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Chapter 13

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Psychology 2042A/B
Alvin Segal

Chapter 13-Disoders of Basic Physical Functions Euresis Euresis comes from the Greek word meaning “I make water”. It refers to the repeated voiding of urine during the day or night into the bed or clothes (not due to physical disorder) • Occurs twice weekly for at least three consecutive months • Also referred to as primary if the child has never demonstrated bladder control and as secondary when the problem is preceded by a period of urinary continence • The problem is at least twice as common in boys than girls • Evidence does not support the fact that enuresis is primarily a psychopathological disorder • Enuresis and emotional problems may occur together because similar factors contribute to the development of both • A maturational delay in the ability to recognize the sensation of a full bladder while asleep • Sleep abnormalities contribute • Has been suggested that reduced bladder capacity or higher production of urine is due to a lack of normal nocturnal increases in antidiuretic hormone. Evidence is not consistent. • Higher rates of concordance for enuresis also have been reported among monozygotic twins [significant genetic contribution] • Wetting results from a failure to learn control over reflexive wetting. Failure can result from either faulty training or other environmental influences • Child should be evaluated by a physician • Desmopre++ssin acetate has become the primary pharmacological treatment • Wetting resumes if the drug is discontinued • “Urine alarm system” successful in a clear majority of cases, and it is the treatment of choice • “Full Spectrum Home Training” includes a urine alarm system; cleanliness training; a procedure to increase bladder capacity, and overlearning (a process of training children to a higher criterion of successive dry nights than is usually thought to be necessary The three conditions were equally effective in treating enuresis. Relapse was significantly less in the BP-RCT-OL group than in the other two groups, showing the importance of overlearning in preventing relapse Encopresis Encopresis refers to the passage of feces into the clothing or other unacceptable area when this is not due to physical disorder • Occurs at least once a month for at least 3 months in a child of at least 4 years of age • Vast majority of encopretic children are chronically constipated • Appears to decrease with age • Occurs more frequently in males • Have no associated psychopathology • More socially evident than enuresis • Initial constipation and soiling may be influenced by factors such as diet, fluid intake, medications, environmental stresses or inappropriate toilet training • The bowel then becomes incapable of responding with a normal defication reflex • Medical perspectives stress a neurodevelopmental approach. More likely to occur in the presence of developmental inadequacies and anatomical mechanisms required for bowel control • A behavioural perspective stresses faulty toilet training procedures. May also be accounted for by avoidance conditioning principles (avoidance of pain or fear reinforces retention) • Treatment combines medical and behavioural management. Schedule regular toilet times, modifications in fluid intake, positive consequences are used to reward unassisted bowel movements • Such treatment is effective and relapse rates are low Sleep Problems • Rapid eye movement (REM) sleep and nonrapid eye movement (NREM) sleep o NREM is divided into four stages (where stage 3 and 4 are the deepest parts of sleep (very slow waves) • Up to one-quarter of infants and younger children experience some form of sleep problem • Insufficient sleep may contribute to problems sucvh a poor academic performance,anxiety, depression, and health difficulties • Sleep disorders of concern are classified into two major categories: o Difficulties in initiating and maintaining sleep or excessive sleepiness (insomnia)  When a child is rocked to sleep and soothed by parent to fall asleep, the child may not learn to sooth himself or herself or learn to return to sleep after a normal night waking  No differences in the actual number of waking for the two groups. Poor sleepers were unable or unwilling to go back to sleep and woke a parent • Good sleepers were able to return to sleep on their own  May be underestimated  Sleep problems may stem from worrisome cognitions  Sleep difficulties are often described as part of the presentation if other disorders such as ADHD, autism, depression, and anxiety. o Disorders of arousal, partial arousal, or sleep-stage transitions (parasomnia) • Sleepwalking o Somnabulism o Child may be non-responsive o It was once believed that the sleep walking child was exceptionally well coordinated and safe, but now we know its just a myth o Occurs in 15% of children 5-12 o Occurs during the later stages of NREM sleep which invalidates the idea that sleepwalking is the acting out of a dream o CNS immaturity is of significance in sleepwalking disorder o Strong genetic component and greater concordance in monozygotic twins • Sleep Terrors o Also known as night terrors o Are experienced by approximately 3% of children o Occur during deep, slow wave sleep o Signs of autonomic arousal o Child sits up and screams, never fully comes to consciousness • Nightmares o Are fright reactions that occur during sleep o Dreams occur during REM sleep o Children typically extinguish their fears by gradually exposing themselves during daytime hours to the feared stimulus o Multiple causes (developmental, physiological, and environmental factors) • Treatment: parents are taught to put the child to bed at a designated consistent time o Extinction (ignoring) procedures are based on the assumption that attention to night-time fussing maintains children’s sleep problems o Value of parent education in preventing the development and worsening of sleep problems o Pharmacological treatment associated with negative side effects and recurrences of sleep disturbances with discontinuation of treatment Parasomnias • Usually disappear spontaneously • Increasing sleep time, instructional procedures, and anxiety reduction procedures • Nightmares: anxiety is the basis for the nightmares. The majority of treatments involved cognitive-behavioural anxiety-reduction techniques Obstructive Sleep Apnea (OSA): • A respiratory sleep disorder characterized by repeated brief episodes of upper airway obstruction and resulting multiple transient arousals from sleep • May occur primarily during REM sleep • Only way to reliably diagnose OSA is by a sleep study • Enlarged tonsils and adenoids are the most common risk factors (obesity in adults) • Removal of tonsils and adenoids is the most common treatment • “{CPAP} continuous positive airway pressure device” Problems of Feeding, Eating, and Nutrition Failure to thrive (life threatening weight loss or failure to gain weight) is a special case of eating and feeding difficulties Rumination Disorder • Rumination disorder is characterized by the voluntary and repeated regurgitation of food or liquid in the absence of an organic cause • Pleasure appears to result from the activity • Observed in two groups: infants and persons with developmental disabilities • Form of self-stimulation • Sensory and or emotional deprivation are both associated with rumination • In intellectually disabled individuals, later onset is often observed • Appears to be more prevalent in males • Treatments emphasizing the use of social attention contingent on appropriate behaviour have been successful Pica Pica is characterized by the habitual eating of substances usually considered inedible • Particularly high among individuals with developmental disabilities • Due to parental inattention, lack of supervision, and lack of adequate stimulation Feeding Disorder of Infancy or Early Childhood Persistent failure to eat adequately that results in a child’s failing to gain weight or experiencing a significant weight loss • More prevalent in children with low birth weight and children with disabilities or medical illness • Appear to be equally common in males and females • Multiple causes • Parent’s competence influenced by three sets of factors o 1 set: parent’s personal resources. Parental psychopathology, maternal eating disorders o 2nd set
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