Nocturnal enuresis is one of the most common and pervasive childhood problems. Without effective intervention, the child's nocturnal enuresis may persist. This may result in possible distress and even psychological problems in the child. The current study had two aims. The first aim was to examine the effectiveness of retention control training, and the urine alarm if necessary, as an intervention for primary nocturnal enuresis. The second aim was to explore children's attributions for the therapeutic outcome of the intervention method regarding their nocturnal enuresis. The first aim was important, as previous research has revealed contradictory findings. The second aim was also important, as to date, research has neglected to explore this topic. Six children aged 8 to 12 years and their primary caregivers participated in the current study. Attribution data was obtained at three intervals through one-on-one semi-structured interviews between the researcher and child. Results found that with retention control training: one child achieved nocturnal urinary continence, three children decreased the number of their wet nights, and two children failed to respond. The addition of the urine alarm enabled three more children to achieve nocturnal urinary continence. In terms of attributions, results found that brief psycho-education appeared to have influenced these children‟s attributions. However, overall attribution findings suggested that children perceived researcher assistance, unknown factors, and the techniques used in retention control training to have influenced their success in the achievement of nocturnal urinary continence. These results would help to inform general practitioners and psychologists in terms of intervention recommendations for evidence-based practice, and future research.

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Thesis (M. Sc.)--Carleton University, 1985. / Also available in electronic format on the Internet.

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The first part of this thesis examines the psychosocial characteristics of a cohort oj 270 bedwetting children attending a community enuresis service for treatment These children were recruited to a stratified cluster randomised controlled trial which forms the second part of this thesis in which additional information wa~ provided via a multimedia computer program and written leaflets. The mail clinical outcome measures were becoming dry and remaining dry six months pos discharge, time to dry, non-attendance and dropout rates. The main psycho socia measures were maternal tolerance, the impact of bedwetting and self-esteem. Th theoretical basis for the intervention(s) was the 'incomplete learning' model c bedwetting.' It was hypothesised that the intervention (s) would improve the sell efficacy of children through the mediation of cognitive, motivational, affectiv and self-selection changes (Bandura 1977). The randomisation procedure was slightly biased with children in the comput( group being sampled from a more affluent population and those in tl control/leaflets group from a more deprived population. There were also few, children from minority ethnic groups in the computer group. Significa differences were found between the ethnic groups in response to the impact bedwetting and maternal tolerance scales, together with parents' reports of th{ child's distress and parental worry. Therefore analysis was conducted on a samI matched by Jarman scores which excluded the children from affluent areas in t computer group and children from deprived areas in the control and leaflets grm Analysis was also conducted on the entire cohort. Bedwetting children had a lower self-esteem than school children. However, selfesteem improved with treatment with the greatest changes occurring for those who became dry. Low self-esteem was significantly related to a high impact of bedwetting. The presence of housing difficulties produced the least positive response on the psychosocial measurement scales. Low parent reported child distress and less severe wetting at initial assessment predicted a successfu: outcome. Although self-esteem was significantly lower for bedwetting children compared t( the school children the mean difference of less than one item suggests this result i not clinically meaningful. Nevertheless there are clearly some bedwettinJ children with less positive psychosocial and clinical situations. Bedwetting seem to be worse psychosocially for children from less affluent backgrounds, measure by the presence of housing difficulties, and those who are most distressed by it ne only have a lower self-esteem, but they are less likely to get dry. Howeve children's self-esteem does improve with treatment. The intervention( s) made no significant difference to any of the clinical outcorr measures or any of the psychosocial measures recorded during and post-treatmel for either the matched sample or the entire cohort. The absence of an intervention effect is disappointing and suggests that it is n sufficient merely to provide novel additional information to bedwetting childre Two main problems with the study design were identified. The large variation bedwetting children's time to dry suggests the outcome measures used may not sufficiently precise to detect a difference if one was present. The computer and the leaflets may have had insufficient power to produce changes in children at the level measured. Future research might wish to use a more intensive program where the computer intervention is combined with the leaflets. Nevertheles~ whilst this intensive training input and measurement is likely to motivate somt children this will not be the case for all.

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