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Elimination Disorders in Children and Adolescents

Kratimenos, Panagiotis N. MD; Sell, Neelam K. MD

Journal of Developmental & Behavioral Pediatrics: November/December 2012 - Volume 33 - Issue 9 - p 731
doi: 10.1097/DBP.0b013e31827b4f22
Book Review

Department of Pediatrics, The Children’s Hospital at Monmouth Medical Center, Long Branch, NJ

Division of Developmental-Behavioral Pediatrics, The Children’s Hospital at Monmouth Medical Center, Barnabas Health Group, Long Branch, NJ

This book is neatly organized into three main chapters: Encopresis, Nocturnal Enuresis and Diurnal Enuresis. Each of these topics is laid out in a consistent format, discussing in detail definitions, symptoms, criteria from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and etiology to assist in accurate diagnosis. Natural course, prognosis, differential diagnosis, and management are also discussed with concise, accurate text along with tables and illustrations to bring the information together for the visual learner. Each chapter has current and up-to-date information and references, with an emphasis on evidence-based treatments. A major plus is the standardized editing in the book, which makes each chapter a part of a well-integrated treatise. A list of online resources, support groups, and organizations for families with children with elimination disorders are included at the end of the book. I have already used this book in my practice when working with children or adolescents with elimination disorders. It puts together all of the current information in an organized and easy-to-read format.

In the first chapter, the authors highlight the major organic and behavioral pathophysiology of encopresis. The medical evaluation and differential diagnosis is discussed in detail, including constipation and celiac disease. They introduce evidence-based behavioral evaluation tools for parents and teachers, as well as tools for parent education. The majority of the chapter is dedicated to the treatment of encopresis on multiple levels, targeting both the organic and behavioral components to this disorder. The authors also discuss toileting refusal, which is often a related issue. Clinical vignettes for both encopresis and for toileting refusal make the information from this chapter both relevant and interesting.

In the chapter on nocturnal enuresis, the authors discuss both medication and biobehavioral treatment options, including bladder training exercises and bedwetting alarm devices. They include the mechanism of actions and prices for the most common devices and compare their efficacy. The best part is the example of Retention Control Training, the “dot-to-dot” rewarding system for the treatment of nocturnal enuresis. The chapter discusses less empirically based treatments, as well as barriers to treatments, both important components on managing enuresis.

The book concludes by covering diurnal enuresis, which the authors divide into medical and functional categories. While acknowledging that less is known about this disorder, the differential diagnosis, comorbidities, and treatment options are discussed in detail, with references to the scientific literature. The authors raise awareness for the possibility of abuse and stress the avoidance of direct and indirect punishment methods, noting that this childhood disorder requires patience and understanding. A well-structured, brief table summarizing the representative multicomponent treatment for diurnal enuresis, along with a clinical vignette, completes the chapter. Marginal highlights summarize the accompanying text for those using this book as a reference.

This text easily achieves its stated goal of providing a scientific, biobehavioral approach to elimination disorders in children. While it is written as part of the Advances in Psychotherapy collection, pediatricians, family practitioners, developmental/behavioral specialists, gastrointestinal doctors, and urologists will find outstanding practical guidance and clinical pearls. This book will quickly become a reference for anyone that manages these childhood disorders.

© 2012 Lippincott Williams & Wilkins, Inc.