Enuresis
What It Is
Enuresis is the voluntary or involuntary repeated release of urine into clothing or bed at a developmental stage where sphincter control (the muscles that allow retention of urine and feces) should be acquired.
Since most children achieve sphincter control during the day and night by around age 5, involuntary urine loss is normal in young children who have not yet learned to control them. We can speak of “enuresis” only if the disorder persists after ages 7-8, distinguishing between nocturnal and diurnal enuresis depending on whether it is limited to nighttime or continues during the day.
Another distinction is between primary enuresis, where sphincter control has never been acquired, and secondary enuresis, where a child who had already learned to hold urine starts wetting again (this second occurrence is often linked to emotional stress or illness).
Enuresis is diagnosed when there is urine release twice a week for a period of at least three months, and this behavior is not due to the physiological effect of a substance or general medical conditions.
Who suffers from it
Enuresis is a common problem, affecting about 7% of 8-year-olds, 3% of 12-year-olds, and 1-2% of 15-year-olds. It often has familial roots and creates increasing discomfort in the family and the child, who may develop feelings of guilt or inferiority. Changes such as the birth of a sibling, starting school life, conflicts in the parental couple, or lack of or delayed education in sphincter control can be causes of enuresis.
The symptoms of adolescent enuresis are more intrusive than those in childhood, and from a psychological perspective, it can be seen as regression and/or linked to a very controlling attitude during the day, only to lose total control of physiological functions at night.
From a psychological perspective, the disorder involves a significant limitation of social moments for both the child and adolescent, sometimes leading to the minor’s isolation and refusal of social activities, particularly those involving going out and staying overnight outside the home environment. Psychological suffering may be linked to the sense of shame experienced due to the mocking behavior of peers and, sometimes, even the attitude of caregivers.
How intervention is possible
It is necessary to evaluate and exclude medical causes related to general medical conditions or genetic predisposition, antidiuretic hormone deficiency, persistent bladder control immaturity, or arousal disorders. Enuresis may be associated with Encopresis (repeated evacuation of feces in inappropriate places), sleep disorders, and urinary tract infections (caused by hygiene conditions due to the disorder).
Although enuresis spontaneously disappears in some individuals, there is a general consensus that it should be treated in any case, given the psychological and social consequences it causes.
Before starting treatment, it is essential to assess the motivation of the child and their family, what this disorder implies psychologically, familiarly, socially, and how it has been addressed so far. About 20-30% of parents, for example, tend to punish the enuretic child, a behavior that is useless and even counterproductive.
In cases where bladder immaturity is associated with constipation, both problems should be addressed simultaneously.
It is necessary to intervene with an appropriate therapeutic path to avoid negative repercussions on self-esteem and prevent reactive emotional disorders that could seriously undermine personal development and social life.
The most suitable approaches for treating enuresis are:
- Cognitive-behavioral psychotherapy that includes psychoeducational interventions with parents, aimed at identifying effective behavioral and communication strategies with the child, avoiding, for example, blame and ridicule. Additionally, behavioral techniques such as bladder-sphincter reeducation can be used.
- Medical – pharmacological intervention, mostly based on the administration of the antidiuretic hormone, whose production is assumed to be deficient.
Bibliographic sources used
- Bagdadi, Masal Pas. Parents are not born but become. How to deal with tantrums, obsessions, nocturnal enuresis, pedophilia, separation, adolescent sexuality. Vol. 117. FrancoAngeli, 2002.
- D’Alessio Antonio and Rita Caruso. “Enuresis: an underestimated problem.”
- Mencoboni, Maria Cristina. “Nocturnal enuresis.” Medico e Bambino 19.9 (2000): 565.
Tic disorder in children
What It Is
Tics are rapid involuntary movements, classified as simple if consisting of brief and stereotyped movements of the face, shoulders, and limbs, and complex if consisting of sequences of sudden and purposeless movements that tend to repeat with an irregular rhythm.
Simple motor tics include, for example: blinking, neck twisting, shoulder shrugging, facial grimaces, coughing; simple vocal tics include: throat clearing, grunting, sniffing, puffing.
Complex motor tics involve: mimic movements, jumping, touching, stomping, smelling an object. Complex vocal tics include the repetition of words or phrases out of context; in more severe cases, we speak of “coprolalia” (use of obscene words) and “echolalia” (repetition of sounds, words, or phrases heard last).
Who suffers from it
Tic Disorders are divided into two main types:
- Transient tics: occur in various children with a peak age between 5 and 9 years; in order of frequency, the most affected body parts are the eyes, face, neck, shoulders, and arms.
- Chronic tics: last more than a year and may be accompanied by new tics. The age of onset is between 5 and 9 years, with a peak incidence around age 7; males are affected three times more frequently than females.
Children with chronic tics may present stuttering, attention deficit, learning disorders, concentration difficulties. Those affected by this disorder may have problems in the school environment and may report difficulties in performance and achievement. Especially during adolescence, when meeting and confronting peers is crucial for defining one’s identity and personality, difficulties in socialization, social withdrawal, and depressed mood may emerge. Tics are often accompanied by shame, frustration following rejection by others or anxiety for fear that the manifestation will occur in public.
Like all rituals, tics can appear and disappear in different situations and automatically and involuntarily.
How intervention is possible
Although in most cases the resolution of the disorder is spontaneous, specific psychological intervention is recommended if the child’s development is threatened in any of its areas or when their serenity is seriously compromised. In these cases, it is important that parents consult a psychologist, as some evaluation interviews (psychological evaluation) and information, combined with a psychoeducational intervention (psychoeducation), can promote the recognition and understanding of the disorder and the discomfort experienced by their child.
Parents should be advised not to scold the child for their tics, asking them to suppress them, nor to overestimate the disorder: reprimands and prohibitions only increase the child’s anxiety and anguish for something they are not responsible for.
The most recommended interventions are of em>cognitive-behavioral matrix, accompanied by psycho-educational and support interventions for the child and their family, especially where the disorder is perceived by the environment as voluntary and even provocative. In some cases, these interventions may be accompanied by pharmacological therapy.
Finally, a meeting with the child’s teachers is useful, aimed at explaining the disorder they suffer from and providing guidance on how to best manage it with peers within the class.
