A pilot investigation of an iOS-based app for toilet training children with autism spectrum disorder.

We developed an iOS-based app with a transmitter/disposable sensor and corresponding manualized intervention for children with autism spectrum disorder. The app signaled the onset of urination, time-stamped accidents for analysis, reminded parents to reinforce intervals of continence, provided a visual outlet for parents to communicate reinforcement, and afforded opportunity for timely feedback from clinicians. We compared this intervention with an intervention that uses standard behavioral treatment in a pilot randomized controlled trial of 33 children with autism spectrum disorder aged 3-6 years with urinary incontinence. Parents in both groups received initial training and four booster consultations over 3 months. Results support the feasibility of parent-mediated toilet training studies (e.g., 84% retention rate, 92% fidelity of parent-implemented intervention). Parents used the app and related technology with few difficulties or malfunctions. There were no statistically significant group differences for rate of urine accidents, toilet usage, or satisfaction at close of intervention or 3-month follow-up; however, the alarm group trended toward greater rate of skill acquisition with significantly less day-to-day intervention. Further development of alarm and related technology and future comparative studies with a greater number of participants are warranted.

Use of urine alarms in toilet training children with intellectual and developmental disabilities: A review.

The purpose of this review is to describe and evaluate the existing research on the use of urine alarms in the daytime toilet training of children with intellectual and developmental disabilities (IDD). A systematic literature search yielded 12 studies, many of which were published over a decade ago. The findings suggest that interventions that incorporate the use of urine alarms are promising in the treatment of daytime enuresis for children with IDD; however, more carefully controlled research is needed to confirm these findings and elucidate the precise role urine alarms may play in toileting interventions. Methodological strengths and limitations of the body of research are discussed.

[REASONS AND CONSEQUENCES OF SOMATOFORM DISORDERS IN CHILDREN AND ADOLESCENTS].

The aim of our study was to find the reason of various forms of somatoform disorders (phobias, behavioral disorders, insomnia, tics, stuttering, enuresis, encopresis) in children and adolescents of various social status for diagnosis and treatment. We have examined 202 patients who referred to our clinic from 2012-2016. The age range was 2-18 years. After examination we have concluded the following recommendations: - to implement neuropsychological rehabilitation in order to stimulate mental development; - to work with speech therapist to improvement the speech; - to work individually with psychotherapist to improve the behavior; - to train the parent to manage the behavior at home; - to give the personal card containing information about exercises, games and puzzles to stimulate the development and in some cases to give individual educational program; - to give separate information to parents and in some cases to teachers of kindergartens and schools.

Toilet training in individuals with Angelman syndrome: a case series.

OBJECTIVE: To assess if adapted versions of the response restriction toilet training protocol, based on the behavioral phenotype of Angelman syndrome (AS), were successful in fostering urinary continence in seven individuals with AS. METHOD: Data were collected in AB-designs during baseline, training, generalization and follow-up. The response restriction protocol was adapted: individuals were trained in their natural environment, were prompted to void and along with improving continence, the interval between voids was prolonged and time-on-toilet decreased. RESULTS: During generalization five individuals had less than two accidents and one to six correct voids per day; during baseline more accidents and/or less correct voids occurred. In two participants correct voids increased, but several accidents still occurred. Three participants maintained positive results after 3-18 months. CONCLUSION: Despite their intellectual and behavioral challenges, urinary continence can be acquired in AS. Several indications of voiding dysfunctions were found; further research is indicated.

Assessment of toileting difficulties in adults with intellectual disabilities: an examination using the profile of toileting issues (POTI).

A lack of toileting skills is one of many impairments that individuals with intellectual and developmental disabilities experience. Unfortunately, little research has focused on problems in this area including assessment, function, and treatment. A newly developed checklist, the Profile of Toileting Issues (POTI), is being considered for use to screen for toileting issues in this population, and to identify potential functions to target in treatment. The purpose of the current study was to examine the reliability of the POTI. Internal consistency was sound (α = .83) and interrater reliability was significant. The implications of these findings are included.

Value of increase in bladder capacity in treatment of refractory monosymptomatic nocturnal enuresis in children.

OBJECTIVES: To evaluate children with refractory monosymptomatic nocturnal enuresis to determine whether detrusor overactivity (DOA) plays a role in 4 weeks of unsuccessful treatment with retention control training (RCT); whether an increase in bladder capacity can eventually be obtained by RCT plus oxybutynin; and whether the increase in capacity is the primary key to success. METHODS: Sixty-eight children with refractory monosymptomatic nocturnal enuresis were included. They all had a maximal cystometric capacity less than the age-expected value. RCT was done by water loading and retention to the point of urgency once daily. During training, changes in bladder capacity were evaluated by voiding charts. If after 4 weeks of RCT, less than a 10% increase in bladder capacity was noted, oral oxybutynin was added. RESULTS: The incidence of DOA was 66%. After 4 weeks of RCT, the bladder capacity increased in 20.6%. Combining RCT with oxybutynin led in the end to normalization of the bladder capacity in 79.4%. Older age and high-pressure DOA negatively influenced the ability to increase the bladder capacity. Fifteen children became completely dry, mainly by converting enuresis to nocturia. CONCLUSIONS: Unsuccessful RCT is often caused by DOA, especially if a bladder capacity rise of at least 10% cannot be achieved within 4 weeks. If oxybutynin is added to the treatment, normalization of bladder capacity can be obtained in most. This increased bladder capacity cures enuresis only in a minority by sharpening their arousal and provoking nocturia.

Urine alarms and prompts for fostering daytime urinary continence in a student with multiple disabilities: a replication study.

The study evaluated a treatment approach based on urine-alarm signals and staff prompts to foster daytime urinary continence of a student with multiple disabilities. Reinforcement was used for urination in the toilet. The study alternated two baseline with two treatment phases. A 3-mo. follow-up also occurred. The student became almost totally free from large urinary accidents, replacing them with self-initiated toileting and small accidents (wetting only a disposable tissue), and retained his improvement over time. Implications of the findings were discussed.

[Contact with dolphins as a method of rehabilitation of children with enuresis at health resorts]. / Obshchenie s del'finami kak metod reabilitatsii detei s sindromom énureza na kurorte.

The system of non-drug correction of the functional status of children with enuresis was studied by using specially trained dolphins. Guidelines and the functional units of a health-promoting complex were elaborated. The use of dolphin therapy caused a positive clinical effect in the examinees, particularly in preschool children, the efficiency of whose rehabilitation was twice higher than that in children from other age groups. The findings strongly favour the specific nature of conditioning procedures involving dolphins.

Bedwetting, behaviour and self-esteem: a review of the literature.

AIM: The aim of this review was to examine the empirical evidence on the impact of bedwetting and its treatment on a child's self-esteem and behaviour. INCLUSION CRITERIA: The inclusion criteria for this review were empirical studies conducted on children, aged 5-16 years old, with primary nocturnal enuresis using measures of self-esteem or behaviour. Studies utilizing psychological measurement scales completed by children were the main focus although those that used scales completed by parents were also included. SEARCH STRATEGIES: The electronic databases from 1981 to 1999 were searched, and hand searching of the literature dating back to 1973 was conducted using the reference lists of key papers. RESEARCH FINDINGS: Fifteen empirical studies matched the inclusion criteria. There was only one randomised-controlled trial and the rest of the studies were cohort, case-control or cross-sectional design. Evidence of sample bias predominantly due to the use hospital-based and/or 'volunteer' subjects was found in five studies. A further five studies used birth cohort data, which excludes important variables such as the impact of treatment. Four studies used single parent-reported measures, which may under or over-estimate the problem. No large cohort studies were available which compare the self-esteem of bedwetting children with matched controls. The most interesting line of enquiry is pursued by studies looking at whether self-esteem improves with successful treatment. However, the use of self-selected subject groups does not make the current evidence convincing and more work is required to determine outcomes for all children. There is empirical evidence for increased behavioural problems in bedwetting children. Studies conducted on younger children report less behavioural problems with more reported in studies conducted on older children with complex wetting disorders. This may point towards wetting being the primary problem, but more work is needed, as causation in any direction is difficult to ascertain from the literature.

What becomes of children hospitalized for enuresis? Results of a catch-up study.

BACKGROUND: . The purpose of this study was to reassess former child and adolescent psychiatric patients with nocturnal enuresis as young adults and to compare them with former patients without enuretic symptoms and with a comparison group from the general population. METHOD: We used a 'catch-up' design. From a former child and adolescent psychiatric patient cohort we identified all subjects with documented enuretic symptoms in childhood and compared them with two groups matched for gender and age - non-enuretic patients and a comparison group from the general population. Subjects were assessed as adults with standardized instruments according to the criteria of ICD-10 (SCAN, IPDE) and dimensional values for depression, satisfaction with life, global functioning and personality (NEO-FFI). RESULTS: We assessed 55 former patients with nocturnal enuresis (recruitment rate 68%) after a mean interval of 13.1 years. At catch-up the former enuretic patients had a lower frequency of personality disorders (ICD-10), lower mean depression values, higher global functioning and a lower rate of psychiatric treatment after the age of 18 years than did former non-enuretic patients. Former enuretic patients did not differ significantly from the comparison group from the general population concerning any of the outcome variables, although there was a non-significant trend for former enuretic patients to more often fulfill criteria for a psychiatric ICD-10 diagnosis at catch-up. There were no differences concerning personality among the three groups at catch-up. CONCLUSION: Although it may constitute a mild vulnerability factor for further development, nocturnal enuresis had a good long-term outcome in a cohort of treated subjects.

'You feel helpless, that's exactly it': parents' and young people's control beliefs about bed-wetting and the implications for practice.

'You feel helpless, that's exactly it': parents' and young people's control beliefs about bed-wetting and the implications for practice Young people wet the bed when they fail to wake up to a full bladder. The causes of bed-wetting are far from certain and this uncertainty is reflected in the diversity of treatments on offer and the lack of any guarantee that treatment will work in a particular case. Most young people are sad and ashamed about the bed-wetting and want it to stop, but they vary widely in their belief in their own capacity to influence the situation, and in their optimism about what the future holds. The problem can persist into adolescence or even adulthood, with far reaching social and emotional consequences, both for the young people and their families. In an ethnographic study involving 19 families 'perceived helplessness' emerged as a key issue permeating the whole system and often activating a downward spiral, leading to abdication of effort and responsibility by the young people themselves, by their parents and sometimes by health care professionals. Informed by the insights gained from this study and an extensive review of the literature on perceived control the Family Perspectives on Bed Wetting Questionnaire has been developed to explore family members' feelings, degree of concern and dimensions of perceived control relating to: effort, ability, luck, important others and the unknown. This questionnaire was used as a basis for structured interviews with family members in a longitudinal survey, involving 40 families attending one of nine community-based, nurse-led enuresis clinics in Greater Glasgow. It was found that only 38% of the young people were entering into treatment with the belief that they had the ability to be dry at night. This became self-fulfilling, with only 33% achieving initial success of 14 consecutive dry nights in a 16-week period (chi-squared test, P=0.029). Seventy per cent of young people felt that luck was important, while most parents felt that luck had little part to play. Implications for practice include the need to assess the families' readiness to engage in treatment, to create opportunities for effective control and to encourage realistic expectations.

Nighttime urinary incontinence and sleep disruption among nursing home residents.

OBJECTIVE: To examine the relationship of urinary incontinence episodes to sleep disruption in a sample of nursing home residents. DESIGN: Descriptive, case series. SETTING: Three community nursing homes. PARTICIPANTS: Seventy-three incontinent residents of three nursing homes participating in a trial of a behavioral intervention for nighttime urinary incontinence. MEASUREMENTS: Data were collected during a baseline and repeat baseline period about 2 months later in nursing homes serving as controls for the intervention homes. Incontinence episodes were identified by incontinence pads, which were wired to detect wetness of 10 mL or more. Sleep was monitored by wireless wrist actigraphs. Noise and light changes were monitored by bedside recording devices. MAIN RESULTS: Recordings covered 403 nights, during which 1715 awakenings from 10 consecutive minutes of sleep were detected as were 1168 incontinent episodes. Only 4% of the awakenings were associated with an incontinence episode, and only 23% of the incontinence episodes occurred during periods of at least 10 consecutive minutes of sleep. Of the latter episodes, only 12% appeared to awaken the resident. CONCLUSIONS: Our data raise questions about the relevance of incontinence episodes to sleep disruption among chronically incontinent nursing home residents. Our findings must be interpreted cautiously because of limitations in the technologies and definitions we used to identify sleep, awakenings, and incontinence episodes. Although logistically and technically difficult to perform, studies using polysomnographic recordings of sleep are needed to examine further these important associations.

Cognitive bladder training in the community.

Following a study trip sponsored through a Cow & Gate scholarship award, the author of this article introduced a cognitive bladder training programme for children with daytime wetting problems. This article looks at how the programme was introduced and describes the components of the programme including educational tools, motivation and bio-feedback. As a result of the programme district-wide, multidisciplinary management guidelines have been introduced.