E-Book, Englisch, 96 Seiten
Christophersen / Friman Elimination Disorders in Children and Adolescents
1. Auflage 2010
ISBN: 978-1-61676-334-3
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark
E-Book, Englisch, 96 Seiten
Reihe: Advances in Psychotherapy - Evidence-Based Practice
ISBN: 978-1-61676-334-3
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark
A compact, “how-to” manual on effective, evidence-based treatments for enuresis and encopresis.
The aim of this book is to provide readers with a practical overview of the definitions, characteristics, theories and models, diagnostic and treatment recommendations, and relevant aspects and methods of evidence-based psychosocial treatments for encopresis and enuresis, primarily in children. Although treatments and research for elimination disorders are reviewed in general, particular attention is directed at constipation and encopresis, toileting refusal, and diurnal and nocturnal enuresis due to the high incidence of these conditions in children. Case vignettes, websites, and suggestions for further reading are provided for the interested reader.
Autoren/Hrsg.
Fachgebiete
Weitere Infos & Material
1;Table of Contents;6
2;1 General Introduction;8
3;2 Constipation and Encopresis;10
3.1;2.1 Description;10
3.1.1;2.1.1 Terminology and Definition;10
3.1.2;2.1.2 Epidemiology;11
3.1.3;2.1.3 Etiology;12
3.1.4;2.1.4 Course and Prognosis;13
3.1.5;2.1.5 Differential Diagnosis;14
3.1.6;2.1.6 Comorbidities;15
3.1.7;2.1.7 Diagnostic Procedures and Documentation;16
3.2;2.2 Theories and Models of Constipation andEncopresis;19
3.2.1;2.2.1 Physiological Factors;19
3.2.2;2.2.2 Psychiatric Factors;20
3.3;2.3 Treatment for Constipation and Encopresis;21
3.3.1;2.3.1 Providing Education;21
3.3.2;2.3.2 Methods of Treatment;25
3.3.3;2.3.3 Problems Carrying Out the Treatments;29
3.3.4;2.3.4 Variations of Methods and other Stategies;30
3.4;2.4 Case Vignette: Encopresis;32
3.5;2.5 Encopresis Without Constipation;34
3.6;2.6 Toileting Refusal;35
3.6.1;2.6.1 Description;35
3.6.2;2.6.2 Diagnostic Procedures and Documentation;36
3.6.3;2.6.3 Treatment for Toileting Refusal;36
3.6.4;2.6.4 Case Vignette: Toileting Refusal;38
3.7;2.7 Adherence and Follow-Up;40
3.7.1;2.7.1 Strategies for Maximizing Treatment Adherence;40
3.7.2;2.7.2 Follow-up;41
3.8;2.8 Summary and Conclusions;42
4;3 Nocturnal Enuresis;44
4.1;3.1 Description;44
4.1.1;3.1.1 Terminology and Definition;44
4.1.2;3.1.2 Epidemiology;45
4.1.3;3.1.3 Course and Prognosis;45
4.1.4;3.1.4 Differential Diagnosis;46
4.1.5;3.1.5 Comorbidities;46
4.1.6;3.1.6 Diagnostic Procedures and Documentation;47
4.2;3.2 Theories and Models of Enuresis;49
4.2.1;3.2.1 Historical;49
4.2.2;3.2.2 Psychopathological;50
4.2.3;3.2.3 Biobehavioral;50
4.3;3.3 Treatment for Enuresis;54
4.3.1;3.3.1 Methods of Treatment;54
4.3.2;3.3.2 Mechanisms of Action;57
4.3.3;3.3.3 Efficacy;58
4.3.4;3.3.5 Empirically Supported Components of Conventional Programs;59
4.3.5;3.3.6 Additional Components with Less Empirical Support;62
4.3.6;3.3.7 Medication;63
4.3.7;3.3.8 Problems in Carrying Out the Treatments;64
4.4;3.4 Case Vignette: Nocturnal Enuresis;65
5;4 Diurnal Enuresis;68
5.1;4.1 Description;68
5.1.1;4.1.1 Terminology and Definition;68
5.1.2;4.1.2 Epidemiology;68
5.1.3;4.1.3 Course and Prognosis;69
5.1.4;4.1.4 Differential Diagnosis;69
5.1.5;4.1.5 Comorbidities;71
5.1.6;4.1.6 Diagnostic Procedures and Documentation;72
5.2;4.2 Theories and Models of Diurnal Enuresis;73
5.3;4.3 Treatment for Diurnal Enuresis;73
5.3.1;4.3.1 Methods of Treatment, Mechanisms of Action, and Efficacy;73
5.3.2;4.3.3 Problems in Carrying Out the Treatments;78
5.4;4.4 Case Vignette: Diurnal Enuresis;78
5.5;4.5 Summary and Conclusions;80
6;5 General Conclusion;82
7;6 Further Reading;83
8;7 References;84
9;8 Appendices: Tools and Resources;92
9.1;Appendix 1: Dietary Fiber Content of Foods;93
9.2;Appendix 2: Bowel Symptom Rating Sheet;94
9.3;Appendix 3: Representative Child and Parent Handout for Alarm Treatment;95
9.4;Appendix 4: Websites;96
In addition to suffering from constipation, children with encopresis may have a diminished sensation in their rectum are thus less likely to perceive the “call to stool” needed for appropriate elimination (Christophersen & Mortweet, 2001). For example, Meunier, Mollard, and Marechal (1976) used anal manometry to determine the rectum sensitivity of children with and without normal bowel histories. They established a laboratory procedure in which a small tube was inserted into the patient’s rectum. One or more portions of the tube could then be inflated until the patients subjectively reported feeling as though they were about to have a bowel movement. The amount of pressure necessary to create that feeling was duly noted. This procedure allowed the researchers to simulate the increased pressure in the rectum that an individual normally feels prior to having a bowel movement. In the Meunier et al. study, most of the children with normal bowel histories required only a small amount of pressure in the rectum, whereas most of the children with encopresis required 2–4 times as much pressure before they felt the “call to stool.” The data presented here lend support to the comment often heard from children with encopresis that they “couldn’t feel the bowel movement coming.”
Further support for the role of biological factors in encopresis was provided by Ingebo and Heyman (1988), who conducted a study to determine whether children with encopresis retained more stool in their rectum than did children without encopresis. They conducted a clinical trial using an oral solution, GoLytely (polyethylene-glycol-electrolyte), with 24 children, ages 9 months to 17 years, with severe constipation (Christophersen & Mortweet, 2001). Approximately 50% of the children were being treated for encopresis, while the other half were being prepared for colonoscopy. The children with encopresis required almost 3 times as much medication, administered over 3 times as long a period of time, in order to clean out the colon. These results support the notion that children with encopresis retain more stool and require more medication over a longer period of time than do children not presenting with encopresis. The author reported no clinically important changes in the laboratory values measured before and after the intestinal cleanout in either group of children, suggesting that the use of enemas to “clean out” the colon is not detrimental to children.
2.2.2 Psychiatric Factors
For many years, encopresis was viewed as a psychiatric disorder or symptom of emotional disturbance. A number of studies specifically examined the notion that children with encopresis have emotional or behavioral problems.
The use of child-behavior rating scales, such as the Achenbach Child Behavior Checklist (Achenbach, 1991), revealed no systematic differences between children with encopresis and normal children of the same age and gender (Christophersen & Mortweet, 2001). Rating scales also showed that children with encopresis tend to be more well adjusted than same-age, same-sex samples of children with “behavior problems” (Gabel et al., 1986; LoeningBaucke et al., 1987). Friman et al. (1988) reported that children referred for management of encopresis did not differ significantly from the standardization sample for the Eyberg Child Behavior Inventory (Robinson, Eyberg, & Ross, 1980). Further, both the children with encopresis and the standardization sample differed significantly from children who were referred for diagnosis and management of behavior problems.
Loening-Baucke et al. (1987) examined the social competence and behavioral profiles of 38 children with encopresis, with a specific interest in children resistant to treatment. They concluded that the persistence of encopresis at 6-month and 12-month follow-ups after the initiation of treatment was not related to social competence or to behavior scores. Given the existence of research that clearly demonstrates the presence of significant physical findings and the absence of research demonstrating consistent behavior problems in the vast majority of children diagnosed and treated for encopresis, we propose that encopresis can and should be treated primarily as a dysfunction of the bowel.
Schonwald, Sherritt, Stadtler, and Bridgemohan (2004) compared 46 children referred for difficult toilet training with 62 comparison children, using three measures of temperament. They reported that difficult toilet training is associated with difficult temperament and constipation. They reported no differences in parenting styles. Interestingly, they noted that 55% of the children in the comparison group had histories of constipation compared to 78% of the children referred for difficult toilet training, leading the authors to conclude that constipation is very common in this age group. Their results were based on a “toileting history questionnaire” that is currently not in the public domain and thus not available for inspection. If this study were replicated, temperament could be added to the list of factors that contribute to difficult toilet training.
2.3 Treatment for Constipation and Encopresis
After an initial assessment to ascertain the extent to which a child with encopresis also presents with behavioral or emotional problems, most authors seem to agree that the first step in treating encopresis is to ensure that parents understand that, in all likelihood, their child is not soiling on purpose, and that the child may not have control over his or her soiling.
2.3.1 Providing Education
Ever since Levine introduced the educational procedure he referred to as “demystification” into the literature in 1982, we have been using this procedure with the vast majority of new referrals of children with encopresis (Levine, 1982). Levine reported that parents often benefited from viewing a simple diagram explaining how abnormal bowel function, in the form of encopresis, can lead to the child’s colon being stretched such that they have diminished sensation when they need to have a bowel movement. He made the point that it was important that both parents and child be told that the child was not to blame for his or her abnormal bowel functioning, and that effective treatment methods are available (Christophersen & Mortweet, 2001).
Figure 1 is the diagram used by Levine (1982) to help parents understand that their child’s bowel “problem” is not intentional soiling. Clinicians can use this diagram to explain to both the child and the parents what factors are present in encopresis, including “the muscles that are thin, weak, and stretched” (i.e., the majority of children with encopresis have a larger diameter rectum than children without encopresis) as well as “warning nerves that don’t work” (i.e., children with encopresis often report – correctly – that they cannot feel the “call to stool”).
2.3.1.1 Relieving Constipation
After explaining the mechanics of encopresis to the child and parents, the clinician can then introduce the steps for successful treatment. The first step is to reduce or eliminate the large amounts of stool that many of these children have retained in their colon, often referred to as “cleaning out the colon” (Christophersen & Mortweet, 2001). Families can be told that, in order to help the muscles “heal,” one must first make sure that the intestine or colon is completely empty.
