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Chapter 13

Chapter 13 Disorders of Basic Functins

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Psychology 2042A/B
Alvin Segal

Chapter 13 Disorders of Basic FunctionsA PROBLEMS OF ELMINATION Typical Elimination TrainingToilet Training For child pleasing parent sense of mastery feeling no longer being a baby may all contribute to the importance of achieving toileting control Usual sequence of acquisition night bowel day bowel day bladder night bladder Usually 1836 months completed Praise and concrete positive reinforces and doing so in a relaxed manner is effectiveEnuresis Enuresis repeated voiding of urine during day or night into the bed or clothes when such voiding is not due to physical disorder o Greek I make water Lack of urinary control not diagnosed as enuresis prior age 5DSM def Frequency of twice weekly for at least 3 months or wetting that is associated with clinically significant distress or impairment in important areas of functioning Primary if child has never demonstrated bladder control Secondary if problem is preceded by period of urinary continenceo 85 cases are of nighttime wetting aloneprimary Who Epidemiology 10 school children exhibit enuresis Declines with age o By 18 1 males less than 1 females o Twice as common amongst boys than girls Why Etiology Primarily a psychopathological disorder not result of emotional disturbance Emotional difficulties consequence of enuresis rather than cause Enuretic children esp when theyre older likely to experience difficulties with peers and other family members Enuresis and emotional problems occur together similar factors contribute to both ex Chaotic home environment Maturational delay in ability to recognize sensation of full bladder while asleep is common explanation For adults sleep abnormalities contribute to development Deep sleepers Role of sleep and arousal is inconsistent Wetting can occur in any stage of sleep not only deep sleep Biological pathway reduced bladder capacity or higher production of urine due to lack of normal nocturnal increase antidiuretic hormone ADH Enuretic children respond to antidiuretic medication o Evidence is not consistent and does not support low levels of ADH as the only cause of enuresis o May be the factor is some cases Family history relatives with enuresiso Significant genetic contributiono Specific gene loci are yet to be identified Failure result from faulty training or other environmental influences that interfere with learningo Maturation delay physical difficulty Treatment Prior any treatment child should be evaluated by physician to rule out medical causes Desmophressin Acetate DDAVP primary pharmacological treatmento Lower risk of side effects than other drugso Ability to control high urine output during sleepo Relapse occurs if drug is eliminated Behavioral treatmento Most well known is UrineAlarm System German pediatrician Pflaunder 1904Basic device absorbent sheet between two foil padsWhen urine is absorbed electric circuit is completed which activates an alarm that sounds until its manually turned off Parents are instructed to awaken the child when the alarm soundsChild is taught to turn off the alarm and got to the bathroom Keep record of dry and wet nights after 14 dry device is removed o Succes in most cases o More cost effective than DDAVPo Relapse in 40 cases reinstituting training often results in complete cure Full Spectrum home trainingo Manual guided package urinealarm system cleanliness training procedure to increase bladder capacity retention control training and overlearning o Training program delivered in 90 minute session or two 1 hour sessionso Parents contact to complete the training at home with regular calls from treatment staff o 30 Minute follow up sessions
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