Do Children With Primary Nocturnal Enuresis Have Clinically Significant Behavior Problems?

Friman, Patrick C.; Handwerk, Michael L.; Swearer, Susan M.; McGinnis, J. Christopher; Warzak, William J.

doi:10.1001/archpedi.152.6.537

Cited by 61 publications

(38 citation statements)

References 15 publications

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“…The only specific links between MNE and behavior problems belong to the domain of secondary nocturnal enuresis. [13][14][15] www.pediatrics.org/cgi …”

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confidence: 99%

“…The only specific links between MNE and behavior problems belong to the domain of secondary nocturnal enuresis. [13][14][15] Much less is known about behavior profiles in children with functional urinary incontinence, but most reports emphasize the comorbidity from behavior problems and personality disorders, and some advocate psychiatric treatment. 16 Attention-deficit disorders (ADDs) somewhat confound the issue, because here the wetting constitutes the comorbidity.…”

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confidence: 99%

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Behavior Profiles in Children With Functional Urinary Incontinence Before and After Incontinence Treatment

Bael

Winkler²,

Lax

et al. 2008

Pediatrics

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Since the 1980s, urinary incontinence and bed-wetting started to be seen as functional problems, with behavioral problems secondary to the bed-wetting. Behavioral problems in bed-wetting is studied extensively, but much less has been studied regarding behavioral problems in functional incontinence. What This Study AddsAbnormal behavior scores in children with functional incontinence were studied prospectively, before and after treatment for incontinence, as part of a randomized controlled trial. ABSTRACTOBJECTIVE. The purpose of this work was to analyze prospectively the prevalence of behavioral disorders in children with urinary incontinence because of nonneuropathic bladder-sphincter dysfunction before and after treatment for incontinence. METHODS.A total of 202 children with nonneuropathic bladder-sphincter dysfunction were enrolled in the European Bladder Dysfunction Study, in branches for urge syndrome (branch 1) and dysfunctional voiding (branch 2); 188 filled out Achenbach's Child Behavior Checklist before treatment and 111 after treatment. Child Behavior Checklist scales for total behavior problems were used along with subscales for externalizing problems and internalizing problems.RESULTS. After European Bladder Dysfunction Study treatment, the total behavior problem score dropped from 19% to 11%, the same prevalence as in the normative population; in branch 1 the score dropped from 14% to 13%, and in branch 2 it dropped from 23% to 8%. The prevalence of externalizing problems dropped too, from 12% to 8%: in branch 1 it was unchanged at 10%, and in branch 2 it dropped from 14% to 7%. The decrease in prevalence of internalizing problems after treatment, from 16% to 14%, was not significant.CONCLUSION. More behavioral problems were found in dysfunctional voiding than in urge syndrome, but none of the abnormal scores related to the outcome of European Bladder Dysfunction Study treatment for incontinence. With such treatment, both the total behavior problem score and the score for externalizing problems returned to normal, but the score for internalizing problems did not change. The drops in prevalence are statistically significant only in dysfunctional voiding. F UNCTIONAL URINARY INCONTINENCE is a leading symptom of both urge syndrome and dysfunctional voiding. These 2 clinical entities occur mainly in girls, 1-3 as manifestations of nonneuropathic bladder-sphincter dysfunction (NNBSD), and have always been associated with behavior problems; the International Classification of Diseases, 10th Revision, lists both "enuresis of nonorganic origin" and "urinary incontinence of nonorganic origin" in the category of mental and behavioral disorders. 4,5 For primary monosymptomatic nocturnal enuresis (MNE), this association has been studied quite extensively, [6][7][8][9][10][11][12] and in terms of temperament, emotional stress, and anxiety, most studies indicate that children with MNE are not different from those without. The only specific links between MNE and behavior problems belong to the domain of secondary...

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“…The only specific links between MNE and behavior problems belong to the domain of secondary nocturnal enuresis. [13][14][15] www.pediatrics.org/cgi …”

mentioning

confidence: 99%

mentioning

confidence: 99%

Behavior Profiles in Children With Functional Urinary Incontinence Before and After Incontinence Treatment

Bael

Winkler²,

Lax

et al. 2008

Pediatrics

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“…Whereas there are several behavioral researchers that publish outside of the behavioral journals (e.g., Friman, Handwerk, Swearer, McGinnis, & Warzak, 1998;Raiff, Faix, Turuturici, & Dallery, 2010), applied behavior analysts wanting to influence health care should be conducting research with medical practitioners, publishing this work in medical journals, and presenting their research at medical conferences, including the Conference of the Society of Behavioral Medicine. While these recommendations might seem lofty, and likely are, there may be ways to collaborate on research in BM in order to reach the medical community.…”

Section: Re-integration Of Behavioral Medicine With Applied Behavior mentioning

confidence: 99%

Applied Behavior Analysis and Behavioral Medicine: History of the Relationship and Opportunities for Renewed Collaboration

2015

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Behavioral Medicine (BM) is an interdisciplinary field concerned with the development and integration of behavioral and biomedical sciences (Schwartz & Weiss, 1978b). The interdisciplinary nature of the field poses barriers to researchers and practitioners interested in the field. While there are currently many disciplines that contribute to the field of behavioral medicine, this paper focuses exclusively on the relationships between the biological and psychological sciences, highlighting the theoretical similarities and differences. Our preliminary analysis of publications in each discipline revealed that while Applied Behavior Analysis (ABA) had early influences in behavioral medicine and many behavior scientists recommend the collaboration between ABA and BM, the relationship between the two is tenuous. The roles of an applied behavior analyst and practitioner of behavioral medicine are largely the same, focused on the prevention and treatment of health conditions. These similarities provide excellent opportunity for collaborative work. The present theoretical analysis of BM examines contributions of ABA to BM and vice versa, discusses ABA's history and current role within the field BM, and provides a rationale for the future collaboration between of behavior science and behavioral medicine.

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“…The extent of increased behavior problems in enuretic children, may probably be a result of than a cause of enuresis (e.g., Friman, Handwerk, Swearer, McGinnis, & Warzak, 1998; also see, Friman, 1986Friman, , 1995Friman, , 2007Friman, , 2008Friman & Jones, 2005). Moreover, longitudinal research showing that maturational variables were predictive of enuresis also showed that psychosocial variables such as emotional disposition were not predictive (Fergusson et al, 1986).…”

Section: Psychopathologymentioning

confidence: 99%

Enuresis and Encopresis

Friman

Freeman

2010

Handbook of Clinical Psychology Competencies

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Abstract:In this chapter, we describe the assessment and treatment of enuresis and encopresis. We first review literature on the symptoms, causes, and evidence-based treatments of each condition separately. We also incorporate a discussion of the mechanisms of change underlying effective intervention. Then, using Ryle's (1949) distinction between "knowing how" and "knowing that" as a framework, we discuss the basic competencies one should possess to address these clinical issues. A major reason for distinguishing between the "knowing how" and "knowing that" skill sets is that some clinicians teach and others practice. Based on this framework, we argue that demonstration of basic competency entails the clinician having the skills to conduct effective assessment and treatment of enuresis and/or encopresis, or the skills necessary to tell others (e.g., supervisees) how to do so. These skills include a thorough knowledge of the physiology of urination and defecation, potential pathophysiology of elimination disorders, the ability to effectively interface with medical providers regarding their treatment, and a strong working knowledge of evidence based treatments and their mechanisms of change. In our discussion of expert competency, we use no such distinction between "knowing how" and "knowing that", as an expert should be skilled in both. Further, expert competency in enuresis and encopresis entails the verbal and performance knowledge base to make scholarly contributions to the field, either by conducting one's own research or serving as a consultant to other research programs. Thus, an expert in this area is well poised to contribute to the field of elimination disorders as a master clinician, a specialty supervisor, and/or as a contributing researcher. OverviewChild clinical and pediatric psychologists confront a diverse set of problems that challenge children and their families. Often overlooked, but critically important, is the ability to successfully evaluate and intervene the challenges that may, at first glance, seem either medically based or within the realm of "typical" child behavioral problems. Among the most common, persistent, and stressful presenting complaints in primary medical care for children are two disorders involving developmentally inappropriate elimination of waste -enuresis (urine) and encopresis (feces). Evidence of their commonality and persistence is found in prevalence and age-range estimates. Prevalence estimates range as high 2% of 5-year-old children for encopresis and 25% of 6-year-old children for enuresis and, although both are much less prevalent by the teenage years, they are not rare. For example, as many as 8% of boys and 4% of girls are still enuretic at the age

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Do Children With Primary Nocturnal Enuresis Have Clinically Significant Behavior Problems?

Cited by 61 publications

References 15 publications

Behavior Profiles in Children With Functional Urinary Incontinence Before and After Incontinence Treatment

Behavior Profiles in Children With Functional Urinary Incontinence Before and After Incontinence Treatment

Applied Behavior Analysis and Behavioral Medicine: History of the Relationship and Opportunities for Renewed Collaboration

Enuresis and Encopresis

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