Auditory intensity as a variable in the conditioning treatment of enuresis nocturna

Auditory intensity in the conditioning treatment of enuresis nocturna was examined in a study by Young and Morgan (1973a). In their study of three alarm intensities, no significant differences either in terms of treatment efficacy or of subsequent relapse were found. For both theoretical and practical reasons, the finding of no differences in treatment parameters as a function of varying alarm intensities is puzzling. In learning theory terms, a very intense UCS (bell or buzzer) would be expected to lead to more rapid acquisition of dryness (conditioned response) than a less intense UCS. Learning theory notwithstanding, the depth of somnolence of the enuretic child is legend. Not only are testimonials from parents regarding difficulty in arousal of their bedwetting child commonly elicited, but the literature on causes and treatment of bedwetting is replete with evidence of a deep-sleep enuresis syndrome (Bostock, 1962). It has been demonstrated by Finley (1971) and Di Perri and Meduri (1972) that the arousal threshold of enuretic children is abnormally high compared to nonenuretic children. The failure of the enuretic to awaken to the presentation of a bell (UCS) is frequently cited as responsible for unsuccessful bell-and-pad conditioning (Browning, 1967). Young and Morgan (1973b) in their study on rapidity of response to the conditioning treatment for enuresis found that one treatment problem most significantly related to slow responders was failure of the alarm stimulus to awaken the child. For those unfamiliar with the literature, the Young and Morgan (1973b) finding appears particularly surprising when one considers that they employed as their alarm UCS “...a powerful auditory stimulus...” (p. 490).Because of these important theoretical as well as practical concerns, an attempt was made to examine the effect of two auditory intensities on treatment and relapse parameters in the conditioning of enuresis nocturna.     

Conditioning treatment of nocturnal enuresis in adults: preliminary findings

Four male and six female adults (aged between 16 and 23) were treated for nocturnal enuresis with bell and pad apparatus. Although the trial was based upon an atypical sample (most patients were referred by psychiatrists), the results do suggest that bell and pad treatment may often markedly reduce or entirely eliminate nocturnal wetting even when the problem has persisted into adulthood.The special problems which may occur when treating enuresis in adults are discussed.     

Conditioning functional enuresis: follow-up after retraining

Of 52 enuretics treated with bell-and-pad, 44 (84.6%) were initial successes. One year after training, 16 (30.8%) remained continually dry. Positive outcomes increased to 24 (46.2%) with the addition of successful retrainees and to 29 (55.8%), including 5 unretrained relapses who subsequently were found dry. Most clients reach initial success, but less than one third remain continually dry.

In retraining, over 84.2% (16/19) of the clients were again successful, but training time was shorter, and half relapsed a second time. Retraining is an appropriate and relatively easy approach for modifying relapse, at least for many enuretics. More rigorous assessment of retraining requires a balanced follow-up design and comparison with other approaches.     

Conditioning treatment of enuresis using a 70% intermittent reinforcement schedule

A 70% intermittent variable ratio reinforcement schedule was administered by automated equipment to 80 enuretic children of both sexes. Dryness criterion (14 consecutive dry nights) was reached by 94% of the sample. Mean treatment duration was less than seven weeks. Approximately 80% of the sample recorded at least one multiple wetting night during the early stages of conditioning treatment. Relapse rates varied as a function of age ranging from 5.25% in 7–8 year olds to 50% in 9–10 year olds. For all ages combined, the observed relapse rate of 25% was found to be significantly lower than reported in the enuresis literature over the past 10 years.     

Auditory discrimination: a three-variable analysis of intensity effects

The acquisition of auditory intensity discriminations in rats trained on multiple variable-interval extinction schedules was studied as a function of some of the variables that contribute to the speed of development of differential responding and the final level attained. The effects of three variables were isolated and studied in detail: (1) the decibel difference between the discriminative stimuli (intensity difference); (2) the intensity relationship between the stimuli (relative intensity); and (3) the position of the stimuli on the intensity continuum (absolute intensity). Each of the three variables generated orderly relationships and interacted with one another to produce complex effects upon differential responding.     

Apparatus for conditioning treatment of enuresis

Recent experimental work is cited which has implications for basic equipment design. Some unsatisfactory earlier innovations are also briefly discussed.

The traditional pad and bell apparatus is not superseded but commonly exhibits defects and hazards for which the recessed electrode principle is introduced as a solution. New high-sensitivity requirements in circuitry to match the recessed electrode pad are met in an unusual and inexpensive way.     

Auditory discrimination: role of time and intensity in the precedence effect.

Rats were trained to respond on a lever adjacent to a sounding speaker (the sound source) when a single click was emitted. A second click (the artificial echo) was presented through a second speaker on the opposite side. In Condition I, the echo (equal in intensity to the source) was delayed from .015 to 32 milliseconds; greater than 75% correct responses were given for delay times between about .040 milliseconds (lower threshold) and 8 milliseconds (upper threshold). In Condition II, the echo (simultaneous with the source) was reduced in intensity relative to the source over a range from 2.5 decibels to 40 decibels; greater than 75% correct responses occurred for intensity reductions greater than 5 decibels. In Condition III, both the intensity and the delay time of the echo were manipulated in a manner analogous to that which would occur under natural conditions; greater than 95% correct responses were given for delay times from 1 to 32 milliseconds. These data indicate that both time and intensity differences are necessary for localization of primary sources, with delay time contributing more at short echo path distances, and intensity differences at long distances.     

Alteration of Auditory Cortex Activity with a Visual Stimulus through Conditioning: A 2-Deoxyglucose Analysis

In two experiments, the 2-deoxyglucose metabolic mapping technique was used to examine the hypothesis that a stimulus of one modality (a light) will begin to activate the sensory cortex of a stimulus of another modality (a tone) with which it has been repeatedly paired. Adult gerbils received repeated presentations of either a light or the light paired with a tone known to affect 2DG labeling patterns in the auditory cortex. Intermittent footshock was included on a pseudo-random basis to maintain arousal in the subjects. One day after training, each gerbil was injected with 2DG and either received repeated presentations of the light only or was simply exposed to the training context. Analysis of the auditory cortex revealed no differences in overall metabolic activity of the auditory cortex between the groups. However, in both experiments, the light that was previously paired with the tone changed the relative activity of the cortical subfields compared to the light not previously paired with the tone. Specifically, the results indicate greater activity in the anterior auditory field (AAF—Experiments 1 and 2) and the posterior fields (DPVP—Experiment 2) relative to the primary field AI in response to the light that was previously paired with the tone during training. Gerbils either only placed in the context during the 2DG session or that received unpaired presentations of the light and tone during training did not show this shift in relative labeling between the subfields. Because no differences in overall activity of the auditory cortex were found, we conclude that the shift in relative labeling between the subfields reflects, on average, both an increase in activity of fields AAF and DPVP and a concomitant decrease in AI activity in response to the light stimulus. The results have implications for our understanding both of brain learning mechanisms in general and the potential functions of auditory cortex subfields in particular.     

Overlearning in the conditioning treatment of enuresis: A long-term follow-up study

V studies have reported high rates of relapse following the otherwise highly successful conditioning treatment of childhood enuresis nocturna (Young, 1969). Relapse would seem to be a hazard inherent in this form of treatment, and to be independent of patient variables (Young and Morgan, 1972a). Use of the technique of intermittent reinforcement schedules (Lovibond, 1964; Turner, Young and Rachman, 1970) and of CNS stimulant drugs (Young and Turner, 1965; Turner and Young, 1966) to counteract the problem of relapse have failed to achieve satisfactory results.

Young and Morgan (1972b) have demonstrated the success of overlearning therapy in reducing the relapse rate. This regime requires the child to maintain or regain his learned nocturnal bladder control, to a success criterion of 14 consecutive dry nights, while drinking up to 2 pints of liquid in the hour before retiring. The present paper reports the experience gained in the counteraction of relapse by the use of overlearning therapy over approximately 4 yr at the Vale Drive Clinic, at which enuresis is treated by conditioning techniques (Young, 1965; Morgan and Young, 1972).     

Auditory stimulus intensity gradients and response to methylphenidate in ADD children

Using an auditory stimulus intensity paradigm, we obtained both event related potentials (ERPs) and press and release reaction times (RT) from a large sample of children with Attention Deficit Disorder (ADD). The ERP gradients to three tone intensities were used to classify the children as augmenters (steep gradients), moderates, or reducers (shallow or negative gradients). The RT data were used to classify the children as strong or sensitive, following neo-Pavlovian guidelines. The children were then cross-classified on these two dimensions and compared on cognitive, behavioral, and performance measures. The groups were also compared in response to two dosage levels of methylphenidate. Based on prior studies, we hypothesized that: 1. ERP augmenters would respond as well to the low as high dose but that reducers would respond better to high than low dose; and II. sensitive types (RT measure) would do better on the higher dose and strong types on the low dose. The first hypothesis was confirmed on a performance task but not on behavioral ratings. At the lower dose, augmenters improved most and reducers least on a 10-minute coding task presumed to require sustained attention. There was no support for the second hypothesis either in ratings or performance. The ERP augmentation measure was significantly related to teacher rated attentiveness; i.e., reducers and moderates were rated more adversely. The RT sensitivity measure tended to be related to achievement; i.e., strong types had lower reading and spelling scores. The ERP and RT sensitivity measures were not significantly correlated.     

A delivery system for the treatment of primary enuresis

To illustrate how to deliver underutilized psychological treatments, a comprehensive, low-cost treatment for primary enuresis was developed consisting of bell-and-pad training, cleanliness training, retention control, and overlearning. Sixty primary enuretic children and their parents attended 1-hour group training sessions and implemented treatment in the home. Each case required 15 minutes of professional time, and net cost to each family was $50. Forty-eight (81%) achieved initial arrest of bedwetting and only 11 (24%) relapsed at 1-year follow-up. Significant association between relapse and prior treatment failure with imipramine was noted. The outcome was found to compare favorably with previous treatments that required more professional time.     

Auditory adaptation to gradual rise or fall in intensity of a tone

The auditory system adapts to gradual changes of intensity. After listening to a gradually loudening (or softening) tone, a steady test tone appeared to be growing gradually softer (or louder). “Tuning curves” for these aftereffects were measured by adapting to one audio frequency and testing at another. Softening tones produced larger aftereffects, which were more sharply tuned for audiofrequency, than did loudening tones.