Alumnado con Trastornos de la Eliminación - Notes

Alumnado con Trastornos de la Eliminación

1. Los Trastornos de la Eliminación

  • Definition: Repeated emission of urine (enuresis) or feces (encopresis) in socially or hygienically inappropriate contexts.
  • Minimum Age for Diagnosis:
    • Enuresis: \geq 5 years
    • Encopresis: \geq 4 years
  • Onset: Can appear in adolescence (11-20 years), considering both chronological and developmental age.
  • Nature: Can be voluntary or involuntary, usually separate but can coexist.
  • Types:
    • Enuresis
    • Encopresis
    • Other specified excretion disorder (urinary or fecal symptoms)
    • Unspecified excretion disorder (urinary or fecal symptoms)
  • Prognosis: Generally favorable.
  • Importance in Early Childhood Education:
    • Sphincter control is a developmental milestone.
    • Influenced by maturation, family environment, and sociocultural context (Friman et al., 2021).
    • Affects self-esteem, social relationships, and family dynamics.
  • Role of Educators:
    • Early detection and educational sensitivity.
    • Coordination with families and healthcare professionals.
    • Prevention of stigma and emotional support.

2. Classification According to DSM-5-TR

  • Grouped within neurodevelopmental disorders (linked to insufficient or atypical maturation of the nervous system regulating sphincter control).
  • Subtypes of enuresis and encopresis allow for better understanding and individualized treatment.
  • Comorbidity is frequent, especially in males (Friman et al., 2021).

3. Trastorno de Enuresis

  • Definition: Repeated urination in inappropriate places, either in bed or clothing, voluntarily or involuntarily.
  • DSM-5-TR Criteria (APA, 2022):
    • Frequency: Minimum of two times per week for three consecutive months, or significant discomfort.
    • Age: Minimum 5 years or equivalent development.
    • Not attributable to a substance or medical condition.
  • Types:
    • Nocturnal only: most frequent.
    • Diurnal only: emission during the day, more common in girls.
    • Nocturnal and diurnal combined.
    • Primary: child never maintained continence.
    • Secondary: appears after at least 6 months of continence.
  • Etiology:
    • Genetic: 77% risk if both parents had enuresis.
    • Physiological: reduced bladder capacity, insufficient secretion of antidiuretic hormone.
    • Psychological: stress, emotional disorders, life changes.
    • Organic: infections, neurological anomalies, spina bifida.
  • Prevalence: Affects 15-20% of children aged 5-6 years and 6-8% of those aged 10 years (Friman et al., 2021).
  • Treatment:
    • Pharmacological: desmopressin, oxybutynin.
    • Psychological/behavioral: urinary alarms, bladder training, positive reinforcement, routines.
  • Prognosis: Generally favorable. Many cases remit spontaneously in puberty. Family support is key.

4. Trastorno de Encopresis

  • Definition: Repeated evacuation of feces in inappropriate places.
  • Diagnosis: From age 4, with at least one episode per month for 3 months.
  • Types:
    • With constipation and overflow (retentive): more common.
    • Without constipation (non-retentive).
    • Primary: child never controlled sphincters.
    • Secondary: reappears after a period of control.
  • Etiology:
    • Chronic constipation.
    • Emotional factors (anxiety, ADHD, depression).
    • Poor eating habits, lack of schedules, negative experiences in learning control.
  • Prevalence: More frequent in males. One-third of children with encopresis also have enuresis.
  • Treatment:
    • Pharmacological: laxatives, enemas, in specific cases imipramine.
    • Psychological: behavior modification, psychotherapy, family psychoeducation.
  • Prognosis: 90% improvement in the first year with adequate treatment. Requires monitoring due to risk of relapse (50% in the medium term).

5. Evaluación e Intervención Multidisciplinar

  • Rule out medical causes: clinical analysis, physical examination.
  • Psychological and functional evaluation: identify emotional and environmental conditions.
  • Family interview: parenting styles, parental reactions, assessment of supports.
  • Functional analysis of behavior: detect antecedents and consequences of the behavior.
    • What has been tried so far?
    • What context does the child have? (punishments, self-esteem, etc.)

6. Dificultades Asociadas

  • Low self-esteem, shame, and social avoidance.
  • Low academic performance.
  • Rejection by peer group.
  • Familial stress: overprotective or punitive parents.
  • Comorbidity: simultaneous presence with ADHD, anxiety disorders, executive dysfunctions.
  • Greater risk of emotional difficulties in adolescence.

7. Pautas de Intervención Educativa

  • Role of the teacher:
    • Avoid sanctions or exposure.
    • Apply discreet strategies (e.g., change of clothes, schedule control).
    • Design Individualized Support Plans.
  • School-family coordination:
    • Regular meetings.
    • Shared record of episodes.
    • Coherence in messages and routines.
  • Prevention of stigma:
    • Group work on emotions and empathy.
    • Preventive interventions in tutoring.
    • Specific training for teachers.
  • Cultural perspective:
    • Variations by country and context.
    • Respect times and traditions.
    • Avoid pathologizing different cultural practices.