Effectiveness of psychological and pharmacological treatments for nocturnal enuresis.
Journal of Consulting and Clinical PsychologyPublished 1 January 1994
Arthur C. Houts, Jeffrey S. Berman, Hillel Abramson
Citations120
SJR quartileQ1
SJR score2.23
SNIP2.00
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
This review provides a quantitative integration of research on the effectiveness of psychological and pharmacological treatments for nocturnal enuresis and confirms that enuretic children benefit substantially from treatment.
Abstract
This review provides a quantitative integration of research on the effectiveness of psychological and pharmacological treatments for nocturnal enuresis. With the use of experiments that compared treatments with either no treatment or another form of treatment, this article assesses (a) the overall effectiveness of psychological and pharmacological treatments, (b) the relative effectiveness of specific types of treatments, and (c) moderators of treatment effectiveness including investigator allegiance. Findings from the review confirm that enuretic children benefit substantially from treatment. However, more children improve from psychological than from pharmacological interventions. Moreover, psychological treatments involving a urine alarm are most likely to yield benefits that are maintained once treatment has ended.
Keywords
Medicine
Encyclopedia of Social WorkDiagnostic and Statistical Manual of Mental Disorders
109,983 Citations2013Janet B. W. Williams, Michael B. First
Psychology Press eBooksApplied Multiple Regression/Correlation Analysis for the Behavioral Sciences
20,853 Citations2014Patricia Cohen, Patricia Cohen +2 more
American Journal of Occupational TherapyDiagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.) Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.) American Psychiatric Association (1987). American Psychiatric Press, Inc., 1400 K Street, NW, Washington, DC 20005. 567 pp., $39.95 hardcover; $29.95 softcover.
5,310 Citations1988Margaret Drake
Psychological BulletinPsychotherapy for the treatment of depression: A comprehensive review of controlled outcome research.
671 Citations1990Leslie A. Robinson, Jeffrey S. Berman +1 more
Findings from the review confirm that depressed clients benefit substantially from psychotherapy, and these gains appear comparable to those observed with pharmacotherapy.
Archives of Disease in ChildhoodEnuresis and spontaneous cure rate: Study of 1129 enuretics
444 Citations1974W. I. Forsythe, Amy M. Redmond
A long-term follow-up of 1129 children with nocturnal enuresis, not treated by the electric alarm, has shown that the annual spontaneous cure rate between 5 and 9 years of age was 14%, between 10 and 14 years 16%, and between 15 and 19 years 16%.
PEDIATRICSFactors Related to the Age of Attainment of Nocturnal Bladder Control: An 8-Year Longitudinal Study
260 Citations1986David M. Fergusson, L. John Horwood +1 more
The results favor the view that the etiology of primary enuresis is mainly biologic and that psychosocial factors play little role in this aspect of bed-wetting.
Acta PaediatricaEnuresis in Seven‐Year‐Old Children
241 Citations1988Marjo‐Riitta Järvelin, L. VIKEVÄINEN‐TERVONEN +2 more
It seems that there are at least two aetiologically significant groups of enuretic children: cases with neurological damage and mixed day and night wetting and cases with delayed maturation, with nightwetting which shows a clear sex and genetic dependency.
Behaviour Research and TherapyDry-bed training: Rapid elimination of childhood enuresis
233 Citations1974Nathan H. Azrin, T.J. Sneed +1 more
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 and the results of a control-procedure showed that the new procedure did not involve Pavlovian conditioning.
PEDIATRICSChildhood Enuresis: Prevalence, Perceived Impact, and Prescribed Treatments
182 Citations1986Betsy Foxman, R. Burciaga Valdez +1 more
Children aged 5 to 13 years were asked about the presence and frequency of enuresis, perceived impact, and physician-prescribed treatments, and the most commonly recommended regimen in the literature, the bed alarm, was prescribed to only 3% of bed-wetting children who saw a physician.
Journal of Consulting and Clinical PsychologyA meta-analysis of antidepressant outcome under "blinder" conditions.
138 Citations1992Roger P. Greenberg, Robert F. Bornstein +2 more
A meta-analysis of 22 studies of antidepressant outcome assessed the level of medication effects under conditions thought to be less subject to clinician bias than those in the typical double-blind drug trial, finding no advantage for antidepressants beyond the placebo effect.
Archives of Disease in ChildhoodFifty years of enuretic alarms.
128 Citations1989W. I. Forsythe, R. J. Butler
Cet article discute le probleme des alarmes pour enuretiques: mode d'action (transformer la signification de the sensation de vessie pleine d'un signal pour uriner en un signal pour inhiber la miction et s'eveiller).
The Journal of PediatricsEnuresis—an etiologic and therapeutic study
120 Citations1965John S. Werry, John J. Cohrssen
A 4 month controlled treatment trial showed that the bedbuzzer or conditioning treatment, though producing a cure rate of only 30 per cent, is significantly superior to brief psychotherapy and spontaneous remission, though the latter two do not differ in end result.
The Journal of PediatricsImprovements in self-concept after treatment of nocturnal enuresis: Randomized controlled trial
119 Citations1987Michael Moffatt, Caroline Kato +1 more
It is concluded that there may be mental health benefits in children helped to master the symptom of enuresis, which in this age group is probably a chronic stressor.
Journal of Abnormal PsychologySymptom treatment and symptom substitution in enuresis.
114 Citations1969Bruce L. Baker
Conditioning was superior to other methods, suggesting that successful treatment was not based solely on the therapist-patient relationship, and substitute problems will arise following remission of symptoms.
Archives of Disease in ChildhoodEstablishment of working definitions in nocturnal enuresis.
92 Citations1991R. J. Butler
Inclusion criteria The following characteristics of enuretics being studied should be included: age, including the range for acceptance in the study, and the mean and actual age range of those children enrolled.
Acta PaediatricaAetiological and Precipitating Factors for Childhood Enuresis
88 Citations1991Marjo‐Riitta Järvelin, I. Moilanen +5 more
These models showed that there are similarities between nocturnal and diurnal enuresis, although there are still many differences and every individual case requires consideration of all these disposing factors.
Behaviour Research and TherapyThe response of day and night wetting children and children who wet only at night to retention control training and the enuresis alarm
88 Citations1980Dorothy Fielding
Although changes in functional bladder capacity were seen in the DNW children who became dry, changes were only noticeable once dryness had been achieved, and the enuresis alarm was far superior to R.C.T. in reducing night wetting in both enuretic groups.
Archives of Disease in ChildhoodPredicting treatment outcome in nocturnal enuresis.
83 Citations1990J B Devlin, C O'Cathain
The favourable success rates with baseline recording and the enuresis alarm confirm the role of conditioning treatment at the forefront of management of enureis and the risk score allows outcome to be predicted for the first time.
Behavior TherapyRapid elimination of enuresis by intensive learning without a conditioning apparatus
79 Citations1978Nathan H. Azrin, P.M. Thienes
The new method provides a convenient method of eliminating enuresis rapidly and durably for almost all enuretic children over 3 years of age.
Journal of Child Psychology and PsychiatryLife Changes and Protective Capacities in Enuretic and Non‐Enuretic Children
74 Citations1990Marjo‐Riitta Järvelin, Irma Moilanen +2 more
A strong ego was found to serve as a protective factor against enuresis under changing life conditions, and secondary night-wetting was precipitated by increased life stress, but this was not the case with secondary day-Wetting.
Behaviour Research and TherapyOverlearning in the conditioning treatment of enuresis
73 Citations1972G.C. Young, R.T.T. Morgan
Overlearning therapy was given to 61 cases randomly allocated from a total sample of 144 patients at a special investigation clinic and was found to significantly reduce the relapse rate without increasing the likelihood of patients terminating treatment prematurely.
Developmental Medicine & Child NeurologyChildhood Nocturnal Enuresis: Factors Associated with Outcome of Treatment with an Enuresis Alarm
65 Citations1983Sylvia Dische, William Yule +2 more
Family difficulties emerged as the most important predictor for outcome of treatment and adversely influenced the rate of initial arrest of wetting, the relapse rate and the long‐term success rate.
PubMedEnuresis: psychopathology, sleep stage, and drug response.
63 Citations1980Edwin J. Mikkelsen, Judith L. Rapoport
The results did not support the premise of different sleep profiles of enuresis in relation to pathologic behavioral patterns, and imipramine was found to be an effective alternative for short-term management of children, who do not respond to the bell and pad conditioning method.
Behaviour Research and TherapyThe mechanism of conditioning treatment of enuresis
61 Citations1963S. H. Lovibond
It is suggested that conditioning treatment of enuresis follows the avoidance rather than the classical conditioning model, and the CS is provided by the pattern of stimulation arising from the micturition response and not by bladder distention stimulation.
The Journal of UrologyEnuresis: Principles of Management and Result of treatment
60 Citations1979Evan J. Kass, Ananias C. Diokno +1 more
Girls with enuresis and urinary infection also are started on anticholinergic medication, and significant improvement occurs in up to 90% of the patients.
PubMedEnuresis: a contrast of attitudes of parents and physicians.
60 Citations1981Steven P. Shelov, John H. Gundy +9 more
American journal of diseases of childrenParental Perceptions of Enuresis
60 Citations1981Malika Haque
Of 1,379 children 4 years of age and older who were patients in nine medical centers across the country, 346 (25.1%) were found to be enuretic.
Behaviour Research and TherapyParental attitudes and the conditioning treatment of childhood enuresis
59 Citations1975R.T.T. Morgan, G.C. Young
Mothers regarding enuresis as a greater nuisance tended to have more anxious enuretic children, and mothers from the less skilled socioeconomic levels were found to be less tolerant of the problem and to rate it as a great nuisance.
Monographs of the Society for Research in Child DevelopmentInfants Who Become Enuretics: A Longitudinal Study of 161 Kibbutz Children
58 Citations1977Mordecai Kaffman, Esther Elizur +5 more
Paediatric and Perinatal EpidemiologySecondary enuresis in a birth cohort of New Zealand children
56 Citations1990David M. Fergusson, L. John Horwood +1 more
Results suggest that the rate at which the child acquires primary bladder control acts as a vulnerability factor which determines the child's susceptibility to developing secondary enuresis when exposed to stress.
Pediatric Clinics of North AmericaNocturnal Enuresis: An Update on Treatment
55 Citations1982Barton D. Schmitt
The benefits and risks of motivational counseling, bladder exercises, medications, and enuresis alarms are compared.
Behaviour Research and TherapyThe effect of continuous, intermittent, and “placebo” reinforcement on the effectiveness of the conditioning treatment for enuresis nocturna
53 Citations1973William W. Finley, R.L. Besserman +3 more
The results of this study may be interpreted as supporting the tenet that relapse can be viewed and treated as an extinction of the acquired response.
Scandinavian Journal of Urology and NephrologyScreening of Urinary Tract Abnormalities Among Day and Nightwetting Children
53 Citations1990Marjo‐Riitta Järvelin, Niilo‐Pekka Huttunen +3 more
Behaviour Research and TherapyRelapse and therapeutic response in the conditioning treatment of enuresis: A review of recent findings on intermittent reinforcement, overlearning and
52 Citations1978R.T.T. Morgan
A consensus of published results to date favouring overlearning as the more effective procedure in countering relapse is found, and auditory stimulus intensity is identified as a critical factor affecting rate of acquisition of continence, but not relapse.
Behavior TherapyPrevention of relapse in full-spectrum home training for primary enuresis: A components analysis
51 Citations1986Arthur C. Houts, Joseph K. Peterson +1 more
It is suggested that overlearning be routinely incorporated into bell-and-pad treatments to prevent relapse.
PEDIATRICSENURESIS: AN ANALYSIS OF VARIOUS THERAPEUTIC APPROACHES
51 Citations1973Sumner Marshall, Hermine H. Marshall +1 more
There is a trend showing that the "responsibility-reinforcement" technique produces more successful longterm results than the therapies employing instrumentation-surgery, medications, or conditioning devices.
PubMedNocturnal enuresis: comparison of the effect of imipramine and dietary restriction on bladder capacity.
45 Citations1969M. Esperanca, J. W. Gerrard
It is concluded that the bladder in the average enuretic is functionally but not structurally small, and that when dietary manipulation helps, it does so by eliminating factors from the diet to which the bladder is sensitive.
Behavior TherapyThe generalization and maintenance of behavior change: Comments, considerations, and the “no-cure” criticism
41 Citations1989Philip C. Kendall
The Journal of UrologyOxybutynin Chloride (Ditropan) in Enuresis
39 Citations1977P.J. Buttarazzi
Of 39 entireties who were non-responsive to imipramine 31 achieved significant nocturnal control with oxybutynin chloride with the aim of determining whether or not this drug should be introduced into the treatment of insomnia.
Journal of Abnormal Child PsychologyChildhood nocturnal enuresis: The prediction of premature withdrawal from behavioral conditioning
38 Citations1988William G. Wagner, James T. Johnson
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.
American Journal of PsychiatryTHE INCIDENCE OF NOCTURNAL ENURESIS AFTER AGE FIVE
37 Citations1944Frederick C. Thorne
It is suggested that nocturnal enuresis may frequently be regarded as a developmental defect which disappears spontaneously when maturation within the central nervous system is completed.
Health PsychologyBehavioral interventions for childhood nocturnal enuresis: The differential effect of bladder capacity on treatment progress and outcome.
37 Citations1986Gary R. Geffken, Suzanne Bennett Johnson +1 more
For both wetting frequency and arising at night, there was a significant interaction between bladder capacity and treatment, and changes and postchanges in MFBC indicated that RCT did not lead to consistent increases in bladder capacity in the sample studies.
The Journal of PediatricsBehavioral and environmental characteristics of treated and untreated enuretic children and matched nonenuretic controls
35 Citations1981Stella M. Couchells, Suzanne Bennett Johnson +2 more
Investigation of possible behavioral, parental, and environmental differences in enuretic children who were either receiving or not receiving treatment for bed-wetting foundEnuretic youngsters displayed more conduct problems and immature behavior than their nonenuretic counterparts.
Developmental Medicine & Child NeurologyA Trial of Conditioning Therapy in Nocturnal Enuresis
34 Citations1964R.M. Forrester, Zena Stein +1 more
A controlled trial of conditioning by alarm and of amphetamine for the treatment of enuresis found that the results for the alarm were significantly better; this was more so among the 23 cases whose treatment was considered adequate.
Developmental Medicine & Child NeurologyPoisoning as a Complication of Enuresis
32 Citations1972J M Parkin, M. S. Frasert
It was found that while the greatest source of danger was drugs prescribed for psychiatric illness in a parent, 6 patients had been poisoned by drugs prescribed—either for the child himself or for a sibling—for enuresis.
Pediatric Clinics of North AmericaIncontinence and Enuresis
32 Citations1987Gordon A. MeLorie, Douglas A. Husmann
By using the criteria outlined in this article, one can manage selective urologic evaluation of the diurnally incontinent and enuretic child, saving most patients the cost and stress of more in-depth diagnostic evaluations.
JAMAMagical Thinking and Imipramine Poisoning in Two School-aged Children
30 Citations1979Victor Herson
Physicians might be able to prevent similar needless tragedies by warning both the child and the parents of the unusual lethality of imipramine and other dangerous prescription drugs.
JAMATreatment of Bedwetting
29 Citations1975Mark A. Stewart
The three methods of treatment for the rascal are reviewed in this communication: advice and encouragement, prescribing antidepressants, or conditioning with an alarm system, together with the evidence for their effectiveness.
Behaviour Research and TherapyAn analysis of the behaviour of day- and night-wetting children: Towards a model of micturition control
27 Citations1982Dorothy Fielding
A working model of daytime bladder control is described which draws attention to significant components which may be disturbed in abnormal bladder control and implies that treatment regimes should be based upon a behavioural analysis of the particular dysfunction shown by the enuretic child.
PEDIATRICSExcretory Urography for Evaluation of Enuresis
23 Citations1980Joanna J. Seibert, Alvin H. Felman +6 more
Acta Psychiatrica ScandinavicaPersonality traits in young adults with a history of conditioning‐treated childhood enuresis
19 Citations1990Annette S Strömgren, Per Hove Thomsen
It is concluded that conditioning therapy, which is usually successful in rapidly alleviating enuresis, can also be regarded as a safe treatment and does not seem to leave unwanted aftereffects that could be interpreted as expressions of persisting psychological conflicts.
BMJValue of Propantheline Bromide in Treatment of Enuresis
19 Citations1956Didier Leys
It is emphasized that a case of post-partum haemorrhage with a contracted uterus must be examined most carefully under general anaesthesia for high vaginal and cervical tears.
Psychological ReportsMethedrine as an Adjunct to Conditioning Treatment of Nocturnal Enuresis in Normal and Institutionalized Retarded Subjects
17 Citations1968Wallace A. Kennedy, E. Wayne Sloop
Treatment of Nocturnal Enuresis
17 Citations1993Stuart L. Kaplan, Joan Busner
Although functional enuresis is one of the more objectively measurable disorders clinicians treat, there is considerable disagreement about its definition.
Pediatric Clinics of North AmericaDaytime Wetting (Diurnal Enuresis)
13 Citations1982Barton D. Schmitt
Type of nonorganic daytime wetting and programs for their treatment are covered in detail and the habit of daytime frequency is reviewed.
MCN The American Journal of Maternal/Child NursingChildhood Nocturnal Ensuresis
5 Citations1981JUDITH A RUBLE
Archives of Disease in ChildhoodEstablishment of working definitions in nocturnal enuresis.
4 Citations1991Jonathan HC Evans
Canadian Psychiatric Association JournalThe Use of Imipramine in the Treatment of Enuresis a Review of the Literature
4 Citations1968Frank A. Dinello, Joyce Champelli
The conclusion is that imipramine has a varied but statistically significant anti-enuretic effect on children.