Aspects of attention predict real-world task performance in Alzheimer's Disease
- Authors: Miloyan, Beyon , Razani, Jill , Larco, Andrea , Avila, Justina , Chung, Julia
- Date: 2013
- Type: Text , Journal article
- Relation: Applied Neuropsychology Vol. 20, no. 3 (2013), p. 203-210
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- Description: More research is needed to examine the relationship between specific neuropsychological functions and observation-based daily activity tests in patients with Alzheimer's disease (AD). Fifty-six patients with AD were administered tests of attention and processing speed and an observation-based activities-of-daily-living (ADL) task. Complex shortterm attention capacity best predicted real-world task performance, accounting for several domains of ADL functioning. These results suggest that complex attention requiring working-memory systems, but not simple attention or processing speed, account for moderate portions of variability in daily task performance. These results may aid in understanding the attentional processes required for performing daily activities and can be useful to health care professionals in treatment planning. Copyright © Taylor & Francis Group, LLC.
Age-related changes in generalized anxiety disorder symptoms
- Authors: Miloyan, Beyon , Byrne, Gerard , Pachana, Nancy
- Date: 2014
- Type: Text , Journal article
- Relation: International Psychogeriatrics Vol. 26, no. 4 (2014), p. 565-572
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- Description: Background: Little is known about the effects of age on the symptoms of anxiety disorder. Accordingly, this study sought to investigate age-related differences in the number and kind of symptoms that distinguish between individuals with and without a diagnosis of generalized anxiety disorder (GAD). Methods: A sample of 3,486 self-reported worriers was derived from Wave 1 of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC), an epidemiological survey of mental health conducted in the USA in 2001-2002. Participants were stratified into the following age groups (18-29 years, 30-44 years, 45-64 years, 65-98 years), and then divided into diagnostic groups (GAD and non-GAD worriers). Results: Binary logistic regression analyses revealed that four distinct sets of symptoms were associated with GAD in each age group, and that numerically fewer symptoms were associated with GAD in older adults. Moreover, there were graduated changes in the type and number of symptoms associated with GAD in each successive age group. Conclusions: There are graduated, age-related differences in the phenomenology of GAD that might contribute to challenges in the detection of late-life anxiety. © International Psychogeriatric Association 2014.
Late-life anxiety
- Authors: Miloyan, Beyon , Byrne, Gerard , Pachana, Nancy
- Date: 2014
- Type: Text , Book chapter
- Relation: Oxford handbook of clinical geropsychology Chapter 22 p. 470-489
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Social Phobia symptoms across the adult lifespan
- Authors: Miloyan, Beyon , Bulley, Adam , Pachana, Nancy , Byrne, Gerard
- Date: 2014
- Type: Text , Journal article
- Relation: Journal of Affective Disorders Vol. 168, no. (2014), p. 86-90
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- Description: Background This study investigated symptom patterns that might distinguish between individuals with and without a diagnosis of Social Phobia (SP) across the adult lifespan. Methods A sample of 5411 self-reported social worriers was derived from Wave 1 (2001 and 2002) of the U.S. National Epidemiological Survey of Alcohol and Related Conditions (NESARC). Participants were stratified into four age groups (18-29 years, 30-44 years, 45-64 years, 65-96 years), and further divided into two diagnostic groups (self-reported social worriers with and without a SP diagnosis). Results Binary logistic regression analyses revealed that a core set of symptoms was associated with SP across the adult lifespan. There were also successive reductions in the number of symptoms associated with SP in each age group, such that older adults endorsed numerically fewer SP symptoms. Limitations Though our sample size is smaller than ideal for the nature of our analyses, the NESARC represents one of the largest existing clinical datasets we know of. Conclusions Despite age-related reductions in symptom frequency, a core set of SP symptoms consistently distinguished between diagnostic groups, irrespective of age.
The effects of declining functional abilities in dementia patients and increases in psychological distress on caregiver burden over a one-year period
- Authors: Razani, Jill , Corona, Roberto , Quilici, Jill , Matevosyan, Adelina , Funes, Cynthia , Larco, Andrea , Miloyan, Beyon , Avila, Justina , Chang, Julia , Goldberg, Hope , Lu, Po
- Date: 2014
- Type: Text , Journal article
- Relation: Clinical Gerontologist Vol. 37, no. 3 (2014), p. 235-252
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- Description: The degree to which changes in caregiver burden over a one-year period can be predicted by functioning of dementia patients and caregiver psychological stress was examined. The Direct Assessment of Functional Status (DAFS) was administered to 44 patients and the Caregiver Burden Inventory and the Brief Symptom Inventory were administered to their next-of-kin caregivers. All patients and caregivers were assessed at baseline and again in approximately one year with the same measures. Hierarchical regression revealed that baseline patient functioning predicted overall changes in caregiver burden, but that increases in psychological symptoms of caregivers such as depression, anxiety, and hostility were the best predictors for specific types of increased caregiver burden, such as social, developmental, or physical burden. These results suggest that interventions should target reduction of particular psychological symptoms in order to reduce caregiver burden over time.
The future is here : A review of foresight systems in anxiety and depression
- Authors: Miloyan, Beyon , Pachana, Nancy , Suddendorf, Thomas
- Date: 2014
- Type: Text , Journal article
- Relation: Cognition and Emotion Vol. 28, no. 5 (2014), p. 795-810
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- Description: Cognitive models of anxiety and depression have long suggested a central role for future-oriented thinking in these disorders. Experimental studies suggest that anxiety and depression are characterised by distinct future-oriented thinking profiles, and that these profiles are markedly different from those of asymptomatic adults. In this paper, we review these profiles and propose two explanatory models marked by two different neurocognitive systems. The Reconstructive Memory Model emphasises a role for emotionally driven learning and retrieval in episodic foresight (i.e., the construction of future-oriented scenarios), and the Valuation Model proposes that an overweighing of risk and uncertainty estimates can be invoked to explain the future-oriented thought patterns. We consider the effectiveness of interventions aimed at altering such thought patterns. We suggest that future research aimed at elucidating the neurobiological underpinnings of future-oriented thinking in anxiety and depression can play an important role in advancing development of effective biological and psychosocial interventions for these disorders.
Clinical significance of worry and physical symptoms in late-life generalized anxiety disorder
- Authors: Miloyan, Beyon , Pachana, Nancy
- Date: 2015
- Type: Text , Journal article
- Relation: International Journal of Geriatric Psychiatry Vol. 30, no. 12 (2015), p. 1186-1194
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- Description: Objective Worry is a hallmark feature of generalized anxiety disorder (GAD). However, age-related changes in symptom presentation raise questions about the clinical significance of these symptom clusters in later life. The aim of this study was to explore the relative contribution of worry and physical symptom frequency to clinical significance associated with late-life GAD. Methods A sample of 637 self-reported worriers (aged 65 years and older) was extracted from Wave 1 of the National Epidemiological Survey of Alcohol and Related Conditions. Results Consistent with previous findings, we observed reductions in worry frequency and increases in physical symptom frequency with increasing age of participants. Physical symptoms, but not worry symptoms, distinguished older adults with clinical and sub-threshold GAD. Whereas physical symptom count was associated with distress, occupational, and functional disability, worry count was only associated with distress. Conclusions Among self-reported worriers, worry frequency provides limited clinical utility over and above physical symptom frequency. These findings suggest that physical symptom frequency may become an increasingly important feature of GAD in later life. Copyright © 2015 John Wiley & Sons, Ltd.
Feelings of the future
- Authors: Miloyan, Beyon , Suddendorf, Thomas
- Date: 2015
- Type: Text , Journal article
- Relation: Trends in Cognitive Sciences Vol. 19, no. 4 (2015), p. 196-200
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- Description: Affective forecasting refers to the capacity to predict future feelings. Humans have been found to exhibit systematic affective forecasting biases that involve overestimation of the intensity and duration of future feelings. Although recent research has elucidated the proximate mechanisms underlying our ability to predict future feelings, explanations concerning the potential adaptive significance of these biases have attracted little attention. Here we consider the function of affective forecasts as signals of biological value, drivers of goal pursuit, and tools for eliciting collaboration. Although affective forecasting biases can have significant costs, for instance in terms of one's pursuit of happiness, they may ultimately serve adaptive functions.
Threshold and subthreshold generalized anxiety disorder in later life
- Authors: Miloyan, Beyon , Byrne, Gerard , Pachana, Nancy
- Date: 2015
- Type: Text , Journal article
- Relation: American Journal of Geriatric Psychiatry Vol. 23, no. 6 (2015), p. 633-641
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- Description: Objective Symptoms and disorders of anxiety are highly prevalent among older adults; however, late-life anxiety disorders remain underdiagnosed. The objective of this study was to (1) estimate the prevalence of late-life threshold and subthreshold generalized anxiety disorder (GAD), (2) examine sociodemographic and health correlates associated with membership in these groups, (3) assess 3-year conversion rates of these groups, and (4) explore characteristics associated with 3-year conversion to GAD. Methods Using Waves 1 and 2 of the National Epidemiological Survey of Alcohol and Related Conditions, 13,420 participants aged 55-98 years were included in this study. Results Subthreshold GAD was more highly prevalent than threshold GAD and was interposed between asymptomatic and GAD groups in terms of severity of health characteristics. Although most participants with subthreshold and threshold GAD were asymptomatic by Wave 2, differences in disability persisted. Subthreshold GAD at baseline was not a predictor of threshold GAD at follow-up. Conclusion These findings suggest that late-life GAD should be conceptualized as a dimensional rather than categorical construct. The temporal stability of anxiety-associated disability further suggests that subthreshold GAD bears clinical significance. However, the suitability and efficacy of interventions for minimizing negative sequelae in this group remain to be determined.
An evolutionary perspective on the co-occurrence of social anxiety disorder and alcohol use disorder
- Authors: Bulley, Adam , Miloyan, Beyon , Brilot, Ben , Gullo, Matthew , Suddendorf, Thomas
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Affective Disorders Vol. 196, no. (2016), p. 62-70
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- Description: Social Anxiety Disorder (SAD) commonly co-occurs with, and often precedes, Alcohol Use Disorder (AUD). In this paper, we address the relationship between SAD and AUD by considering how natural selection left socially anxious individuals vulnerable to alcohol use, and by addressing the underlying mechanisms. We review research suggesting that social anxiety has evolved for the regulation of behaviors involved in reducing the likelihood or consequences of threats to social status. The management of potential threats to social standing is important considering that these threats can result in reduced cooperation or ostracism - and therefore to reduced access to coalitional partners, resources or mates. Alcohol exerts effects upon evolutionarily conserved emotion circuits, and can down-regulate or block anxiety (or may be expected to do so). As such, the ingestion of alcohol can artificially signal the absence or successful management of social threats. In turn, alcohol use may be reinforced in socially anxious people because of this reduction in subjective malaise, and because it facilitates social behaviors - particularly in individuals for whom the persistent avoidance of social situations poses its own threat (i.e., difficulty finding mates). Although the frequent co-occurrence of SAD and AUD is associated with poorer treatment outcomes than either condition alone, a richer understanding of the biological and psychosocial drives underlying susceptibility to alcohol use among socially anxious individuals may improve the efficacy of therapeutic interventions aimed at preventing or treating this comorbidity. © 2016 Elsevier B.V. All rights reserved.
Anxiety disorders and all-cause mortality : Systematic review and meta-analysis
- Authors: Miloyan, Beyon , Bulley, Adam , Bandeen-Roche, Karen , Eaton, William , Goncalves-Bradley, Daniela. C.
- Date: 2016
- Type: Text , Journal article
- Relation: Social Psychiatry and Psychiatric Epidemiology Vol. 51, no. 11 (2016), p. 1467-1475
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- Description: PURPOSE: The purpose of this study was to perform a systematic review and meta-analysis of prospective cohort studies that examined the relationship between anxiety disorders, or clinically significant anxiety symptoms, at baseline and all-cause mortality at follow-up relative to control participants without clinically significant anxiety. METHODS: PubMed, EMBASE, PsycInfo, and CINAHL were searched through July 2015, along with manual searches of published reviews and forward and backward snowball searches of included studies. Studies were excluded if anxiety was not defined with a standardized instrument, or if participants were followed-up for 1 year or less. The initial search yielded 7901 articles after the removal of duplicates, of which 328 underwent full-text screening. RESULTS: Forty-two estimates from 36 articles were included in the meta-analysis with a total sample of 127,552 participants and over 11,573 deaths. The overall hazard ratio (HR) estimate of mortality in clinically anxious participants relative to controls was 1.09 (95 % CI 1.01-1.16); however, this was reduced after adjusting for publication bias (1.03; 95 % CI 0.95-1.13). There was no evidence of increased mortality risk among anxious participants derived from community samples (0.99; 95 % CI 0.96-1.02) and in studies that adjusted for a diagnosis of depression (1.01; 95 % CI 0.96-1.06). CONCLUSIONS: These findings suggest that positive associations in the literature are attributable to studies in smaller samples, comorbid depression (or other psychiatric conditions) among participants, and possible confounding in medical patient samples followed-up for short durations.
Blood-injection-injury phobia in older adults
- Authors: Miloyan, Beyon , Eaton, William
- Date: 2016
- Type: Text , Journal article
- Relation: International Psychogeriatrics Vol. 28, no. 6 (2016), p. 897-902
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- Description: Background: This study aims to (i) estimate the prevalence of blood-injection-injury phobia (BIIP) diagnosed as present at any time during the life prior to the interview, with or without another Specific Phobia diagnosed as present during the 12 months prior to the interview, (ii) characterize types and frequencies of co-occurring fears, (iii) evaluate the association with chronic medical conditions and lifetime psychiatric comorbidity, and (iv) explore medical service use associations in a nationally representative sample of older adults. Methods: A sample of 8,205 older adults, aged 65 years or older, was derived from Wave 1 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Results: The weighted lifetime prevalence of BIIP with and without 12-month Specific Phobia was 0.6% (95% CI: 0.4-0.8) and 4.2% (95% CI: 3.7-4.8), respectively, and these two groups ranked similarly in terms of sociodemographic, health, and psychiatric characteristics. BIIP most frequently co-occurred with other lifetime fears, and was positively associated with hypertension and lifetime history of anxiety and personality disorders after controlling for sociodemographic and psychiatric confounders. Conclusions: Our findings suggest that lifetime BIIP may bear mental and physical health significance in older adults. © 2016 International Psychogeriatric Association.
Clinical significance of individual GAD symptoms in later life
- Authors: Miloyan, Beyon , Pachana, Nancy
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Geriatric Psychiatry and Neurology Vol. 29, no. 2 (2016), p. 92-98
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- Description: Background: There are age-related differences in the manifestation of generalized anxiety disorder (GAD) symptoms and their associated impact on psychosocial and functional status. However, it remains unclear whether specific symptoms (or symptom patterns) are of comparable clinical significance across different functional domains. Methods: A sample of 865 self-reported worriers (aged 60 years and older) who endorsed GAD screening questions in the Alcohol Use Disorder and Associated Disabilities Interview Schedule, Diagnostic and Statistical Manual of Mental Disorders, fourth edition, were derived from Wave 1 of the National Epidemiological Survey of Alcohol and Related Conditions. Results: Being easily fatigued was significantly associated with occupational disability and a functional disability variable (restricting usual activity in any way). Irritability was significantly associated with social friction (arguments with friends, family, or colleagues) and a functional disability variable (found was unable to do something wanted to do), and poor self-perceived health was also associated with the same functional disability variable. Excessive worry, despite being among the least reported symptoms, was significantly associated with distress. Conclusions: These findings suggest that individual GAD symptoms are differentially associated with aspects of clinical significance relevant to daily life, such as social, occupational, and functional ability. The differential impact of individual symptoms on functional status may be diluted when using symptom sum scores. A nuanced approach to assessing the clinical significance of individual GAD symptoms in older adults may be fruitful for efforts aimed at early detection and treatment. © 2015 SAGE Publications.
Episodic foresight and anxiety : Proximate and ultimate perspectives
- Authors: Miloyan, Beyon , Bulley, Adam , Suddendorf, Thomas
- Date: 2016
- Type: Text , Journal article
- Relation: British Journal of Clinical Psychology Vol. 55, no. 1 (2016), p. 4-22
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- Description: Objective In this paper, we examine the relationship between episodic foresight and anxiety from an evolutionary perspective, proposing that together they confer an advantage for modifying present moment decision-making and behaviour in the light of potential future threats to fitness. Methods We review the body of literature on the role of episodic foresight in anxiety, from both proximate and ultimate perspectives. Results We propose that anxious feelings associated with episodic simulation of possible threat-related future events serve to imbue these simulations with motivational currency. Episodic and semantic details of a future threat may be insufficient for motivating its avoidance, but anxiety associated with a simulation can provoke adaptive threat management. As such, we detail how anxiety triggered by a self-generated, threat-related future simulation prepares the individual to manage that threat (in terms of its likelihood and/or consequences) over greater temporal distances than observed in other animals. We then outline how anxiety subtypes may represent specific mechanisms for predicting and managing particular classes of fitness threats. Conclusions This approach offers an inroad for understanding the nature of characteristic future thinking patterns in anxiety disorders and serves to illustrate the adaptive function of the mechanism from which clinical anxiety deviates. © 2015 The British Psychological Society.
A reassessment of the relationship between depression and all-cause mortality in 3,604,005 participants from 293 studies
- Authors: Miloyan, Beyon , Fried, Eiko
- Date: 2017
- Type: Text , Journal article
- Relation: World psychiatry : Official Journal of the World Psychiatric Association (WPA) Vol. 16, no. 2 (2017), p. 219-220
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Future-oriented thought patterns associated with anxiety and depression in later life : The intriguing prospects of prospection
- Authors: Miloyan, Beyon , Pachana, Nancy , Suddendorf, Thomas
- Date: 2017
- Type: Text , Journal article
- Relation: Gerontologist Vol. 57, no. 4 (2017), p. 619-625
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- Description: Anxiety and mood disorders in later life are the focus of an increasing amount of intervention research, however basic mechanisms and paradigms explaining etiology and maintenance warrant further exploration. Research on future-oriented thought patterns associated with anxiety and depression in this age group may prove useful, as these disorders are both characterized by a tendency to generate and fixate on threat-related future scenarios that may or may not materialize. Additionally, depression is associated with a reduced expectancy of positive future events. In this paper, we review the literature relevant to future thinking in anxiety and depression in older adults. We focus on the mental construction and anticipation of negative future events, and their underlying neurocognitive mechanisms. We then consider clinical and research implications of anxious and depressive future-oriented thought patterns for older adults. We believe that more research investigating future-oriented thought patterns associated with emotional disorders in later life could improve conceptualization, measurement, and perhaps potential treatments for late-life anxiety and depression. © 2016 The Author.
The association of Social Anxiety Disorder, Alcohol Use Disorder and reproduction: Results from four nationally representative samples of adults in the USA
- Authors: Miloyan, Beyon , Bulley, Adam , Brilot, Ben , Suddendorf, Thomas
- Date: 2017
- Type: Text , Journal article
- Relation: PLoS ONE Vol. 12, no. 11 (2017), p.
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- Description: Social Anxiety Disorder (SAD) and Alcohol Use Disorder (AUD) are highly prevalent and frequently co-occur. The results of population studies suggest that SAD tends to precede AUD, and the results of laboratory studies suggest that alcohol use facilitates social behaviors in socially anxious individuals. Therefore, we posited that, in a modern context, a tendency to consume alcohol may be positively selected for among socially anxious individuals by its effect on the likelihood of finding a partner and reproducing. We tested the hypothesis that a higher proportion of individuals with a lifetime diagnosis of SAD and AUD reproduce (i.e., have at least one child) relative to individuals with SAD absent AUD in an individual participant meta-analysis based on over 65,000 adults derived from four nationally representative cross-sectional samples. We then cross-validated these findings against the results of a 10-year follow up of one of these surveys. Lifetime history of SAD was not associated with reproduction whereas lifetime history of AUD was positively associated with reproduction. There was no statistically detectable difference in the proportion of individuals with a lifetime history of SAD with or without AUD who reproduced. There was considerable heterogeneity in all of the analyses involving SAD, suggesting that there are likely to be other pertinent variables relating to SAD and reproduction that should be delineated.
Adverse life events and the onset of anxiety disorders
- Authors: Miloyan, Beyon , Bienvenu, Oscar , Brilot, Ben , Eaton, William
- Date: 2018
- Type: Text , Journal article
- Relation: Psychiatry Research Vol. 259, no. (2018), p. 488-492
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- Description: This study tested the hypothesis that adverse events are associated with increased risk of onset of anxiety disorders. Data from Waves 1 (N = 43,093; 2001–2002) and 2 (N = 34,653; 2004–2005) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were used to assess whether adverse events at baseline are associated with increased risk of anxiety disorder onset over three years of follow up. Sixty-six percent (SE: 1.0) of respondents with an anxiety disorder in the intervening period between Waves 1 and 2 had experienced an adverse life event in the year prior to the Wave 1 interview. In logistic regression models adjusted for sociodemographic and psychiatric characteristics, adverse life events at baseline were associated with anxiety disorder onset within the three-year follow up period. The pattern of association between adverse events and anxiety disorder onset was similar across sub-types, and injury, illness or death of family or close friends consistently had the strongest association with anxiety disorder onset. These findings suggest that adverse life events play a role in the onset of anxiety disorders.
Anxiety: Here and beyond
- Authors: Miloyan, Beyon , Bulley, Adam , Suddendorf, Thomas
- Date: 2018
- Type: Text , Journal article
- Relation: Emotion Review Vol. , no. (2018), p.
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- Description: The future harbours the potential for myriad threats to the fitness of organisms, and many species prepare accordingly based on indicators of hazards. Here, we distinguish between defensive responses on the basis of sensed cues and those based on autocues generated by mental simulations of the future in humans. Whereas sensed threat cues usually induce specific responses with reference to particular features of the environment or generalized responses to protect against diffuse threats, autocues generated by mental simulations of the future enable strategic preparation for hazards that may not require an immediate response. The overlap of these mechanisms makes defence effective and versatile, yet can manifest as contemporary anxiety disorders in humans.
Prospection and natural selection
- Authors: Suddendorf, Thomas , Bulley, Adam , Miloyan, Beyon
- Date: 2018
- Type: Text , Journal article
- Relation: Current Opinion in Behavioral Sciences Vol. 24, no. (2018), p. 26-31
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- Description: Prospection refers to thinking about the future, a capacity that has become the subject of increasing research in recent years. Here we first distinguish basic prospection, such as associative learning, from more complex prospection commonly observed in humans, such as episodic foresight, the ability to imagine diverse future situations and organize current actions accordingly. We review recent studies on complex prospection in various contexts, such as decision-making, planning, deliberate practice, information gathering, and social coordination. Prospection appears to play many important roles in human survival and reproduction. Foreseeing threats and opportunities before they arise, for instance, drives attempts at avoiding future harm and obtaining future benefits, and recognizing the future utility of a solution turns it into an innovation, motivating refinement and dissemination. Although we do not know about the original contexts in which complex prospection evolved, it is increasingly clear through research on the emergence of these capacities in childhood and on related disorders in various clinical conditions, that limitations in prospection can have profound functional consequences.