Effect of varying alarm schedules on acquisition and relapse parameters in the conditioning treatment of enuresis

Acquisition and relapse rates for 178 enuretic children were examined as a function of varying intermittent alarm schedules ranging from the standard (100%) bell-and-pad conditioning alarm treatment to a variable-ratio (VR) alarm schedule of 30–59%. Median follow-up time was 25 months. Children who experienced multiple wetting (MW) events beyond the third treatment week experienced twice as many wettings to reach dryness criterion as non-multiple wetting (NMW) children. Approximately one-third of the sample proved to be MW children. Optimal relapse results for NMW children were achieved with the 70–79% VR alarm schedule (10% relapse rate). MW children treated with the standard experienced a 100% relapse rate. For MW children the lowest relapse rates were attained with a 60–69% VR schedule (42% relapse). Older children experienced higher relapse rates than younger children, but age differences were eliminated with a 70–79%, VR alarm schedule. Collectively, the results demonstrate optimal VR intermittent alarm schedules for differen: categories of enuretic children.     

Childhood nocturnal enuresis: The prediction of premature withdrawal from behavioral conditioning

Predictors of premature withdrawal from a 12-week program of behavioral conditioning for childhood nocturnal enuresis were examined for 47 children treated at a university outpatient clinic. All children were administered the Piers-Harris Children's Self-Concept Scale; parents completed the 55-item Behavior Problem Checklist and the Tolerance Scale for Enuresis. Parents also reported the methods (i.e., random awakening, restriction of fluids, rewards,punishment, medication, other) previously used to control their child's wetting. A stepwise discriminant function analysis revealed that the function containing number of previous techniques used, presence of child behavior problems, and parent tolerance of enuresis was a significant predictor of early termination of treatment.     

The effects of extending the CS-UCS interval on the effectiveness of the conditioning treatment for nocturnal enuresis

Previous studies of the “conditioning method” of enuresis treatment have confounded the effects of conditioning with those of nonspecific psychotherapeutic aspects of the procedure. The present study compared three groups of enuretic children: (1) under the conventional bell-light conditioning procedure; (2) under a similar procedure, but which involved a three-minute delay between wetting and alarm, and (3) under no-treatment conditions. Double-blind precautions were used. Results suggested that conditioning effects improvement over and above that effected by nonspecific influences. The findings are qualified by large variances in improvement, and by premature termination of the experiment.     

Latent inhibition and compound conditioning: a reply to Holmes and Harris (2009)

Schmajuk, Lam, and Gray (SLG, 1996) presented a neural network model of classical conditioning that addresses the multiple properties of latent inhibition (LI). According to the model, LI is the result of the decreased attention to the target stimulus during preexposure and testing. Recently, Holmes and Harris (2009) suggested that, although the model was able to describe their experimental results showing that LI to a preexposed stimulus disappears with extended compound conditioning, it could not describe the fact that LI is not affected by a delay following compound conditioning. However, computer simulations demonstrate that the SLG model describes and explains both results. Because the model also explains both the deleterious and the facilitating effects on LI of a delay following simple conditioning, the SLG model seems unique in explaining the complete range of reported effects of temporal delays on LI as well as most of the properties of LI.     

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.     

Value change and relapse following a decision to quit or reduce smoking

Ainslie (1975) suggested a model according to which values change subsequent to decision and in which the value of a smaller, immediately available, reward increases at a faster rate than that of a later reward. The rank orde between the two rewards may therefore become reversed, leading to impulsive behavior. The assumptions of this model as applied to addition are discussed. As an alternative, it is suggested that values and beliefs may be more indicative of stereotypical, biased thinking during the course of an attempt to quit. A study of 23 smokers who tried to quit or reduce smoking supported the latter view rather than the Ainslie model However, neither approach was successful in accounting of relapses. This may be because action is hard to predict from beliefs and values, and it may more suitably be accounted for by desires and emotional states, the latter most importantly because they affect the ability of self-monitoring.     

Behavioral interventions for childhood nocturnal enuresis: the differential effect of bladder capacity on treatment progress and outcome

Study participants were fifty 5- to 13-year-old children (33 boys and 17 girls) with nocturnal enuresis of at least 3 months duration. All wet their beds at least twice per week, were of normal intelligence, and were without demonstrable organic cause for their enuresis. Each youngster's pretreatment maximum functional bladder capacity (MFBC) was used to classify the child as having small or large MFBC based on available norms. Youngsters were then randomly assigned to treatment with the urine alarm (UA) alone or with the urine alarm supplemented with retention control training (UA plus RCT). Of the 40 youngsters who completed treatment, 37 (92.5%) achieved the treatment goal of 14 consecutive dry nights. Two additional children became dry during follow-up, leaving only one child who failed to stop wetting. Sixteen children (41%) subsequently relapsed, but all who reentered treatment became dry. Because treatment outcome was uniformly excellent across all groups, treatment progress was evaluated by analyzing wetting frequency and arising at night to use the bathroom during treatment, as well as prechange and postchange in MFBC For both wetting frequency and arising at night, there was a significant interaction between bladder capacity and treatment. Small MFBC children treated with the UA plus RCT and large MFBC youngsters treated with the UA alone had the fewest wetting episodes and got up at night to use the bathroom less often; these youngsters took less time to be successfully treated. Prechanges and postchanges in MFBC indicated that RCT did not lead to consistent increases in bladder capacity in the sample studies. The 10 children who terminated treatment prematurely had lower self-esteem and more parent-reported conduct problems than the 40 children who completed treatment.