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Background: Hospitalized patients with palliative care needs often have high levels of physical and psychological symptom distress. Virtual reality (VR) with a music therapy intervention may improve physical and psychological symptoms. Objectives: To assess symptom distress and quality of life (QOL) among hospitalized palliative care patients who participated in a virtual reality-based music therapy (VR-MT) intervention, and to explore VR-MT from the perspectives of health care professionals involved in their care. Design: Single-arm pilot study of a two-day VR-MT intervention. Setting/Participants: Patients seen by an inpatient palliative care consultation service at a U.S. hospital could participate in the VR-MT intervention. Participants created a customized soundtrack with a music therapist and then listened to it while experiencing a 360-degree VR nature-based environment of their choice. Measurements: Patients completed the Edmonton Symptom Assessment System, revised version (ESAS-r) and McGill Quality of Life, revised version (MQOL-R) before and after VR-MT. Members of the participants' health care teams were interviewed. Results: Seventeen patients completed VR-MT (range 20-79 years of age, 59% women). Moderate clinical improvements were observed for total ESAS-r score (Cohen's d effect size, 0.68), physical distress subscale (0.52), and psychological distress subscale (0.60); small improvements were observed in total MQOL-r score (0.26) and the existential subscale (0.27). Health care team members described the value of VR-MT as facilitating meaningful conversations. Conclusions: This pilot study of VR combined with a music therapy intervention for hospitalized patients with palliative care needs supports opportunities for future study of potential improvements in symptom distress and QOL.
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Symptoms of poor mental health among working people, especially health workers, are on the rise in the United States, contributing to a burgeoning market of thousands of mental health technology products, few of which have undergone rigorous evaluation. Most research on these products focuses on deploying digital mental health interventions as ancillary support in clinical practice and community settings. Little is known of the effectiveness of these tools when employers offer them. We describe the landscape of digital mental health interventions, providing an overview of mental health conditions that are addressed with technology-based solutions in the workplace and the products and services available. We argue for employers to apply a methodical approach to evaluating and selecting technologies for their organizations, and we review relevant frameworks for evaluation. Considering the rapidly evolving landscape of digital mental health interventions, we offer evidence-informed recommendations to organizations and decision-makers seeking to support workplace mental health and well-being, and we advocate the development of products that help organizations assess how they can mitigate workplace conditions that may contribute to poorer mental health. (Am J Public Health. 2024;114(S2):S171-S179. https://doi.org/10.2105/AJPH.2023.307505).
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Personal de Salud , Salud Mental , Humanos , Personal de Salud/psicología , Lugar de Trabajo/psicología , Salud DigitalRESUMEN
BACKGROUND: Most adolescents in the United States engage with technology. Social isolation and disruptions in activities owing to the COVID-19 pandemic have been linked to worsening mood and overall decreased well-being in adolescents. Although studies on the direct impacts of technology on adolescent well-being and mental health are inconclusive, there are both positive and negative associations depending on various factors, such as how the technology is used and by whom under certain settings. OBJECTIVE: This study applied a strengths-based approach and focused on the potential to leverage technology to benefit adolescent well-being during a public health emergency. This study aimed to gain an initial and nuanced understanding of how adolescents have used technology to support their wellness throughout the pandemic. In addition, this study aimed to further motivate future large-scale research on how technology can be leveraged to benefit adolescent well-being. METHODS: This study used an exploratory qualitative approach and was conducted in 2 phases. Phase 1 consisted of interviewing subject matter experts who work with adolescents to inform the creation of a semistructured interview for phase 2. Subject matter experts were recruited from existing connections with the Hemera Foundation and National Mental Health Innovation Center's (NMHIC) networks. In phase 2, adolescents (aged 14-18 years) were recruited nationally through social media (eg, Facebook, Twitter, LinkedIn, and Instagram) and via email to institutions (eg, high schools, hospitals, and health technology companies). High school and early college interns at NMHIC led the interviews via Zoom (Zoom Video Communications) with an NMHIC staff member on the call in an observational role. A total of 50 adolescents completed interviews regarding their technology use and its role during the COVID-19 pandemic. RESULTS: The overarching themes identified from the data were COVID-19's impact on adolescent lives, positive role of technology, negative role of technology, and resiliency. Adolescents engaged with technology as a way to foster and maintain connection in a time of extended isolation. However, they also demonstrated an awareness of when technology was negatively affecting their well-being, prompting them to turn to other fulfilling activities that do not involve technology. CONCLUSIONS: This study highlights how adolescents have used technology for well-being throughout the COVID-19 pandemic. Guidelines based on insights from the results of this study were created for adolescents, parents, caregivers, and teachers to provide recommendations for how adolescents can use technology to bolster overall well-being. Adolescents' ability to recognize when they need to engage in nontechnology-related activities and their ability to use technology to reach a larger community indicate that technology can be facilitated in positive ways to benefit their overall well-being. Future research should focus on increasing the generalizability of recommendations and identifying additional ways to leverage mental health technologies.
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Digital mental health interventions (DMHIs) have the potential to serve a significantly wider portion of the population in need of mental health services. The coronavirus disease 2019 (COVID-19) pandemic has especially highlighted the exacerbation of mental health disparities among minoritized populations. Innovations and research on DMHIs continue to expand, reinforcing the need for a more systemic process of DMHI implementation. In practice, DMHI implementation often skips the fundamental steps of conducting acceptability and feasibility studies. We propose a DMHI implementation framework that identifies an acceptability and feasibility study as an essential first step, simultaneously centering equitable processes that address populations disproportionately affected by mental illness.
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Background: In response to the COVID-19 pandemic, people worldwide have experienced increased anxiety, depression, and loneliness and decreased well-being. Mindfulness has been shown to enhance well-being across a variety of settings and for a variety of populations. Purpose: We developed and implemented a digital mindfulness program called Mindful Moment across a US university system as an innovative wellness resource to facilitate well-being and sense of connection among faculty, staff, and students. Attendees engaged in 5-minute live guided mindfulness sessions twice per week. This paper outlines our program evaluation over the course of four months. Methods: A total of 236 individuals attended between one to 30 mindful moment sessions. Data were collected on attendance, perception of the program's impact on attendee well-being and connectedness to the community, and feedback for future program development. Data collection included standardized stress and belongingness measures in addition to qualitative data related to perceived impact and reasons for attending. Results: Students, faculty, and staff who attended Mindful Moment and completed surveys reported that the program was easy to access, noted immediate benefits including decreased stress and improved well-being, and some attendees reported increased feelings of connection with the community. Conclusions: The present paper is exploratory in nature, a first step to assessing feasibility and overall impact. Future research assessing the impact of digital mindfulness programs can be improved by including a comparison group, additional standardized assessment, and a pre-post design, allowing for stronger conclusions to be drawn regarding efficacy and generalizability.
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Background: Music therapy (MT) and virtual reality (VR) have shown favorable patient-reported outcomes during serious illness. Objectives: To evaluate implementation measures of feasibility, usability, and acceptability of a VR-based MT intervention. Design: A pilot implementation study of a two-day VR-MT intervention using mixed methods. Patients created a personalized soundtrack with a music therapist, and then paired the soundtrack with a 360° VR environment. Setting/Subjects: Hospitalized patients with palliative care needs. Results: Of 23 patients (ages 20-74 years, 52% women), 17 completed the intervention, including 39% during an intensive care unit stay. Participants scored usability above average. For satisfaction, 53% chose the highest rating. Most participants spoke favorably of VR-MT, describing pleasant emotional and physical responses. Participants provided feedback on length, frequency of use, VR options, and timing of delivery. Conclusion: This VR-MT intervention was feasible, usable, and acceptable for hospitalized palliative care patients. Further study will test VR-MT outcomes.
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Enfermería de Cuidados Paliativos al Final de la Vida , Musicoterapia , Música , Realidad Virtual , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Adulto JovenRESUMEN
Despite strong evidence of effectiveness, exposure therapy is an underutilized treatment for anxiety disorders at a time when effective treatment for anxiety is greatly needed. The significant worldwide prevalence and negative impact of anxiety are documented and highlight the importance of increasing therapist and patient use of effective treatment. Obstacles to the use of exposure therapy are explored and steps to lessen these obstacles are proposed. In particular, virtual reality (VR) technology is discussed as a way to increase the availability of exposure therapy. Incorporating VR in therapy can increase the ease, acceptability, and effectiveness of treatment for anxiety. VR exposure therapy (VRET) permits individualized, gradual, controlled, immersive exposure that is easy for therapists to implement and often more acceptable to patients than in vivo or imaginal exposure. VR is presented as a scalable tool that can augment access to and effectiveness of exposure therapy thus improving treatment of anxiety disorders. VR also has the potential to help with assessment and with therapist training standardization. The authors advocate for providing continuing education in VRET to practicing clinicians and including training in exposure therapy and VRET in training programs. Ongoing development of VR applications for clinical use is encouraged, especially when developed in collaboration with software developers, clinical users, therapists who are experienced in VRET, and researchers.
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The present study examined the influence of maternal and child characteristics on parenting behaviors in a genetically informative study. The participants were 976 twins and their mothers from the Colorado Longitudinal Twin Study and the Twin Infant Project. Indicators of positive parenting were coded during parent-child interactions when twins were 7-36 months old. Child cognitive abilities and affection were independent correlates of positive parenting. There were significant gender differences in the magnitude of genetic and environmental influences on positive parenting, with shared environmental influences on parenting of girls and additive genetic influences on parenting of boys. Girls received significantly more positive parenting than boys. Differences in etiology of positive parenting may be explained by developmental gender differences in child cognitive abilities and affection, such that girls may have more rewarding interactions with parents, evoking more positive parenting.
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Conducta Infantil/psicología , Madres/psicología , Relaciones Padres-Hijo , Responsabilidad Parental/psicología , Adulto , Preescolar , Cognición , Colorado , Correlación de Datos , Escolaridad , Emociones , Femenino , Humanos , Lactante , Desarrollo del Lenguaje , Estudios Longitudinales , Masculino , Modelos Genéticos , Análisis de Regresión , Factores Sexuales , Estudios en Gemelos como Asunto , Gemelos , Adulto JovenRESUMEN
Existing research in consumer behavior suggests that perceptions and usage of a product post-purchase depends, in part, on how the product was marketed, including price paid. In the current study, we examine the effect of providing an out-of-pocket co-payment for consumer genomic testing (CGT) on consumer post-purchase behavior using both correlational field evidence and a hypothetical online experiment. Participants were enrolled in a longitudinal cohort study of the impact of CGT and completed behavioral assessments before and after receipt of CGT results. Most participants provided a co-payment for the test (N = 1668), while others (N = 369) received fully subsidized testing. The two groups were compared regarding changes in health behaviors and post-test use of health care resources. Participants who paid were more likely to share results with their physician (p = .012) and obtain follow-up health screenings (p = .005) relative to those who received fully subsidized testing. A follow-up online experiment in which participants (N = 303) were randomized to a "fully-subsidized" versus "co-payment" condition found that simulating provision of a co-payment significantly increased intentions to seek follow-up screening tests (p = .050) and perceptions of the test results as more trustworthy (p = .02). Provision of an out-of-pocket co-payment for CGT may influence consumer's post-purchase behavior consistent with a price placebo effect. Cognitive dissonance or sunk cost may help explain the increase in screening propensity among paying consumers. Such individuals may obtain follow-up screenings to validate their initial decision to expend personal resources to obtain CGT.
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Deducibles y Coseguros , Pruebas Genéticas/economía , Conductas Relacionadas con la Salud , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Aceptación de la Atención de SaludRESUMEN
This study assessed perspectives on whole-genome sequencing (WGS) for rare disease diagnosis and the process of receiving genetic results. Semistructured interviews were conducted with adult patients and parents of minor patients affected by idiopathic diseases (n = 10 cases). Three main themes were identified through qualitative data analysis and interpretation: perceived benefits of WGS; perceived drawbacks of WGS; and perceptions of the return of results from WGS. Findings suggest that patients and their families have important perspectives on the use of WGS in diagnostic odyssey cases. These perspectives could inform clinical sequencing research study designs as well as the appropriate deployment of patient and family support services in the context of clinical genome sequencing.
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Pruebas Genéticas/ética , Medicina de Precisión/psicología , Enfermedades Raras/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Actitud Frente a la Salud , Niño , Exoma , Femenino , Pruebas Genéticas/métodos , Genoma Humano , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Enfermedades Raras/diagnóstico , Análisis de Secuencia de ADN/métodos , Secuenciación Completa del Genoma/éticaRESUMEN
Background. Mobile health and digital medicine technologies are becoming increasingly used by individuals with common, chronic diseases to monitor their health. Numerous devices, sensors, and apps are available to patients and consumers-some of which have been shown to lead to improved health management and health outcomes. However, no randomized controlled trials have been conducted which examine health care costs, and most have failed to provide study participants with a truly comprehensive monitoring system. Methods. We conducted a prospective randomized controlled trial of adults who had submitted a 2012 health insurance claim associated with hypertension, diabetes, and/or cardiac arrhythmia. The intervention involved receipt of one or more mobile devices that corresponded to their condition(s) (hypertension: Withings Blood Pressure Monitor; diabetes: Sanofi iBGStar Blood Glucose Meter; arrhythmia: AliveCor Mobile ECG) and an iPhone with linked tracking applications for a period of 6 months; the control group received a standard disease management program. Moreover, intervention study participants received access to an online health management system which provided participants detailed device tracking information over the course of the study. This was a monitoring system designed by leveraging collaborations with device manufacturers, a connected health leader, health care provider, and employee wellness program-making it both unique and inclusive. We hypothesized that health resource utilization with respect to health insurance claims may be influenced by the monitoring intervention. We also examined health-self management. Results & Conclusions. There was little evidence of differences in health care costs or utilization as a result of the intervention. Furthermore, we found evidence that the control and intervention groups were equivalent with respect to most health care utilization outcomes. This result suggests there are not large short-term increases or decreases in health care costs or utilization associated with monitoring chronic health conditions using mobile health or digital medicine technologies. Among secondary outcomes there was some evidence of improvement in health self-management which was characterized by a decrease in the propensity to view health status as due to chance factors in the intervention group.
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BACKGROUND: As a result of the digital revolution coming to medicine, a number of new tools are becoming available and are starting to be introduced in clinical practice. OBJECTIVE: We aim to assess health care professional and consumer attitudes toward new medical technology including smartphones, genetic testing, privacy, and patient-accessible electronic health records. METHODS: We performed a survey with 1406 health care providers and 1102 consumer responders. RESULTS: Consumers who completed the survey were more likely to prefer new technologies for a medical diagnosis (437/1102, 39.66%) compared with providers (194/1406, 13.80%; P<.001), with more providers (393/1406, 27.95%) than consumers (175/1102, 15.88%) reporting feeling uneasy about using technology for a diagnosis. Both providers and consumers supported genetic testing for various purposes, with providers (1234/1406, 87.77%) being significantly more likely than consumers (806/1102, 73.14%) to support genetic testing when planning to have a baby (P<.001). Similarly, 91.68% (1289/1406) of providers and 81.22% (895/1102) of consumers supported diagnosing problems in a fetus (P<.001). Among providers, 90.33% (1270/1406) were concerned that patients would experience anxiety after accessing health records, and 81.95% (1149/1406) felt it would lead to requests for unnecessary medical evaluations, but only 34.30% (378/1102; P<.001) and 24.59% (271/1102; P<.001) of consumers expressed the same concerns, respectively. Physicians (137/827, 16.6%) reported less concern about the use of technology for diagnosis compared to medical students (21/235, 8.9%; P=.03) and also more frequently felt that patients owned their medical record (323/827, 39.1%; and 30/235, 12.8%, respectively; P<.001). CONCLUSIONS: Consumers and health professionals differ significantly and broadly in their views of emerging medical technology, with more enthusiasm and support expressed by consumers.
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Registros Electrónicos de Salud/normas , Pacientes , Médicos/normas , Recolección de Datos , Atención a la Salud , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , TelemedicinaRESUMEN
BACKGROUND: A number of benefits have been described for the long-term practice of meditation, yet little is known regarding the immediate neurological and cardiovascular responses to meditation. Wireless sensor technology allows, for the first time, multi-parameter and quantitative monitoring of an individual's responses during meditation. The present study examined inter-individual variations to meditation through continuous monitoring of EEG, blood pressure, heart rate and its variability (HRV) in novice and experienced meditators. METHODS: Participants were 20 experienced and 20 novice meditators involved in a week-long wellness retreat. Monitoring took place during meditation sessions on the first and last full days of the retreat. All participants wore a patch that continuously streamed ECG data, while half of them also wore a wireless EEG headset plus a non-invasive continuous blood pressure monitor. RESULTS: Meditation produced variable but characteristic EEG changes, significantly different from baseline, even among novice meditators on the first day. In addition, although participants were predominately normotensive, the mean arterial blood pressure fell a small (2-3 mmHg) but significant (p < 0.0001) amount during meditation. The effect of meditation on HRV was less clear and influenced by calculation technique and respiration. No clear relationship between EEG changes, HRV alterations, or mean blood pressure during meditation was found. CONCLUSION: This is the first study to investigate neurological and cardiovascular responses during meditation in both novice and experienced meditators using novel, wearable, wireless devices. Meditation produced varied inter-individual physiologic responses. These results support the need for further investigation of the short- and long-term cardiovascular effects of mental calm and individualized ways to achieve it.
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PURPOSE: The Scripps Idiopathic Diseases of Man (IDIOM) study aims to discover novel gene-disease relationships and provide molecular genetic diagnosis and treatment guidance for individuals with novel diseases using genome sequencing integrated with clinical assessment and multidisciplinary case review. Here we describe the operational protocol and initial results of the IDIOM study. METHODS: A total of 121 cases underwent first-tier review by the principal investigators to determine whether the primary inclusion criteria were satisfied, 59 (48.8%) underwent second-tier review by our clinician-scientist review panel, and 17 patients (14.0%) and their family members were enrolled. RESULTS: 60% of cases resulted in a plausible molecular diagnosis, and 18% of cases resulted in a confirmed molecular diagnosis. Two of three confirmed cases led to the identification of novel gene-disease relationships. In the third confirmed case a previously described but unrecognized disease was revealed. In all three confirmed cases a new clinical management strategy was initiated based on the genetic findings. CONCLUSION: Genome sequencing provides tangible clinical benefit for individuals with idiopathic genetic disease, not only in the context of molecular genetic diagnosis of known rare conditions but also in cases where prior clinical information regarding a new genetic disorder is lacking.
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Enfermedades Genéticas Congénitas/diagnóstico , Genoma Humano , Patología Molecular , Adolescente , Adulto , Niño , Preescolar , Femenino , Enfermedades Genéticas Congénitas/terapia , Genómica , Humanos , Lactante , Masculino , Enfermedades Raras/diagnóstico , Enfermedades Raras/genética , Enfermedades Raras/terapia , Análisis de Secuencia de ADN , Adulto JovenRESUMEN
This study was conducted to estimate the magnitude of genetic and environmental influences on the association between three indices of subjective well-being (i.e., life satisfaction, positive affect, negative affect) and positive and negative components of marital adjustment (i.e., spousal support, spousal strain) in a sample of adult married twin pairs (N = 453 pairs). Results indicated that subjective well-being and marital adjustment were significantly associated (particularly in women), that there were gender differences in the magnitude of genetic and environmental influences on this covariation, and that this association was largely influenced by genetic factors in women and genetic and nonshared environmental factors in men. These findings highlight the importance of using genetically informed research to evaluate the genetic and environmental influences on the covariation between marital adjustment and individual outcomes such as subjective well-being.
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BACKGROUND: Prediction of antisocial behavior is important, given its adverse impact on both the individuals engaging in antisocial behavior and society. Additional research identifying early predictors of future antisocial behavior, or antisocial propensity, is needed. The present study tested the hypothesis that both concern for others and active disregard for others in distress in toddlers and young children predict antisocial behavior during middle childhood and adolescence. METHODS: A representative sample of same-sex twins (N=956) recruited in Colorado was examined. Mother-rated and researcher-observed concern and disregard for others assessed at age 14-36 months were examined as predictors of parent- (age 4-12), teacher- (age 7-12), and self-reported (age 17) antisocial behavior. RESULTS: Observed disregard for others predicted antisocial behavior assessed by three different informants (parents, teachers, and self), including antisocial behavior assessed 14 years later. It also predicted a higher order antisocial behavior factor (ß=.58, p<.01) after controlling for observed concern for others. Mother-rated disregard for others predicted parent-reported antisocial behavior. Contrary to predictions, neither mother-rated nor observed concern for others inversely predicted antisocial behavior. RESULTS of twin analyses suggested that the covariation between observed disregard for others and antisocial behavior was due to shared environmental influences. CONCLUSIONS: Disregard for others in toddlerhood/early childhood is a strong predictor of antisocial behavior in middle childhood and adolescence. The results suggest the potential need for early assessment of disregard for others and the development of potential interventions.
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Trastorno de Personalidad Antisocial/psicología , Empatía , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Estudios Longitudinales , Masculino , Madres/psicología , Autoinforme , Gemelos Dicigóticos/psicología , Gemelos Monocigóticos/psicologíaRESUMEN
We examined the associations between language skills and concern and disregard for others in young children assessed longitudinally at ages 14, 20, 24, and 36 months, testing the hypothesis that language skills have a specific role (distinct from that of general cognitive ability) in the development of concern and disregard for others. We found that higher language skills predicted higher concern for others and lower disregard for others even after controlling for general cognitive ability, whereas the association between general cognitive ability and concern/disregard for others was not significant after controlling for language skills. Language skills at 14 months predicted concern for others at 36 months, and results suggested that the relations between language skills and concern and disregard for others begin early in development. Gender differences in concern and disregard for others were at least partially explained by differences in language skills. These results support the specific role of language skills in concern and disregard for others.
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Cognición/fisiología , Empatía , Desarrollo del Lenguaje , Lenguaje , Factores de Edad , Preescolar , Análisis Factorial , Femenino , Humanos , Lactante , Estudios Longitudinales , Masculino , Modelos Psicológicos , Relaciones Madre-Hijo , Pruebas Neuropsicológicas , Caracteres Sexuales , Estadística como AsuntoRESUMEN
The present study examined the role of positive parenting on externalizing behaviors in a longitudinal, genetically informative sample. It often is assumed that positive parenting prevents behavior problems in children via an environmentally mediated process. Alternatively, the association may be due to either an evocative gene-environment correlation, in which parents react to children's genetically-influenced behavior in a positive way, or a passive gene-environment correlation, where parents passively transmit a risk environment and the genetic risk factor for the behavioral outcome to their children. The present study estimated the contribution of these processes in the association between positive parenting and children's externalizing behavior. Positive parenting was assessed via observations at ages 7, 9, 14, 24, and 36 months and externalizing behaviors were assessed through parent report at ages 4, 5, 7, 9, 10, 11, and 12 years. The significant association between positive parenting and externalizing behavior was negative, with children of mothers who showed significantly more positive parenting during toddlerhood having lower levels of externalizing behavior in childhood; however, there was not adequate power to distinguish whether this covariation was due to genetic, shared environmental, or nonshared environmental influences.
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BACKGROUND: Diagnostic validity of oppositional defiant and conduct disorders (ODD and CD) for preschoolers has been questioned based on concerns regarding the ability to differentiate normative, transient disruptive behavior from clinical symptoms. Data on concurrent validity have accumulated, but predictive validity is limited. Predictive validity is critical to refuting the hypothesis that diagnosing ODD and CD in young children leads to pathologizing normal behavior. ODD and CD have emerged as gateway disorders to many forms of adult psychopathology. Establishing how early we can identify symptoms and disorders that herald poor prognosis is one of the most important goals for research on etiology and prevention. METHODS: Subjects were 3-5-year-old consecutive referrals to a child psychiatry clinic (n=123) and demographically matched children from a pediatric clinic (n=100). A diagnostic interview was used to assess DSM-IV ODD and CD in a prospective follow-up design from preschool to school age. Stability of ODD and CD diagnoses and level of impairment were tested as a function of preschool diagnosis. RESULTS: Over 80% of preschoolers diagnosed with ODD and approximately 60% of preschoolers diagnosed with CD met criteria for the same disorder during follow-up. Impairment over time varied significantly as a function of stability of diagnosis across three years. CONCLUSIONS: These results provide the first evidence of the predictive validity of DSM-IV ODD and CD in clinically referred preschool children. The findings challenge the assumption that symptoms of disruptive behavior disorders that occur during the preschool period tend to be transient.