Four out of ten kids say they know someone troubled enough to be a potential killer.

Bedwetting  
by Susan Solomon Yem

A child must make tremendous adjustments when entering a foster care placement. For some, these changes are coupled with the common, but embarrassing problem of bedwetting.

Six-year-old Jonathan wet his bed frequently when he first entered a foster home. He felt both humiliation and shame as he watched his new foster mother change his sheets and air his mattress every morning. He also experienced frustration because he knew he could not control this problem.

"It is wrong to assume that every foster child who wets the bed does so because of a trauma he or she has suffered," says Brian F. Greer, Director of the Center for Preventive Psychiatry in Coconut Creek, Florida. "Perhaps the first assumption should be that this is happening because the child is adjusting to placement. If the bedwetting continues for more than three weeks, this child should be evaluated first for physical causes and then emotional."

Five to seven million American children over the age of six have a condition called Primary Nocturnal Enuresis (PNE), more commonly known as bedwetting. Clinically, PNE is defined as a condition in a child over the age of six who has never achieved dryness at night.

Doctors are divided in their opinions as to its cause, but a genetic predisposition to PNE and bladder size are considered contributing factors. Recent research indicates that the absence of the hormone ADH, which acts as an anti-diuretic, limiting the body's urine output at night, may cause PNE. Children without ADH produce four times the amount of urine as those who have the hormone.

"Bedwetting can also be an indicator of an emotional disorder," says Dr. Greer. "But physical causes should be ruled out before psychiatric evaluation is sought."

Secondary Enuresis occurs in children who are enduring trauma or stress. Often these kids have already overcome Enuresis once; however, an event they perceive as stressful triggers the bedwetting once again. "Enuresis is not a wilIful act. A sleeping child has no control over this," explains Clinical Pediatric Psychologist, Blair Barone. "Anything from a trivial situation such as school ending for the summer to abuse and trauma in the home can trigger Secondary Enuresis.

No matter what cause, quick and effective treatment of Enuresis will bring positive results. "To help a child achieve more positive self esteem by stopping the bedwetting behavior is most important," stresses Dr. Greer. "However we cannot just take care of the symptoms without first looking at the cause.

Dr. Greer suggests three steps. First, allow the child ample time to comfortably adjust to the foster home. If bedwetting has not stopped by the fourth week of placement, schedule a physical with a pediatrician or pediatric urologist to rule out any physiological problems.

No matter what cause, quick and effective treatment of Enuresis will bring positive results. "To help a child achieve more positive self esteem by stopping the bedwetting behavior is most important."

The factors which are evaluated at an Enuresis consultation include: diabetes, urinary tract infection, small bladder capacity, lack of ADH, neurological problems, and serious medical concerns such as a misplaced ureter or problems with ureter reflex. The National Kidney Foundation's Physician Referral Network (1-800-622-9010) can put you in touch with a doctor experienced in treating Enuresis. Finally, if the condition cannot be traced to a physical cause, consult a pediatric psychologist or psychiatrist.

Many children are not treated for Enuresis because they are too embarrassed to tell a doctor. Foster parents should stress to the child the importance of being open about bedwetting in the hopes of correcting the condition.

Including the child's social worker in a discussion about the problem is also important, as Dr. Greer points out. Most children will not volunteer this information to their social workers, but through a private interview with the foster parents and the child, the worker should be informed so that he or she can help make referrals for follow-up care.

While Primary Nocturnal Enuresis cannot be cured, it can be controlled through behavior modification, rewards, and for some, medication. Those children with Secondary Enuresis will benefit from psychological counseling. But for any treatment to work, the child has to be willing to face the problem and with the foster parent, treat it. "It helps the child so much if we can stop the bedwetting quickly as we treat its underlying causes," says Dr. Greer.

For some children, an alarm system available from a pharmacy or department store may be the first step. Ask your social worker if this is a reimbursable expense. Used as a motivational tool, the alarm is attached to the child’s shoulder and the front of the underwear. At the first sign of wetness, the alarm buzzes, awakens the child and reminds him or her to complete urination in the toilet. Continued use of the alarm conditions the child to get up sooner, until just the urge to use the bathroom get him or her out of bed.

While the alarm can be successful if used properly, it may not be appropriate for all households. It may take as long as six months to work. Some experts think the alarm motivates the adults in the home more than the child.

Behavior modification, including limiting drinks in the evening, escorting the child to the bathroom during the night, and acknowledging dry nights can be effective, but this requires an intense commitment for all involved.

Medication is often prescribed as an adjunct to behavior management. Imipramine, an anti-depressant, may provide some relief, but doctors caution that the side effects can be severe.

Another drug called DDAVP Nasal Spray or desmopressin acetate has been proven to provide quick, effective relief for Enuresis. DDAVP is a synthetic form of the urine limiting hormone ADH. It is prescribed as a nasal spray to be used once a day at bedtime. Improvement usually comes within one to three days. Many medical experts believe DDAVP is the most appropriate choice for foster children, especially those in temporary placement. Medicines prescribed to treat Enuresis are usually covered by Medicaid.

Alleviating a foster child of the distress of bedwetting will yield positive results. Not only will the child's shame and embarrassment be reduced, but the foster parent will no longer have the daily burden of laundry and housekeeping associated with the condition.

Susan Solomon Yem has been a Foster Parent since 1988. She and her husband were named Massachusetts Foster Parents of the Year in 1994. Her articles have appeared in such publications as The Boston Globe and Family Times, as well as many others. Reprinted from C.A.F.A.P. News, Summer 1997, vol. 1-7, published by the Connecticut Association of Foster and Adoptive Parents.

Biofeedback - How To Calm A Child

A relaxation technique from the ‘60s--combined with computer technology of the ‘90s--is proving effective as a drug-free treatment for hyperactive kids.
By Jim Robbins, Parade Magazine

Linda Vergara, an assistant principal of a public school in Yonkers, N.Y., wasn’t sure what to do when her own son, Jon-Michael Negrón, was asked to leave the private school he attended because of behavioral problems. Experts diagnosed the seven-year-old with attention deficit-hyperactivity disorder–which frequently means children are disruptive in the classroom–and recommended drug treatment.

"They told me I needed to give him something to calm him down," Vergara said. She refused. The drugs prescribed for hyperactivity have side-effects, and there are concerns about their long-term use. Vergara also felt that giving her son drugs would send him the wrong message.

Instead, she turned to Mary Jo Sabo, a therapist in Spring Valley, N.Y., who uses biofeedback to treat kids like Jon-Michael, now 11. Twice a week, for half an hour each session, he sat in front of an EEG biofeedback system--sometimes called neurobiofeedback--with sensors placed on his scalp and earlobes to monitor his brainwaves. In this system, the patient watches a kind of video game of his brainwaves on a display. When the patient produces waves associated with concentration, the game speeds up. When the patient shows brainwaves associated with daydreaming, the game slows down. Usually by the 10th biofeedback session, the patient has begun to recognize his own brain patterns. With more sessions, the patient learns to apply this recognition to everyday life, helping him to stay focused. The gains patients make are permanent.

Biofeedback has been around since the ‘60s, but computers have improved the technique and made it more powerful. In addition to attention-deficit/hyperactivity disorder--which is thought to afflict up to nine percent of U.S. school age children- biofeedback is being used to treat such problems as closed head injuries, which can result from a blow to the skull.

As a treatment, however, biofeedback remains controversial. Even proponents stop short of calling it a cure. Joel Lubar, a psychologist at the University of Tennessee at Knoxville, has used biofeedback to treat attention-deficit/hyperactivity disorder and epilepsy in more than 2000 patients. He believes the technique can help a child use the brain patterns he or she doesn’t normally employ, causing "increased metabolism and blood flow into parts of the brain," said Lubar. "That can help the brain heal."

Other experts are skeptical. "It is highly experimental at the moment," said Dr. Russell Barkley, director of psychology at the University of Massachusetts Medical School and an expert on hyperactivity. "We don’t have any studies that say it’s bad for you," he added, "but I don’t think it will do any good."

Linda Vergara also was skeptical, but after seven sessions Jon-Michael was calmer and able to sit still through dinner. After 20 sessions, he stopped fighting with his siblings and began doing his homework. His grades improved.

Vergara’s experience led her to try biofeedback with some students at the Enrico Fermi School for the Performing Arts and Computer Science, where she works. With a small grant, she bought a biofeedback machine, and 100 students have been trained on it in the last three years. One was Mohammed Hussain, 13, who was hyperactive and violent. "I used to be the biggest, baddest bully in school," said Mohammed, who completed 62 biofeedback sessions. "Now I’m different."

"My life was miserable," said his mother, Faten Hussein. "He was very bad. Now he’s like a normal kid." Others tell similar stories. "We’ve seen dramatic changes," said Mary Jo Sabo. "Increased attention spans. Less disruptive behavior. Fewer outbursts."

Enrico Fermi was one of the first schools in the country to use biofeedback. The equipment costs as much as $7500, but savings come from keeping kids out of special-education classes that can cost $25,000 a year for each child. Based on the success at Fermi, the Yonkers school board is expanding the program to other schools.

While questions remain, biofeedback researchers are encouraged. "It’s like we’ve been given a grand piano," said Susan Othmer of EEG Spectrum, an Encino, Calif., company that does biofeedback research. "So far we’ve only learned to play a few keys."

For more information, write: Dr. Joel Lubar, Southeastern Biofeedback and Neurobehavioral Institute, Dept. P, P.O. Box 10437, Knoxville, TN 37919; or EEG Spectrum, Dept. P, 16100 Ventura Blvd., Suite 10, Encino, CA 91436. Or visit www.eegspectrum.com on the Web.

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