Preventing Mental, Emotional, and Behavioral Disorders Among Young People

Progress and Possibilities

Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions

Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, Editors

Board on Children, Youth, and Families

Division of Behavioral and Social Sciences and Education

NATIONAL RESEARCH COUNCIL AND INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

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Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, Editors Board on Children, Youth, and Families Division of Behavioral and Social Sciences and Education

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Grant No. NO1-OD-4-2139, Task Order #181 between the National Academy of Sciences and the Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. Library of Congress Cataloging-in-Publication Data Preventing mental, emotional, and behavioral disorders among young people : progress and possibilities / Committee on Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions ; Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, editors ; Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. p. cm. Rev. ed. of: Reducing risks for mental disorders. 1994. Includes bibliographical references and index. ISBN 978-0-309-12674-8 (hardcover) — ISBN 978-0-309-12675-5 (pdf) 1. Mental illness—Prevention—Research—Government policy—United States. 2. Mental health promotion—Research—Government policy—United States. 3. Mental illness—United States—Prevention. 4. Mental health promotion—United States. I. O’Connell, Mary Ellen. II. Boat, Thomas F. III. Warner, Kenneth E., 1947- IV. Institute of Medicine (U.S.). Committee on Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions. V. National Research Council (U.S.). Board on Children, Youth, and Families. VI. Reducing risks for mental disorders. RA790.6.R44 2009 362.196′890072—dc22 2009003378 Additional copies of this report are available from National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334- 3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. Copyright 2009 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Research Council and Institute of Medicine. (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibili- ties. Committee on the Prevention of Mental Disorders and Substance Abuse Among Chil- dren, Youth, and Young Adults: Research Advances and Promising Interventions. Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, Editors. Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

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COMMITTEE ON THE PREVENTION OF MENTAL DISORDERS AND SUBSTANCE ABUSE AMONG CHILDREN, YOUTH, AND YOUNG ADULTS: RESEARCH ADVANCES AND PROMISING INTERVENTIONS KENNETH E. WARNER (Chair), School of Public Health, University of Michigan THOMAS F. BOAT (Vice Chair), Cincinnati Children’s Hospital Medical Center WILLIAM R. BEARDSLEE, Department of Psychiatry, Children’s Hospital, Boston CARL C. BELL, University of Illinois at Chicago and Community Mental Health Council ANTHONY BIGLAN, Center on Early Adolescence, Oregon Research Institute C. HENDRICKS BROWN, College of Public Health, University of South Florida E. JANE COSTELLO, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center TERESA D. LaFROMBOISE, School of Education, Stanford University RICARDO F. MUÑOZ, Department of Psychiatry, University of California, San Francisco PETER J. PECORA, Casey Family Programs and School of Social Work, University of Washington BRADLEY S. PETERSON, Pediatric Neuropsychiatry, Columbia University LINDA A. RANDOLPH, Developing Families Center, Washington, DC IRWIN SANDLER, Prevention Research Center, Arizona State University MARY ELLEN O’CONNELL, Study Director BRIDGET B. KELLY, Christine Mirzayan Science and Technology Policy Graduate Fellow (September-November 2007) and Senior Program Associate (December 2007-August 2008) WENDY E. KEENAN, Program Associate MARY ANN KASPER, Senior Program Assistant v

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BOARD ON CHILDREN, YOUTH, AND FAMILIES BERNARD GUYER (Chair), Bloomberg School of Public Health, Johns Hopkins University BARBARA L. WOLFE (Vice Chair), Department of Economics and Population Health Sciences, University of Wisconsin WILLIAM R. BEARDSLEE, Department of Psychiatry, Children’s Hospital, Boston JANE D. BROWN, School of Journalism and Mass Communication, University of North Carolina, Chapel Hill LINDA MARIE BURTON, Sociology Department, Duke University P. LINDSAY CHASE-LANSDALE, Institute for Policy Research, Northwestern University CHRISTINE C. FERGUSON, School of Public Health and Health Services, George Washington University WILLIAM T. GREENOUGH, Department of Psychology, University of Illinois RUBY HEARN, Robert Wood Johnson Foundation (emeritus), Princeton, New Jersey MICHELE D. KIPKE, Saban Research Institute, Children’s Hospital of Los Angeles BETSY LOZOFF, Center for Human Growth and Development, University of Michigan SUSAN G. MILLSTEIN, Division of Adolescent Medicine, University of California, San Francisco CHARLES A. NELSON, Laboratory of Cognitive Neuroscience, Children’s Hospital, Boston PATRICIA O’CAMPO, University of Toronto and Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto FREDERICK P. RIVARA, Schools of Medicine and Public Health, University of Washington, and Children’s Hospital and Regional Medical Center, Seattle LAURENCE D. STEINBERG, Department of Psychology, Temple University JOHN R. WEISZ, Judge Baker Children’s Center and Harvard Medical School MICHAEL ZUBKOFF, Department of Community and Family Medicine, Dartmouth Medical School ROSEMARY CHALK, Board Director WENDY KEENAN, Program Associate vi

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Acknowledgments T his report is the work of the Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions, a project of the National Research Council (NRC) and the Institute of Medicine (IOM). The expertise and hard work of the committee were advanced by the sup- port of our sponsors, the contributions of able consultants and staff, and the input of outside experts. The majority of funding for this project was provided by the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration (SAMHSA), with supplemen- tary funding from the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The guidance and support of Anne Mathews-Younes and Paul Brounstein, SAMHSA; Robert Heinssen, NIMH; Elizabeth Robertson, NIDA; and Vivian Faden, NIAAA, were much appreciated. Throughout this process, the committee benefited from presentations or written input by individuals with a range of perspectives (see Appen- dix B). The committee is thankful for the useful contributions of these many individuals. We would like to thank those who wrote papers that were invaluable to the committee’s discussions: Tom Dishion, University of Oregon; Daniel Eisenberg, University of Michigan; Pauline E. Ginsberg, Utica College; Mark Greenberg, Pennsylvania State University; J. David Hawkins, University of Washington; Kamilah Neighbors, University of Michigan; Ron Prinz, University of South Carolina; Anne W. Riley, Johns Hopkins University; Herbert Severson, Oregon Research Institute; Brian vii

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viii ACKNOWLEDGMENTS Smith, University of Washington; Hill Walker, Oregon Research Institute; and Hirokazu Yoshikawa, Harvard University. We are also thankful to those who assisted committee members with literature searches, back- ground research, or analyses, including Mark Alter, Columbia University; Christine Cody, Oregon Research Institute; Alaatin Erkanli, Duke Univer- sity Medical Center; Erika Hinds, University of Oregon; Armando Pina, Arizona State University; and Joan Twohey-Jacobs, University of La Verne. We also thank Casey Family Programs for their travel support. This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the NRC. The purpose of this independent review is to provide candid and critical com- ments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: Sherry Glied, Mailman School of Public Health, Columbia University; Larry A. Green, University of Colorado Health Science Center, Denver, CO; Mark T. Greenberg, Prevention Research Center, Pennsylvania State University; Deborah Gross, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Nursing and School of Medicine; Peter S. Jensen, President’s Office, The REACH Institute (REsource for Advancing Children’s Health), New York; Sheppard G. Kellam, Center for Integrat- ing Education and Prevention Research in Schools, American Institutes for Research; Bruce G. Link, Mailman School of Public Health, Columbia University; Patricia J. Mrazek, independent consultant; Estelle B. Richman, Secretary’s Office, Pennsylvania Department of Public Welfare; and Huda Y. Zoghbi, Departments of Pediatrics, Molecular and Human Genetics, Neurology, and Neuroscience, Baylor College of Medicine. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Floyd E. Bloom, Pro- fessor Emeritus, Department of Molecular and Integrative Neuroscience, Scripps Research Institute, and Richard G. Frank, Department of Health Care Policy, Harvard University Medical School. Appointed by the NRC, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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ix ACKNOWLEDGMENTS The committee appreciates the support provided by members of the Board on Children, Youth, and Families, under the leadership of Bernard Guyer, and we are grateful for the leadership and support of Rosemary Chalk, director of the Board on Children, Youth, and Families. Finally, numerous National Academies’ staff played meaningful roles that contributed to the production of this report. Ann Page, with the IOM Board on Health Care Services, provided useful guidance and suggestions during the launch of the study. Bridget Kelly, who initially joined the team as a policy fellow, was convinced to stay on to assist with innumerable analytic and writing tasks that were consistently handled with the utmost competence. Along with Bridget, Margaret Hilton served as a reviewer of project abstracts, and Hope Hare helped set up an abstract database. Wendy Keenan was an asset to the team from the very first day by helping with a range of research, analysis, contracting, and logistical challenges. In addition, Matthew Von Hendy and Bill McLeod, research librarians, provided invaluable assistance with literature searches and references. Jay Labov provided a very insightful review of an earlier draft of the neuro- science chapter. A final thanks is due to Mary Ann Kasper, who managed numerous administrative details during our multiple meetings, workshops, and conference calls. Kenneth E. Warner, Chair Thomas F. Boat, Vice Chair Mary Ellen O’Connell, Study Director Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions

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Contents Preface xiii Acronyms xvii Glossary xxiii Summary 1 1 Introduction 15 PART I: OVERVIEW AND BACKGROUND 2 The Nature and Extent of the Problem 35 3 Defining the Scope of Prevention 59 4 Using a Developmental Framework to Guide Prevention and Promotion 71 5 Perspectives from Developmental Neuroscience 113 PART II: PREVENTIVE INTERVENTION RESEARCH 6 Family, School, and Community Interventions 157 7 Prevention of Specific Disorders and Promotion of Mental Health 191 8 Screening for Prevention 221 xi

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xx ACRONYMS NREPP National Registry of Evidence-Based Programs and Practices of the Substance Abuse and Mental Health Services Administration NSDUH National Survey on Drug Use and Health ODD oppositional defiant disorder OJJDP Office of Juvenile Justice and Delinquency Prevention of the U.S. Department of Justice PALS Positive Attitudes Toward Learning in Schools PATHS Promoting Alternative Thinking Strategies POP Penn Optimism Program PPN Promising Practices Network PPP Penn Prevention Program PROSPER PROmoting School-community-university Partnerships to Enhance Resilience PRP Penn Resiliency Program PSMG Prevention Science and Methodology Group PTC Parenting Through Change PTSD posttraumatic stress disorder PUP Prohibition of Youth Possession, Use, or Purchase of Tobacco QALY quality-adjusted life year SAMHSA Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services SBD sleep-related breathing disorder SCHIP State Children’s Health Insurance Program SDB sleep-disordered breathing SDFS Safe and Drug-Free Schools Program of the U.S. Department of Education SEL social and emotional learning SFP Strengthening Families Program SPR Society for Prevention Research SSDP Seattle Social Development Program SS/HS Safe Schools Healthy Students Program of the U.S. Departments of Health and Human Services, Education, and Justice TANF Temporary Assistance for Needy Families TLFB Timeline Follow Back Interview TPRCs Transdisciplinary Prevention Research Centers of the National Institute on Drug Abuse

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xxi ACRONYMS Triple P Positive Parenting Program USPHS U.S. Public Health Service WHO World Health Organization WIC Special Supplemental Nutrition Program for Women, Infants, and Children WISC-R Wechsler Intelligence Scale for Children, Revised YRBSS Youth Risk Behavior Surveillance System

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Glossary Adaptation: The modification of evidence-based interventions that have been developed for a single ethnic, linguistic, and/or cultural group for use with other groups. Adoption: The selection and incorporation of a prevention program into a service system. Alcohol abuse: The consumption of alcohol despite negative consequences. Alcohol dependence: The persistent consumption of alcohol despite nega- tive consequences, often with a physiological dependence characterized by tolerance and/or symptoms of withdrawal. Alcohol use disorder: An inclusive term referring to either alcohol abuse or alcohol dependence. Comorbidity: The presence of one or more disorders in addition to a pri- mary disorder. Confound: A variable in an experiment or trial that may be related to observed effects and therefore may limit the ability to make inferences about causal effects of the experimental variables. Cost-benefit analysis: A method of economic analysis in which costs and outcomes of an intervention are both valued in monetary units, permit- ting a direct comparison of the benefits produced by the intervention with its costs. Cost-effectiveness analysis: A method of economic analysis in which out- comes of an intervention are measured in nonmonetary terms. The outcomes and costs are compared with both the costs and the same out- come measure for competing interventions or an established standard xxiii

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xxiv GLOSSARY to determine if the outcomes are achieved at a reasonable monetary cost. Cross-sectional study: A study to estimate the relationship between an outcome of interest and specified variables by comparing groups that differ on those variables at a single point in time. Developmental competence: The ability to accomplish a broad range of appropriate social, emotional, cognitive, and behavioral tasks at vari- ous developmental stages, including adaptations to the demands of different social and cultural contexts and attaining a positive sense of identity, efficacy, and well-being. Developmental competencies: Social, emotional, cognitive, and behavioral tasks that are appropriate at various developmental stages and in vari- ous social and cultural contexts. Developmental neuroscience: The study of the anatomical and functional development of the nervous system in humans and animal models. This encompasses the fields of molecular and behavioral genetics, molecular and cellular neurobiology, biochemistry, physiology, pharmacology, pathology, and systems-level neuroscience and applies methods ranging from molecular biology to imaging to functional studies of cognition and behavior. Dissemination: The distribution of program information with the aim of encouraging program adoption in real-world service systems or communities. Dissemination trial: A trial designed to experimentally test approaches and strategies to influence providers, communities, or organizations to adopt evidence-based prevention programs in real-world service settings. DSM-IV: The current edition of the Diagnostic and Statistical Manual of Mental Disorders, a handbook published by the American Psychiatric Association describing different categories of mental disorders and the criteria for diagnosing them. Effect size: A statistical measure of the strength of the relationship between two variables. Effectiveness: The impact of a program under conditions that are likely to occur in a real-world implementation. Effectiveness trial: A trial designed to test whether an intervention can achieve effects when delivered by a natural service delivery system (i.e., similar to the institutions or communities that are ultimately intended to implement the intervention). The emphasis is on demonstrating posi- tive outcomes in a real-world setting using nonresearch staff to deliver the intervention.

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xxv GLOSSARY Efficacy: The impact of a program under ideal research conditions. Efficacy trial: A trial designed to test whether a new or significantly modi- fied intervention has effects when it is delivered in a research environ- ment by research staff under optimal conditions. Efficacy trials can take place in research or real-world settings but are typically delivered by trained research staff under the direction and control of the research team, using resources beyond what might be available in the natural course of service delivery. A trial is also considered an efficacy trial if an intervention is being tested by research staff with a new population or in an amended form. Encouragement designs: Trial designs that randomize individuals to dif- ferent modalities of recruitment, incentives, or persuasion messages to influence their choice to participate in one or another intervention condition. Epidemiology: The study of factors that influence the health and illness of populations. Epigenetics: Alterations in gene expression through mechanisms other than modifications in the genetic sequence. Etiology: The cause of a disease or condition. Externalizing: Problems or disorders that are primarily behavioral (e.g., conduct disorder, oppositional defiant disorder). Fidelity: The degree to which an intervention is delivered as designed. Genotype: An individual’s genetic makeup. Iatrogenic effect: An adverse effect caused by an intervention. ICD-9: The current International Statistical Classification of Diseases and Related Health Problems, a classification system published by the World Health Organization and used to code disease as well as signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. Implementation: The process of introducing and using interventions in real-world service settings, including how interventions or programs are adopted, sustained, and taken to scale. Implementation trial: A trial designed to experimentally test approaches and strategies for successful utilization of evidence-based prevention programs in real-world service settings. Incidence: The number, proportion, or rate of occurrence of new cases of a disorder in a population within a specified period of time. Indicated prevention: Preventive interventions that are targeted to high-risk individuals who are identified as having minimal but detectable signs or symptoms that foreshadow mental, emotional, or behavioral disorder,

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xxvi GLOSSARY as well as biological markers that indicate a predisposition in a person for such a disorder but who does not meet diagnostic criteria at the time of the intervention. Internalizing: Problems or disorders that are primarily emotional (e.g., anxiety, depression). Longitudinal study: A study that involves repeated observations of targeted outcomes over a long period of time. Main effect: The effect of an independent variable averaged over all levels of other variables in an experiment. Mediator: A variable factor that explains how an effect occurs (i.e., the causal pathway between an intervention and an outcome). Mental, emotional, and behavioral disorders: A diagnosable mental or substance use disorder. Mental, emotional, and behavioral problems: Difficulties that may be early signs or symptoms of mental disorders but are not frequent or severe enough to meet the criteria for a diagnosis. Mental health promotion: Interventions that aim to enhance the ability to achieve developmentally appropriate tasks (developmental competen- cies) and a positive sense of self-esteem, mastery, well-being, and social inclusion and to strengthen the ability to cope with adversity. Mental illness: A condition that meets DSM-IV diagnostic criteria. Meta-analysis: A statistical analysis that combines the results of several studies that address the same research question. Moderator: A variable factor that influences how an intervention or mediator exerts its effect. Natural experimental design: A naturally occurring opportunity to observe the effects of defined variables that approximates the properties of a controlled experiment. Neural systems: Functionally integrated circuits in the nervous system that operate in the context of genetic and environmental influences to pro- duce complex behaviors. Nonexperimental studies: Observational research designs that do not include an experimental manipulation of variables by the researchers. Odds ratio: The ratio of the odds of an outcome occurring in an experi- mental group to the odds of it occurring in a control group, a measure of the size of the effect of an intervention. Pathogenesis: The mechanisms by which etiological factors cause a disease or disorder.

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xxvii GLOSSARY Pathophysiology: The disturbance of normal functions that are the result of a disease or disorder. Phenotype: An individual’s observed physical or behavioral characteristics. Polymorphism: A variation in genetic sequence. Premorbid: A sign or symptom that occurs before the development of disease. Pre-post studies: Nonrandomized studies that evaluate an intervention on the basis of the changes that occur in the same subject from a baseline (the “pre” measurement) to after the intervention period (the “post” measurement). Prevalence: The total number of cases of a disorder in a population. Prevention: Interventions that occur prior to the onset of a disorder that are intended to prevent or reduce risk for the disorder. Prevention research: The study of theory and practice related to the preven- tion of social, physical, and mental health problems, including etiology, methodology, epidemiology, and intervention. Prevention science: A multidisciplinary field devoted to the scientific study of the theory, research, and practice related to the prevention of social, physical, and mental health problems, including etiology, epidemiology, and intervention. Preventionist: A practitioner who delivers prevention interventions. Problem behaviors: Behaviors with negative effects that are often signs or symptoms of mental, emotional, or behavioral disorders that may not be frequent or severe enough to meet the criteria for a diagnosis (e.g., aggressiveness, early alcohol use) but have substantial personal, family, and societal costs. Prodrome: An early, nonspecific set of symptoms that indicate the onset of disease before specific, diagnosable symptoms occur. Protective factor: A characteristic at the biological, psychological, family, or community (including peers and culture) level that is associated with a lower likelihood of problem outcomes or that reduces the negative impact of a risk factor on problem outcomes. Psychiatric disorder: A condition that meets DSM-IV diagnostic criteria. Psychopathology: Behaviors and experiences that are indicative of mental, emotional, or behavioral disorder or impairment. Qualitative data: Research information that is descriptive but not measured or quantified for statistical analysis. Qualitative review: A review of research evidence relevant to a research question that does not include new statistical analysis. Quantitative data: Research information that is measured for statistical analysis.

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xxviii GLOSSARY Quasi-experimental studies: Experimental designs in which subjects are not randomly assigned to experimental and control groups. Randomized studies: Experimental designs that randomly assign subjects (individuals, families, classrooms, schools, communities) into equiva- lent groups that are exposed to different interventions in order to com- pare outcomes with the goal of inferring causal effects. Replication: The reproduction of a trial or experiment by an independent researcher. Research funders: For purposes of this report, federal agencies and founda- tions that fund research on mental health promotion or prevention of mental, emotional, or behavioral disorders. Resilience: The ability to recover from or adapt to adverse events, life changes, and life stressors. Retrospective study: A study that looks back at the histories of a group that currently has a disorder or characteristic in comparison to a similar group without that disorder or characteristic to determine what factors may be associated with the disorder or characteristic. Risk factor: A characteristic at the biological, psychological, family, com- munity, or cultural level that precedes and is associated with a higher likelihood of problem outcomes. Selective prevention: Preventive interventions that are targeted to individu- als or to a subgroup of the population whose risk of developing mental, emotional, or behavioral disorders is significantly higher than average. The risk may be imminent or it may be a lifetime risk. Risk groups may be identified on the basis of biological, psychological, or social risk fac- tors that are known to be associated with the onset of a disorder. Those risk factors may be at the individual level for nonbehavioral character- istics (e.g., biological characteristics such as low birth weight), at the family level (e.g., children with a family history of substance abuse but who do not have any history of use), or at the community/population level (e.g., schools or neighborhoods in high-poverty areas). Substance abuse: The use of alcohol or drugs despite negative consequences. Substance dependence: The persistent use of alcohol or drugs despite nega- tive consequences, often with a physiological dependence characterized by tolerance and/or symptoms of withdrawal. Substance use disorder: An inclusive term referring to either substance abuse or substance dependence. Systematic review: A literature review that tries to identify, appraise, select, and synthesize all high-quality research evidence relevant to a research question.

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xxix GLOSSARY Taxonomy: A system of names and classifications. Translational research (type 1): The transfer of basic science discoveries into clinical research as well as the influence of clinical research findings on basic science research questions. Translational research (type 2): The study of the real-world effectiveness and implementation of programs for which efficacy has been previously demonstrated. Treatment: Interventions targeted to individuals who are identified as cur- rently suffering from a diagnosable disorder that are intended to cure the disorder or reduce the symptoms or effects of the disorder, including the prevention of disability, relapse, and/or comorbidity. Universal prevention: Preventive interventions that are targeted to the gen- eral public or a whole population group that has not been identified on the basis of individual risk. The intervention is desirable for everyone in that group. Wait-list designs: Research designs that provide the new intervention first to the experimental group and later to those who were initially assigned to the control group. Young people: For purposes of this report, children, youth, and young adults (to age 25).

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