms                       affiliation


                                The Same Nurturing Conditions Protect and Prevent
Wednesday, November 14, 12
Principles for Increasing
                             Nurturing Environments
                               Minimize toxic social and biological
                               conditions
                               Promote and richly reinforce diverse
                               forms of prosocial behavior
                               Limit opportunities for problem behavior
                               Promote psychological flexibility—a
                               mindful approach to pursuing one’s
                               values




Wednesday, November 14, 12
Let’s survey current “toxic” conditions




Wednesday, November 14, 12
Lifetime Prevalence of Disorders in US Adolescents (N=10,123)

          35%

          30%

          25%

          20%

          15%

          10%

           5%
                                                                                          Merikangas et al., 2010
           0%
                   4         5   6   7   8   9   10 11 12       13   14   15   16   17   18
                                                 Age in Years



Wednesday, November 14, 12
Lifetime Prevalence of Disorders in US Adolescents (N=10,123)

          35%
                                                                                              Anxiety
          30%

          25%

          20%

          15%

          10%

           5%
                                                                                          Merikangas et al., 2010
           0%
                   4         5   6   7   8   9   10 11 12       13   14   15   16   17   18
                                                 Age in Years



Wednesday, November 14, 12
Lifetime Prevalence of Disorders in US Adolescents (N=10,123)

          35%
                                                                                              Anxiety
          30%

          25%
                                                                                              Behavior
          20%

          15%

          10%

           5%
                                                                                          Merikangas et al., 2010
           0%
                   4         5   6   7   8   9   10 11 12       13   14   15   16   17   18
                                                 Age in Years



Wednesday, November 14, 12
Lifetime Prevalence of Disorders in US Adolescents (N=10,123)

          35%
                                                                                              Anxiety
          30%

          25%
                                                                                              Behavior
          20%
                                                                                              Mood
          15%

          10%

           5%
                                                                                          Merikangas et al., 2010
           0%
                   4         5   6   7   8   9   10 11 12       13   14   15   16   17   18
                                                 Age in Years



Wednesday, November 14, 12
Lifetime Prevalence of Disorders in US Adolescents (N=10,123)

          35%
                                                                                              Anxiety
          30%

          25%
                                                                                              Substance
                                                                                              Behavior
          20%
                                                                                              Mood
          15%

          10%

           5%
                                                                                          Merikangas et al., 2010
           0%
                   4         5   6   7   8   9   10 11 12       13   14   15   16   17   18
                                                 Age in Years



Wednesday, November 14, 12
The US has
          75 million
          children and
          teens.
          40.4 million
          are on
          psychotropic
          medications
           Wall Street Journal, 12-28-2010



Wednesday, November 14, 12
Cumulative prevalence of psychiatric disorders by young adulthood

      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%.


  a prospective cohort analysis from the Great Smoky Mountains Study.
Wednesday, November 14, 12
The US has 75
          million children
          and teens.




                             Wall Street
                              Journal,
                             12-28-2010

Wednesday, November 14, 12
The US has 75
          million children
          and teens.
           40.4 million kids had
           one psychotropic
           med in 2009



                             Wall Street
                              Journal,
                             12-28-2010

Wednesday, November 14, 12
So can we actually impact these toxic trends?

                                                   Perhaps, with some non-
                                                   pharmaceutical, universal
                                                      “behavioral vaccines”



Wednesday, November 14, 12
What are behavioral vaccines?




                             Read more about the science at www.PubMed.gov
Wednesday, November 14, 12
Muriel Saunders
           invented the Game in
           1967 as a first-year,
           4th grade teacher.



                                                                                                          Harriet Barrish    Montrose Wolf




                                                                                                          These two scientists published
Copyright © 2011-12, PAXIS Institute. Only for use by accredited PAX GBG Coaches and licensed by PAXIS.   the first proof of the Game in 1969.

Wednesday, November 14, 12
Longitudinal Johns Hopkins Studies of GBG
                             Kindergarden


                                Every
                                child
                              rated by
                              teachers




Wednesday, November 14, 12
Longitudinal Johns Hopkins Studies of GBG
                             Kindergarden


                                Every
                                child
                              rated by
                              teachers




Wednesday, November 14, 12
Longitudinal Johns Hopkins Studies of GBG
                             Kindergarden         First Grade


                                Every                GBG
                                child
                              rated by
                              teachers            NO GBG

                                              Tested in 41 first-
                                             and second-grade
                                            classrooms within 19
                                             elementary schools
                                            with two consecutive
                                                groups of first
                                                   graders.



Wednesday, November 14, 12
Longitudinal Johns Hopkins Studies of GBG
                                                                     Grades 2 thru 12
                             Kindergarden         First Grade
                                                                        Follow Up

                                Every                GBG             No More GBG
                                child
                              rated by
                              teachers            NO GBG                 No GBG

                                              Tested in 41 first-   Purpose: To find out if
                                             and second-grade       GBG affected their
                                            classrooms within 19     adolescent lives.
                                             elementary schools
                                                                   Note: Some kids got GBG
                                            with two consecutive     in 1st Grade only, and
                                                groups of first      some in both 1st & 2nd
                                                   graders.                  grade,




Wednesday, November 14, 12
Longitudinal Johns Hopkins Studies of GBG
                                                                     Grades 2 thru 12            Young Adulthood
                             Kindergarden         First Grade
                                                                        Follow Up                   Follow Up

                                                     GBG                                       Age      Age      Age
                                Every                                No More GBG
                                child                                                         19-21      26       30
                              rated by
                                                                                               Age      Age      Age
                              teachers            NO GBG                 No GBG
                                                                                              19-21      26       30
                                              Tested in 41 first-   Purpose: To find out if      Purpose: To find out if
                                             and second-grade       GBG affected their          GBG affected their
                                            classrooms within 19     adolescent lives.              adult lives.
                                             elementary schools
                                                                   Note: Some kids got GBG
                                            with two consecutive     in 1st Grade only, and
                                                groups of first      some in both 1st & 2nd
                                                   graders.                  grade,




Wednesday, November 14, 12
They teach children a vision of a wonderful school




Wednesday, November 14, 12
To create more good,   By sweeping away the
                             called “PAX”           “bad”, called “Spleems”

Wednesday, November 14, 12
Playing the PAX Game by Teams:
                             During any regular teaching & learning activity
                                  The Blue Team   The Red Team   The Yellow Team




Wednesday, November 14, 12
Their Team Aim: 	 	 	 	 	 	      to Win PAX

 Not OK
                                                        Ms. Dion   Jan 23


                                                                            Spleems are counted and marked with neutral
No              Spleems                         Blue                        tone for the team, not the individual child.
Peeling cards up is a spleem for your team      Red
                                                                            Teams who have 3 or fewer Spleems win.
                                               Yellow
                                                                            Winning teams earn a “Granny’s Wacky Prize”.
                                                                            Team having 4 or more Spleems lose that game.
                                                                            PAX Minutes = winning teams x minutes played.




Wednesday, November 14, 12
Their Team Aim: 	 	 	 	 	 	      to Win PAX

 Not OK
                                                        Ms. Dion   Jan 23


                                                                            Spleems are counted and marked with neutral
No              Spleems                         Blue                        tone for the team, not the individual child.
Peeling cards up is a spleem for your team      Red
                                                                            Teams who have 3 or fewer Spleems win.
                                               Yellow
                                                                            Winning teams earn a “Granny’s Wacky Prize”.
                                                                            Team having 4 or more Spleems lose that game.
                                                                            PAX Minutes = winning teams x minutes played.




Wednesday, November 14, 12
Their Team Aim: 	 	 	 	 	 	           to Win PAX

 Not OK
                                                             Ms. Dion   Jan 23


                                                                                 Spleems are counted and marked with neutral
No              Spleems                         Blue                             tone for the team, not the individual child.
Peeling cards up is a spleem for your team      Red
                                                                                 Teams who have 3 or fewer Spleems win.
                                               Yellow
                                                                                 Winning teams earn a “Granny’s Wacky Prize”.
                                                                                 Team having 4 or more Spleems lose that game.
                                                        20
                                                        40                       PAX Minutes = winning teams x minutes played.




Wednesday, November 14, 12
Their Team Aim: 	 	 	 	 	 	           to Win PAX

 Not OK
                                                             Ms. Dion   Jan 23


                                                                                 Spleems are counted and marked with neutral
No              Spleems                         Blue                             tone for the team, not the individual child.
Peeling cards up is a spleem for your team      Red
                                                                                 Teams who have 3 or fewer Spleems win.
                                               Yellow
                                                                                 Winning teams earn a “Granny’s Wacky Prize”.
                                                                                 Team having 4 or more Spleems lose that game.
                                                        20
                                                        40                       PAX Minutes = winning teams x minutes played.




Wednesday, November 14, 12
Their Team Aim: 	 	 	 	 	 	        to Win PAX

 Not OK
                                                          Ms. Dion   Jan 23


                                                                              Spleems are counted and marked with neutral
No              Spleems                         Blue                          tone for the team, not the individual child.
Peeling cards up is a spleem for your team      Red
                                                                              Teams who have 3 or fewer Spleems win.
                                               Yellow
                                                                              Winning teams earn a “Granny’s Wacky Prize”.
                                                                              Team having 4 or more Spleems lose that game.
                                                        20 20
                                                        40 60                 PAX Minutes = winning teams x minutes played.




Wednesday, November 14, 12
Winning teams get “Granny’s
                             Wacky Prizes”
                              Brief (30 seconds or so) activity rewards for winning game
                              Start and stop with non-verbal cue
                              Based on mystery motivator and Premack Principle
                              Function as “intrinsic motivators”




Wednesday, November 14, 12
The PAX Game teaches
                              Individual and group goal orientation/
                              dependency
                              Voluntary control over attention
                              Self-regulation, self-calming under excitement
                              Self-regulation during failure or disappointment
                              Delay of gratification
                              Cooperation to achieve a bigger goal
                              How to ignore accidental attention to negative
                              behavior from peers
                              Mild sanctions for anti-social acts by others



Wednesday, November 14, 12
Relational
                                  Antecedent        Reinforcement         Physiological
                                                                                                 Frame
                                   Kernels             Kernels               Kernel
                                                                                                 Kernel



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




Wednesday, November 14, 12
Relational
                                  Antecedent        Reinforcement         Physiological
                                                                                                 Frame
                                   Kernels             Kernels               Kernel
                                                                                                 Kernel



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

                               PAX Quiet,
                               PAX Voices,
                               PAX Hands,
                               PAX Lines,
                                PAX Stix




Wednesday, November 14, 12
Relational
                                  Antecedent        Reinforcement         Physiological
                                                                                                 Frame
                                   Kernels             Kernels               Kernel
                                                                                                 Kernel



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

                               PAX Quiet,
                                                    Granny’s
                               PAX Voices,
                                                  Wacky Prizes,
                               PAX Hands,
                                                  Tootle Notes,
                               PAX Lines,
                                                  PAX It Notes
                                PAX Stix




Wednesday, November 14, 12
Relational
                                  Antecedent        Reinforcement         Physiological
                                                                                                 Frame
                                   Kernels             Kernels               Kernel
                                                                                                 Kernel



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

                               PAX Quiet,                                                     Wonderful
                                                    Granny’s
                               PAX Voices,                                                     School,
                                                  Wacky Prizes,
                               PAX Hands,                                                      PAX OK,
                                                  Tootle Notes,
                               PAX Lines,                                                    Spleems Not
                                                  PAX It Notes
                                PAX Stix                                                         OK




Wednesday, November 14, 12
Relational
                                  Antecedent        Reinforcement         Physiological
                                                                                                 Frame
                                   Kernels             Kernels               Kernel
                                                                                                 Kernel



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

                               PAX Quiet,                                                     Wonderful
                                                    Granny’s
                               PAX Voices,                                                     School,
                                                  Wacky Prizes,
                               PAX Hands,                                                      PAX OK,
                                                  Tootle Notes,
                               PAX Lines,                                                    Spleems Not
                                                  PAX It Notes
                                PAX Stix                                                         OK




Wednesday, November 14, 12
Seine River Manitoba Pilot Demonstration
                               April, 2011 – Principals and key
                               staff trained for two days for all
                               12 schools.
                                                                        45%
                               April, 2011 – First grade
                               classrooms then trained that
                               week
                               April through May – Each
                               successive month other grades
                               trained, including 8th grade
                               classes.




Wednesday, November 14, 12
Timeline of Benefits…




Wednesday, November 14, 12
Timeline of Benefits…
                             First Month

                                  More time for             Less stress for
                              teaching and learning        Staff & Students
                             First Year

                                 Better         Fewer       Fewer Service     Less       Happier      Less          Better
                              Attendance       Referrals       Needs         Illness     Families   Vandalism     Academics
                             2nd & 3rd Years

                                ADHD            Oppositional         Special Education
                                Averted        Defiance Averted           Averted
                             5-15 Years

                                No          Less       Less Conduct           Less            Less Crime,      High School
                              Tobacco      Alcohol       Disorders          Depression     Violence, Suicide Grad & University




Wednesday, November 14, 12
HS
                                                                   Long term impact of GBG on
                                         School
                                        Graduation
                                                                           Academic Outcomes

                                                                                                   GBG                Control
                             80%                              73.6%

                             64%
                                      53.3%
                                                                         58.6%
                             48%
                                                                                                              40.3%
                                                44.8%
                             32%                                                       26%
                                                                                                                          26.4%
                             16%
                                                                                                 12.8%
                              0%
                                      Boys HS Graduation      Girls HS Graduation     Boys Univ. Entrance      Girls Univ. Entrace



 Source: Bradshaw, C. P., J. H. Zmuda, et al. (2009). "Longitudinal Impact of Two Universal Preventive Interventions in First Grade on
                   Educational Outcomes in High School." Journal of Educational Psychology 101(4): 926-937.
Wednesday, November 14, 12
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Upstream alcohol prevention rowan university

  • 1. Upstream Prevention of Alcohol and Related Problems among America’s Young People: Reclaiming America’s Promise An  inquiry  into  possibili/es Dennis D. Embry, Ph.D. President/Senior Scientist West  Windsor,  NJ  •  Nov  14,  2012 PAXIS Institute Wednesday, November 14, 12
  • 2. A recent webinar experience on prevention Wednesday, November 14, 12
  • 4. How early is this prevention? Wednesday, November 14, 12
  • 6. Is this early prevention? Wednesday, November 14, 12
  • 8. Is this early prevention? Wednesday, November 14, 12
  • 10. Is this early prevention? Wednesday, November 14, 12
  • 11. Thinking way upstream What might be the early malleable predictors? What if universities started here with early prevention? Wednesday, November 14, 12
  • 12. Thinking way upstream What might be the early malleable predictors? Could we actually change those predictors easily and reliably? And what else might change as a consequence of the prevention or protection strategies? That is, how and why are these human problems so deeply connected? Wednesday, November 14, 12
  • 14. 15 Will have Eating Disorders Sexual Weapons 28 Violence Will have Sexual Crimes Out of 100 Violent Physical Weapons Substance Bullying Assaults Violence Fighting Felonies Abuse SexualViolent Abuse Crimes Disorder 20 Antisocial Violence Bullying Bullying Assaults Weapons Fighting Felonies Physical Fighting Abuse Crimes Will have Bullying Violent youth will… Depression Assaults Assaults Fighting Felonies Crimes Physical Weapons Abuse Violent Sexual Physical Felonies Abuse Violence 37 Will engage in Risky Sexual 37% Behavior Wednesday, November 14, 12
  • 15. 15 Will have Eating 14 Will have Eating Disorders Disorders 28 33 Sexual Violence Weapons Will have Unprotected Sex Sexual Crimes Out of 100 Violent Physical Weapons Substance Bullying Assaults Violence Fighting Felonies Abuse SexualViolent Abuse Crimes Disorder Out of 100 Teen Pregnancy Multiple Partners Will have Unprotected Sex AIDS HIV EarlyUnprotected Sex Sex Substance 20 Antisocial Violence Bullying Bullying Assaults Weapons Fighting Felonies Physical Fighting Abuse Crimes 23 Youth doing Teen Pregnancy Multiple Partners Abuse Disorder Teen Pregnancy Multiple Partners Will have Bullying Violent HIV AIDS Will have Early Sex Unprotected Sex youth will… Depression Assaults Assaults Fighting Felonies Crimes Physical Weapons Abuse Depression Risky Sex Early Sex HIV AIDS Violent Teen Pregnancy Multiple Partners Sexual Physical Felonies HIV AIDS Abuse Early Sex Violence 37 Will engage in Risky Sexual 30 Will have 37% Antisocial Behavior Behavior Wednesday, November 14, 12
  • 16. 15 Will have Eating 14 Will have Eating Disorders Disorders 28 33 Sexual Violence Weapons Will have Unprotected Sex Sexual Crimes Out of 100 Violent Physical Weapons Substance Bullying Assaults Violence Fighting Felonies Abuse SexualViolent Abuse Crimes Disorder Out of 100 Teen Pregnancy Multiple Partners Will have Unprotected Sex AIDS HIV EarlyUnprotected Sex Sex Substance 20 Antisocial Violence Bullying Bullying Assaults Weapons Fighting Felonies Physical Fighting Abuse Crimes 23 Youth doing Teen Pregnancy Multiple Partners Abuse Disorder Teen Pregnancy Multiple Partners Will have Bullying Violent HIV AIDS Will have Early Sex Unprotected Sex youth will… Depression Assaults Assaults Fighting Felonies Crimes Physical Weapons Abuse Depression Risky Sex Early Sex HIV AIDS Violent Teen Pregnancy Multiple Partners Sexual Physical Felonies HIV AIDS Abuse Early Sex Violence 37 Will engage in 14 will have 30 Will have Risky Sexual 37% Behavior Eating Disorders 30Will have Antisocial Behavior Antisocial Poly Drug Addiction Behavior 18 Poly Drug Addiction Tobacco Addiction Alcohol Abuse Prescription Drug Abuse Out of 100 Poly Drug Addiction Prescription Drug Abuse Tobacco Addiction 100e Illegal Drug Abus Prescription Drug Abuse Drug Abuse Illegal Will have Alcohol Abuse Addiction Depression Substance Poly Drug Tobacco Addiction Illegal DrugTobacco Addiction Abuse Users… Alcohol Abuse Prescription Drug Abuse Poly Drug Illegal Drug Abuse Addiction Alcohol Abuse 38 Will engage in Risky Sexual Behavior Wednesday, November 14, 12
  • 17. 15 Will have Eating 14 Will have Eating Disorders Disorders 28 33 Sexual Violence Weapons Will have Unprotected Sex Sexual Crimes Out of 100 Violent Physical Weapons Substance Bullying Assaults Violence Fighting Felonies Abuse SexualViolent Abuse Crimes Disorder Out of 100 Teen Pregnancy Multiple Partners Will have Unprotected Sex AIDS HIV EarlyUnprotected Sex Sex Substance 20 Antisocial Violence Bullying Bullying Assaults Weapons Fighting Felonies Physical Fighting Abuse Crimes 23 Youth doing Teen Pregnancy Multiple Partners Abuse Disorder Teen Pregnancy Multiple Partners Will have Bullying Violent HIV AIDS Will have Early Sex Unprotected Sex youth will… Depression Assaults Assaults Fighting Felonies Crimes Physical Weapons Abuse Depression Risky Sex Early Sex HIV AIDS Violent Teen Pregnancy Multiple Partners Sexual Physical Felonies HIV AIDS Abuse Early Sex Violence 37 Will engage in 14 will have 30 Will have 23 Will have Antisocial 20 Will have Substance Risky Sexual 37% Behavior Eating Disorders 30Will have Antisocial Behavior Behavior Abuse Disorder Antisocial Eating Disorders Poly Drug Addiction Behavior Out of 100 Eating Disorders Eating Disorders 18 Poly Drug Addiction Tobacco Addiction Alcohol Abuse Prescription Drug Abuse Eating disorders Eating Disorders Eating Disorders Eating Disorders Out of 100 Poly Drug Addiction Prescription Drug Abuse Tobacco Addiction 100e Illegal Drug Abus YouthDisorders 26 Eating DisordersEating with Eating Disorders Eating DIsorders Eating Disorders Prescription Drug Abuse Drug Abuse Illegal Will have Alcohol Abuse Addiction Substance Poly Drug Eating Disorders S Eating Disorders Depression Tobacco Addiction Illegal DrugTobacco Addiction Abuse eating Disorders Risky Eating Disorders Eating Disorders Eating Will engage in Users… Alcohol Abuse Prescription Drug Abuse disorders DisordersSexual Eating Eating Disorders behavior Poly Drug Illegal Drug Abuse Addiction Alcohol Abuse 31 Will have Depression 38 Will engage in Risky Sexual Behavior Wednesday, November 14, 12
  • 18. 15 Will have Eating 14 Will have Eating Disorders And, how are Disorders 28 33 Sexual Weapons Unprotected Sex these connected? Violence Will have Sexual Crimes Out of 100 Violent Physical Weapons Substance Bullying Assaults Violence Fighting Felonies Abuse SexualViolent Abuse Crimes Disorder Out of 100 Teen Pregnancy Multiple Partners Will have Unprotected Sex AIDS HIV EarlyUnprotected Sex Sex Substance 20 Antisocial Violence Bullying Bullying Assaults Weapons Fighting Felonies Physical Fighting Abuse Crimes 23 Youth doing Teen Pregnancy Multiple Partners Abuse Disorder Teen Pregnancy Multiple Partners Will have Bullying Violent HIV AIDS Will have Early Sex Unprotected Sex youth will… Depression Assaults Assaults Fighting Felonies Crimes Physical Weapons Abuse Depression Risky Sex Early Sex HIV AIDS Violent Teen Pregnancy Multiple Partners Sexual Physical Felonies HIV AIDS Abuse Early Sex Violence 37 Will engage in 14 will have 30 Will have 23 Will have Antisocial 20 Will have Substance Risky Sexual 37% Behavior Eating Disorders 30Will have Antisocial Behavior Behavior Abuse Disorder Antisocial Eating Disorders Poly Drug Addiction Behavior Out of 100 Eating Disorders Eating Disorders 18 Poly Drug Addiction Tobacco Addiction Alcohol Abuse Prescription Drug Abuse Eating disorders Eating Disorders Eating Disorders Eating Disorders Out of 100 Poly Drug Addiction Prescription Drug Abuse Tobacco Addiction 100e Illegal Drug Abus YouthDisorders 26 Eating DisordersEating with Eating Disorders Eating DIsorders Eating Disorders Prescription Drug Abuse Drug Abuse Illegal Will have Alcohol Abuse Addiction Substance Poly Drug Eating Disorders S Eating Disorders Depression Tobacco Addiction Illegal DrugTobacco Addiction Abuse eating Disorders Risky Eating Disorders Eating Disorders Eating Will engage in Users… Alcohol Abuse Prescription Drug Abuse disorders DisordersSexual Eating Eating Disorders behavior Poly Drug Illegal Drug Abuse Addiction Alcohol Abuse 31 Will have Depression 38 Will engage in Risky Sexual Behavior Wednesday, November 14, 12
  • 19. 15 Will have Eating 14 Will have Eating Disorders And, how are Disorders 28 33 Sexual Weapons Unprotected Sex these connected? Violence Will have Sexual Crimes Out of 100 Violent Physical Weapons Substance Bullying Assaults Violence Fighting Felonies Abuse SexualViolent Abuse Crimes Disorder Out of 100 Teen Pregnancy Multiple Partners Will have Unprotected Sex AIDS HIV EarlyUnprotected Sex Sex Substance 20 Antisocial Violence Bullying Bullying Assaults Weapons Fighting Felonies Physical Fighting Abuse Crimes 23 Youth doing Teen Pregnancy Multiple Partners Abuse Disorder Teen Pregnancy Multiple Partners Will have Bullying Violent HIV AIDS Will have Early Sex Unprotected Sex youth will… Depression Assaults Assaults Fighting Felonies Crimes Physical Weapons Abuse Depression Risky Sex Early Sex HIV AIDS Violent Teen Pregnancy Multiple Partners Sexual Physical Felonies HIV AIDS Abuse Early Sex Violence 37 Will engage in 14 will have 30 Will have 23 Will have Antisocial 20 Will have Substance These are examples 30Will have of interrelated multi-problem behaviors. Risky Sexual Eating 37% Behavior Abuse Antisocial Behavior Disorders Disorder Behavior Antisocial Eating Disorders Poly Drug Addiction Behavior Out of 100 Eating Disorders Eating Disorders 18 Poly Drug Addiction Tobacco Addiction Alcohol Abuse Prescription Drug Abuse Eating disorders Eating Disorders Eating Disorders Eating Disorders Out of 100 Poly Drug Addiction Prescription Drug Abuse Tobacco Addiction 100e Illegal Drug Abus YouthDisorders 26 Eating DisordersEating with Eating Disorders Eating DIsorders Eating Disorders Prescription Drug Abuse Drug Abuse Illegal Will have Alcohol Abuse Addiction Substance Poly Drug Eating Disorders S Eating Disorders Depression Tobacco Addiction Illegal DrugTobacco Addiction Abuse eating Disorders Risky Eating Disorders Eating Disorders Eating Will engage in Users… Alcohol Abuse Prescription Drug Abuse disorders DisordersSexual Eating Eating Disorders behavior Poly Drug Illegal Drug Abuse Addiction Alcohol Abuse 31 Will have Depression 38 Will engage in Risky Sexual Behavior Wednesday, November 14, 12
  • 20. A question about genes (biology) and jeans (environment)? How much evidence is there for genes predicting risk of mental, emotional, and behavioral disorders? Wednesday, November 14, 12
  • 21. A question about genes (biology) and jeans (environment)? How much evidence is there for genes predicting risk of mental, emotional, and behavioral disorders? A lot Some A little None Wednesday, November 14, 12
  • 22. A question about genes (biology) and jeans (environment)? How much evidence is there for genes predicting risk of mental, emotional, and behavioral disorders? A lot Some A little None How much evidence is there for environmental prediction risk of mental, emotional, & behavioral disorders? A lot Some A little None Wednesday, November 14, 12
  • 24. What became the principal vertebrate predator of humans after the invention of stone tools? My hypothesis emerges from a What became the principal source of safety for humans after series of questions? that fierce predator appeared of humans? What are the unique, innate (evolutionarily selected) “tool kits” that humans have to cooperate with other humans? Wednesday, November 14, 12
  • 25. Some example evolutionary “tool kits”: Use of arbitrary sounds and symbols to influence each others’ behavior. Bi-directional “wealth” transfer between generations. Ability to form “teams” of non-related humans for group advantage and reinforcers. Ability to plan modifications of environment for common gain. Wednesday, November 14, 12
  • 26. Social Biological Epigenesis Environmental Inputs Genesis Nurturing or Toxic Epigenetics are Environments, These heritable Disease, or polygenes Threats changes in can be gene expression “added”, caused by “subtracted”, M mechanisms g “divided”, or or lin Phosphorlyation ph other than “multiplied.” na og Acetylation Sig en changes in the Methylation sis underlying DNA Histone Remodeling Chromatin Stucture Changes sequence. Development Immunity Stem Cell Changes Imprinting These changes Parent, can pass Three 1st Generation through multiple Generation Baby, 2nd Generation Effects generations. Reproductive Cells, 3rd Generation Wednesday, November 14, 12
  • 27. Evolutionary Path of a Child’s Life Wednesday, November 14, 12
  • 28. K R Path Path Evolutionary Path of a Child’s Life Probability of short-life and Probability of long-life and doubtful reproductive success reproductive success Wednesday, November 14, 12
  • 29. Multi-Inflammatory Brain & Body Response Toxic Influences of the Adverse Trends Predicting MEBs & Related Illnesses Toxic Reinforcement Toxic Antecedents Toxic Physiological Toxic Verbal Relations more for anti-social cue anti-social influences trigger occasion perceived than prosocial acts and threats adverse biological threats and related behaviors mechanisms reactions The Same Toxic Conditions Predict Multiple Disorders Wednesday, November 14, 12
  • 30. Mood Lo Reward Lo Executive Lo Behavioral Inattention Function Instability Delay Competencies Poor Immune- Motor Healing Skills Multi-Inflammatory Brain & Body Response Dysfunction Toxic Influences of the Adverse Trends Predicting MEBs & Related Illnesses Toxic Reinforcement Toxic Antecedents Toxic Physiological Toxic Verbal Relations more for anti-social cue anti-social influences trigger occasion perceived than prosocial acts and threats adverse biological threats and related behaviors mechanisms reactions The Same Toxic Conditions Predict Multiple Disorders Wednesday, November 14, 12
  • 31. Substance Work Obesity, Early Mental Illness Violence Cancer School Abuse Problems etc Sex Failure Mood Lo Reward Lo Executive Lo Behavioral Inattention Function Instability Delay Competencies Poor Immune- STD’s Motor Healing Special Skills Multi-Inflammatory Brain & Body Response Dysfunction Ed Toxic Influences of the Adverse Trends Predicting MEBs & Related Illnesses Toxic Reinforcement Toxic Antecedents Toxic Physiological Toxic Verbal Relations more for anti-social cue anti-social influences trigger occasion perceived than prosocial acts and threats adverse biological threats and related behaviors mechanisms reactions The Same Toxic Conditions Predict Multiple Disorders Wednesday, November 14, 12
  • 32. Multi Anti-Inflammatory Brain & Body Response Nurturing Environments Protecting the Futures of Children, Youth and Adults Nur. Reinforcement Nur. Antecedents Nur. Physiological Nur. Verbal Relations more for prosocial cue prosocial influences trigger occasion perceived behaviors behaviors protective biological efficacy, safety and mechanisms affiliation The Same Nurturing Conditions Protect and Prevent Wednesday, November 14, 12
  • 33. Mood Hi Reward Hi Executive Hi Behavioral Attention Delay Stability Function Competencies Good Immune- Motor Healing Skills Multi Anti-Inflammatory Brain & Body Response Efficiency Nurturing Environments Protecting the Futures of Children, Youth and Adults Nur. Reinforcement Nur. Antecedents Nur. Physiological Nur. Verbal Relations more for prosocial cue prosocial influences trigger occasion perceived behaviors behaviors protective biological efficacy, safety and mechanisms affiliation The Same Nurturing Conditions Protect and Prevent Wednesday, November 14, 12
  • 34. Heart Low Work Low Delayed Mental health Prosociality Success Health Hi Sch. Addictions etc Cancer Sex Grad Mood Hi Reward Hi Executive Hi Behavioral Attention Delay Stability Function Competencies Good Immune- Low Motor Healing Higher Injuries Skills Multi Anti-Inflammatory Brain & Body Response Efficiency Ed Nurturing Environments Protecting the Futures of Children, Youth and Adults Nur. Reinforcement Nur. Antecedents Nur. Physiological Nur. Verbal Relations more for prosocial cue prosocial influences trigger occasion perceived behaviors behaviors protective biological efficacy, safety and mechanisms affiliation The Same Nurturing Conditions Protect and Prevent Wednesday, November 14, 12
  • 35. Principles for Increasing Nurturing Environments Minimize toxic social and biological conditions Promote and richly reinforce diverse forms of prosocial behavior Limit opportunities for problem behavior Promote psychological flexibility—a mindful approach to pursuing one’s values Wednesday, November 14, 12
  • 36. Let’s survey current “toxic” conditions Wednesday, November 14, 12
  • 37. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 35% 30% 25% 20% 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Wednesday, November 14, 12
  • 38. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 35% Anxiety 30% 25% 20% 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Wednesday, November 14, 12
  • 39. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 35% Anxiety 30% 25% Behavior 20% 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Wednesday, November 14, 12
  • 40. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 35% Anxiety 30% 25% Behavior 20% Mood 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Wednesday, November 14, 12
  • 41. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 35% Anxiety 30% 25% Substance Behavior 20% Mood 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Wednesday, November 14, 12
  • 42. The US has 75 million children and teens. 40.4 million are on psychotropic medications Wall Street Journal, 12-28-2010 Wednesday, November 14, 12
  • 43. Cumulative prevalence of psychiatric disorders by young adulthood 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%. a prospective cohort analysis from the Great Smoky Mountains Study. Wednesday, November 14, 12
  • 44. The US has 75 million children and teens. Wall Street Journal, 12-28-2010 Wednesday, November 14, 12
  • 45. The US has 75 million children and teens. 40.4 million kids had one psychotropic med in 2009 Wall Street Journal, 12-28-2010 Wednesday, November 14, 12
  • 46. So can we actually impact these toxic trends? Perhaps, with some non- pharmaceutical, universal “behavioral vaccines” Wednesday, November 14, 12
  • 47. What are behavioral vaccines? Read more about the science at www.PubMed.gov Wednesday, November 14, 12
  • 48. Muriel Saunders invented the Game in 1967 as a first-year, 4th grade teacher. Harriet Barrish Montrose Wolf These two scientists published Copyright © 2011-12, PAXIS Institute. Only for use by accredited PAX GBG Coaches and licensed by PAXIS. the first proof of the Game in 1969. Wednesday, November 14, 12
  • 49. Longitudinal Johns Hopkins Studies of GBG Kindergarden Every child rated by teachers Wednesday, November 14, 12
  • 50. Longitudinal Johns Hopkins Studies of GBG Kindergarden Every child rated by teachers Wednesday, November 14, 12
  • 51. Longitudinal Johns Hopkins Studies of GBG Kindergarden First Grade Every GBG child rated by teachers NO GBG Tested in 41 first- and second-grade classrooms within 19 elementary schools with two consecutive groups of first graders. Wednesday, November 14, 12
  • 52. Longitudinal Johns Hopkins Studies of GBG Grades 2 thru 12 Kindergarden First Grade Follow Up Every GBG No More GBG child rated by teachers NO GBG No GBG Tested in 41 first- Purpose: To find out if and second-grade GBG affected their classrooms within 19 adolescent lives. elementary schools Note: Some kids got GBG with two consecutive in 1st Grade only, and groups of first some in both 1st & 2nd graders. grade, Wednesday, November 14, 12
  • 53. Longitudinal Johns Hopkins Studies of GBG Grades 2 thru 12 Young Adulthood Kindergarden First Grade Follow Up Follow Up GBG Age Age Age Every No More GBG child 19-21 26 30 rated by Age Age Age teachers NO GBG No GBG 19-21 26 30 Tested in 41 first- Purpose: To find out if Purpose: To find out if and second-grade GBG affected their GBG affected their classrooms within 19 adolescent lives. adult lives. elementary schools Note: Some kids got GBG with two consecutive in 1st Grade only, and groups of first some in both 1st & 2nd graders. grade, Wednesday, November 14, 12
  • 54. They teach children a vision of a wonderful school Wednesday, November 14, 12
  • 55. To create more good, By sweeping away the called “PAX” “bad”, called “Spleems” Wednesday, November 14, 12
  • 56. Playing the PAX Game by Teams: During any regular teaching & learning activity The Blue Team The Red Team The Yellow Team Wednesday, November 14, 12
  • 57. Their Team Aim: to Win PAX Not OK Ms. Dion Jan 23 Spleems are counted and marked with neutral No Spleems Blue tone for the team, not the individual child. Peeling cards up is a spleem for your team Red Teams who have 3 or fewer Spleems win. Yellow Winning teams earn a “Granny’s Wacky Prize”. Team having 4 or more Spleems lose that game. PAX Minutes = winning teams x minutes played. Wednesday, November 14, 12
  • 58. Their Team Aim: to Win PAX Not OK Ms. Dion Jan 23 Spleems are counted and marked with neutral No Spleems Blue tone for the team, not the individual child. Peeling cards up is a spleem for your team Red Teams who have 3 or fewer Spleems win. Yellow Winning teams earn a “Granny’s Wacky Prize”. Team having 4 or more Spleems lose that game. PAX Minutes = winning teams x minutes played. Wednesday, November 14, 12
  • 59. Their Team Aim: to Win PAX Not OK Ms. Dion Jan 23 Spleems are counted and marked with neutral No Spleems Blue tone for the team, not the individual child. Peeling cards up is a spleem for your team Red Teams who have 3 or fewer Spleems win. Yellow Winning teams earn a “Granny’s Wacky Prize”. Team having 4 or more Spleems lose that game. 20 40 PAX Minutes = winning teams x minutes played. Wednesday, November 14, 12
  • 60. Their Team Aim: to Win PAX Not OK Ms. Dion Jan 23 Spleems are counted and marked with neutral No Spleems Blue tone for the team, not the individual child. Peeling cards up is a spleem for your team Red Teams who have 3 or fewer Spleems win. Yellow Winning teams earn a “Granny’s Wacky Prize”. Team having 4 or more Spleems lose that game. 20 40 PAX Minutes = winning teams x minutes played. Wednesday, November 14, 12
  • 61. Their Team Aim: to Win PAX Not OK Ms. Dion Jan 23 Spleems are counted and marked with neutral No Spleems Blue tone for the team, not the individual child. Peeling cards up is a spleem for your team Red Teams who have 3 or fewer Spleems win. Yellow Winning teams earn a “Granny’s Wacky Prize”. Team having 4 or more Spleems lose that game. 20 20 40 60 PAX Minutes = winning teams x minutes played. Wednesday, November 14, 12
  • 62. Winning teams get “Granny’s Wacky Prizes” Brief (30 seconds or so) activity rewards for winning game Start and stop with non-verbal cue Based on mystery motivator and Premack Principle Function as “intrinsic motivators” Wednesday, November 14, 12
  • 63. The PAX Game teaches Individual and group goal orientation/ dependency Voluntary control over attention Self-regulation, self-calming under excitement Self-regulation during failure or disappointment Delay of gratification Cooperation to achieve a bigger goal How to ignore accidental attention to negative behavior from peers Mild sanctions for anti-social acts by others Wednesday, November 14, 12
  • 64. Relational Antecedent Reinforcement Physiological Frame Kernels Kernels Kernel Kernel Creates verbal Happens BEFORE the Happens AFTER the Changes biochemistry relations for the behavior behavior of behavior behavior Wednesday, November 14, 12
  • 65. Relational Antecedent Reinforcement Physiological Frame Kernels Kernels Kernel Kernel Creates verbal Happens BEFORE the Happens AFTER the Changes biochemistry relations for the behavior behavior of behavior behavior PAX Quiet, PAX Voices, PAX Hands, PAX Lines, PAX Stix Wednesday, November 14, 12
  • 66. Relational Antecedent Reinforcement Physiological Frame Kernels Kernels Kernel Kernel Creates verbal Happens BEFORE the Happens AFTER the Changes biochemistry relations for the behavior behavior of behavior behavior PAX Quiet, Granny’s PAX Voices, Wacky Prizes, PAX Hands, Tootle Notes, PAX Lines, PAX It Notes PAX Stix Wednesday, November 14, 12
  • 67. Relational Antecedent Reinforcement Physiological Frame Kernels Kernels Kernel Kernel Creates verbal Happens BEFORE the Happens AFTER the Changes biochemistry relations for the behavior behavior of behavior behavior PAX Quiet, Wonderful Granny’s PAX Voices, School, Wacky Prizes, PAX Hands, PAX OK, Tootle Notes, PAX Lines, Spleems Not PAX It Notes PAX Stix OK Wednesday, November 14, 12
  • 68. Relational Antecedent Reinforcement Physiological Frame Kernels Kernels Kernel Kernel Creates verbal Happens BEFORE the Happens AFTER the Changes biochemistry relations for the behavior behavior of behavior behavior PAX Quiet, Wonderful Granny’s PAX Voices, School, Wacky Prizes, PAX Hands, PAX OK, Tootle Notes, PAX Lines, Spleems Not PAX It Notes PAX Stix OK Wednesday, November 14, 12
  • 69. Seine River Manitoba Pilot Demonstration April, 2011 – Principals and key staff trained for two days for all 12 schools. 45% April, 2011 – First grade classrooms then trained that week April through May – Each successive month other grades trained, including 8th grade classes. Wednesday, November 14, 12
  • 71. Timeline of Benefits… First Month More time for Less stress for teaching and learning Staff & Students First Year Better Fewer Fewer Service Less Happier Less Better Attendance Referrals Needs Illness Families Vandalism Academics 2nd & 3rd Years ADHD Oppositional Special Education Averted Defiance Averted Averted 5-15 Years No Less Less Conduct Less Less Crime, High School Tobacco Alcohol Disorders Depression Violence, Suicide Grad & University Wednesday, November 14, 12
  • 72. HS Long term impact of GBG on School Graduation Academic Outcomes GBG Control 80% 73.6% 64% 53.3% 58.6% 48% 40.3% 44.8% 32% 26% 26.4% 16% 12.8% 0% Boys HS Graduation Girls HS Graduation Boys Univ. Entrance Girls Univ. Entrace Source: Bradshaw, C. P., J. H. Zmuda, et al. (2009). "Longitudinal Impact of Two Universal Preventive Interventions in First Grade on Educational Outcomes in High School." Journal of Educational Psychology 101(4): 926-937. Wednesday, November 14, 12