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Chapter 13

Psychology 2042A/B Chapter Notes - Chapter 13: Nocturnal Enuresis, Enuresis, Encopresis


Department
Psychology
Course Code
PSYCH 2042A/B
Professor
Richard Brown
Chapter
13

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Psych 2042A
Chapter 13: Disorders of Basic Physical Functions
in this chapter, we discuss problems of physical functioning and health
pediatric psychology is often applied to to research and practice of problems
representing the interface of psychology and pediatrics (medicine in children)
ie. sleep problems, anorexia, enlarged colons, toilet training problems
important to acquire appropriate habits in elimination, sleep, and eating - how these
tasks are handled and mastered can set the foundation for later interactions
Problems of Elimination
Typical Elimination Training
parents may view control of elimination as a developmental milestone for the child
entry into day care or another program may depend on achievement of appropriate
toileting
for the child, having a sense of mastering, pleasing their parent, and feeling that
they are no longer a ʻbabyʼ has its benefits
the usual sequence of acquisition of control over elimination is nighttime bowel
control, day-time bowel control, daytime bladder control, and nighttime bladder
control
usually, bowel and daytime bladder training are completed between the ages of
18-36 months
much of the parentsʼ decision to begin daytime training depends on cultural values,
attitudes, and real-life pressures on the parent
ready availability of the disposable diapers reduced many parentsʼ inclinations
to start training early
many factors take part in successful potty training - judging whether the child has
to go, using training pants, having the child in clothes that are easy to remove, and
having a child-size potty seat available are also helpful
common practice of providing praises and concrete positive reinforcements
Enuresis
Description and Classification
the term enuresis comes from the Greek word meaning “I make water” - refers
to the repeating voiding of urine during the day or night into the bed/clothes
when such voiding is not due to a medical condition (ie. diabetes, urinary tract
infection)
diagnosis enuresis is not usually given before age 5 - a certain frequency of
lack of control (depending on age of child) before the diagnosis is given
DSM definition requires either a frequency of twice weekly for at least 3
consecutive months or wetting that is associated with clinically significant
distress or impairment in important areas of functioning
distinctions between nocturnal enuresis (nighttime bedwetting) and diurnal
enuresis (daytime wetting)
Primary enuresis: when the child has never demonstrated bladder control
(85% of the enuresis cases)
Secondary enuresis: when the problem is preceded by a period of urinary
continence
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Epidemiology
among 5 year olds, 7% of boys and 3% of girls exhibit enuresis and by 10 years
old, the percentages are 3% and 2% respectively
by 18 years old, the prevalence decreases for 1% in males and less than 1%
for females
Etiology
at one time, enuresis was widely believed to be the result of emotional
disturbance
when emotional difficulties are present in a child with enuresis, they are
commonly a result of enuresis rather than a cause of enuresis
parents of children with combined nocturnal and diurnal enuresis may report
psychological problems in their children
enuretic children, especially as they become older, are very likely to experience
difficulties with peers and other family members.
suggested that sleep abnormalities contribute to the development of enuresis
wetting can occur in any stage of sleep, not just deep sleep
another biological pathway that has been suggested is a lack of normal
nocturnal increases in antidiuretic hormone (ADH), which leads to a higher
production of urine
family histories of youths with enuresis reveal a number of relatives with the
same problem
higher rates of concordance among monozygotic twins than dizygotic twins
several chromosomes have been implicated with enuresis
Treatment
prior beginning any treatment, the child should rule out any medical conditions
for the causation of urinary difficulties
a variety of pharmacological agents have been used in the treatment of
enuresis
Imipramine hydrochloride (Tofranil), a tricyclic antidepressant, was once
commonly employed
effectiveness relies on the childʼs willingness to take the medication, and
there is concern regarding the side effects
Desmopressin acetate (DDVAP) has become the primary pharmacological
treatment for enuresis, because it has lower side effects than imipramine
research suggests that DDAVP may reduce bedwetting even in cases that
are difficult to treat, but with imipramine, relapse occurs when medication is
discontinued
behavioural treatments for nocturnal enuresis have received attention as well
urine-alarm system: 1904 introduced by Pflaunder, basic device consists
of an absorbent sheet, an electric circuit is completed which activated an
alarm that sounds until it is manually turned off
after 14 consecutive nights of dryness, the device is removed
most cost-effective that DDAVP, and treatment durations last about 5-12
weeks
relapse has been reported in about 40% of the cases.
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modifications have been made to the urine-alarm system and the Full
Spectrum Home Training was to build on initial treatment success, reduce
relapse, and to decrease the rate at which families dropped out of treatment
this included the urine-alarm system, cleanliness training (having the
child change their own bed/night clothes), a procedure to increase
bladder capacity (known as retention control training), and overlearning
(training children to a higher criterion of successive dry nights than is
usually thought to be necessary)
training program is delivered within 1-hour group session, and the
parents and children them contract to complete the training at home with
regular calls from the treatment staff
study done on 3 groups: Group 1 received urine-alarm system plus
cleanliness training (BP), Group 2 received these two components plus
retention control training (BP-RCT) and Group 3 received the three
components plus overlearning (BP-RCT-OL)
relapse significantly less in Group 3
Encopresis
Description and Classification
functional encopresis refers to the passage of feces into clothing or other
unacceptable area when this is not due to a physical disorder
this event occurs at least once a month for a period of 3 months, in a child of at
least 4 years of age
two subtypes of encopresis are recognized on the basis of the presence or
absence of constipation
vast majority of encopretic children are chronically constipated and are
classified as having constipation with overflow incontinence (or retentive
encopresis)
Epidemiology
prevalence ranges between 1.5% and 7.5%
the prevalence decreases with age, and is rare by adolescence
more common in males than females
majority of children with encopresis have no associated psychopathology
since it is more likely to occur during the day than at night, it is more socially
evident than enuresis and is more likely to carry a social stigma
children who were reported to pediatricians had more behavioural problems
and lower social competence scores
Etiology
initial constipation and soiling may be influenced by factors such as diet, fluid
intake, medications, environmental stresses, or inappropriate toilet training
encopresis is viewed as more likely to occur in the presence of developmental
inadequacies in the structure and functioning of the physiological and
anatomical mechanisms required for bowel control
a behavioural perspective on encopresis stresses faulty toilet training
procedures - poor dietary choices may combine with the failure to apply
appropriate training methods consistently
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