Evidence-Based_Psychotherapies_for_Children_and_Ad..._----_(19._Behavioral_Treatment_for_Enuresis_and_Encopresis)

Enuresis Overview

Bedwetting is commonly observed in children aged 5 to 12, with a prevalence of approximately 15% at age 6, decreasing to 1% by age 18. Only about 15% of affected children will outgrow enuresis in a single year. Persistent bedwetting can result in social restrictions, embarrassment, and lowered self-esteem. Research indicates that a 4-month behavioral treatment course can permanently resolve the issue for about 75% of children aged 6 and older. Most parents lack awareness regarding effective treatments, often receiving poor advice. Among the 7 to 10 million bedwetting children in the U.S., around 85% are monosymptomatic primary enuretics (MPEs), who wet only at night and have never experienced 6 months of dryness.

Conceptual Model of Treatment

The failure to stop bedwetting can be attributed to missed opportunities for developing proper responses for nighttime dryness. Behavioral treatments are typically initiated at age 5 and focus on conditioning the child's physiological responses to urination. The urine alarm serves to initiate an active avoidance response, teaching children to inhibit urination by contracting the pelvic floor muscles when they detect bladder fullness. According to studies, when children successfully avoid wetting, they show an increase in pelvic floor muscle activity, indicating a learned response.

Treatment Strategies

Full-Spectrum Home Training (FSHT) consists of four components: 1) urine alarm treatment, 2) cleanliness training, 3) retention control training, and 4) overlearning. A critical aspect of FSHT is for children to achieve 14 consecutive dry nights, which typically takes 8-12 weeks. If relapse occurs, the overlearning process, which includes gradually increasing water consumption, is reinforced to help maintain dryness. Successful treatment requires the active engagement and cooperation of both the family and child.

Encouragement and Motivation

Reinforcement of accomplishments is crucial. Children who experience multiple wetting episodes need encouragement to see progress over time, emphasizing the reduction in the size of wet spots. Education for both children and parents is essential to adjust expectations and foster motivation throughout the treatment process.

Efficacy and Follow-Up

Evidence shows that around 70-75% of MPEs can be expected to cease wetting after a 12-week treatment period. The treatment involves ongoing follow-up and education to reduce the chances of relapse, which may reach as high as 40% without adequate follow-up strategies. Success in treatment for encopresis involves coordinated medical and behavioral approaches, emphasizing the complementary nature of both interventions.

Encopresis Overview

Functional constipation and encopresis affect 1.5-7.5% of preschool and elementary school-age children, predominantly boys. Treatment often requires a combination of medical interventions to address the physiological aspects of constipation and behavioral therapies to improve toilet training and address emotional factors related to avoidance.

Characterizing Treatment Programs

Effective management of encopresis includes detailed assessments of developmental history and family dynamics. Educational tools, such as the Encopresis Game Board Protocol (GBP), engage children with interactive elements that promote positive toilet behaviors, reinforcing the treatment process through positive reinforcement while avoiding punitive measures for accidents.

Future Directions

Research into the treatment of encopresis continues to evolve, highlighting the effectiveness of combined medical and behavioral approaches. Future studies should emphasize rigorous methodologies to discern effective treatment components, enhancing outcomes for this challenging condition.