Therapeutic Treatment Protocol for Enuresis Using an Enuresis Alarm.

Despite the high prevalence of enuresis (i.e., about 15% in children age 5 years; Cendron, 1999) and the financial, physical, and emotional burdens it can place on the child and the family, clinicians are often uninformed about the clinical manifestations of and effective interventions for the disorder. Many pediatricians and clinicians justify delaying or not providing treatment by arguing that most children will eventually grow out of it (Houts, Berman, & Abramson, 1994), which only adds to the problems related to this disorder. It is true that many children will eventually stop wetting their bed on their own; however, this process can take many years, during which the child experiences embarrassment and other stresses related to the disorder. In addition, research indicates that the longer a child has enuresis, the greater his or her chance for developing behavioral and emotional problems (Fergusson & Horwood, 1994). Conversely, research has proven that successful enuresis treatment will improve the child's self-esteem (Hagglof, Andren, Bergstrom, Marklund, & Wendelius, 1998) and long-term emotional development (Stromgren & Thomsen, 1990). In this article, we provide counselors with guidelines for the effective treatment of enuresis with the use of an enuresis alarm. First, we inform counselors about the complex etiologies, diagnostic criteria, and additional treatment options for this condition. Next, we introduce clinical parameters for counselors treating children with enuresis, which include strategies for a diagnostic interview, detailed treatment guidelines explaining the use of an enuresis alarm, family supportive interventions, and advocacy related issues. * Diagnostic Criteria of Enuresis Enuresis is defined by the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000) as repeated intentional or involuntary urination, with wetting episodes occurring at least twice a week for a minimum of 3 consecutive months, or when the occurrence of the wetting episodes creates significant distress or impairment in social, academic, or other vital functioning areas. To be diagnosed with enuresis, the child needs to be at least 5 years old or have achieved a developmental level comparable to that of a 5-year-old (DSM-IV-TR; APA, 2000). Excluded from the diagnosis of enuresis are wetting episodes that are due to a general medical condition or episodes that are the direct physiological consequence of a substance (e.g., diuretic; DSM-IV-TR; APA 2000). Enuresis presents in different types. Nocturnal enuresis refers to wetting episodes at night only (Yhiedke, 2003). Diurnal enuresis refers to daytime wetting episodes only (Skoog & Andriole, 2004), and mixed enuresis refers to both day and nighttime wetting (Mikkelsen, 2001). Primary enuresis is a condition that occurs in children who never reached consistent dryness (Goin, 1998), while secondary enuresis is defined as a reoccurrence of enuretic symptoms in children who had previously reached consistent dryness over a period of 6 months or longer (Gera, Seth, & Mathew, 2002). * Etiology of Enuresis The etiology of enuresis has been widely discussed in the literature (Cendron, 1999), and there seems to be no consensus on a single explanation for the cause of the disorder (Thiedke, 2003). Recent research indicates that the etiology is complex (Boris & Dalton, 2004) and multifactored (El-Radhi, 2005). To date, the primary etiological variables recognized in the literature are genetic factors, lack of sleep arousal, delayed maturation, psychological factors, reduced functional bladder capacity, and low level of the antidiuretic hormone (ADH) vasopressin. Genetic Factors A genetic predisposition for enuresis is the most commonly supported etiological variable for developing enuresis (Thiedke, 2003). Research indicates that children whose parents have a history of enuresis have a 77% chance to develop enuresis, while children with one parent with a family history of enuresis have a 43% chance to become enuretic. …