Dry-bed training for childhood bedwetting: A comparison of group with individually administered parent instruction

Thirty nocturnally enuretic children and their parents took part in this study which examined the effectiveness of Dry-Bed Training (DBT) with and without the adjunct of a urine-alarm device. Parents administered all treatment, following initial instruction in small group settings and supported by regular group meetings with a professional therapist. Ten children were treated by DBT without an alarm. Results showed this method to be effective in significantly reducing bedwetting frequency but not in effecting complete arrest of bedwetting symptoms. Ultimately all 30 children were treated by DBT with an alarm and this method led to 29 children reaching the success criterion of 14 consecutive dry nights. The average time taken to the last wet night was 30 days. There were 10 relapses at a 3-month follow-up. These results were virtually the same as those from a previous study involving 60 subjects who were treated by DBT with an alarm, either under the direction of a professional therapist, or of the child's parents who had been previously trained in the procedure on an individual basis (Bollard and Nettelbeck, 1981). Instructing parents in a group to administer DBT with an alarm is therefore an economical large-scale method of treating nocturnal enuresis because of savings in therapist time and effort in administering the demanding procedure.     

The response of day and night wetting children and children who wet only at night to retention control training and the enuresis alarm

Forty-five children with night wetting only (NW) and 30 children with day and night wetting (DNW) were randomly assigned to 2 treatment groups: alarm only and alarm preceded by 4 weeks of retention control training (R.C.T.). Fewer children became dry at night in the DNW group than the NW group and DNW children relapsed earlier following treatment. The enuresis alarm was far superior to R.C.T. in reducing night wetting in both enuretic groups. It also reduced day wetting in some of the DNW children. Children who became dry in the NW group did not show significant changes in functional bladder capacity. Although changes in functional bladder capacity were seen in the DNW children who became dry, changes were only noticeable once dryness had been achieved.     

Parent‐administered modified dry‐bed training for childhood nocturnal enuresis: evidence for superiority over urine‐alarm conditioning when delivery factors are controlled

We compared the relative efficacy of modified dry‐bed training and standard urine‐alarm conditioning for treating functional nocturnal enuresis in 36 children aged 7–12 years attending health centres in Glasgow, Scotland. A minimal intervention, self‐help approach was adopted. Parents and children received standardized instruction, which, for each method, consisted of one clinic interview and a manual and videotape for home viewing. Outcomes were contrasted with those from untreated controls. Twelve children were randomly assigned to each condition. All groups were matched for age, gender, social class (deprivation category), and baseline wetting frequency. In the two treated groups, an intake interview was followed by two review appointments, otherwise families carried out the programmes independently at home with fortnightly telephone support either until the success criterion of 14 consecutive dry nights was met or the 16 week maximum treatment period expired. Of the 12 children treated by dry‐bed training, eight achieved initial success compared with only three of the 12 treated by the conventional urine‐alarm method. One waiting‐list control child remitted spontaneously. ANOVA showed highly significant differences in wet nights per week immediately after intervention for both treatment and time factors (p < 0.001) and their interaction (p < 0.01). The dry‐bed group averaged 0.8 nights per week wet on treatment cessation, a frequency which was significantly superior to the average of 3.25 for the urine‐alarm group and 5.00 for the controls. Six months after attaining initial success, one child in each treated group had relapsed. Our results show an outcome of 58% long‐term remission (67% initial arrest, 13% relapse) for dry‐bed training when delivered by minimal intervention methods and indicate dry‐bed training as being more effective than orthodox urine‐alarm conditioning for the same input of clinic time and instruction. Copyright © 2002 John Wiley & Sons, Ltd.     

Effects of positive and negative adult-child interactions on children's social preference

The effects of positive and negative interactions on children's performance and preferences for the adults associated with each type of interaction were studied. Five children served as subjects during daily sessions in which each of three adults followed prescribed patterns of social interaction. One adult (positive) dispensed positive comments contingent upon either color-sorting or completion of arithmetic problems; a second adult (negative) mildly reprimanded the child for off-task behavior; and the third adult (extinction or nonreactive) said nothing to the child when he was present. Following each session the three adults reentered and the child chose one of them for an additional period of interaction. Three response measures (frequency, latency, and percent of time on-task) and children's adult preferences were obtained daily. The negative adult affected the most task behavior and had strongest stimulus control; the positive adult, though exerting little control over children's behavior, was the most preferred. Children's adult preferences were not specific to the task setting, but were observed across a variety of contexts.     

Correlates of children's television viewing: Expectancies,age, and sex

The relationship of interpersonal trust and locus of control expectancies to amounts of television viewing and viewing preferences were examined among children in grades five through eight. Age and sex differences in viewing times, preferences, and viewing habits, as well as children's scores on the Children's Interpersonal Trust Scale and the Intellectual Achievement Responsibility Scale were assessed. Several findings suggested that heavy viewing is associated with less trusting perceptions of others and less belief in controlling one's academic successes and failures, although the pattern found does not suggest so specific an effect of viewing television violence as Gerbner's cultivation hypothesis might suggest. Age and sex differences found were largely consistent with those reported in the previous literature.     

Mediation and production deficiencies in children's judgments of morality

This study investigated the influence of intentions and consequences on moral judgments. Children's and adults' production of inferences about an actor's intentions was assessed separately from their use of intentions as mediators of moral judgments. Two hundred and sixteen kindergarten, fourth grade and adult subjects viewed one of four videotaped episodes in which an actor either intentionally or accidentally produced a positive or negative result. Participants received one of two prompts to produce inferences about the actor's intentions or received no prompt. Each subject rated the actor's intent and the good-ness-badness of the actor. Results supported a mediational deficiency explanation for children's objective moral judgments. Both 6- and 10-year-old children made reliable, adult-like inferences of intentions. However, children's moral evaluations were based primarily on objective consequences while adults' evaluations were based primarily on the intentions of the actor. Young children did have intentionality information available, yet even with prompting this information did not mediate their judgments in an adult-like way; suggesting that there may be a period in development during which the child understands and produces subjective inferences but does not use this information as a basis for moral judgments.     

Predicted strategies and success in children's resolution of interpersonal problems

Preschool, first grade and second grade firstborn children generated strategies for two types of hypothetical interpersonal problems that might arise within the context of a friendship relationship. Children's reasoning about types of initial and follow-up strategies and predicted success of interpersonal strategies varied with age and the type of interpersonal problem. Increases in social modes that have previously been related to behavior adjustment and social competence were discussed in terms of development of cognitive processes and socialization factors.     

Learning to form relationships in infancy: Parallel attainments with parents and peers

Freud's assertion notwithstanding, the attachment relationship is not “without parallel” in social life. Children's attainments in forming attachments to parents parallel the steps they take in relating to their peers. During the first 3 years of life, in both domains, infants come to recognize prospective social partners, communicate with them, engage them in patterned interaction, including both cooperation and conflict, learn from their presence and actions, and interact in idiosyncratic ways with particular companions. Toward the end of this period, children show signs of acquiring generalized concepts of the social relationships in which they engage. It is proposed that biological constraints on learning promote human infants' interest in and rudimentary abilities to interact with other members of their species. Subsequent incidental and intentional learning processes shape both the child's attachments and less intense relationships with other persons.     

Sensation seeking of young children

Thirty-six boys and 33 girls, attending kindergatern, second-grade and fourth-grade, and their parents responded to a simplified version of the general Sensation Seeking Scale. Children's preferences for activities, puzzles, pictures, responses, foods, mazes and behaviors were also assessed. Results showed that the mean scores for the Sensation Seeking Scale of young children were much lower than scores of high school and college students, and significantly lower than the guesses of their parents. Sensation seeking was found to be related to preference for complex puzzles and pictures, to engagement in negative behaviors and to the children's knowledge about the environment. These findings suggest that the level of sensation seeking of children is related to their activities and preferences as well as their exposure to a variety of experiences.     

Evaluative verbalization and delay maintenance behavior in children

An experiment is presented which examined the influence of verbalizations on children's tendencies to postpone immediate gratification in terms of increased delayed reward. Children's verbalizations were varied in terms of their evaluative valence and whether they focused upon the reward itself or the delay task. During a delay task children in experimental groups periodically verbalized evaluative statements that were either positive (I like …) or negative (I don't like …) and which focused upon either the reward itself (… the tokens) or the delay behavior (… to wait). Children who focused on reward, under conditions of either positive or negative evaluation, postponed immediate gratification less than control subjects who made no verbalization. Children who evaluated delay behavior positively postponed immediate gratification longer than silent subjects, though children who negatively evaluated delay behavior did not differ from subjects who did not verbalize. The results are interpreted in terms of the influence of evaluative valence and focus as parameters of plans for delay behavior.     

Form and function in children's understanding of ironic utterances

Children's use of contextual discrepancy and stressed intonation to interpret literal form and illocutionary function in the use of ironic utterances was examined in two experiments. First and third grade children (6 and 8 years of age, respectively) and college adults were read short stories consisting of an utterance by a speaker and contextual information that was either neutral or that biased an ironic or literal interpretation of the utterance. The intonation of the utterance was either stressed or unstressed. Questions were asked about the literal form of the utterance, and the speaker's attitude in using the utterance. The results suggest that evaluation of the literal form and inference to the speaker's intended use of an utterance are independent components of irony comprehension in children: that contextual discrepancy and intonation function differently in cueing these processes; and that children and adults differ both in accomplishing these processes and in the use of these cues.     

Separate factor analyses of the McCarthy Scales for groups of black and white children

Factor analyses of the McCarthy Scales of Children's Abilities (MSCA) were performed on separate groups of black (N = 124) and white (N = 688) children, aged 3.0 to 7.6 years, to assess the comparability of the underlying structures and to evaluate the construct validity of the MSCA for each racial group. Little Jiffy I (principal components) solutions produced four factors for the blacks and three for the whites. Each “white” factor had a coefficient of congruence of .85–.93 with one “black” factor, indicating the close similarity of the solutions. In addition, the factors which emerged for the blacks and whites corresponded to several of the scales constituting the MSCA, offering evidence of the instrument's construct validity for each racial group. The results of the study should enhance the use of the McCarthy Scales for assessing young children of all races.     

Effects of parent enhancement therapy on the treatment outcome and generalization of a parent training program

The purpose of the present study was to examine the effectiveness of parent enhancement training in facilitating treatment and maintenance effects of a parent training program. Seventeen mothers and their clinic-referred noncompliant children were assigned to either a parent training alone group or a parent training plus parent enhancement therapy group. Fifteen mothers and their nonclinic children served as a quasi-control group. All clinic-referred mother-child dyads were treated individually by teaching the mother to reward compliance and other prosocial behavior and to use time-out for noncompliance. In addition, mothers in the parent training plus parent enhancement group also received treatment related to the following areas: parent's perception of their child's behavior, parent's personal adjustment, parent's marital adjustment, and parent's extrafamilial relationships. Assessment consisted of four home observations by independent observers prior to treatment, after treatment, and at a 2-month follow-up. The data indicated that the parent training plus parent enhancement therapy was more effective than parent training alone in changing child deviant behavior at posttreatment and in maintaining child compliance, child deviant behavior, parental rewards and parent contingent attention at follow-up. The control group did not change over the three assessment periods.     

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.     

“John thinks that Mary thinks that…” attribution of second-order beliefs by 5- to 10-year-old children

Understanding of second-order belief structures by 5- and 10-year-old children was assessed in acted stories in which two characters (John and Mary) were independently informed about an object's (ice-cream van's) unexpected transfer to a new location. Hence both John and Mary knew where the van was but there was a mistake in John's second-order belief about Mary's belief: “John thinks Mary thinks the van is still at the old place”. Children's understanding of this second-order belief was tested by asking “Where does John think Mary will go for ice cream?” Correct answers could only be given if John's second-order belief was represented, since all shortcut reasoning based on first-order beliefs would have led to the wrong answer. Results suggested unexpected early competence around the age of 6 and 7 years, shown under optimal conditions when inference of second-order beliefs was prompted.     

Treatment of nocturnal enuresis by conditioning techniques

One hundred and fifteen enuretic children were assigned to five treatment groups. Three groups received Mowrer-type continuous signal (C.S.), Twin-Signal (T.S.) or intermittent Twin Signal (T.S.-I.R.) conditioning treatment, and two groups were given “placebo” or “arousal” control treatments. Over a one-month period, there was no difference between conditioning and control procedures, and it was concluded that further research is needed to determine the basis of treatment response. There was no evidence in support of the escape training hypothesis, and the twin-signal modification to standard bell-and-pad treatment is not recommended. The investigation confirmed the success of conditioning treatment in bringing about the initial arrest of enuresis (i.e. in 81.4 per cent of the cases) but the relapse rate was high. The investigation provided tentative evidence that intermittent conditioning treatment offers one way of reducing the frequency of relapse. The problem of obtaining satisfactory parental co-operation in a badly housed working-class population was apparent, and ways of reducing the demands that treatment imposes on parents are indicated. The results are discussed with regard to theories of conditioning treatment of nocturnal enuresis, and possible improvements in this technique of treatment.     

Children's understanding of food and its functions: A preliminary study of the development of concepts of nutrition

Children's developing conceptions of how the body functions nutritionally were examined. Two different tasks provided converging findings. One task asked children to judge the causes of certain end states (e.g., why X is fat). The second task asked children to judge the result of certain contrasting diets (e.g., twin-1 eats twice as much candy as twin-2). The results evidenced; (a) systematic misconceptions on the part of kindergarteners that were overcome by sixth grade; and (b) other fairly sophisticated conceptions present even at the youngest ages tested. The research provides a needed first step toward describing the naive theories of nutrition possessed by children at different ages. Knowledge of childrens' theories of nutrition are essential for optimal planning of curricula and methods in nutrition education.     

An examination of project aware: The effects on children's attitudes toward themselves,others, and school

The purpose of this study was to determine the impact of Project AWARE on children's attitudes about themselves, peers, teachers, principals, and school. Data were collected on children's sex, race, stanine score on achievement tests, and pretest performance in order to determine the differential effects of the treatment. Eighty students were included in the study, 40 in the experimental group and 40 in the control group. All were from fourth and fifth grade classrooms. The major findings were that children involved in the program achieved greater personal adjustment and accepted responsibility for negative outcomes in social situations (internal control). White children scored higher in personal and social adjustment. Black children evidenced more positive attitudes toward school. Girls scored significantly higher than boys on the social adjustment subtests and attitudes toward peers. Black children in the control group had less positive attitudes toward teachers than white children in the experimental group     

Childhood obesity and parental reflective functioning: Is there a relation?

Background/ObjectiveIn recent decades, the prevalence of childhood obesity has increased, with the major implications for public health. However, the factors that contribute to obesity in children are still poorly understood. The present study aimed to investigate the role of parental reflective functioning (PRF) in childhood obesity.MethodIn a cross-sectional design, 120 sets of parents of 60 children (n = 30 with obesity, age range 6–11) were recruited by local paediatricians. Parents completed the Parental Reflective Functioning Questionnaire. Children's and parents’ weight (assessed by BMI), as well as their socio-economic status (SES), were assessed to explore the contribution of PRF in the prediction of children's weight, controlling for parents’ weight and SES.Resultst-test showed significant differences with medium effect sizes in BMI, SES and PRF between parents of children with and without obesity. The best model resulted from hierarchical multiple regression analyses and showed that mothers’ PRF predicted children's BMI above and beyond the prediction by parents’ BMI and SES.ConclusionsLow maternal PRF could be an important target for intervention strategies, highlighting the need to consider parental responses to children's emotions in the treatment of childhood obesity, particularly in parents with low SES and high BMI.