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Author(s): Schneider, Ruth B; Myers, Taylor L; Rowbotham, Helen M; Luff, Marie K; Amodeo, Katherine; Sharma, Saloni; Wilson, Renee; Jensen-Roberts, Stella; Auinger, Peggy; McDermott, Michael P; Alcalay, Roy N; Biglan, Kevin; Kinel, Daniel; Tanner, Caroline; Winter-Evans, Reni; Augustine, Erika F; Cannon, Paul; 23andMe Research Team; Holloway, Robert G; Dorsey, E Ray | Abstract: BackgroundThe rise of direct-to-consumer genetic testing has enabled many to learn of their possible increased risk for rare diseases, some of which may be suitable for gene-targeted therapies. However, recruiting a large and representative population for rare diseases or genetically defined sub-populations of common diseases is slow, difficult, and expensive.ObjectiveTo assess the feasibility of recruiting and retaining a cohort of individuals who carry a genetic mutation linked to Parkinson's disease (G2019S variant of LRRK2); to characterize this cohort relative to the characteristics of traditional, in-person studies; and to evaluate this model's ability to create an engaged study cohort interested in future clinical trials of gene-directed therapies.MethodsThis single-site,3-year national longitudinal observational study will recruit between 250 to 350 LRRK2 carriers without Parkinson's disease and approximately 50 with the condition. Participants must have undergone genetic testing by the personal genetics company, 23andMe, Inc., have knowledge of their carrier status, and consent to be contacted for research studies. All participants undergo standardized assessments, including video-based cognitive and motor examination, and complete patient-reported outcomes on an annual basis.Results263 individuals living in 33 states have enrolled. The cohort has a mean (SD) age of 56.0 (15.9) years, 59% are female, and 76% are of Ashkenazi Jewish descent. 233 have completed the baseline visit: 47 with self-reported Parkinson's disease and 186 without.ConclusionsThis study establishes a promising model for developing a geographically dispersed and well-characterized cohort ready for participation in future clinical trials of gene-directed therapies.

Despite significant progress in research on the treatment and prevention of psychological, behavioral, and health problems, the translation of this knowledge into population-wide benefit remains limited. This paper reviews the state of America's children and families, highlighting the influence of stressful contextual and social conditions on child and family well-being and the concentration of disadvantage in numerous neighborhoods and communities throughout the nation. It then briefly reviews the progress that has been made in pinpointing policies that can reduce stressful contextual conditions such as poverty, discrimination, and the marketing of unhealthful foods and substances. It also describes numerous family and school interventions that have proven benefit in preventing psychological and behavioral problems as diverse as tobacco, alcohol, and other drug use; depression; antisocial behavior; academic failure; obesity prevention; and early childbearing. We argue that progress in translating existing knowledge into widespread benefit will require a nationwide effort to intervene comprehensively in neighborhoods and communities of concentrated disadvantage. We present a strategic plan for how such an effort could be organized. The first step in this organizing would be the creation of a broad and diverse coalition of organizations concerned with advancing public health and well-being. Such a coalition could increase public support both for the policies needed to focus on these disadvantaged areas and the research needed to incrementally improve our ability to help these areas.

This article reviews the evidence regarding behavioral science approaches to the prevention of substance use disorders. Prevention science grew out of research on family and school-based interventions that were designed to treat common behavioral problems of children and adolescents. That research showed that the amelioration of problems such as aggressive behavior could prevent the development of later problems including substance use, depression, and academic failure. We begin by reviewing evidence regarding the risk factors that contribute to the development of substance use disorders, as well as the protective factors that can reduce their likelihood. We then describe a variety of family, school, and community prevention programs that have been shown to prevent youthful use and abuse of substances. We conclude by describing the progress that has been made in getting these programs widely and effectively implemented, and the challenges we face in getting to the point where most communities are achieving considerable success in prevent substance use and the other common and costly behavioral and psychological problems of children and adolescents.

Reward & Reminder has been a component of community-based preventive efforts against sales of substances (e.g., tobacco) to youth. To date, there has not been a randomized trial of Reward & Reminder as a stand-alone prevention program targeting youth access to alcohol. In this study, we addressed that gap. Data were collected as part of a randomized trial of a school- and community-based prevention program. Our analysis included 23 vendors in control communities and 33 vendors in intervention communities. We visited each vendor at least two times, and vendors in intervention communities received the Reward & Reminder protocol. Using McNemar’s Test, which evaluates the degree to which the outlets in each condition moved to a different cell in the contingency table from the first visit to the second (i.e., from yes to no or vice versa), we found that the control outlets did not change (all p values were non-significant). In contrast, the test results for the intervention outlets were significantly more likely to ask for ID (p < .05) and significantly less willing to sell alcohol to young-looking project confederates (p < .05); Asked for Age did not change. We conclude that Reward & Reminder could assist in preventing underage access to alcohol.

This paper describes the culture and components of the PAX Good Behavior Game and offers it as one model for how to enhance the well-being of populations through the diffusion of nurturing practices into several venues of society. The PAX components, also known as evidence-based kernels, are proposed to be useful in classrooms, families, organizations, criminal justice, and in improving public discussion and government. Kernels affect behavior in the short- and long-term through combinations of antecedents, reinforcers, relational networks, and physiological effects. Identifying common strategies, tools, and clear targets of change is suggested as a way to work towards evolving freely available evidence-based tools that can be combined to improve social conditions in multiple contexts. This work was in part supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (Grant # R01 AA021726). Open Access funding provided by OsloMet - Oslo Metropolitan University.

The COVID-19 pandemic has brought about significant stress and anxiety for many parents around the world. Psychological flexibility and self-care are fundamental aspects of psychological health (Kashdan & Rottenberg, 2010). For parents, shaping these processes may help promote family nurturance, support children’s prosocial behavior, and provide effective and consistent use of evidence-based parenting “kernels”. The goal of this article is to provide practitioners with evidence-based tools that will support psychological flexibility, self-care, and positive parenting behaviors in caregivers during COVID-19 and beyond.

Parents managing their home environments during government ordered stay-at-home periods are likely to need new skills for occupying their children’s time with activities which promote health and emotional well-being. Moreover, parents and children know they need help managing these circumstances. Perhaps for the first time, behavior analysts hold the reinforcers for increasing parental involvement in effective child-rearing practices. In fact, behavior analysts can help parents enlist their children in managing the household by framing their behavior in terms of hidden superpowers. In the current paper, we argue that behavior analysts have a range of tools to offer which are grounded in evidence-based principles, strategies, and kernels, or essential units of behavioral influence. When combined into scheduled daily practices and invoked by children taught to see their use of the tools as nothing short of heroic, these practices function as vaccinations that inoculate families against toxic and unsafe behaviors.

In this study, we tested the effects of cooperative learning on students' prosocial behavior. Cooperative learning is a small-group instructional technique that establishes positive interdependence among students and, unlike most current school-based programs, does not mandate a formal curriculum. Given the emphasis in cooperative learning on peer reinforcement for positive and helpful behavior during learning activities, we hypothesized that cooperative learning would promote higher levels of prosocial behavior, and that these effects would be mediated by peer relatedness. Using a sample of 1,890 students (47.1% female, 75.2% White) from a cluster randomized trial of 15 middle schools, we found that cooperative learning significantly enhanced prosocial behavior across two years. Mediation was only partial, however, suggesting that additional mechanisms were at work, such as changes to social norms or teacher behavior. Given that cooperative learning has been shown to enhance student engagement and academic achievement in prior research, we argue that cooperative learning should be a central component of teacher training and professional development.

This paper examines the misalignment between modern human society and certain male phenotypes, a misalignment that has been highlighted and explored in great detail in the work of Tom Dishion. We begin by briefly enumerating the ongoing developmental difficulties of many boys and young men and how these difficulties affect them and those around them. We then suggest that the qualities that have been advantageous for men and their families in our earlier evolution but that are often no longer functional in modern society are a source of these problems. Finally, we provide a brief review of prevention programs that can contribute to preventing this type of problematic development and eliciting more prosocial behavior from at-risk boys and men. We conclude with an overview of research and policy priorities that could contribute to reducing the proportion of boys and young men who experience developmental difficulties in making their way in the world.

This paper reviews research suggesting that the prevention of intergenerational poverty will be enhanced if we add evidence-based family and school prevention programs to existing efforts to reduce poverty in order to address the adverse social environments that often accompany poverty. Government policies such as the Earned Income Tax Credit can reduce family poverty, but simply improving the economic stability of the family will not necessarily prevent the development of child and adolescent problems such as academic failure, antisocial behavior, drug abuse, and depression, all of which can undermine future economic wellbeing. We briefly review the evidence linking family poverty to adverse social environments, which can have deleterious effects on children's psychological, behavioral, neurological, and physical development. We then document the value of evidence-based family- and school-based prevention programs in effectively addressing these behavioral, emotional, cognitive, and neurophysiological factors that can put children at risk for continued poverty in adulthood. We also describe three family-based prevention programs that have been found to have a direct effect on families' future economic wellbeing. The evidence indicates that widely disseminating effective and efficient family- and school-based prevention programs can help to address both poverty itself and the effects of adverse social environments, making future poverty less likely. We conclude with specific recommendations for federal and state policymakers, researchers, and practitioners.

This paper argues that diverse disciplines within the human sciences have converged in identifying the conditions that human beings need to thrive and the programs, policies, and practices that are needed to foster well-being. In the interest of promoting this view, we suggest that this convergence might usefully be labeled “The Nurture Consilience.” We review evidence from evolutionary biology, developmental, clinical, and social psychology, as well as public health and prevention science indicating that, for evolutionary reasons, coercive environments promote a “fast” life strategy that favors limited self-regulation, immediate gratification, and early childbearing. However, this trajectory can be prevented through programs, practices, and policies that (a) minimize toxic social and biological conditions, (b) limit opportunities and influences for problem behavior, (c) richly reinforce prosocial behavior, and (d) promote psychological flexibility. The recognition of these facts has prompted research on the adoption, implementation, and maintenance of evidence-based interventions. To fully realize the fruits of this consilience, it is necessary to reform every sector of society. We review evidence that free-market advocacy has promoted the view that if individuals simply pursue their own economic well-being it will benefit everyone, and trace how that view led business, health care, education, criminal justice, and government to adopt practices that have benefited a small segment of the population but harmed the majority. We argue that the first step in reforming each sector of society would be to promote the value of ensuring everyone's well-being. The second step will be to create contingencies that select beneficial practices and minimizes harmful ones., Highlights • Describes coercive and nurturing environments and their impact on health. • Reviews interdisciplinary evidence to identify consilience on targets of change. • Advocates prosocial values and reformed contingencies in all sectors of society. • Documents how most psychological and behavioral problems can be prevented.

Background: The Unified Huntington’s Disease Rating Scale (UHDRS) is the principal means of assessing motor impairment in Huntington disease but is subjective and generally limited to in-clinic assessments. Objective: To evaluate the feasibility and ability of wearable sensors to measure motor impairment in individuals with Huntington disease in the clinic and at home. Methods: Participants with Huntington disease and controls were asked to wear five accelerometer-based sensors attached to the chest and each limb for standardized, in-clinic assessments and for one day at home. A secondchest sensor was worn for six additional days at home. Gait measures were compared between controls, participants with Huntington disease, and participants with Huntington disease grouped by UHDRS total motor score using Cohen’s d values. Results: Fifteen individuals with Huntington disease and five controls completed the study. Sensor data were successfully captured from 18 of the 20 participants at home. In the clinic, the standard deviation of step time (timebetween consecutive steps) was increased in Huntington disease (p

Behavior analysis has produced a robust theoretical analysis of the contingencies involved in cultural evolution. Yet, thus far, the empirical yield of this work remains quite limited. With this paper, I attempt to provide specific examples of the ways to advance an experimental analysis of the contingencies involved in cultural evolution. I begin with a review of the theoretical analyses developed by behavior analysts and other contextually oriented scientists. Next, I submit that, if the goal of our science is both predicting and influencing cultural phenomena, we must produce experimental analyses of the impact of meta-contingencies on organizations’ practices. There is no more pressing reason for doing this than the threat of climate change posed by the continuing growth in human use of fossil fuels. Therefore, the paper provides an analysis of the contingencies influencing organizational practices now affecting continued use of fossil fuels and the contingencies for organizations seeking to prevent their use. One concrete step to advance a science of cultural change relevant to climate change would be to create a database of organizations that are promoting vs. working to prevent fossil fuel consumption and the consequences that seem to maintain their practices. I call for experimental analysis of the impact of altering consequences for these practices and for experimental analyses of interventions intended to change the norms, values, and behavior of organizational leaders who can influence fossil fuel consumption. I then discuss the role of prosocial behavior and values in affecting behavior relevant to reducing fossil fuel consumption because the empirical evidence shows that prosociality favors more “green” behavior. Recent advances in prevention research have identified interventions to promote prosociality, but we need experimental analyses of how advocacy organizations can be more effective in getting these interventions widely adopted.

Type II translational research tends to emphasize getting evidence-based programs implemented in real world settings. To fully realize the aspirations of prevention scientists, we need a broader strategy for translating knowledge about human wellbeing into population-wide improvements in wellbeing. Far-reaching changes must occur in policies and cultural practices that affect the quality of family, school, workplace, and community environments. This paper describes a broad cultural movement, not unlike the tobacco control movement, that can make nurturing environments a fundamental priority of public policy and daily life, thereby enhancing human wellbeing far beyond anything achieved thus far.

Extensive research has explored the relationship between family interactions and problem development in youth. When families are living in poverty and facing discrimination at work, in schools, and in society in general, it exacerbates the difficulties in these families. Problem behaviors include antisocial behavior, substance use, high-risk sexual behavior, dropping out of school, depression, and suicide, among others. Problem behaviors are often interrelated and occur concurrently, resulting in a high burden of cost to society.

Background In Huntington disease (HD), cognitive changes due to disease-progression or treatment are potentially confounded by "practice effects" (PE)--performance improvement from prior exposure to test materials. Objective A practice run-in ("dual baseline") was used in an HD cognitive trial to determine if PE could be minimized and evaluate performance trajectories over multiple visits. Methods Non-depressed adults (N = 36) with mild to moderate HD-related cognitive deficits participated in a clinical trial to examine the efficacy of citalopram to enhance cognition. Cognitive tests were administered at three visits (2 weeks separating each visit), before active treatment randomization. Some tests were also administered at screening. Therefore 3-4 pre-treatment repetitions were available. We examined test improvement using repeated-measures ANOVAs with planned pairwise comparisons. Results Despite the practice run-in and use of alternate test forms, results indicated ongoing improvements over at least three test sessions on all three UHDRS cognitive tests. Trails A and B showed improvements between the third and fourth session, which suggests that one pre-baseline visit may not be effective in reducing practice on this important and commonly used test. Conclusions Overall, 7 out of 13 variables showed some degree of short-term PE, even after multiple sessions and alternate forms. Tests assessing processing speed and memory may be particularly confounded by ongoing PE across at least 2-3 sessions. Practice run-in periods and alternate forms may help minimize the impact of such effects in HD clinical trials but awareness of which tests are most susceptible to PE is important in clinical trial design.

Background: Remote, non-invasive and objective tests that can be used to support expert diagnosis for Parkinson's disease (PD) are lacking. Methods: Participants underwent baseline in-clinic assessments, including the Unified Parkinson's Disease Rating Scale (UPDRS), and were provided smartphones with an Android operating system that contained a smartphone application that assessed voice, posture, gait, finger tapping, and response time. Participants then took the smart phones home to perform the five tasks four times a day for a month. Once a week participants had a remote (telemedicine) visit with a Parkinson disease specialist in which a modified (excluding assessments of rigidity and balance) UPDRS performed. Using statistical analyses of the five tasks recorded using the smartphone from 10 individuals with PD and 10 controls, we sought to: (1) discriminate whether the participant had PD and (2) predict the modified motor portion of the UPDRS. Results: Twenty participants performed an average of 2.7 tests per day (68.9% adherence) for the study duration (average of 34.4 days) in a home and community setting. The analyses of the five tasks differed between those with Parkinson disease and those without. In discriminating participants with PD from controls, the mean sensitivity was 96.2% (SD 2%) and mean specificity was 96.9% (SD 1.9%). The mean error in predicting the modified motor component of the UPDRS (range 11-34) was 1.26 UPDRS points (SD 0.16). Conclusion: Measuring PD symptoms via a smartphone is feasible and has potential value as a diagnostic support tool.

Teachers' psychological wellbeing is important for teachers and students, but is highly stressful, particularly in special education. We examined the role of experiential avoidance (EA) in the wellbeing of 529 middle and elementary school teachers. EA involves the tendency to avoid thoughts, feelings, and other internal experiences even when doing so causes long-range consequences. Using a teacher-specific measure, we investigated its relationship to stress associated with student misbehavior and limited social support. We assessed EA's relationship to burnout and depression, finding EA significantly and moderately correlated with depression and all scales of Maslach's Burnout Inventory. Mediation analyses showed EA mediated the relationship between stress associated with student behavior and measures of wellbeing. We found 26.8% of teachers mildly, 8.9% moderately, and 2.8% moderately severely or severely depressed. This evidence concurs with studies showing the value of mindfulness-based interventions and points to the utility of implementing interventions aimed at decreasing EA in teachers.

Experiential avoidance (EA) consists of efforts to control or avoid unwanted emotions, upsetting memories, troubling thoughts, or physical pain and the contexts that occasion them, even when doing so creates problems over the long run. While substantial evidence finds EA to be a risk factor for diverse psychological problems, most of that evidence comes from research with adults. This paper presents longitudinal findings from a study of adolescents that examined the relationships between EA, family conflict and depression. We obtained data from students in grades 6, 7, and 8 (81.8% white, with Hispanic students the largest group of minority participants—8.8%). The analysis included latent growth models of family conflict, adolescent EA, and adolescent depression: all showed acceptable fit; mean intercepts and slopes (with their respective variances) were significant. The results suggest that EA is associated with depression and is more likely in families with high conflict. Female adolescents had higher EA and were differentially affected by family conflict.

The current cross-sectional study examined psychological inflexibility, a process in which behavior is rigidly guided by psychological reactions rather than direct contingencies or personal values, as a transdiagnostic process relevant to a range of depressive, anxiety, substance use and eating disorders. A sample of 972 first-year college students between 17 and 20 years of age completed self-report measures of psychological inflexibility and psychological distress as well as a structured diagnostic interview. Psychological inflexibility was significantly higher across a range of current and lifetime depressive and anxiety disorders as well as lifetime history of eating disorders, relative to students with no disorder, even after controlling for general psychological distress. Findings were mixed for substance use disorders, with a more consistent pattern for lifetime history than for current disorders. Psychological inflexibility was also related to having comorbid depressive, anxiety, and substance use disorders relative to only having one of these diagnoses. Results are discussed in relation to research on psychological inflexibility as a transdiagnostic pathological process and target for interventions.

Substantial evidence in the behavioral and social sciences has accrued in support of numerous intervention programs and policies bearing on improving the lives of children and families. To this end, Clinical Child and Family Psychology Review features a special journal issue on "Evolving Toward a More Nurturing Society." The field has achieved numerous advances regarding how to create and promote nurturing environments that foster successful development and prevent psychological and behavioral problems in children and youth. Such advances cut across multiple strategies (e.g., programs and interventions, practices, and public policies), settings (e.g., family, school including preschool and K-12, service sectors, community), domains (e.g., behavioral health, parenting, cognitive and academic functioning, nutrition, physical activity, obesity, safety, and many other domains), and developmental periods of childhood. The special journal issue showcases a sampling of strategies and domains relevant to producing optimal conditions of nurturance for children and families.

Huntington disease (HD) is an autosomal-dominant, progressive neurodegenerative condition characterized by multiple movement disorders, psychiatric disturbances, and cognitive decline. As an insidious, progressive disorder, clinical phenoconversion in HD can be quite subtle and difficult to pinpoint. In light of this ambiguity, substantial interest has developed in HD research for biomarker identification, with the intent of establishing specific changes or “stages” of disease progression. Presumably, earlier stages of dysfunction offer greater chance for intervention or modification of disease mechanisms. As such, identifying disease processes as early as possible, in a prediagnostic period if possible, has been of paramount interest. Emerging evidence suggests motor dysfunction in HD long precedes clinical diagnosis, raising questions about the initiation of HD pathology and in turn our understanding of disease progression. This chapter summarizes advances in characterizing and understanding preclinical motor manifestations in HD, including changes in eye movements, gait, and fine motor performance. Development of the most sensitive and specific outcome measures for trial design is a rapidly evolving field in HD experimental therapeutics, with exciting implications for the study and treatment of this challenging disorder.

Humans possess great capacity for behavioral and cultural change, but our ability to manage change is still limited. This article has two major objectives: first, to sketch a basic science of intentional change centered on evolution; second, to provide examples of intentional behavioral and cultural change from the applied behavioral sciences, which are largely unknown to the basic sciences community.All species have evolved mechanisms of phenotypic plasticity that enable them to respond adaptively to their environments. Some mechanisms of phenotypic plasticity count as evolutionary processes in their own right. The human capacity for symbolic thought provides an inheritance system having the same kind of combinatorial diversity as does genetic recombination and antibody formation. Taking these propositions seriously allows an integration of major traditions within the basic behavioral sciences, such as behaviorism, social constructivism, social psychology, cognitive psychology, and evolutionary psychology, which are often isolated and even conceptualized as opposed to one another.The applied behavioral sciences include well-validated examples of successfully managing behavioral and cultural change at scales ranging from individuals to small groups to large populations. However, these examples are largely unknown beyond their disciplinary boundaries, for lack of a unifying theoretical framework. Viewed from an evolutionary perspective, they are examples of managing evolved mechanisms of phenotypic plasticity, including open-ended processes of variation and selection.Once the many branches of the basic and applied behavioral sciences become conceptually unified, we are closer to a science of intentional change than one might think.

Background The objective of this study was to evaluate citalopram for executive functioning in Huntington's disease (HD). Methods The study was randomized, double-blind, and placebo-controlled. Thirty-three adults with HD, cognitive complaints, and no depression (Hamilton Depression [HAM-D] rating scale ≤12) were administered citalopram 20 mg or placebo (7 visits, 20 weeks), with practice and placebo run-ins. The primary outcome was change in executive functioning. Results The intent to treat analysis was controlled for practice effects, comparing visits 1 and 2 to visits 5 and 6 for citalopram versus placebo. There were no significant benefits on the executive function composite (treatment-placebo mean difference −0.167; 95% confidence interval [CI], −0.361 to 0.028; P = .092). Citalopram participants showed improved clinician-rated depression symptoms on the HAM-D (t = −2.02; P = 0.05). There were no group differences on motor ratings, self-reported executive functions, psychiatric symptoms, or functional status. Conclusions There was no evidence that short-term treatment with citalopram improved executive functions in HD. Despite excluding patients with active depression, participants on citalopram showed improved mood, raising the possibility of efficacy for subsyndromal depression in HD. © 2013 International Parkinson and Movement Disorder Society

We present a framework for a pragmatic science of cultural evolution. It is now possible for behavioral science to systematically influence the further evolution of cultural practices. As this science develops, it may become possible to prevent many of the problems affecting human wellbeing. By cultural practices , we refer to everything that humans do, above and beyond instinctual or unconditioned behaviors: not only art and literature, but also agriculture, manufacturing, recreation, war making, childrearing, science—everything. We can analyze cultural practices usefully in terms of the incidence and prevalence of individual behavior and group and organization actions. An effective science of intentional cultural evolution must guide efforts to influence the incidence and prevalence of individuals' behaviors and the actions of groups and organizations. In this paper, we briefly sketch advances in scientific understanding of the influences on individual behavior. Then we describe principles that could guide efforts to influence groups and organizations. Finally, we discuss legitimate concerns about the use and misuse of a science for intentional cultural change.

Background By permitting remote assessments of patients and research participants, telemedicine has the potential to reshape clinical care and clinical trials for Parkinson disease. While the majority of the motor Unified Parkinson's Disease Rating Scale (UPDRS) items can be conducted visually, rigidity and retropulsion pull testing require hands-on assessment by the rater and are less feasible to perform remotely in patients' homes. Methods In a secondary data analysis of the Comparison of the Agonist pramipexole vs. Levodopa on Motor complications in Parkinson's Disease (CALM-PD) study, a randomized clinical trial, we assessed the cross-sectional (baseline and 2 years) and longitudinal (change from baseline to 2 years) reliability of a modified motor UPDRS (removing rigidity and retropulsion items) compared to the standard motor UPDRS (all items) using intraclass correlation coefficients (ICC), stratified by treatment group. Internal consistency of the modified UPDRS (mUPDRS) was measured using Cronbach's alpha, and concurrent validity was assessed using Pearson's correlation coefficient (r) between the standard motor UPDRS and mUPDRS. Results The mUPDRS versus standard motor UPDRS is cross-sectionally (ICC ≥ 0.92) and longitudinally (ICC ≥ 0.92) reliable for both treatment groups. High internal consistencies were also observed (α ≥ 0.96). The mUPDRS had high concurrent validity with the standard UPDRS at both time points and longitudinally (r ≥ 0.93, p Conclusions A modified version of the motor UPDRS without rigidity and retropulsion pull testing is reliable and valid and may lay the foundation for its use in remote assessments of patients and research participants.

This article presents a framework for evolving a society that nurtures the health and well-being of its population. We review evidence that adverse social conditions, including poverty, conflict, discrimination, and other forms of social rejection, contribute immensely to our most ubiquitous psychological, behavioral, and health problems. We then enumerate the ways that effective family and school prevention programs could ameliorate much of the social adversity leading to these problems. The widespread and effective implementation of these programs—in primary care, social services, and education—must be a high priority. Beyond the implementation of specific programs, however, we must also make a more concerted effort to promote prosocial values that support nurturing families and schools. Our society's priorities must be to generate specific policies that reduce poverty and discrimination and, in so doing, reduce the risk for negative health-related outcomes.

The success of translational research can ultimately be judged by the degree to which it reduces the incidence and prevalence of psychological, behavioral, and physical disorders and the major factors influencing them. In our view, we currently place insufficient emphasis on assessing our impact on the social determinants of disorders. As a result, we are failing to affect the incidence and prevalence of critical disorders. Moreover, translational research fails to take into account the full range of interventions that could significantly reduce the incidence and prevalence of our most pressing disorders. These include policy changes, media, and broad cultural change movements. In this paper, we discuss the momentous achievements the tobacco prevention movement made over the last half-century, describe how the lessons gleaned from this success can apply to other prevention efforts, and contrast this success with progress made in battling other major public health concerns. We call for an expansion of the translational research agenda to develop and evaluate broader and more comprehensive strategies to affect well-being in entire populations.

This study explored the relationship of experiential avoidance (eg, the tendency to avoid, suppress, or otherwise control internal experiences even when doing so causes behavioral harm) to alcohol use disorders and alcohol-related problems.Cross-sectional data were collected from 240 undergraduate college students in their first year in college between December 2009 and April 2010.Participants completed a diagnostic interview and online self-report survey.Students with a history of alcohol abuse or dependence had significantly higher levels of experiential avoidance relative to students with no alcohol use disorder diagnosis. A hierarchical linear regression analysis found that experiential avoidance significantly predicted alcohol-related problems, even after controlling for gender and psychological distress. Furthermore, experiential avoidance mediated the relationship of psychological distress to alcohol-related problems.These findings suggest that experiential avoidance may play a role in problematic alcohol use among college students.

The recent Institute of Medicine report on prevention (National Research Council & Institute of Medicine, 2009) noted the substantial interrelationship among mental, emotional, and behavioral disorders and pointed out that, to a great extent, these problems stem from a set of common conditions. However, despite the evidence, current research and practice continue to deal with the prevention of mental, emotional, and behavioral disorders as if they are unrelated and each stems from different conditions. This article proposes a framework that could accelerate progress in preventing these problems. Environments that foster successful development and prevent the development of psychological and behavioral problems are usefully characterized as nurturing environments. First, these environments minimize biologically and psychologically toxic events. Second, they teach, promote, and richly reinforce prosocial behavior, including self-regulatory behaviors and all of the skills needed to become productive adult members of society. Third, they monitor and limit opportunities for problem behavior. Fourth, they foster psychological flexibility-the ability to be mindful of one's thoughts and feelings and to act in the service of one's values even when one's thoughts and feelings discourage taking valued action. We review evidence to support this synthesis and describe the kind of public health movement that could increase the prevalence of nurturing environments and thereby contribute to the prevention of most mental, emotional, and behavioral disorders. This article is one of three in a special section (see also Munoz Beardslee, & Leykin, 2012; Yoshikawa, Aber, & Beardslee, 2012) representing an elaboration on a theme for prevention science developed by the 2009 report of the National Research Council and Institute of Medicine.

Despite extensive knowledge of how to prevent or ameliorate serious diseases, natural disasters, environmental degradation, and a wide range of other problems, we often fail to take action that that would prevent or mitigate these problematic outcomes. In short, although we may have sound scientific knowledge about threats to future wellbeing, we appear to have limited insight into how to benefit from this knowledge. With this paper, we argue that our current scientific understanding of how to act in light of the future is limited, but we offer a theoretical analysis of future-oriented behavior at both individual and organizational levels. Specifically, the paper draws on a functional contextualist account of human language and cognition, Relational Frame Theory (RFT), and its integrated therapeutic approach, Acceptance and Commitment Therapy (ACT), and extends this framework to analyzing the evolution of the practices of groups and organizations. This framework can provide an understanding of how human behavior may be modified in the present to serve improving human wellbeing in the future at individual, organizational, and even national levels.

Replication research is essential for the advancement of any scientific field. In this paper, we argue that prevention science will be better positioned to help improve public health if (a) more replications are conducted; (b) those replications are systematic, thoughtful, and conducted with full knowledge of the trials that have preceded them; and (c) state-of-the art techniques are used to summarize the body of evidence on the effects of the interventions. Under real-world demands it is often not feasible to wait for multiple replications to accumulate before making decisions about intervention adoption. To help individuals and agencies make better decisions about intervention utility, we outline strategies that can be used to help understand the likely direction, size, and range of intervention effects as suggested by the current knowledge base. We also suggest structural changes that could increase the amount and quality of replication research, such as the provision of incentives and a more vigorous pursuit of prospective research registers. Finally, we discuss methods for integrating replications into the roll-out of a program and suggest that strong partnerships with local decision makers are a key component of success in replication research. Our hope is that this paper can highlight the importance of replication and stimulate more discussion of the important elements of the replication process. We are confident that, armed with more and better replications and state-of-the-art review methods, prevention science will be in a better position to positively impact public health.

Living in poverty and living in areas of concentrated poverty pose multiple risks for child development and for overall health and wellbeing. Poverty is a major risk factor for several mental, emotional, and behavioral disorders, as well as for other developmental challenges and physical health problems. In this paper, the Promise Neighborhoods Research Consortium describes a science-based framework for the promotion of child health and development within distressed high-poverty neighborhoods. We lay out a model of child and adolescent developmental outcomes, and integrate knowledge of potent and malleable influences to define a comprehensive intervention framework to bring about a significant increase in the proportion of young people in high-poverty neighborhoods who will develop successfully. Based on a synthesis of research from diverse fields, we designed the Creating Nurturing Environments framework to guide community-wide efforts to improve child outcomes and reduce health and educational inequalities.

This article describes the use of an observation system to measure middle-school staff practices, environment characteristics, and student behavior in the school common areas. Data were collected at baseline from 18 middle schools participating in a randomized controlled trial of school-wide Positive Behavior Support. The observations were reliable and showed sensitivity to differences between school settings and between schools. Multilevel models with students nested in schools were used to examine the associations of staff practices and the school environment with student behavior. Less effective behavior management and more staff criticism, graffiti, and percentage of low-income students were associated with student problem behaviors. Greater use of effective behavior management and positive attention, and fewer low-income students were associated with positive student behavior. The use of data-based feedback to schools for intervention planning and monitoring is illustrated. Implications for school-wide efforts to improve student behavior in middle schools are discussed. This article reports on an observation system for measuring middle-school staff practices, environment characteristics, and student behavior in school common areas. The observation system was developed to measure the outcomes of school-wide interventions aimed at improving middle-school practices and environmental characteristics in an effort to decrease problem behaviors and increase positive behaviors in middle-school students. Almost two thirds of aggressive incidents at school occur outside of the classroom in a school common area (Lockwood, 1997). Middle-school students feel particularly unsafe in school areas that are lacking adult supervision (Astor, Meyer, & Pitner, 2001). The observation system therefore focuses on common areas of the school―places where students spend time before and after school starts, during passing times between classes, and during school breaks―such as hallways, the cafeteria, outdoor areas, the gym or game room, and school entryways and bus areas. The aims of this article are to describe the observation system procedures, reliability, and sensitivity to detect differences and to examine associations of observed staff practices and school environment characteristics with student behavior. The use of such descriptive and correlational information from baseline data can inform researchers and educators about potential mechanisms of school-wide efforts for student behavior improvement.

Huntington disease (HD) is a progressive, fatal, autosomal dominant neurodegenerative disease that primarily affects movement, cognition, and psychiatric functions. Diagnosis of HD is based on the presence of unequivocal motor signs of HD, in conjunction with a positive genetic test for the HD CAG expansion or a confirmed family history of HD. Most people with the HD gene appear healthy throughout their youth and early adulthood, and then gradually develop signs and symptoms of HD, often leading to a diagnosis in middle age. The age of diagnosis varies in accordance with the number of CAG repeats on the expanded allele, although there is also substantial individual variability not accounted for by this genetic factor (Andrew et al., 1993; Gusella, MacDonald, Ambrose, & Duyao, 1993). A growing community of researchers is directing efforts at finding treatments to delay onset or slow the progression of early pathological changes in an attempt to reduce the tremendous personal and social costs of HD. Finding effective therapeutic or preventive treatments for HD depends critically on the ability to reliably and sensitively measure clinical signs of disease. Cognitive measures have excellent potential both for identifying individuals beginning to show subtle signs prior to the diagnosis of HD who might be suitable for clinical trials, and as sensitive outcome measures in HD trials. Cognition is an important target for therapeutic trials because even subtle cognitive changes can affect functional abilities like work performance, driving, and financial management. Cognition is actively studied in the HD prodrome, with more than 150 empirical reports of neurocognitive function published since the genetic mutation for HD was identified in 1993. In early studies, the evidence of cognitive dysfunction was inconsistent. But more recent, adequately powered studies have revealed that people with the HD prodrome have poorer performance on measures of attention, working memory, processing speed, psychomotor functions, episodic memory, emotion processing, sensory-perceptual functions, and executive functions (Johnson et al., 2007; Kirkwood et al., 2000; Paulsen et al., 2006a; Paulsen et al., 2008; Paulsen et al., 2001; Pirogovsky et al., 2007; e.g., Stout et al., 2007). The use of cognitive measures in clinical trials requires a substantial knowledge base, indicating when in the HD prodrome cognitive changes can be reliably detected, and which measures show adequate sensitivity. The PREDICT-HD study was designed to address these questions. PREDICT-HD is a 31-site international study of potential clinical and biological markers of HD in individuals with the CAG-expansion for HD, but who did not meet criteria based on motor impairment for diagnosis at the time of enrolment. The PREDICT-HD cohort is large, with more than 700 non-diagnosed CAG-expanded (prodromal) participants. For each participant, age-conditioned estimates of time to onset of motor disease were derived using a survival analysis regression equation based on CAG repeat length (Langbehn et al., 2004). Estimated time to motor disease onset in the sample varies from 5 to 25 years. The size and diversity of this sample makes it possible to stratify participants based on their estimated proximities to diagnosis, allowing an estimation of when, in the extended period leading up to HD diagnosis, cognitive signs can be detected, and which cognitive measures appear to have the most promise for detecting change in longitudinal studies. We report findings based on three stratified prodromal HD groups, a far from diagnosis group (FAR) estimated to be more than 15 years from diagnosis, a middle group, estimated to be between 9 and 15 years from diagnosis (MID), and a near diagnosis group, estimated to be less than 9 years from diagnosis (NEAR). For each of these groups compared to controls, we computed effect sizes for individual cognitive measures, allowing a direct comparison of all the tasks in our cognitive assessment. This allows a determination of which tasks are most adversely affected during the HD prodrome, and an upper-limit estimate of how early in the prodromal phase significant effects could be detected (Paulsen et al., 2008). Additionally, we examined the associations between cognitive findings and results of the clinical motor examination, which also reveals subtle signs prior to diagnosis (Biglan et al., 2009). Thus, this study provides a comprehensive depiction of the cognitive prodrome for HD.

The current study examined how maternal catecholamine levels and perceived stress, and anxiety during pregnancy were related to indices of infant temperament at 3 months postpartum. Forty‐three (n = 43) pregnant women completed stress and anxiety questionnaires at 28–30 weeks gestation and consented to a blood draw that yielded estimates of sympathetic and parasympathetic nervous system function, epinephrine (E) and norepinephrine (NE), respectively. At 3 months postpartum, these women reported on their newborn's temperament using the Infant Behaviour Questionnaire. Maternal catecholamine levels obtained during pregnancy were not significantly associated with maternal report of perceived stress, life event, or pregnancy‐related anxiety. However, maternal NE during pregnancy was associated with higher report of infant soothability and maternal E was marginally associated with lower ratings of infant soothability. Exploratory analyses revealed that infant sex moderated the relationship between maternal cate...

Increasing the prevalence of caring in society could contribute to the evolution of a society that ensures the wellbeing of every member. Recent research on psychological flexibility suggests that helping people to accept, but not believe, their unpleasant thoughts and feelings contributes to people becoming more caring. This paper reviews evidence of the value of Acceptance and Commitment Therapy for increasing psychological flexibility and focuses, in particular, on its impact on prejudice and caring. It then discusses how this empirically based strategy for increasing psychological flexibility could contribute to the evolution of a more caring society with less conflict and prejudice and that is less punitive and more sustainable.

This paper reports relationships between methamphetamine use and behaviors and social influences using data from a population-based survey of 8th- and 11th-grade students in Oregon for the 2001-2003 school years. We analyze methamphetamine use within a general problem behavior framework to identify malleable correlates of behavior for future prevention interventions. We specifically test two models of methamphetamine use employing logistic regression analysis: one comprised of behaviors and traits of the individual students and another focusing on peer and parental influences. This study finds adolescent methamphetamine use related to several problem behaviors. However, the specific problems vary by grade and are moderated by gender. Findings indicate the need for tailored interventions targeting gender/grade-specific behaviors or problems such as antisocial activities, risky sex, and depression, as well as social influences such as peers engaging in antisocial behaviors or using drugs and parents favoring drug use or poorly monitoring or setting limits for their children.

Introduction Executive dysfunction (ED) is a prominent and often disabling feature of cognitive impairment in Parkinson’s disease (PD). Few studies have examined treatments. Given the role of noradrenergic pathology in ED, atomoxetine, a norepinephrine reuptake inhibitor indicated for attention deficit hyperactivity disorder (ADHD), may be a potential treatment for PD-related ED.

Este artigo brevemente descreve a Terapia de Aceitação e Compromisso (ACT), seus modelos subjacentes e as evidências que defendem a sua eficácia. Fornecendo exemplos de como esta terapia pode ser estendida para o tratamento de outros distúrbios, este trabalho assim inclui no âmbito da ACT a prevenção do suicídio e sua ideação. Ambos o modelo e suas técnicas aplicadas são empiricamente comprovados, o que sugere que outras extensões podem ser feitas de forma segura.

This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior-influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of its components would render it inert. Existing evidence shows that a variety of kernels can influence behavior in context, and some evidence suggests that frequent use or sufficient use of some kernels may produce longer lasting behavioral shifts. The analysis of kernels could contribute to an empirically based theory of behavioral influence, augment existing prevention or treatment efforts, facilitate the dissemination of effective prevention and treatment practices, clarify the active ingredients in existing interventions, and contribute to efficiently developing interventions that are more effective. Kernels involve one or more of the following mechanisms of behavior influence: reinforcement, altering antecedents, changing verbal relational responding, or changing physiological states directly. The paper describes 52 of these kernels, and details practical, theoretical, and research implications, including calling for a national database of kernels that influence human behavior.

Objective: The objective of the Predict-HD study is to use genetic, neurobiological and refined clinical markers to understand the early progression of Huntington’s disease (HD), prior to the point of traditional diagnosis, in persons with a known gene mutation. Here we estimate the approximate onset and initial course of various measurable aspects of HD relative to the time of eventual diagnosis. Methods: We studied 438 participants who were positive for the HD gene mutation, but did not yet meet the diagnostic criteria for HD and had no functional decline. Predictability of baseline cognitive, motor, psychiatric and imaging measures was modelled non-linearly using estimated time until diagnosis (based on CAG repeat length and current age) as the predictor. Results: Estimated time to diagnosis was related to most clinical and neuroimaging markers. The patterns of association suggested the commencement of detectable changes one to two decades prior to the predicted time of clinical diagnosis. The patterns were highly robust and consistent, despite the varied types of markers and diverse measurement methodologies. Conclusions: These findings from the Predict-HD study suggest the approximate time scale of measurable disease development, and suggest candidate disease markers for use in preventive HD trials.