Enuresis & Encopresis
Elimination Disorders
Daytime or nighttime wetting (diurnal or nocturnal enuresis) occurs in approximately 5-10% of school age children, and by definition, is not considered a “disorder” until the child is at least five years old. Further, a number of studies have found that as many as 4% of adolescents wet the bed. Nighttime wetting, which is more common after age 6, occurs twice as often in boys than in girls while girls appear to outnumber boys in the frequency of daytime wetting.
There are a number of possible reasons why a child might wet. Daytime wetting, in particular, may be associated with bladder or urinary tract infections and should be checked out medically before parents consider psychological or behavioral treatment. Wetting might also be caused by a small bladder, weak muscle control, anxiety, or simply forgetting to use the bathroom in time. The most common causes of nighttime wetness are a bladder that is too small to make it through the night, and/or a very deep sleep pattern that keeps the child from waking up and using the bathroom in time. In absence of medical factors, wetting may also be caused by anxiety or depression.
Soiling (encopresis) occurs in 2-8% of children and is most often associated with constipation. Ongoing constipation can stretch the rectum, which in turn dulls the nerve endings in the rectum. Without adequate sensitivity, these nerve endings do not send the child the signal that it is time to go to the bathroom. As a result, the child doesn’t feel the pressure to use the restroom, and often ends up soiling him or herself.
Not all soiling accidents are related to constipation. A child may be so busy playing that he either holds it until the urgency to go passes or doesn’t realize that he has to go until it’s too late. Shy or cautious children may be reluctant to use a strange toilet and may try to hold it until the urgency passes. Regularly holding bowel movements, however, will also lead to constipation and further problems with soiling.
Problems with wetting and soiling can also cause anxiety, low-self esteem, and shame in children. Often children cover their confusion and embarrassment by either developing a flippant or uncaring attitude about the elimination problem (including denying that it is really problem at all) or by hiding dirty or wet underwear.
The treatment of these disorders depends in large part on what leads to the problem. A full medical evaluation is recommended as a first step in order to rule out any biological reasons for the wetting or soiling behaviors. Following that, a psychological evaluation is recommended to determine the psychological and/or social factors at work. Regardless of the treatment plan, prognosis for successful treatment is dependent on a biopsychosocial approach that includes ongoing coordination with the pediatrician or gastroenterologist. The Tarnow Center offers several services that can be helpful in treating elimination disorders:
- Family therapy: empathic education about the causes of the problem, a supportive behavioral approach that emphasizes the importance of the child as a team member, and strategies to understand and manage the emotional aspects that can lead to or arise from the elimination problem.
- Individual therapy: The goal of individual treatment with elimination disorders will depend in large part on the psychosocial factors that contribute to the child’s difficulty with appropriate bathroom behavior. But a supportive approach can help the child to process feelings of shame and empower the child to exercise more control. However, individual therapy will not be as effective if parents are not doing their own work in learning how to work with the child at home.
To contact one of our clinicians, or to schedule an Intake Evaluation, please click on the link below or call 713-621-9515.
Learning Disorders
“Learning Disability” is a general term that refers to someone’s difficulty in understanding or in using language, whether the language is oral (listening, speaking) or written (reading, writing). Learning disabilities can affect a great many areas of academic functioning, including:
- Listenting
- Speaking
- Thinking
- Reading
- Writing
- Spelling
- Mathematics
Learning disabilities may occur simultaneously with other conditions (sensory impairment, anxiety, ADHD, or other emotional issues), or alongside environmental influences such as cultural differences or lack of instruction. However, learning disabilities are not the result of those conditions or influences.
Even though learning disabilities are typically diagnosed in relation to a child’s academic struggles, the impact of a learning disorder goes well beyond the classroom walls. Difficulties in school often lead to low self-esteem, and problems communicating with others impact the child’s social skills and friendships. Learning disabilities are generally diagnosed in childhood, but they can occur across the lifespan. Some types of learning disorders are:
- Cognitive Disorders
- Auditory Processing Disorder
- Mixed Receptive-Expressive Language Disorder
- Mathematics Disorder
- Reading Disorder
- Written Expression Disorder
Since learning disabilities cover so many different areas of learning and communication, it is difficult to list a specific symptom or profile of symptoms that indicate a problem. However, there are some warning signs that are more common at certain ages:
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Kindergarten – 4th Grade |
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5th Grade – 8th Grade |
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If you recognize any of the above warning signs in your child or student, it is recommended that the child complete a comprehensive Learning Style Evaluation. Evaluation helps identify a student's cognitive strengths and weaknesses. T
Obsessive Compulsive Disorder in Children
Obsessive-Compulsive Disorder (OCD) is characterized by intense obsessions and/or compulsions that significantly interfere with daily functioning. Obsessions are recurrent and persistent unwanted thoughts, impulses, or images that are usually irrational and cause the child to have negative feelings such as anxiety, doubt, or feelings of incompleteness. Compulsions are intentional and repetitive behaviors that serve to quiet these thoughts and the negative emotions that accompany them.
Some examples of obsessions and the accompanying compulsions are listed below. It is important to note that for a diagnosis of OCD, the pattern of obsessions and/or compulsions must cause significant impairment to the person's life. Having the thought "Did I lock the door?" and going back to check once is not a sign of OCD. But going back to check it several times may be indicative of an anxiety disorder.
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Obsessions and compulsions may vary with age. For example, a younger child may worry that he or his family will be harmed by an intruder breaking into the house (Obsession). So he will check all the doors and windows to make sure they’re locked. But he may then fear that he accidentally unlocked a door while checking, and will go back through the ritual a second, third, fourth time (Compulsion). An older child or a teenager with OCD may fear that she will become ill with germs, so she may cope through excessive hand washing, refusing to touch door knobs with her bare hand, or refusing to use restrooms away from home.
One important factor with OCD is that the person continues to have the obsessions or compulsions despite realizing that they are unreasonable. This can lead to feelings of shame or embarrassment for children who suffer from OCD, and they may be hesitant to disclose what is happening for them. Good communication between parents and children can increase understanding of the problem and help the parents appropriately support their child.
Research shows that OCD is a neurological disorder and that it tends to run in families, but this is not a direct correlation meaning that parents with OCD will not definitely pass it down to their children. Likewise, children may develop OCD even if there is no history of OCD in the family. As it is a neurological disorder and tends to run in the family, the most effective intervention is a combination of medication, individual therapy, and family therapy.
Adult Anxiety Disorders
Everyone worries. As our age increases, so do our worries. Finances, health, and children can all be things that keep us up at night. In many ways, worry is a good thing. It can be the motivating force that helps us stick with a problem or a project until we find a solution. But when the worry is excessive, and interferes with normal daily functioning, it may be a sign of a more serious anxiety disorder.
General symptoms of anxiety, as opposed to worry, include:
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Behavioral |
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Shortness of breath |
Social isolation/withdrawal |
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Heart pounding |
Difficulty sleeping, or sleeping too much |
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Shaking/trembling |
Changes to appetite |
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Emotional |
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Trouble concentrating |
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Irritability |
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Anticipate the worst |
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Fear of dying |
The following are five types of anxiety disorders that commonly occur in adults:
- Generalized Anxiety Disorder
- Obsessive-Compulsive Disorder
- Panic Disorder
- Social Phobia
- Post Traumatic Stress Disorder
Anxiety disorders can look like many different things, which may result in an inaccurate diagnosis. Therefore, it is important to receive a thorough evaluation of social, emotional, and academic functioning in order to fully assess the presenting symptoms and issues. If undiagnosed and untreated, anxiety disorders can have significant effects on an individual’s life, including poor social relationships, depression, poor academic/job performance, and may lead to other disorders, such as depression or substance abuse.
Oppositional Defiant Disorder
Oppositional Defiant Disorder (ODD) occurs primarily in children and adolescents. It is characterized by negative, defiant, disobedient, or hostile behavior towards parents or other authority figures (teachers, grandparents, etc.). It is important to note that many children and teenagers display some of these behaviors, and it is normal for these kids to go through difficult periods as they try to become their own person. But if you notice several of the following behaviors, lasting longer than 6 months, it may be an indication of more severe difficulty.
- Often loses his or her temper
- Frequently argues with adults
- Often ignores adults' requests or rules
- Deliberately tries to provoke people
- Frequently blames others for his or her mistakes or misbehavior
- Often easily irritated by others
- Often angry and resentful
- Often spiteful
Children with ODD are often disobedient. They become angry easily and may seem to be angry much of the time. Younger children may have temper tantrums that last for 30 minutes or longer. A child with ODD often starts arguments and will not give up. Winning the argument is very important to a child with ODD even if it means being punished.
If you recognize any of these patterns in yourself, a friend, or a loved one, a psychological evaluation is recommended. Appropriate intervention for ODD includes:
- Individual Therapy: Individual work focuses on developing specific skills for managing anxiety, while also addressing the struggles with daily stressors and low self-esteem that often accompany a diagnosis of anxiety.
- Family Therapy: Family work is important in the treatment of anxiety in that it focuses on developing open communication and expression of emotion, while teaching parents/loved ones techniques to utilize at home with the client.
- Group Therapy: Groups provide safe and appropriate social training where the client can get feedback from peers and professionals about how to regulate their behavior.