This document discusses the need for prevention of mental, emotional, behavioral, and related physical disorders in America. It notes that these disorders have reached epidemic proportions, affecting over 50% of adolescents and costing the nation billions each year. The author argues that many of these disorders are preventable and that prevention programs can pay for themselves within a year by reducing healthcare and social costs. International comparisons show much lower rates of these disorders in other developed countries, implying prevention strategies could significantly reduce rates in the US as well.

1. Prevention for Everyone
Averting America’s epidemic of mental, emotional, mental and related behavioral disorders
Dennis D. Embry, Ph.D. • President/Senior Scientist, PAXIS Institute
The University of Kansas Medical Center WIMS Conference, August 18th & 19, 2011

2. Horace Crandell Embry
Near the end of medical school,
Kansas City Medical College, 1909
Dr. Horace Crandell Embry
Last year of his life, Great Bend, Kansas, 1947

3. Horace Crandell Embry
Near the end of medical school,
Kansas City Medical College, 1909
Dr. Horace Crandell Embry
Last year of his life, Great Bend, Kansas, 1947
About 10 years ago, we learned my
grandfather, Dr. H.C. Embry was the son of
freed slave.
He would have lied on his admission papers
about his origin, and he lied on the death
certificate of his father and my great-
grandfather by signing “white”. He and his
father passed in the era of the one-drop
rule.
Today, he is free of the family secret.

4. Considering why
we should have
prevention for
everyone?

5. The nation faced
a national
epidemic of polio.
Emergency
wards were filled
with iron lungs.
Children died or
crippled. The
nation was
terrified.

6. The nation faced
a national
epidemic of polio.
Emergency
wards were filled
with iron lungs.
Children died or
crippled. The
nation was
terrified.
Which children in
America got the
Polio Vaccine during
the Polio Epidemic?

7. WhichF(4,*7"*=($#:&4,*6,:*844,-*G44:*>6HH$,6'$",-I
children should have these vaccinations?
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DE4* 0%$+"("(/!1 '($)")%*(+,!
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Haemophilus
influenzae!"#$%!&
!"#$" 2-%.345455+6!
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*.&%66+
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3+?(*./
9%-(-845455+6!
54-7.8+"%
1,234,56
$%*".//(/
%$&'(
)*+",'(-
(1–2 mos)
1
.*+",'(-
2 2
/*+",'(-
0)*+",'(-
4
(15–18 mos) (12–15 mos) (6–18 mos) (12–15 mos) (12–15 mos) (2 doses given
0O*+",'(- (6–18 mos) (12–15 mos)
6 mos apart at
age 12–23 mos)
0B*+",'(- 3
5 5 Catch-up5 Catch-up5
Catch-up Catch-up
0C?)A*+",'(- Catch-up5 (to 5 years) Catch-up5 (to 5 years) (given each fall
or winter to
children ages
.?/*@46&- 6 mos–18 yrs)
Catch-up5
M?0N*@46&- Catch-up5
Catch-up5
6
Catch-up5 Catch-up5 Catch-up5
00?0)*@46&-
Tdap
Catch-up5 Catch-up5,6 Catch-up5,7
0A?0B*@46&- (Tdap/Td)
1. Your infant may not need a dose of HepB at age 4 months depending on the type of vaccine that 5. If your child’s vaccinations are delayed or missed entirely, they should be given as soon as
your healthcare provider uses. possible.

8. Who pays for children’s,
teen’s, and adult’s
vaccinations in
America?

9. Who pays for children’s,
teen’s, and adult’s
vaccinations in
America?
How good of an idea would it be to stop
funding these vaccines to save money to
pay down the Federal, state, and local
government debt?

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

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

12. Depression by Jobs

13. Lifetime Prevalence of Disorders in US Adolescents (N=10,123)
Merikangas et al., 2010 40%
35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years

14. Lifetime Prevalence of Disorders in US Adolescents (N=10,123)
Merikangas et al., 2010 40%
35%
Anxiety 33%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years

15. Lifetime Prevalence of Disorders in US Adolescents (N=10,123)
Merikangas et al., 2010 40%
35%
Anxiety 33%
30%
25%
Behavior 22%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years

16. Lifetime Prevalence of Disorders in US Adolescents (N=10,123)
Merikangas et al., 2010 40%
35%
Anxiety 33%
30%
25%
Behavior 22%
20%
Mood 18%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years

17. Lifetime Prevalence of Disorders in US Adolescents (N=10,123)
Merikangas et al., 2010 40%
35%
Anxiety 33%
30%
25%
Substance 24%
Behavior 22%
20%
Mood 18%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years

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

19. Nearly 3 out of 4 of the nation's 17- to 24-year-olds are
ineligible for military service for based on national
epidemiological data
• Medical/physical problems,
35 percent.
• Illegal drug use, 18 percent.
• Mental Category V (the
lowest 10 percent of the
population), 9 percent.
• Too many dependents under
age 18, 6 percent.
• Criminal record, 5 percent.
Army Times, Nov 5, 2009 • www.missionreadiness.org/PAEE0609.pd

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

21. Youth MEB Prevalence Rate Comparison
50%
25%
What do these comparisons imply about the prevention
of mental, emotional, and behavioral disorders?

22. Youth MEB Prevalence Rate Comparison
50%
25%
USA United Kingdom OECD Nordic
What do these comparisons imply about the prevention
of mental, emotional, and behavioral disorders?

23. Youth MEB Prevalence Rate Comparison
50%
25%
USA United Kingdom OECD Nordic
What do these comparisons imply about the prevention
of mental, emotional, and behavioral disorders?

24. Youth MEB Prevalence Rate Comparison
50%
25%
USA United Kingdom OECD Nordic
What do these comparisons imply about the prevention
of mental, emotional, and behavioral disorders?

25. Youth MEB Prevalence Rate Comparison
50%
25%
USA United Kingdom OECD Nordic
What do these comparisons imply about the prevention
of mental, emotional, and behavioral disorders?

26. Youth MEB Prevalence Rate Comparison
?
50%
25%
USA United Kingdom OECD Nordic
What do these comparisons imply about the prevention
of mental, emotional, and behavioral disorders?

27. Youth MEB Prevalence Rate Comparison
? ?
50%
25%
USA United Kingdom OECD Nordic
What do these comparisons imply about the prevention
of mental, emotional, and behavioral disorders?

28. What happen if rates of MEB’s could be cut 25-50%?

29. Suicidal acts/thoughts?
Child maltreatment?
ADHD?
Oppositional Defiant Disorders? Major Depression?
Anxiety Disorders?
Conduct Disorders?
Psychosis onset?
Tobacco addiction?
Learning Disorders/Disabilities?
Alcohol abuse?
Drug abuse rates? School failure/dropping out?
Drug abuse?

30. What would happen in the US, in
this state, and in this community if
the rates of the following were cut Suicidal acts/thoughts?
25% to 50%…
Child maltreatment?
ADHD?
Oppositional Defiant Disorders? Major Depression?
Anxiety Disorders?
Conduct Disorders?
Psychosis onset?
Tobacco addiction?
Learning Disorders/Disabilities?
Alcohol abuse?
Drug abuse rates? School failure/dropping out?
Drug abuse?

31. The call
“How are the children?” Hongi
After the challenge warning,
the eldest woman calls forth
the women and children.
Two chiefs
meet
Tamariki Wairua
“The children are the gift of
the gods held in common.”
Turia te marae e tamara ma, Now take your stand on the marae.
Whaikorero kae i te pa-uauatanga, Share your concerns about the state of affairs,
I puta ai to ihu ki Rangiatea, Let your wisdom lead us into the light,
I mau ai te puni wahine, Let it be as a mantle over the assembly of women,
Te tira taitama, the band of young people;

32. Key messages about mental, emotional & behavioral disorders…

33. Key messages about mental, emotional & behavioral disorders…
MEB’s are
preventable.

34. Key messages about mental, emotional & behavioral disorders…
MEB’s are Break-even for
preventable. MEB prevention
is one year.

35. Key messages about mental, emotional & behavioral disorders…
MEB’s are Break-even for MEB prevention
preventable. MEB prevention balances
is one year. budgets.

36. Key messages about mental, emotional & behavioral disorders…
MEB’s are Break-even for MEB prevention MEB prevention
preventable. MEB prevention balances improves US
is one year. budgets. business.

37. Key messages about mental, emotional & behavioral disorders…
MEB’s are Break-even for MEB prevention MEB prevention
preventable. MEB prevention balances improves US
is one year. budgets. business.
Effective MEB
prevention helps
national security.

38. Key messages about mental, emotional & behavioral disorders…
MEB’s are Break-even for MEB prevention MEB prevention
preventable. MEB prevention balances improves US
is one year. budgets. business.
Effective MEB MEB prevention
prevention helps helps US global
national security. success.

39. Key messages about mental, emotional & behavioral disorders…
MEB’s are Break-even for MEB prevention MEB prevention
preventable. MEB prevention balances improves US
is one year. budgets. business.
MEB prevention
Effective MEB MEB prevention saves Social
prevention helps helps US global Security &
national security. success. Medicare.

40. Key messages about mental, emotional & behavioral disorders…
MEB’s are Break-even for MEB prevention MEB prevention
preventable. MEB prevention balances improves US
is one year. budgets. business.
MEB prevention
Effective MEB MEB prevention saves Social MEB prevention
prevention helps helps US global Security & heals past
national security. success. Medicare. inequities.

41. Introducing “behavioral
vaccines”
Behavioral vaccines are a simple
procedure that, when used
repeatedly, reduce morbidity and
mortality and/or increase
wellbeing or health.
Such behavioral vaccines can
become cultural practices.
• Embry, D. D. (2011). "Behavioral Vaccines and Evidence-Based Kernels: Non-pharmaceutical Approaches for the Prevention of
Mental, Emotional, and Behavioral Disorders." Psychiatric Clinics of North America 34(March): 1-34
• Embry, D. D. (2004). "Community-Based Prevention Using Simple, Low-Cost, Evidence-Based Kernels and Behavior Vaccines."
Journal of Community Psychology 32(5): 575.
• Embry, D. D. (2002). "The Good Behavior Game: A Best Practice Candidate as a Universal Behavioral Vaccine." Clinical Child &
Family Psychology Review 5(4): 273-297.

42. Brushing teeth Watching TV in
3x per day bedroom
Yes Yes
No No
Buckling a child 30 minutes of
in a car seat physical activity
per day
Yes Yes
No No
Checking for understanding:
Which are “behavioral vaccines”?

43. Evidence-Based Kernels…
Is the smallest unit of scientifically proven behavioral
influence.
• Is indivisible; that is, removing any part makes it
inactive.
Produces quick easily measured change that can
grow much bigger change over time.
Can be be used alone OR combined with other
kernels to create new programs, strategies or
policies.
• Are the active ingredients of evidence-based
programs
• Can be spread by word-of-mouth, by modeling, by
non professionals.
• Can address historic disparities without stigma, in
part because they are also found in cultural wisdom.

44. Further reading…
Clin Child Fam Psychol Rev
DOI 10.1007/s10567-008-0036-x
Evidence-based Kernels: Fundamental Units of Behavioral
Influence
Fundamental unites of behavior change
Dennis D. Embry Æ Anthony Biglan
Embry, D. D. and A. Biglan (2008). "Evidence-Based Kernels:
Fundamental Units of Behavioral Influence." Clinical Child & Family
Ó The Author(s) 2008. This article is published with open access at Springerlink.com
Abstract This paper describes evidence-based kernels, This paper presents an analysis of fundamental units of
Psychology Review 11(3): 75-113.
fundamental units of behavioral influence that appear to behavioral influence that underlie effective prevention and
underlie effective prevention and treatment for children, treatment. We call these units kernels. They have two
adults, and families. A kernel is a behavior–influence defining features. First, in experimental analysis,
procedure shown through experimental analysis to affect a researchers have found them to have a reliable effect on
A R T I C L E
COMMUNITY-BASED
Creating population change
PREVENTION USING SIMPLE, Embry, D. D. (2004). "Community-Based Prevention Using Simple,
LOW-COST, EVIDENCE-BASED
KERNELS AND BEHAVIOR Low-Cost, Evidence-Based Kernels and Behavior Vaccines."
VACCINES
Dennis D. Embry
PAXIS Institute
Journal of Community Psychology 32(5): 575.
A paradox exists in community prevention of violence and drugs. Good
B e h a v i o r a l Vac c i n e s an d
Evidence-Based Kernels:
Nonpharmaceutical Behavioral vaccines for disease control
A p p ro a c h e s f o r th e
Prevention of Mental, Embry, D. D. 2011. Behavioral vaccines and evidence-based kernels:
Emotional, and non-pharmaceutical approaches for the prevention of mental, emotional,
B e ha vi ora l D is o rd er s
and behavioral disorders. Psychiatr Clin North Am 34 (1):1-34.
Dennis D. Embry, PhD
KEYWORDS

45. Packing our young
people’s suitcases for
their whole lives…

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

47. Bi-directional Wealth and Wellbeing Transfer
5-Year 65-Year
Olds Olds

48. Bi-directional Wealth and Wellbeing Transfer
5-Year 65-Year
Olds Olds
Who are living
longer though get
progressively sicker…

49. Bi-directional Wealth and Wellbeing Transfer
Requiring more wealth transfer
5-Year 65-Year
Olds Olds
Who are living
longer though get
progressively sicker…

50. Bi-directional Wealth and Wellbeing Transfer
Requiring more wealth transfer
5-Year 65-Year
Olds Olds
Who are living
Who are less
longer though get
and less able…
progressively sicker…

51. Bi-directional Wealth and Wellbeing Transfer
Requiring more wealth transfer
5-Year 65-Year
Olds But elders voting to stop funds to kids Olds
Who are living
Who are less
longer though get
and less able…
progressively sicker…

52. Meet Muriel Saunders, the 4th-grade teacher who
invented the Good Behavior Game in 1967
JOURNAL OF APPLIED BEHAVIOR ANALYSIS 1969, 2, 119-124 NUMBER 2 (SUMMER 1969)
GOOD BEHAVIOR GAME: EFFECTS OF INDIVIDUAL
CONTINGENCIES FOR GROUP CONSEQUENCES ON
DISRUPTIVE BEHAVIOR IN A CLASSROOM'
HARRIET H. BARRISH, MURIEL SAUNDERS, AND MONTROSE M. WOLF
UNIVERSITY OF KANSAS
Out-of-seat and talking-out behaviors were studied in a regular fourth-grade class that in-
cluded several "problem children". After baseline rates of the inappropriate behaviors were
obtained, the class was divided into two teams "to play a game". Each out-of-seat and talking-
out response by an individual child resulted in a mark being placed on the chalkboard, which
meant a possible loss of privileges by all members of the student's team. In this manner a
contingency was arranged for the inappropriate behavior of each child while the consequence
(possible loss of privileges) of the child's behavior was shared by all members of this team
as a group. The privileges were events which are available in almost every classroom, such
as extra recess, first to line up for lunch, time for special projects, stars and name tags, as
well as winning the game. The individual contingencies for the group consequences were
successfully applied first during math period and then during reading period. The experi-
mental analysis involved elements of both reversal and multiple baseline designs.
Researchers have recently begun to assess Hall and Broden, 1967; Becker, Madsen,
the effectiveness of a variety of behavioral Arnold, and Thomas, 1967; Hall, Lund, and
procedures for management of disruptive class- Jackson, 1968; Thomas, Becker, and Arm-
room behavior. Some investigators have ar- strong, 1968; Madsen, Becker, and Thomas,
ranged token reinforcement contingencies for 1968). Even so, at least one group of investi-
appropriate classroom behavior (Birnbrauer, gators (Hall et al., 1968) encountered a teacher
Wolf, Kidder, and Tague, 1965; O'Leary and who apparently did not have sufficient social
Becker, 1967; Wolf, Giles, and Hall, 1968). reinforcers in her repertoire to apply social
However, these token reinforcers often have reinforcement procedures successfully. The
been dependent upon back-up reinforcers that present study investigated the effects of a class-
were unnatural in the regular classroom, such room behavior management technique based
as candy and money. On the other hand, on reinforcers natural to the classroom, other
several investigators have utilized a reinforcer than teacher attention. The technique was
intrinsic to every classroom, i.e., teacher at- designed to reduce disruptive classroom be-
tention (Zimmerman and Zimmerman, 1962; havior through a game involving competition
for privileges available in almost every class-
'This study is based upon a thesis submitted by the room. The students were divided into two
senior author to the Department of Human Develop- teams and disruptive behavior by any member
ment in partial fulfillment of the requirements for the of a team resulted in possible loss of privileges
Master of Arts degree. The research was supported by for every member of his team.
a Public Health Service Fellowship IFI MH-36, 964-01
from the National Institute of Mental Health and by
a grant (HD 03144) from the National Institute of METHOD
Child Health and Human Development to the Bureau
of Child Research and the Department of Human Subjects and Setting
Development, University of Kansas. The authors wish The study was conducted in a fourth-grade
to thank Drs. Donald M. Baer and Don Bushell, Jr.,
for helpful suggestions in preparation of the manu- classroom of 24 students. Seven of the students
script; Mr. Rex Shanks, Mr. Frank A. Branagan, and had been referred several times by the teacher
Mrs. Betty Roberts for their invaluable help in con- to the school principal for such problems as
ducting the study; and Mrs. Susan Zook, Mrs. Sue out-of-seat behavior, indiscriminate noise and
Chen, and Mr. Jay Barrish for their contributions of talking, uncooperativeness, and general class-
time for reliability checks. Reprints may be obtained
from the authors, Department of Human Development, room disruption. Further, the school principal
University of Kansas, Lawrence, Kansas 66044. reported that a general behavior management
119
Barrish, H. H., Saunders, M., & Wolf, M. M. (1969). Good behavior game: Effects of individual contingencies for group
consequences on disruptive behavior in a classroom. Journal of Applied Behavior Analysis, 2(2), 119-124

53. Meet Muriel Saunders, the 4th-grade teacher who
invented the Good Behavior Game in 1967
JOURNAL OF APPLIED BEHAVIOR ANALYSIS 1969, 2, 119-124 NUMBER 2 (SUMMER 1969)
GOOD BEHAVIOR GAME: EFFECTS OF INDIVIDUAL
CONTINGENCIES FOR GROUP CONSEQUENCES ON
DISRUPTIVE BEHAVIOR IN A CLASSROOM'
HARRIET H. BARRISH, MURIEL SAUNDERS, AND MONTROSE M. WOLF
UNIVERSITY OF KANSAS
Out-of-seat and talking-out behaviors were studied in a regular fourth-grade class that in-
cluded several "problem children". After baseline rates of the inappropriate behaviors were
obtained, the class was divided into two teams "to play a game". Each out-of-seat and talking-
out response by an individual child resulted in a mark being placed on the chalkboard, which
meant a possible loss of privileges by all members of the student's team. In this manner a
contingency was arranged for the inappropriate behavior of each child while the consequence
(possible loss of privileges) of the child's behavior was shared by all members of this team
as a group. The privileges were events which are available in almost every classroom, such
as extra recess, first to line up for lunch, time for special projects, stars and name tags, as
well as winning the game. The individual contingencies for the group consequences were
successfully applied first during math period and then during reading period. The experi-
mental analysis involved elements of both reversal and multiple baseline designs.
Researchers have recently begun to assess Hall and Broden, 1967; Becker, Madsen,
the effectiveness of a variety of behavioral Arnold, and Thomas, 1967; Hall, Lund, and
procedures for management of disruptive class- Jackson, 1968; Thomas, Becker, and Arm-
room behavior. Some investigators have ar- strong, 1968; Madsen, Becker, and Thomas,
ranged token reinforcement contingencies for 1968). Even so, at least one group of investi-
appropriate classroom behavior (Birnbrauer, gators (Hall et al., 1968) encountered a teacher
Wolf, Kidder, and Tague, 1965; O'Leary and who apparently did not have sufficient social
Becker, 1967; Wolf, Giles, and Hall, 1968). reinforcers in her repertoire to apply social
However, these token reinforcers often have reinforcement procedures successfully. The
been dependent upon back-up reinforcers that present study investigated the effects of a class-
were unnatural in the regular classroom, such room behavior management technique based
as candy and money. On the other hand, on reinforcers natural to the classroom, other
several investigators have utilized a reinforcer than teacher attention. The technique was
intrinsic to every classroom, i.e., teacher at- designed to reduce disruptive classroom be-
tention (Zimmerman and Zimmerman, 1962; havior through a game involving competition
for privileges available in almost every class-
room. The students were divided into two
The first whole classroom
'This study is based upon a thesis submitted by the
senior author to the Department of Human Develop- teams and disruptive behavior by any member
ment in partial fulfillment of the requirements for the of a team resulted in possible loss of privileges
Master of Arts degree. The research was supported by for every member of his team.
a Public Health Service Fellowship IFI MH-36, 964-01
from the National Institute of Mental Health and by
a grant (HD 03144) from the National Institute of METHOD
Child Health and Human Development to the Bureau
study of behavioral
of Child Research and the Department of Human Subjects and Setting
Development, University of Kansas. The authors wish The study was conducted in a fourth-grade
to thank Drs. Donald M. Baer and Don Bushell, Jr.,
for helpful suggestions in preparation of the manu- classroom of 24 students. Seven of the students
script; Mr. Rex Shanks, Mr. Frank A. Branagan, and had been referred several times by the teacher
Mrs. Betty Roberts for their invaluable help in con- to the school principal for such problems as
ducting the study; and Mrs. Susan Zook, Mrs. Sue out-of-seat behavior, indiscriminate noise and
psychology in the world
Chen, and Mr. Jay Barrish for their contributions of talking, uncooperativeness, and general class-
time for reliability checks. Reprints may be obtained
from the authors, Department of Human Development, room disruption. Further, the school principal
University of Kansas, Lawrence, Kansas 66044. reported that a general behavior management
119
Barrish, H. H., Saunders, M., & Wolf, M. M. (1969). Good behavior game: Effects of individual contingencies for group
consequences on disruptive behavior in a classroom. Journal of Applied Behavior Analysis, 2(2), 119-124

54. Behavior Tracking Results in Baltimore 150+ classrooms
No or Low Implementation High Implementation
of PAX (Good Behavior) Game of PAX (Good Behavior) Game
17 per/hr X 5.5 class
hours X 30 students =
2,805 disruptions per
school day per
classroom

55. Behavior Tracking Results in Baltimore 150+ classrooms
No or Low Implementation High Implementation
of PAX (Good Behavior) Game of PAX (Good Behavior) Game
17 per/hr X 5.5 class
hours X 30 students =
2,805 disruptions per
school day per
classroom
6 per/hr X 5.5 class
hours X 30 students =
990 disruptions per
school day per
classroom

56. incur a checkmark, lessening In 1985, Dr. Kellam and colleagues 29 percent who played the GBG reported abuse and dependence. Teachers gave out the Dr. Kellam and colleagu
’ chances for prizes. identified three to four schools in each of stickers and other token rewards and penalties dinal study of the GBG wh
Univers
me is played for brief intervals at five demographically distinct neighbor-
hoods, ranging more than mostly
In 1985, in ethnicity from MALES BENEFIT ACROSS THE AS THE TWIG IS BENT Young adults who had played the Good
ship wit
me and frequency are gradually
BOARD As they grew, boys who had partici- Behavior Game in first and second grade were less likely to smoke ciga- Public S
d as the children gain practice 1,000 children from
African-American to mostly White and in pated in the Good Behavior Game in first and rettes or abuse drugs than those who hadn’t played the game. Males
Kellam
ng their behaviors. Eventually, economic status from very low to moder- second grade in 1985–1986 used fewer social whose first-grade teachers identified them as aggressive and disruptive
constant attentiveness to
41 first-grade classes
ate income. Altogether, more than 1,000 services than a control group. benefited the most. activity
spectrum
e behavior, the teacher stops in 19 from 41 first-grade classes in 19
children schools either efits by s
Good Behavior Game Control
g when the game is in play and schools either used the GBG or served as Game
used the GBG or Players
Controls olds awa
prizes to successful teams only controls in the study. 70%
disrupti
servedthe first weeks of in
as controls school,
Prevalence of Problem Behaviors at Age 19–21
h of a GBG period. During School 60%
have lon
G was devised in the 1960s the study.
teachers in both the GBG and the control Services*
9% 14% precurso
H. Barrish, Muriel Saunders, classes assessed each student’s behav- 50% adolesce
Mental Health or comes. T
ose M. Wolf at the University ior; about 12 percent of the males and 3 Medical Services
13% 18%
Its underlying concept is that These results are
percent of the females were classified as
40%
the GBG
only aga
bers, wanting to win, will pres- longitudinal results at
aggressive and disruptive. Teachers in the Drug Abuse
Treatment
4% 9% 30%
and dep
help—each other to meet the game-playing classrooms divided these
objectives.
age 21 from the
high-risk students roughly equally among 20% against t
Social antisoci
kids come to school, they often study.
the teams. Services
1% 6%
10% der, and
w how to behave like students. The teachers using the GBG began by
to be taught. It’s not intuitive, implementing the game for 10 minutes Criminal Justice 0
12% 20% HOW TO
System Drug Abuse Smoking Drug Abuse Smoking Drug Abuse Smoking
n’t always get it, and teachers three times a week; they then increased its Teach
All Males Males Disruptive in First Grade
g trained to deal with it,” says frequency and duration as the school year *For problems with behavior, emotions, drugs, or alcohol. All Females
of the ga
. “This is the issue the GBG progressed. The same children contin-
o address.” ued to play the GBG or serve as controls
stakes are high: Children who through second grade. The game did not drug use disorder, compared with 68 per-
pt to the student role early in
ol careers risk rejection by
Example long-term results of a behavior vaccine
cut into instructional time because it took cent of controls (see graph, page 1).
place when students were at their desks “We did not anticipate that a single
ure to achieve academically, reading, completing work assignments, or intervention a universal classroom behavior management program in first and second
Kellam, S., C. H. Brown, et al. (2008). "Effects of would have such a major
t with their teachers and other engaging in other quiet activities.
grades on young adult behavioral, psychiatric,says Dr. Kellam, who led Drug & Alcohol Dependence(Special Issue): 24.
impact,” and social outcomes,." the
igures. The consequences of About 15 years later, the researchers study. “The key to the GBG’s efficacy
lems in the teen years include located and interviewed approximately 75 seems to be its effect on aggressive and

57. Timeline of benefits from PAX GBG
Ageof Child Benefits
75% reduction in disturbing, disruptive and destructive behavior;
1st Grade 25% increase academic achievement; less bullying and intimidation
43% reduction in ADHD diagnoses; 33% reduction in Oppositional Defiant
3rd Grade Disorder;
30%+ reduction special services needs;
50%+ reduction in conduct disorders; 25% to 50% reduction tobacco
6th grade use; reduction in bullying or harassment behaviors
8th Grade 75%r reduction in serious drug use and engagement in delinquent acts
Major increase in high-school graduation; lower utilization of special
12th Grade services
Increase in college entry; Major reductions drug use; reductions in prison
Early 20’s time
Lifetime reduction in violent crime, suicide, psychiatric diagnoses, and
Age 29 lifetime addictions

58. Lessons learned
Class-wide peer from one-room
tutoring process Kansas school
houses
Children have lifetime
achievement gains from
rapid paced, daily process
of tutoring each other
developed and tested at
the University of Kansas

59. Table 1. Methodologically Rigorous Evidence (Randomized Trials) Supporting the Efficacy of CWPT
Citation Description Indicator Effect Size
1. Greenwood, Delquadri, & Hall (1989) Prospective, Longitudinal Reading Achievement 0.57
(Note. These four peer-reviewed publications Randomized CWPT trial, Language Achievement 0.60
report the longitudinal achievement, behavior 1st-4th Grades (N = 416) Arithmetic Achievement 0.37
and life event effects of a single CWPT trial) AcademicEngagement 1.41
2. Greenwood (1991a) Multiyear Behavioral Trajectories, Academic Engagement 0.63
1st-3th Grades (N = 115) Task Management 0.61
Inappropriate Behavior 0.83
3. Greenwood, Terry, Utley et al. (1993) Follow-up at 7th Grade Reading Achievement 0.39
(N = 303) Language Achievement 0.35
Arithmetic Achievement 0.57
Social Studies Achievement 0.39
Science Achievement 0.48
Reduction in SPED Services 0.54*
Less Restrictiveness Services 0.73*
4. Greenwood, & Delquadri (1995) Follow-up at 12th Grade (N = 231) Reduction in School Dropout 0.66*
Mathes, Howard, Allen, & Fuchs (1998) (N = 96) Randomized PALS Trial, Grade K Woodcock Word ID 0.70
Woodcock Word Attack 0.78
Woodcock Comprehension 0.27
CBM (Low Achievers) .03-1.35
Fuchs, Fuchs, Thompson et al. (2001) (N = 379) Randomized PALS trial, Grade K Segmentation, Blending 0.45-2.1
Alphabetics 0.02 -1.96
Fuchs, Fuchs, Phillips, et al. (1995) (N = 120) Randomized PALS Trial, 2-4 Grades Math Achievement 0.34
Fuchs, Fuchs, Mathes & Simmons (1997) (N = 120) Randomized PALS trial, 2-6 Grades Reading Achievement 0.22-0.56
Note. Effects sizes are Cohen's d ; *= effect size calculated from Chi-square as w

60. Language development

61. Special “Me” Books, and
evidence-based kernel:
Can change parent and child behavior,
as well as language development.
Twelve such books can affect early
literacy, too.

62. What happens if
you teach students
to praise each other
for “peaceability”
CDC Nurses Office Study
60%
50%
Percentage Change
40%
30%
20%
10%
0%
-10%
-20%
All Visits Injury Viists Non-Injuries Fighting Non-Fighting
Injuries Injuries
Control/Wait List PeaceBuilders
A “Tootle” is the opposite of a tattle.

63. Hope for Our Futures:
Preventing Child Maltreatment & Adverse Childhood Experiences

64. JOURNAL OF APPLIED BEHAVIOR ANALYSIS 1972, 530 139-149
TRAINING PARENTS AS BEHAVIOR MODIFIERS:
SELF-RECORDING OF CONTINGENT ATTENTION'
NUMBER 2 (SUMMER 1972)
Behaviorally Based Parenting Supports:
Triple P Intervention Studies
EMILY W. HERBERT AND DONALD M. BAER
UNIVERSITY OF KANSAS
Two mothers of deviant young children were instructed to count their episodes of
attention to appropriate child behavior in their homes, using wrist counters. Attention
and appropriate child behavior were defined before counting began. Independent ob-
servations of parent-child interactions showed that, for each mother-child pair, the
percentage of maternal attention given following appropriate child behavior increased,
as did the child's appropriate behavior. Removal of the counters did not produce a
reversal of the behaviors; instead the increased level stabilized. One mother was then
instructed to count her attention to inappropriate child behavior and to decrease it.
This instruction had little effect on her attention, and her child's behavior did not change.
!"#$%&'(&)) 8+%9&.:)
When both parents were again instructed to count their episodes of attention to ap-
propriate behavior, further improvements in both mothers, and in their children
resulted. These results were obtained despite inaccurate parent self-recording. Follow-up
observations made over the next five months showed these behavioral gains to be
!"#"$%&'()*+,)+-)./01$()2)345(/'(4&+4)65"70(8) *+,)-+&'&./)) ;<+)*+$<+%'&./#)
durable. A third parent and his child were unaffected by this training procedure. Thus,
there are instances in which self-recording may function as an effective and economical
parent-training technique for effecting improvements in child behavior.
0.1'&./)
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NumzER4 (wiN-r 1972) C30:"?:=@/3"A" 2,($>+%'&./)
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1972, 59 405-420
'!!"
JOURNAL OF APPLIED BEHAVIOR ANALYSIS R
THE ORGANIZATION OF DAY-CARE ENVIRONMENTS:
REQUIRED VS. OPTIONAL ACTIVITIES'
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LARRY A. DOKE AND TODD R. RISLEY 40.3" D3B08" 6.($+/)2$&$+#)
&!"
UNIVERSITY OF KANSAS
2(.1&?4%+)
Measures of group participation were used in an experimental analysis of the effects of 7&.&/&)
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two preschool activity schedules. Children's participation in preschool activities remained
as high when children were allowed no options but were required to follow a schedule ,-.-/0123"456"
of activities in sequence, as when they were free to choose between several optional activ- %!" 5%&.)
ities. However, this was only true: (1) when a child was not forced to wait until all other 7893:238158"
children had finished, but could start the next required activity individually as soon as
;9-<=3>"
he had finished the preceding one, and (2) when there was an abundance of materials
in each required activity. When there were not adequate materials in each activity,
children's participation was disrupted unless they were free to choose among several 7"%&3&4) A4.1)B4.1)
optional activities. Thus, in order to maintain high levels of participation in preschool $!"
play activities, it is not necessary to allow children to choose among several alternative
activities. High participation may be more efficiently maintained by providing a supply
of materials that is adequate to occupy all children in each of a sequence of required
activities and staffing by at least two teachers, so that while one teacher is supervising
children still finishing one activity another teacher can supervise children who are ready
to start the next. #!"
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65. Substantiated Child Maltreatment
16
Rates per 1,000 Children (0-8 Years)
15
13
12
10
Pre Post
Prinz et al., 2009, Prevention Science

66. Substantiated Child Maltreatment
16
Control Counties
Rates per 1,000 Children (0-8 Years)
15
13
12
10
Pre Post
Prinz et al., 2009, Prevention Science

67. Substantiated Child Maltreatment
16
Control Counties
Rates per 1,000 Children (0-8 Years)
15
13
Triple P Counties
12
10
Pre Post
Prinz et al., 2009, Prevention Science

68. Child Abuse Hospital Injuries
1.80
Rates per 1,000 Children (0-8 Years)
1.68
1.55
1.43
1.30
Pre Post
Prinz et al., 2009, Prevention Science

69. Child Abuse Hospital Injuries
1.80
Rates per 1,000 Children (0-8 Years)
1.68
Control Counties
1.55
1.43
1.30
Pre Post
Prinz et al., 2009, Prevention Science

70. Child Abuse Hospital Injuries
1.80
Rates per 1,000 Children (0-8 Years)
1.68
Control Counties
1.55
1.43 Triple P Counties
1.30
Pre Post
Prinz et al., 2009, Prevention Science

71. Child Out-of-Home Placements
4.50
Rates per 1,000 Children (0-8 Years)
4.13
3.75
3.38
3.00
Pre Post
Prinz et al., 2009, Prevention Science

72. Child Out-of-Home Placements
4.50
Control Counties
Rates per 1,000 Children (0-8 Years)
4.13
3.75
3.38
3.00
Pre Post
Prinz et al., 2009, Prevention Science

73. Child Out-of-Home Placements
4.50
Control Counties
Rates per 1,000 Children (0-8 Years)
4.13
Triple P Counties
3.75
3.38
3.00
Pre Post
Prinz et al., 2009, Prevention Science

74. Apparent consumption o inoleic acid (% of dietary energy) among
Australia, Canada, UK and USA for the years 1961–2000
#" +651.-:8- A-0-;- BC BD+2
+,,-./012340567,1840 492:804:/83 -38;
$
&
'
<=2/0/.>?@
(
%
*
)
!
#
"
#$(" #$(% #$'" #$'% #$&" #$&% #$$" #$$% !"""
E/-.5
Susan Elaine Carlson, PhD
AJ Rice Professor of
Evolution Neonates Breast Milk “Risky” Behavior
Nutrition
KU Department of Dietetics In the Rife Valley, the Successful human American infants have Almost all adolescent
and Nutrition
University of Kansas human brain evolution neonates born with been getting steadily less risky behaviors have now
Medical Center
60-day supply of omega-3 (n3) and more been documented to be
the result of eating
pro-inflammatory omega-6 related to low n3 and
fish high in omega-3 omega-3 in
(n6) in breast milk high n6 in US diet
not savannah animals subcutaneous fat from
See Ailhaud et al. (2006).Temporal changes change in last 50 years
mother’s diet in dietary fats: Role of n6
See Broadhurst, Cunnane, & Hibbeln et al. (2006). Healthy intakes of n-3
polyunsaturated fatty acids in excessive
Crawford (1998). Rift Valley lake fish and n-6 fatty acids: estimations considering
See HIbbeln et al. (2007).Maternal seafood adipose tissue
worldwide diversity.
and shellfish provided brain-specific consumption in pregnancy and development and relationship to obesity
nutrition for neurodevelopmental outcomes in childhood
early Homo (ALSPAC study): an observational cohort
study

75. Physiological Kernel: Omega-3
30%
Why not help
Percentage with Psychosis at 12 months
27.5%
at-risk young 24%
adults to
18% This cost $12
prevent to achieve
psychosis? 12%
6%
4.9%
0% Amminger, G. P., M. R. Schafer, et al.
Omega-3 Placeo (2010). "Long-Chain {omega}-3 Fatty Acids
Psychosis for Indicated Prevention of Psychotic
Disorders: A Randomized, Placebo-
Controlled Trial." Arch Gen Psychiatry 67(2):
146-154.
See p.214, IOM Report

76. Omega-3 Intake and developmental outcomes
Reduction in ADHD-related Symptoms
DSM Combined-type
DSM Hyperactivity
DSM Inattention
Conners Global Index
CG Emotional Lability
CG Restless-Impulsive
Conners Index
Social Problems
Perfectionism
Anxiety
Hyperactivity
Cognitive Problems
Opposition
-0.15 0 0.150.300.450.60
Treatment Effect Size
(Mean change 0-3m / Pooled Baseline SD)
Placebo (N=52)
Active (N=50)
Richardson and Montgomery 2005Text

77. Reduced Felony Violent Offenses Among Prisoners
with recommended daily amounts of vitamins, minerals and essen=al fa>y acids
Ratio of Disciplinary Incidents Supplementation/Baseline
Ac=ve ‐37.0%
p ‹ 0.005
1.00
Placebo ‐10.1%
0.75 p = ns
0.50
0.25
0
Before supplementation During supplementation
Active
Placebo
UK maximum security prison ‐ 338 offences among 172 prisoners over 9 months treatment in a compared to 9
months baseline.
Gesch et al. Br J Psychiatry 2002, 181:22‐28