Dry-bed training: rapid elimination of childhood enuresis

Enuresis has been treated with moderate effectiveness by the urine-alarm method which requires many weeks of training. The present procedure used a urine-alarm apparatus but added such features as training in inhibiting urination, positive reinforcement for correct urinations, training in rapid awakening, increased fluid intake, increased social motivation to be nonenuretic, self-correction of accidents, and practice in toileting. After one all-night training session, the 24 enuretic children averaged only two bedwettings before achieving fourteen consecutive dry nights and had no major relapses. Little or no reduction in bedwetting occurred within the first two weeks for matched-control enuretics who were given the standard urine-alarm training. The results of a control-procedure showed that the new procedure did not involve Pavlovian conditioning. The new method appears to be a more rapid, effective and different type of treatment for enuresis.     

A 2-year follow-up of bedwetters treated by dry-bed training and standard conditioning

Sixty nocturnally-enuretic children treated by Dry-Bed Training (DBT) and 35 children treated by standard conditioning were followed-up over a 2-yr period. Results showed that after achieving the initial success criterion of 14 consecutive dry nights, 39% of the DBT group and 41% of the standard-conditioning group relapsed during the follow-up period. Renewed bedwetting was arrested in 14 out of 15 cases re-treated by DBT and in all 10 cases re-treated by standard conditioning. Children who relapsed following initial treatment were compared with those who remained dry in respect of the child's age and sex, bedwetting frequency prior to treatment, the number of bedwets (and consequent conditioning trials) during treatments, a history of primary or secondary enuresis and a history of diurnal micturitional difficulty. Children who had a history of day-time wetting accidents beyond the age of 4 were found to be more likely to suffer a relapse in bedwetting following either DBT or standard conditioning. None of the other variables examined was found to be significantly associated with proneness to relapse.     

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.     

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.     

An analysis of the behaviour of day- and night-wetting children: Towards a model of micturition control

Recent research has suggested that features of daytime bladder control are of importance in predicting the treatment response of nocturnal enuretics to the enuresis alarm. This paper suggests that a detailed analysis of daytime toileting behaviour should be carried out. A study is described where 22 children with day and night wetting and 22 matched normal controls were observed after they had consumed a considerable amount of fluid. The limb movements and postures were reliably rated by two observers and wetting events and visits to the toilet were recorded. Various deficits in bladder control were shown by the enuretic children. A working model of daytime bladder control is described which draws attention to significant components which may be disturbed in abnormal bladder control. The models implies that treatment regimes should be based upon a behavioural analysis of the particular dysfunction shown by the enuretic child.     

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.     

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.     

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.     

The effectiveness of Dry Bed Training for nocturnal enuresis in adults

Nine enuretic adults were successfully treated by the Dry Bed Training in a fairly short time (means = 15 weeks) including the retraining period for 3 Ss who relapsed after the therapy. There were no differences between primary and secondary (nocturnal) enuretics. The few relapses were neutralized by a short retraining. The study shows that this minimal intervention treatment is effective and efficient.     

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.     

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.     

Effect of neutral conditioning on racial attitudes of children.

The purpose of this experiment was to test the effectiveness of classical conditioning procedures in reducing negative evaluative responses, i.e., attitudes, toward pictures of Afro-American people. Ss were 73 Euro-American kindergarten children who received either 0, 1, 4, or 8 conditioning sessions of 36 pairings of the color black with neutral words. Two racial attitude scales were employed to measure amount of change in Ss' racial attitudes after exposure to the conditiong procedures. Parish's (1972) Revised PRAM II did not detect any change, but Williams' (1971) PRAM II demonstrated a significant reduction in anti-Afro-American attitudes for those Ss who received 8 conditioning sessions.     

A note on conditional reflex studies of schizophrenia in France

In France, beginning with 1946, the method of Ivanov-Smolenski was used to study schizophrenia, but after 1957, sensory conditioning procedures have been employed (EEG sound-light, evoked potentials in children, SAE conditioning in adults) and more recently eye blink and operant conditioning).     

EEG findings in 130 enuretics with special reference to spike potentials

As a result of an one time electroencephalographic transversal examination of 130 patients with enuresis aged from 3 to 18 years a back ground activity that was too slow for their age was found as the most frequent abnormal finding (31,5%). Focal sharp waves and spikes were observed in 20 per cent; they seem to be more frequent in enuretics than in other children and adolescents with disorders of behaviour. Their frequency is dependent on age. They are of small use for proving an epilepsy as possible cause of enuresis.     

The development of skin conductance fear conditioning in children from ages 3 to 8 years

Although fear conditioning is an important psychological construct implicated in behavioral and emotional problems, little is known about how it develops in early childhood. Using a differential, partial reinforcement conditioning paradigm, this longitudinal study assessed skin conductance conditioned responses in 200 children at ages 3, 4, 5, 6, and 8 years. Results demonstrated that in both boys and girls: (1) fear conditioning increased across age, particularly from ages 5 to 6 years, (2) the three components of skin conductance fear conditioning that reflect different degrees of automatic and controlled cognitive processes exhibited different developmental profiles, and (3) individual differences in arousal, orienting, and the unconditioned response were associated with individual differences in conditioning, with the influence of orienting increasing at later ages. This first longitudinal study of the development of skin conductance fear conditioning in children both demonstrates that children as young as age 3 years evidence fear conditioning in a difficult acquisition paradigm, and that different sub-components of skin conductance conditioning have different developmental trajectories.     

Use of classical conditioning procedures to control aggressive behaviors in children: a preliminary report.

This experiment tested the effectiveness of classical conditioning procedures in reducing children's aggressive behaviors in a classroom setting. As hypothesized, 11 boys and 14 girls who were shown pictures of aggressive scenes paired with the presentation of negatively evaluated words subsequently displayed significantly fewer aggressive responses than controls who had not experienced these conditioning procedures. A significant teacher/classroom effect was also found, which appeared to be a function of the level of the 3 teachers' permissiveness. Specifically, children's aggressive behaviors occurred more frequently in the classroom where a permissive atmosphere prevailed than in the classroom where a more restrictive atmosphere was maintained. In those classrooms where a permissive atmosphere prevailed, the children who were the same sex as their teacher tended to display more aggressive responses than those children who were the opposite sex from their teacher.     

Conditioned and unconditioned caloric compensation: Evidence for self-regulation of food intake in young children

The purpose of these two experiments was to determine (a) whether young children can be responsive to caloric density cues in regulating their food intake, (b) whether such cues can be associatively conditioned to organoleptic cues in foods, and (c) to obtain evidence regarding which of the many cues available are involved as conditioned stimuli. In Experiment 1 participants were eighteen 3- to 5-year-old children, who were seen for a series of pairs of conditioning trials, followed by extinction test trials. Each trial consisted of a two-part snack: approximately 100 ml of a pudding preload (chocolate or vanilla; high or low caloric density) followed after a delay by ad-lib consumption of snack foods (cookies and crackers). In extinction trials, flavors previously paired with high- or low-caloric density preloads during conditioning were presented in isocaloric intermediate density preloads. Results indicated that 14 of 18 children showed unconditioned caloric compensation on the first pair of conditioning trials; 16 of 18 children showed compensation following the second pair of trials, and 12 of these 16 subjects continued to show this consumption pattern during extinction. Consumption was significantly greater following the low calorie paired flavor than following the high calorie paired flavor during extinction. Experiment 2 (N = 10) replicated these findings, and uncorrelating preload and snack food flavors indicated that flavor cues in the preloads can serve as conditioned stimuli. Children showed both initial responsiveness to caloric density and evidence for associative conditioning of food cues to the physiological consequences of eating. These results provide initial evidence for a mechanism allowing the child to learn to anticipate the caloric consequences of familiar foods and regulate food intake accordingly.     

The Successful Treatment of Diurnal and Nocturnal Enuresis and Encopresis

Two children, a boy aged six and a girl aged five-and-one half, were treated for diurnal enuresis. The boy was also treated for bedwetting and the girl for encopresis. The treatment program was conducted by the children's parents and featured daily, weekly, and monthly rewards, a feedback "star chart" and nonexclusionary timeout for accidents. The girl's daytime wetting and soiling were treated simultaneously with soiling being eliminated first. After the boy's daytime wetting had been eliminated, he was given dry-bed training (Azrin, Sneed, & Foxx, 1974) with equal success. Long term follow-ups revealed that all forms of toileting accidents had been eliminated.     

Autonomic conditioning to monetary and social stimuli and aggression in children

Poor conditioning to punishment, such as loud tones or electric shock, has been proposed as an important factor involved in the etiology of aggressive and psychopathic behavior. However, it is not known whether the association holds when monetary or social stimulus is used as the unconditioned stimulus, and if aggressive individuals also have impaired conditioning to rewards. In this study, skin conductance responses in a conditioning task involving both monetary/social reward and punishment as unconditioned stimuli were assessed in 340 male and female 8‐ to 9‐year‐old children from the community. Children reported their reactive and proactive aggression using the Reactive and Proactive Aggression Questionnaire (RPQ; Raine et al., 2006). Results showed that monetary/social reward and punishment were effective in eliciting physiological classical conditioning in children, and that reduced reward conditioning was associated with high levels of proactive aggression in particular. Findings highlight the importance of distinguishing between reactive and proactive aggression when examining antisocial behavior in children, and suggest that reward‐oriented treatment programs may not be effective for children with more proactive, instrumental aggressive behavior.