According to the Alzheimer’s Association’s report, an estimated 6.9 million Americans are living with Alzheimer’s disease in 2024, and this number is expected to continue to grow as the population of Americans age 65 or older is also increasing. June is a month dedicated to raising awareness about Alzheimer’s disease and to promoting brain health. In this article, we will focus on the following topics:
The latest research on early signs of Alzheimer’s
Before examining the latest advancements in Alzheimer’s disease, understanding how a brain with Alzheimer’s disease works is essential.
With aging, the brain undergoes certain changes:
A healthy older person may experience a certain decline in the ability to learn new things or have difficulty retrieving certain information, but in a brain with Alzheimer's disease, significant neuronal loss occurs, mainly related to the accumulation of:
These plaques and tangles affect the functioning and survival of neurons. In addition to generating toxicity processes, they interrupt the ability of neurons to communicate with each other, inevitably leading to their death.
Beta-amyloid plaques begin to form decades before the first symptoms appear, which makes research on the early signs of Alzheimer’s disease crucial because it can lead to more efficient prevention. A recent large-scale study of posterior cortical atrophy completed by an international team suggests this condition may predict Alzheimer’s. Early identification of these visual symptoms, which normally appear around 59 years of age, may have important implications for Alzheimer’s treatment, as patients with posterior cortical atrophy may be candidates for anti-amyloid therapies, like lecanemab or donanemab.
The influence of modern lifestyle on the disease
According to research carried out by the University of Southern California and published in the Journal of Alzheimer’s Disease, Alzheimer’s disease and related dementias are closely related to modern environments and lifestyles, as medical texts from 2,500 years ago rarely mention them. Researchers not only studied ancient medical writings from ancient Greeks and Romans, but they also turned to an Indigenous people of the Bolivian Amazon, the Tsimane, who have a physically active, pre-industrial lifestyle. These people show minimal dementia, which suggests that environmental factors such as pollution and sedentary behavior may be important determinants of dementia risk.
Latest advances in diagnosis: amyloid PET
Early diagnosis of Alzheimer’s disease is essential to initiate treatment and slow down the cognitive decline. Despite the increasing use of positron emission tomography (PET) to measure the abnormal accumulation of amyloid beta protein plaques, evidence for its utility and cost-benefit ratio was limited, but for the first time there has been a randomized controlled clinical trial carried out to confirm the clinical utility of amyloid PET, says Juan Domingo Gispert, head of the BBRC Neuroimaging Research Group, who has led the center's participation in AMYPAD.
The findings demonstrated that performing amyloid PET early in the diagnostic workup (within 1 month) allowed 40% of memory clinic patients to receive an etiological diagnosis with very high diagnostic confidence after only 3 months. This is relevant because, as the trial concludes, a timely high-confidence diagnosis is critical to the success of disease-modifying therapies, especially anti-amyloid drugs, whose efficacy might decrease with advancing disease progression.
Noninvasive devices to detect biomarkers
In an effort to find noninvasive detection methods for degenerative brain disease, an international team of researchers has developed a non-invasive device that can detect biomarkers for Alzheimer's and Parkinson's diseases. The detection of three important amyloids is reported:
Although the results of these experiments are promising, the challenges of brain-derived amyloid protein detection directly via bodily fluids are also acknowledged and research in this field has to continue.
Hope in promising new drugs
Anti-amyloid drugs represent a significant advance in Alzheimer’s research.
Immunotherapies
Immunotherapies are already used in medicine, for example in the treatment of some cancers. They target amyloid plaques in the brains of people with Alzheimer’s to help them break them down.
Hope lies in the mentioned advances in research, with the help of artificial intelligence to analyze the large quantities of data generated.
Caregivers and their challenges are certainly the other crucial part of Alzheimer’s. Caring for a person with this disease involves a team of specialized professionals but also loved ones who will need support and resources as the patient’s health declines. It’s important for caregivers to prioritize care of themselves and stay strong physically and emotionally.
This is part of PAR’s Mental Health Awareness Month series, in which we will be focusing on the multifaceted issue of mental health in the U.S. Come back each week for more insight.
The last few years have seen a global pandemic, international conflicts, civil unrest, increased inflation, and many natural disasters. The American Psychological Association (APA) Stress in America survey takes a closer look at what Americans have been experiencing and provides insight into recent trends. This data provides better understanding of how Americans are handling a multitude of stressors and helps to show us what is going on in the minds of Americans of different ages.
Collective trauma and post-pandemic effects
The survey starts with the idea of collective trauma, understanding that everyone has been deeply affected by difficult events collectively. Even though COVID-19 may not be a national emergency anymore, it has left mental and emotional effects on most Americans.
Arthur C. Evans Jr., PhD, Chief Executive Officer of the APA, points out that although many people seem to be moving on from the pandemic, we are still dealing with the lasting effects of these challenging times. The collective trauma of the pandemic continues to have an impact on individuals in significant ways.
Long-term stress and health implications
The survey looks at how long-term stress has affected the bodies and minds of Americans. In addition to the impact of stress on mental health, ongoing stress has also led to various physical health problems. These physical health problems include inflammation, weakened immune systems, digestive issues, heart disease, weight gain, and even stroke.
Dealing with long-term stress requires different approaches and comprehensive strategies to stay healthy.
Increase in chronic illnesses and mental health diagnoses
One of the striking findings of this survey is the significant increase in chronic illnesses and mental health issues, especially among adults age 35 to 44 years.
The numbers show that chronic illnesses increased from 48% in 2019 to 58% in 2023 in this age group. At the same time, mental health diagnoses rose from 31% to 45%.
Moreover, although many people rated their physical health as good (81%), two-thirds still cite chronic illnesses like high blood pressure (28%), high cholesterol (24%), or arthritis (17%). Similarly, while 81% said their mental health is good, over a third have been diagnosed with mental health conditions, mainly anxiety (24%) or depression (23%).
Challenges in stress management
Although people know stress is a problem, many find it hard to handle. They may think their problems aren't big enough to be concerned about or they may not have time or resources to devote to combatting this concern.
According to survey data, about three out of every five adults don't talk about their stress because they don't want to bother anyone else—meaning most people who are struggling with stress are not sharing this concern.
Stress levels and sources
The survey gives a clear view of how stressed people are and what's causing this stress. The most common causes of stress were found to be worries about the country's future, violence, crime, money problems, and health issues.
Age-based and lifestyle stress variations
Different age cohorts experience stress differently. Adults age 35 to 44 and 45 to 64 are more likely to be stressed about financial and economic issues, whereas those age 65 years and older cite being concerned about health-related problems. Parents, single-adult households, and retirees experience stressors related to family responsibilities, finances, and personal safety, showcasing the diverse stress landscape across life stages.
According to the survey, the following are the top stressors based on age group:
Age 18–25 years
Age 26–39 years
Age 40–55 years
Age 56 and older
Gender disparities in stress
This year's data reveals that women report higher stress levels than men. On a scale of 1 to 10, women report an average of 5.3 compared to 4.8 for men. Nearly a third of women ranked their current stress level as an 8 out of 10, compared to 21% of men. Furthermore, 68% of women stated they needed more emotional support in the past year to deal with stress about money problems, family responsibilities, relationships, and discrimination.
Discrimination and personal safety are significant stressors
Discrimination is a growing concern for adults. Nearly two in five of the individuals surveyed cite personal safety as a major cause of stress. More than a quarter mention discrimination as a significant stressor.
LGBTQIA+ adults face even higher levels of discrimination-related stress, with more than half saying they do not feel comfortable sharing their experiences out of fear and 43% saying they do not feel acceptance in their community.
Adults with a disability cite discrimination as a significant factor (34%) in their stress and 40% of these individuals feel a lack of acceptance in their community.
Furthermore, Black and Latino/a/e adults surveyed were more likely than Asian and White adults to mention discrimination as a significant stressor (43% and 40% vs. 31% and 19%) and were more likely to report experiencing everyday acts of discrimination.
Importance of social support and coping mechanisms
The survey shows how important it is to have support from friends, family, and communities when dealing with stress. People who feel supported by others tend to have less stress. About 75% of the participants said social support helps them feel better and improves their mental health. Yet stress gets in the way of individuals bettering their communities—about 46% of adults say their day-to-day stress distracts them from acting to create change where they live.
The survey also found that doing things like exercising, practicing mindfulness, or enjoying hobbies can help manage stress. About 80% of people said using these coping strategies has proven to be helpful to their wellbeing.
Conclusion
The APA Stress in America survey offers important insights into stress across the US. Understanding these trends can help policymakers, healthcare providers, and communities in creating strategies and support systems for improving stress management, boosting mental health, and building resilience amidst ongoing challenges.
Learn more about APA's Stress in America results.
The changing landscape of workplaces has drawn heightened attention to the needs and expectations of employees nationwide regarding the issues of work–life balance and mental health support.
The recent survey by the American Psychological Association (APA) sheds light on the prevalence of toxic workplaces and their detrimental impact on mental health. Of the data coming out of this survey, most startling was the revelation that 19% of workers reported their workplace as somewhat or very toxic. Even more alarming, those in such environments are three times more likely to suffer mental health harm at work than those individuals who are in nontoxic settings.
This blog discusses the importance of these findings, what employers can do in light of this data, and the role mental health providers can play in supporting individuals facing toxic work situations.
Understanding the impact of a toxic work environment
The APA survey brought to light the destructive toll a workplace can have on an individual’s mental well-being.
According to the survey, more than one in five workers revealed they've suffered mental health harm at work. Even worse, reported cases of harassment have jumped from 14% in 2022 to 22% in 2023. More than two-thirds of employees report experiencing workplace stress in the last month, with 57% reporting negative impacts that are associated with burnout.
Other notable findings from the survey include:
No matter the field, it is clear that employers need customized strategies to combat toxicity in various work environments.
Proactive steps for employers
To foster a supportive and mentally healthy work environment, employers can take several proactive measures to combat toxicity and promote mental health:
The role of mental health providers
For mental health providers, it's essential to address the challenges faced by individuals who are working in toxic environments. Some notable numbers from the survey: individuals who reported a toxic workplace were more than twice as likely to report that their overall mental health was fair or poor than those who did not report a toxic workplace (58% versus 21%). Of those who reported working in a toxic environment, 76% also conveyed that their work environment has a negative impact on their mental health.
Here are some strategies you can use with individuals who are experiencing workplace stress that impacts their mental health:
What now?
The results of the APA survey underscore how widespread the problem of workplace stress has become and emphasize what a toll a toxic workplace takes on mental health. Although workplaces tend to be one of the greatest areas of stress, they can also drive change by emphasizing the importance of self-care and wellbeing. Those involved in the mental health field can provide support to individuals who are experiencing workplace stress but also need to be cognizant of their own workplaces, as well. It's time to shape healthier work environments that empower everyone to thrive.
Need help hiring and developing your team? Let InVista help!
Further resources
American Psychological Association. (May 2023). 2023 Work in America Survey.
U.S. Surgeon General’s Framework for Workplace Mental Health & Well-Being. (2022).
PARiConnect, our online assessment platform, can help you expand your reach when doing research!
Expand your geographic reach
By using PARiConnect, our digital assessment platform, you can email HIPAA compliant links directly to research participants. This enables you to complete research assessments online, expanding your geographic reach to areas you may not be able to use otherwise. This also allows you easier access to observer and collateral research data without requiring additional individuals to make the trip to your data collection site.
Reduce unused assessment costs
If you email an assessment link to a participant who decides not to complete it, PARiConnect allows you to easily revoke the link and reuse that assessment with another participant. You won’t have to pay for an unused assessment like you might with a paper form, saving you money typically lost on unused assessments.
Improve data integrity
When participants enter their own data, it reduces the time needed for data entry and reduces the possibility of data entry errors. PARiConnect offers settings to prevent skipping questions, so you can reduce the risk of missing data. Furthermore, you can review completion time to be sure your participants put forth appropriate effort. This can reduce the amount of time and energy needed to enter and check data, freeing up your financial and physical resources for other tasks.
Integrate efficiently with your work
The PARiConnect system allows you to download item-level assessment data to a CSV excel spreadsheet that is formatted to integrate with statistics software such as SPSS for ease of data processing and analyzation.
Let PARiConnect help you increase your geographic reach, expand your subject numbers, reduce attrition, lower assessment and travel costs, and decrease the burden of data collection.
Learn more about PARiConnect today!
Need assistance selecting assessments for your research? Learn more about all the ways PAR can help! Check out this video on using PAR assessments in research settings.
Learn more about PAR’s training and research discounts!
This week’s blog was contributed by Erika Thompson, PAR’s managing production editor. It is the second in a series on writing. Catch up on the first part here.
As a mental health practitioner, you are required to write throughout your career. One way you can streamline your writing is by using a style guide. At PAR, the house style we use for all our publications is based on American Psychological Association (APA) Style. Via the PAR Blog, we’re providing some useful information about facets of APA Style that will help you tackle research, write better reports, and communicate more effectively with colleagues.
This week, we’re covering how to cite sources properly. According to APA (2020): “Scientific knowledge represents the accomplishments of many researchers over time. A critical part of writing in APA Style is helping readers place your contribution in context by citing the researchers who influenced you” (p. 253). In other words, citing helps readers better understand what led to your conclusions. It also prevents you from accidentally plagiarizing someone else’s work. It’s important to cite both ideas, which may be paraphrased from someone else’s work, and direct quotes.
Two elements are needed to cite properly: a short mention of the author and date of publication, or in-text citation, which appears within the text at the appropriate and relevant place; and a reference list entry, which expands on the citation by including the title, the source, and sometimes a link to locate the work.
In-text citations can be narrative or parenthetical. In a narrative citation, the author and date are mentioned as part of the running text: “In 2010, Costa and McCrae published new normative data on the NEO.” In a parenthetical citation, the author and date are mentioned in parentheses: “New normative data on the NEO are also available (Costa & McCrae, 2010).”
Reference list entries vary in format based on the type of publication, but generally the author is mentioned first, with the date of publication, title, and source following. Use a 0.5-in. hanging indent to format each entry—that is, indent the second and any subsequent lines.
In some instances, it may be hard to figure out which reference entry format to use. The most recent edition of the Publication Manual of the American Psychological Association provided much-needed guidance on how to cite a test and how to cite a variety of different websites:
Test
Feifer, S. G., & Clark, H. K. (2016). Feifer Assessment of Mathematics (FAM): Professional manual. PAR.
(Note that the “supporting literature” [i.e., the manual; APA, 2020, p. 340] is cited versus the test itself, the title of the test is capitalized and italicized, and the publisher location is not mentioned.)
Online magazine or newspaper article
Bourke, J., & Titus, A. (2019, March 29). Why inclusive leaders are good for organizations, and how to become one. Harvard Business Review. https://hbr.org/2019/03/why-inclusive-leadersare-good-for-organizations-and-how-to-become-one
Website article
Gupta, G. (2016, September 4). Empowering leadership. People Matters. https://www.peoplematters.in/blog/leadership/empowering-leadership-14014
(Note that established newspaper and magazine titles are italicized, whereas for websites that don’t have a publication associated with it, the title of the article is italicized.)
A recent APA blog post explained how to cite ChatGPT. Because the results of the chat cannot be retrieved by others, communications are considered to be the output of the ChatGPT algorithm, and OpenAI is considered to be the “author” of the algorithm. Thus, each communication should be explained very clearly in text and cited as such:
OpenAI. (2023). ChatGPT (Mar 14 version) [Large language model]. https://chat.openai.com/chat The in-text citation is (OpenAI, 2023).
The Publication Manual of the American Psychological Association covers many, many more types of sources, including journal articles, books, audiovisual media, and social posts.
Curious about how we keep track of references to our products? Check out our white paper on Zotero, which includes links to product-specific, continually updated, easy-to-access bibliographies.
Interested in partnering with PAR for research or publishing? Visit our Partner with PAR page to learn more.
References
American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). https://doi.org/10.1037/0000165-000
McAdoo, T. (2023, April 7). How to cite ChatGPT. APA Style. https://apastyle.apa.org/blog/how-to-cite-chatgpt
This week’s blog was contributed by Erika Thompson, PAR’s managing production editor. It is the first in an ongoing series on writing.
As a mental health practitioner, you are required to write throughout your career. One way you can streamline your writing is by using a style guide. At PAR, the house style we use for all our publications is based on American Psychological Association (APA) Style. Over the next few weeks, we’ll provide some useful information about facets of APA Style that will help you tackle research, write better reports, and communicate more effectively with colleagues.
This week, we’re covering how to write as respectfully and inclusively as possible. According to APA (2020):
It is unacceptable to use constructions that might imply prejudicial beliefs or perpetuate biased assumptions against persons on the basis of age, disability, gender, participation in research, racial or ethnic identity, sexual orientation, socioeconomic status, or some combination of these or other personal factors (e.g., marital status, immigration status, religion). (p. 131)
To prevent biased writing, we must focus on two things: specificity and sensitivity.
When we write with specificity, we eliminate unconscious attitudes that might sneak into overly general language. Being as precise as possible also allows your research or other scholarly work to reflect the most accurate and helpful information for readers. For example, use exact age ranges versus broad categories of ages, use specific names for racial and ethnic groups versus broad categories (e.g., “Chinese American” vs. “Asian American”), and use specific terms for gender identity and sexual orientation (e.g., “cisgender women,” “bisexual people”). Provide definitions of research groups early, and then stick to the same label throughout the manual: “Participants scoring between X and X on the ANX scale made up the low anxiety group.” “The low anxiety group exhibited no change from test to retest.”
Writing with sensitivity means writing while acknowledging people’s preferences and their humanity. For example, overgeneralizing by using adjectives as nouns to label groups—for example, “the poor” or “schizophrenics”—eliminates the individuality of the people in those groups. Instead, use adjectival forms or nouns with descriptive phrases, like “poor people” or “individuals with schizophrenia.”
There are many other areas that require writing with sensitivity:
These are just a few tips and examples of how to improve your writing by focusing on specificity and sensitivity. For more information, see the Publication Manual of the American Psychological Association.
This week’s blog was contributed by Melissa Milanak, PhD, PAR’s clinical assessment. Melissa is a licensed clinical psychologist and internationally recognized academic. She has extensive clinical experience providing therapy and conducting assessments with a diverse array of patient populations.
As your trusted source for assessments for all your clinical needs, PAR is excited to also partner with you in many practical ways as you conduct your research, whether it be a large federally funded grant, a manuscript you are preparing to submit, or a course project with your students and trainees running on zero budget. Here are just a few of the ways PAR can help researchers.
The submission deadline is approaching, and it is time to write the methods section. Instead of spending hours pouring through assessment manuals and reading journal article after journal article to extract psychometric data for the one paragraph, consider reaching out to PAR directly. Our psychologists and researchers have already prepared and formatted the assessment info paragraphs for you that you can insert into your manuscripts and grant applications. Don’t see the one you need there? Let us know and we will get you the info you need.
Through our data sharing program, you can partner with our R&D team to help us collect important data on our assessments all while receiving discounts and/or free usage of the related assessments. All data sharing is of course de-identified and confidential to protect participants.
Through our digital assessment platform, PARiConnect, you can email HIPAA-compliant links directly to research participants to complete all of your research assessments online, expanding your geographical reach. You can also access observer and collateral research data without requiring additional individuals to come into your data collection site. Plus, if you send out an assessment link and a participant decides not to participate, you can revoke the link and reuse the assessment with another participant without having to pay for an unused assessment.
By using PARiConnect, either through a HIPAA-compliant email link or in-person digital entry option, participants enter their own data, removing a layer of data entry error (and the need to invest in time for research assistants to enter and check data entry). Plus, with settings to prevent skipping questions, you can reduce the risk of missing data.
In less than a minute, you can download item-level assessment data to a CSV spreadsheet formatted to integrate with statistics software such as SPSS to increase the ease of data processing and analyzation.
Through our FREE Training Portal and team of clinical assessment advisors, PAR provides on-demand training for you and your research teams to learn about the assessments from underlying constructs to administration, scoring, and interpretation.
As you are designing your research, clinical psychologists, neuropsychologists, and psychometrists who have a history of successfully securing federally funded grants and publishing in high impact-factor journals are available to consult with you to build effective, efficient research assessment batteries.
These examples are just the beginning when exploring ways that PAR can partner with you to design, conduct, and publish your research using high-caliber, industry gold-standard assessments. Reach out to our team today to learn more!
Check out this video on ways PAR can help you easily integrate digital assessments into your practice.
This week’s blog was contributed by Sierra Iwanicki, PhD. Sierra is a clinical psychologist and project director in the research and development department at PAR.
In the mid-20th century, humanistic psychology emerged in direct response to perceived limitations of psychoanalysis and behaviorism. Contrary to those earlier theories, humanism focused on the individual as a whole person, with the cardinal belief that perceived experiences fundamentally shaped us as human beings. In the 1940s and 1950s, clinicians began to encourage the collaborative use of projective instruments (e.g., drawings, Rorschach, TAT) to develop insight with clients.
A few decades later, clinicians began to write about the use of psychological assessment within a humanistic frame. Ray A. Craddick criticized the approach of treating a “person primarily as a series of building blocks of traits, factors, habits, etc. [calling] the separation of man into parts…antithetical to both the humanistic tradition and to personality assessment.” Drawing from a phenomenological perspective, researchers like Constance Fischer first wrote about the “testee as a co-evaluator,” and later articulated a model of collaborative, individualized psychological assessment. In subsequent years, clinicians continued to write about the therapeutic benefits and collaborative approaches of assessment.
In 1993, Stephen Finn coined the term therapeutic assessment to describe a semi-structured, systemized method for using assessment in a collaborative, therapeutic fashion. Since then, he and psychologists like Constance Fischer and others have promoted collaborative methods to conduct assessments.
According to Finn and colleagues, defining elements of collaborative and therapeutic assessment include:
• Having respect for clients (e.g., providing them with comprehensible feedback)
• Taking a relational view of psychological assessment (e.g., acknowledging the vulnerability of clients in the assessment situation)
• Maintaining a stance of compassion and curiosity rather than judgment and classification (e.g., fully understanding clients in all their complexity, not just summarizing them in terms)
• Having a desire to help clients directly (e.g., not just providing helpful information to other stakeholders)
• Taking a special view of tests (e.g., viewing tests as tools and results as ways to understand and help clients)
• Staying flexible (e.g., conducting a home visit as part of an assessment)
Fast forward to 2021: A multidisciplinary database search yielded more than 4,000 peer-reviewed journal articles related to psychological assessment as a therapeutic intervention, therapeutic assessment, or collaborative assessment. However, Kamphuis et al. note that the treatment utility of assessment has long been controversial, stipulating a broader view of relevant outcome metrics, more powerful research designs, and use of stepped assessment, taking into account the complexity of the patient’s psychopathology. Nevertheless, there is consensus that therapeutic assessment tends to yield more useful psychological assessment data as well as increase the effectiveness of assessment feedback.
In fact, a meta-analysis found the therapeutic benefits of individualized feedback following psychological assessment yielded a notable effect size of .42. More recently, a meta-analysis compared well-defined therapeutic assessment compared to other forms of intervention and showed three areas where it was superior: 1) decreasing symptoms (effect size .34), 2) increasing self-esteem (effect size .37), and 3) fostering therapeutic alliance and engagement and satisfaction with treatment (effect size .46). Overall,
research has shown that collaborative and therapeutic assessment is effective for adults, couples, children, adolescents, and families. According to the Therapeutic Assessment Institute, more than 35 studies have demonstrated that collaborative/therapeutic assessment is generally effective at improving outcomes for a wide range of clients with diverse clinical problems across various settings.
The Therapeutic Assessment Institute was formed in 2009 to promote and coordinate training in Therapeutic Assessment. Learn more.
Clinicians and researchers—are you using a PAR product in your research? If you a professional who would be interested in partnering with us to advance the scope of solutions PAR provides, we would love to talk to you about it!
We are looking to gather additional data on our existing assessments with the goal of further validating our instruments, developing and identifying product enhancements, or adding features that allow our customers to better meet the needs of those they serve.
Learn more about the PAR Data Program and find out how you can take part!
The Social Emotional Assets and Resilience Scales (SEARS) assesses positive social–emotional attributes in children and adolescents. New research published in the June issue of Assessment provides further data to support its clinical use.
The authors studied the factor structure, measurement invariance, internal consistency, and validity of the SEAR-Adolescent (SEARS-A) Report in individuals ages 8 to 20 years. The study focused on 225 childhood cancer survivors and 122 students without a history of significant health problems in the control group. They were all administered the SEARS-A, finding it to have an adequate factor structure and model fit and demonstrated invariance across domains of age, health status, gender, race, and socioeconomic status.
Additionally, the researchers found the SEARS-A to have excellent internal reliability, criterion validity, and current validity when compared with another similar instrument.
The researchers concluded that the SEARS-A has the potential to be a sound tool to assess and predict social–emotional outcomes among at-risk youth between the ages of 8 and 20 years.
Learn more about this research or learn more about the SEARS.