Academic journal article Journal of Cognitive Psychotherapy

Self-Control and Enuresis

Academic journal article Journal of Cognitive Psychotherapy

Self-Control and Enuresis

Article excerpt

This paper presents the link between self-control and childhood enuresis, assuming that enuresis is maintained by deficiencies in self-control skills, whether caused by physiological, behavioral, or cognitive components. Acquisition of self-control skills is proposed as helping in eliminating enuresis. Seventy-seven enuretic children (aged 7 to 14) were randomly assigned to three treatment modes (bell and pad, token economy, and cognitive therapy) and to one control group. The self-control skills of children and their parents and the frequency of enuresis were measured before and after treatment. Results showed a negative correlation between self-control and enuresis on the one hand and between the acquisition of self-control skills and recovery from enuresis on the other hand. The results also highlighted the need for a follow-up period to determine the different longer-term effects of treatments.

There are two main approaches to the concept of self-control among children. One relates to the child's personality and suggests that children be classified into "undercontrolled" (i.e., hyperactive, impulsive, aggressive) versus "overcontrolled" (i.e., anxious, depressive, avoidant) categorizations (Achenbach, 1985; Mash & Terdal, 1988). Self-control is therein perceived as the outcome of the child's behavior, suggesting that adults can evaluate children's selfcontrol ability through observation.

The second approach (which is purported by the present paper) does not seek out links between self-control and personality outcomes, but rather examines specific abilities and skills that may characterize children with different personality classifications. Self-control is herein defined as the process occurring when, in the relative absence of immediate external constraints, a person engages in a behavior that had previously been less probable than had alternative available behaviors (Thoresen & Mahoney, 1974). According to this perspective, the only way to know whether a child can control himself or herself is to evaluate his or her intentions, means, and skills, rather than to observe outcomes. This approach to self-control focuses on the acquisition of skills such as learned resourcefulness (Rosenbaum, 1993), pinpointing the child's ability to overcome pain, pressure, and disturbing feelings by acquiring skills such as self-talk, thought modification, imagination, self-reinforcement, and self-evaluation (Ronen, 1993b, 1994, 1995; Ronen & Wozner, 1995). The present paper deals with self-control in relation to the problem of enuresis.

Enuretic children constitute an heterogeneous group, differing in many of the relevant variables: the frequency of enuresis (between once a month to several times every night); the nature of the phenomenon (primary versus secondary); the relation between children's enuresis and that of their parents; and the relation of enuresis to other organic or physiological problems. Several characteristics of enuresis suggest its link with a deficiency in self-control skills. First, enuresis is considered to be one of the most frequent behavior problems among children (Rutter, Yule, & Graham, 1973). The frequency of enuretic children in the population and the drop in prevalence with increased age (Doleys, 1977) imply a problem of gaps between chronological, cognitive, and emotional maturation levels (Ronen, 1993a). These gaps, typically characterizing children, may lie at the root of enuresis. It is possible that as the child acquires the cognitive and emotional maturation that is manifested as the acquisition of self-control, he or she becomes able to stop bed-wetting with or without intervention, accounting for the cases of spontaneous recovery. In addition, approximately twice as many boys as girls wet their beds (De Jong, 1973; Doleys, 1977). The higher frequency of enuresis among boys than among girls may also be related to self-control. Girls mature earlier than boys, and research has also shown a higher self-control level among girls than among boys (Kendall &Braswell, 1985; Kendall & Wilcox, 1979; Rosenbaum, 1980). …

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