Empirically supported treatments in pediatric psychology: Nocturnal enuresis

Abstract

Objective: To review the medical and psychological literature concerning enuresis treatments in light of the Chambless criteria for empirically supported treatment. Method: A systematic search of the medical and psychological literature was performed using Medline and Psychlit. Results: Several review studies and numerous well-controlled experiments have clearly documented the importance of the basic urine alarm alone as a necessary component in the treatment of enuresis or combined with the 'Dry-Bed Training' intervention, establishing them as 'effective treatments.' Other multicomponent behavioral interventions that also include the urine alarm such as 'Full Spectrum Home Training' have further improved the outcome for bed-wetters, but are classified as 'probably efficacious' at this time because independent researchers have not replicated them. Less rigorously examined approaches that focus on improving compliance with treatment or include a 'cognitive' focus (i.e., hypnosis) warrant further study. Conclusions: We recommend a 'biobehavioral' perspective in the assessment and treatment of bed-wetting and suggest that combining the urine alarm with desmopressin offers the most promise and could well push the already high success rates of conditioning approaches closer to 100%. Much important work is yet to be completed that elucidates the mechanism of action for the success of the urine alarm and in educating society about its effectiveness so that its availability is improved.