Abnormal Psychology

Childhood Disorders 675

14.6 • Behavioral Treatment

of Enuresis A bed-wetting alarm is

the treatment of choice for nighttime

enuresis. In the model shown here,

the sensor immediately detects any

wetness, triggering the alarm, which

is near enough to the child’s ear that it

will probably wake the child up when

it goes off. Although initially the child

wakes up after wetting the bed, with

motivation and experience, he or she

will learn to wake up increasingly

closer in time to the release of urine.

Soon thereafter, the child becomes

able to wake up before urine is

released and thus urinate in the toilet.

6 hh ll

a pervasive developmental disorder, mental retardation, or another disorder (Ameri-

can Psychiatric Association, 2000).

Feeding and Eating Disorders

Feeding and eating disorders are characterized by problems with eating or with feed-

ing in the case of infants or young children whose diet consists entirely or mainly of

liquids, such as formula or milk (American Psychiatric Association, 2000). Disor-

ders in this subcategory include those that arise when a child does not eat enough

(and so either loses weight or fails to gain adequate weight), disorders that lead

the child to exhibit bizarre eating habits (such as eating nonfood objects, including

dirt), as well as the eating disorders anorexia nervosa and bulimia nervosa (dis-

cussed in Chapter 10).

When the eating problem results from a medical problem or another psychologi-

cal disorder, the diagnosis of a feeding or eating disorder is not made. Mental health

clinicians may be asked to help determine whether feeding or eating problems arise

from another psychological disorder, such as depression, anxiety, or oppositional

defi ant disorder, or from other causes. Mental health clinicians may also treat the

child with a feeding or eating disorder and his or her family.

Elimination Disorders

Humans are not born knowing how to use the toilet; we must learn to do so. Most

children learn by the age of 5 years, although they may have occasional accidents.

But some children who are 5 years old or older do not routinely use the toilet ap-

propriately to urinate or defecate, indicating an elimination disorder.

DSM-IV-TR includes two types of elimination disorders. Encopresis is the elim-

ination disorder characterized by a child’s persistently defecating in improper loca-

tions—neither in a toilet nor in a diaper (American Psychiatric Association, 2000).

Encopresis often arises, paradoxically, as the result of constipation (Loening-Baucke,

1996): The colon and large intestine become full of hard stool, which makes bowel

movements painful; children may then put off defecating as long as possible, which

makes the constipation worse. The intestines cannot function properly because they

are so full of stool (Partin et al., 1992), and the passage of feces becomes uncon-

trolled as looser stool from the small intestine leaks out around the mass of stool

in the large intestine, colon, and rectum. Parents may then think their child is will-

fully refusing to use the toilet or has diarrhea, even though the real problem is the

opposite—a large, hard stool that is diffi cult to pass. Encopresis that results from

hard stool is often resolved through changes in diet, such as increasing the child’s

intake of fl uids and high-fi ber foods.

Enuresis is another elimination disorder, which is characterized by a child’s

persistently urinating in bed or into his or her clothes; nighttime enuresis, or bed-

wetting, is common: Approximately a tenth of children between 5 and 16 years

old wet their beds, although not necessarily nightly (Mellon & McGrath, 2000).

As children age, this problem becomes less common. Nighttime enuresis usually

involves abnormal sleep patterns that cause children to sleep so deeply that they are

not aware of the sensations of a full bladder or cannot rouse themselves to get out

of bed and get to the bathroom (Nield & Kamat, 2004).

The most successful treatment for enuresis is based on behavioral principles

and uses a bed-wetting alarm, as shown in Figure 14.6 (Mellon & McGrath, 2000;

Mikkelsen, 2001): This treatment helps the child learn to control his or her blad-

der at night (some models of the equipment, such as that in Figure 14.6, also work

for daytime enuresis). The alarm goes off immediately after its sensor (attached to

underwear) detects wetness. Initially, the child wakes up from the alarm after wet-

ting the bed but is instructed to try to urinate in the toilet after being awakened by

the alarm’s going off. With motivation and repeated experience, the child learns to

wake up increasingly earlier in the process of bed-wetting; within 6 months (but

often in less time), the child usually learns to wake up and go to the bathroom

Figure 14.6

Feeding and eating disorders

A set of psychological disorders characterized

by problems with feeding or eating.

Elimination disorders

A set of psychological disorders characterized

by inappropriate urination or defecation.

Encopresis

An elimination disorder characterized by

a child’s persistent defecation in improper

locations—neither in a toilet nor in a diaper.

Enuresis

An elimination disorder characterized by a

child’s persistent urination in bed or into his

or her clothes.

Sensor

Alarm