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Chapter 13

Chapter 13 - ONLINE

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Psychology 2042A/B
Richard Brown

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 baby has its benets 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 parents 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 parents 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 Classication 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 denition requires either a frequency of twice weekly for at least 3 consecutive months or wetting that is associated with clinically signicant 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 1 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 difculties 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 difculties 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 difculties 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 childs 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 difcult 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 Paunder, 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. 2 modications 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 signicantly less in Group 3 Encopresis Description and Classication 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 classied as having constipation with overow 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 inuenced by factors such as diet, uid 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 3
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