Success and failure in the conditioning treatment of childhood enuresis.

Problems occurring in the treatment of childhood enuresis were investigated at a behaviourally oriented special investigation clinic in north London. Four major problems were identified; non-attendance for the commencement of treatment, the termination of treatment through patient withdrawal, slow response to treatment and relapse. A wide range of patient, background and treatment variables were investigated, and measures of relevant patient and parental expectancies and attitudes (including child concern and parental intolerance) were developed. Non-attenders were found to be characterized by low proportion of referrals from general practitioners, a high proportion of referrals from health visitors and a longer period spent on the waiting list for treatment. A 9.7 per cent waiting list remission rate is reported, and non-attenders were found to be less severely enuretic than attenders following the waiting period. A termination rate of 31.6 per cent of patients entering treatment is reported. Terminators were found to have progressed poorly in treatment, termination being associated with poor cooperation and appointment failure. A positive family history of enuresis, a low child prognostic expectancy and high maternal intolerance of the enuretic child were associated with termination. Termination occurred most slowly in four-child families, and the first ten appointments were identified as a "failure zone". Failure to awake to an auditory enuresis alarm stimulus was associated with both termination and slow therapeutic response. Slow response was also associated with maternal anxiety and a history of familial disruption. The patients' CMAS and JEPI scores were not found to be associated with therapeutic response. None of 38 patient, background and treatment variables were found to be associated with relapse, although older children tended to relapse more rapidly. The procedure of overlearning by increased fluid intake in conjunction with an enuresis alarm was evaluated, and was found to be strongly associated with a lower relapse rate