East Asian Arch Psychiatry 2011;21:37


Elimination Disorders in Children and Adolescents (Advances in Psychotherapy — Evidence-based Practice)

Authors: Edward R. Christophersen, Patrick C. Friman
Hogrefe Publishing
USD30; pp85; ISBN 978-0-88937-334-1

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The Freud’s theory of psychosexual meaning towards incontinence in children probably deeply and powerfully influenced how we think of this behaviour. Therefore, elimination disorders were historically viewed as psychiatric disorders or symptoms of emotional disturbance. The triad of fire-setting, cruelty to animals, and bedwetting is spuriously used to identify a group of children predisposed to violence. The children were blamed, misunderstood, and mistreated because of unsubstantiated theory or antiquated convention. Furthermore, elimination disorders are not uncommon. According to the epidemiological data reviewed in this book, the prevalence of encopresis in the US was estimated to be 1% to 3%. The National Health Examination Survey also reported that as many as 25% of boys and 15% of girls were enuretic at the age of 6 years, with as many as 8% of boys and 4% of girls still enuretic at the age of 12 years.

This book challenges Freud’s theories and describes how a scientific approach has dramatically reduced and simplified the meaning attributed to both encopresis and enuresis. The book emphasises the importance of biobehavioural approaches to assessment and treatment. A physical examination for each child is paramount for clinicians to include or exclude any physiopathological process. The only aetiological factor for encopresis that is supported by the literature is constipation. More than 90% of children referred for treatment of encopresis present with functional constipation. There is absence of research demonstrating consistent behavioural problem in the vast majority of children diagnosed and treated for encopresis. Most empirical research showed that this group of children exhibited a slight elevation in any other psychological problems; only a small minority are significantly impaired.

The authors of this book are both experienced paediatricians and Fellows of the American Psychological Association. They have assessed and treated more than 1000 incontinent children. They produced this masterful volume to provide readers with a practical overview of elimination disorders. The book includes the definition, epidemiology, prognosis, recommendations for diagnosis, and different treatment modalities. It is also refreshing to have a comprehensive review of evidence-based therapies extending beyond cognitive-behavioural methods. The book speaks to every clinician who has to treat enuresis and encopresis in children and adolescents.

This book is divided into 3 sections. The first covers constipation and encopresis, the second discusses nocturnal enuresis, and the third concentrates on diurnal enuresis. These 3 neat chapters make up this 85-page book and are written in a specified sequence: basic descriptions, influential theories and models, and problems encountered with each treatment, and then follows up with illustrative case vignettes. The marginal notes, tables, and summary boxes in each chapter also assist orientation. The useful appendices at the end of the book provide helpful tools for implementing intervention in daily practice. The appendices consist of the dietary fibre content of foods, bowel symptoms rating sheet, and representative child and parent handouts for alarm treatment. Useful websites and suggested journals are provided for further help on the subject.

This book serves as a guidebook for standard practice. It is an addition to the bookshelf of clinician who tends to be more empirically focused and wishes to bring a brighter future to incontinent children.

Caroline Shea, MBChB (carolinesks@gmail.com)
Department of Psychiatry
Shatin Hospital
Shatin, New Territories
Hong Kong SAR, China

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