108:
typical classical conditioning, when the unconditioned stimulus is withdrawn, the conditioned response gradually weakens with repeated application of the conditioned stimulus. In successful cases of the enuresis alarm conditioning treatment, no extinction occurs following the withdrawal of the alarm stimulus (US). This suggests that the conditioning treatment may follow the operant avoidance conditioning rather than the classical conditioning pattern. In addition, a strictly classical conditioning explanation fails to incorporate that social positive reinforcement may be introduced to the individuals environment from family members from signs of improvement taking into account social learning. However, it is theorized that classical and operant conditioning both contribute to the effectiveness of the treatment.
82:(feeling of having a full bladder), the conditioned stimulus (CS) is the feeling produced by bladder distention, and the conditioned response (CR) is the awakening response and sphincter contraction. Initially the individual experiences the alarm sounding (activated by urination) (US) eliciting the awakening response and sphincter contraction (UR) to wake up, stop urinating, and travel to the bathroom. After continued pairing of the alarm sound (US) with the feeling of a full bladder (NS), the previous NS of feeling a full bladder becomes the CS and elicits the waking response (CR) of waking up to go use the bathroom and urinate.
117:
so as not to be dangerous to the user. When this insulating material (frequently cotton cloth as in common briefs) absorbs urine, it allows electricity to pass through it and between the conductors, resulting in a small electric current in the conductors. The conductors are attached to an alarm device, which triggers an alarm when it senses this current. Most sensors and alarms are engineered based on this concept. Note that unless the urine reaches the sensor mechanism and adequately wets the briefs (or insulator between the conductors), the urine may not be sensed and the alarm will not activate.
167:. The signal is transmitted wirelessly to a unit that is across the room from the child or an alarm unit in the child's room. Once the alarm unit is activated, it is necessary to get out of bed to turn it off. New wireless alarms add the convenience of also sounding an alarm in the caregiver's room, allowing both patient and caregiver to sleep in the comfort and privacy of their own beds and rooms. Multiple alarms in the house can further increase convenience. Remote controls can facilitate using the wireless bedwetting alarm system, and be especially convenient for the parent or caregiver.
133:) underneath the user's pajama shirt to wherever the alarm is located on the body (frequently on the collar of the pajama shirt, so that it is close to the ear). The attachment mechanism to the alarm, through which the electric current flows to the alarm, is important. If it is easily detached (unintentionally comes out from the alarm during use) the alarm may not be triggered. Most connectors are plastic telephone jacks which are very unlikely to be detached unintentionally (RJ-11, RJ-12, 616E, etc.).
60:
its acceptability, as it may be highly disruptive for the household and may require a significant commitment of time and effort. The family must be motivated and adhere to this therapy if it is to be successful so they should be preemptively apprised of likely difficulties, but assured the first few weeks are the most troublesome. If necessary, doctors should monitor the child's progress early to address any problems and facilitate adherence.
39:, a German pediatrician made the discovery accidentally, with the original intention to create an alarm device that would notify nursing staff when a child had bed wetting and needed to be changed, showing the device to have a significant therapeutic advantages after a certain time of use. Despite early success, the treatment was not developed until the 1930s by two independent groups of psychologists:
147:
47:(1938) and John Morgan and Frances Witmer (1939). Mowrer used a modified Pfaundler alarm device with 30 children (ages 3–13 years) showing empirical success of the bell and pad method as a treatment for nocturnal enuresis, with the maximum time required to accomplish the treatment not exceeding two months.
116:
A urine sensor is a necessary part of any bedwetting alarm. A basic urine sensor consists of two electricity conductors separated by moisture absorbing insulating material. A low DC electric voltage, provided by batteries, is applied across these conductors. This low voltage is usually about 3 volts,
107:
Most researchers of the enuresis alarm credit the treatment effect to the classical conditioning paradigm as was explained in the original research by Mowrer. However, some researchers have noted an important difference between conditioning treatment and the usual classical conditioning treatment. In
81:
paradigm components for the bell and pad method are the following: The unconditioned stimulus (US) is the awakening stimulus or the alarm sound, the unconditioned response (UR) is the awakening response and sphincter contraction, the neutral stimulus (NS) is the feeling produced by bladder distention
175:
Bell-and pad alarms do not attach to the child in any way. The moisture sensor is in the form of a pad or mat that the child sleeps on top of. The pad detects moisture after urine has leaked onto it. The alarm unit is connected with a cord and usually sits on the bedside stand. This alarm requires a
55:
The individual places the sensor (usually located in briefs or underwear) and turns the alarm device on (there are various types of alarms) before going to sleep. The enuresis alarm is triggered when a sensor in the sheets or night clothes becomes wet with urine, setting off an auditory signal with
184:
Successful outcome of enuresis alarm treatment is associated with optimal motivation of the child and family, higher frequency of dry nights, and the absence of adverse environmental factors and psychiatric disorders. Reduced efficacy of the treatment is associated with lack of concern shown by the
98:
procedure whenever the individual activates the alarm by urinating. This eventually causes an avoidance response from the individual, maintain the behavior through negative reinforcement by avoiding the alarm sound altogether. In the future the individual wakes up to urinate and avoids wetting the
128:
Another consideration is how the sensor (through its cable, if applicable) is attached to its alarm or transmitter in the case of wired alarms or wireless alarms. Some wireless alarms are truly wireless, with the transmitter being part of the sensor and completely self-contained. For wired alarms,
124:
Stainless steel clips are most often used and are easily attached and detached to the briefs at the point of urination. Flat surface sensors require sticky tape or pads to be attached to the briefs. The magnetic sensors are magnetically attached to the briefs. Magnetic sensors and wired briefs are
59:
It is highly suggested that during treatment the alarm should be worn every night. The treatment effect and response are not immediate and treatment should be continued for 2–3 months or until the child is dry for 14 consecutive nights (whichever comes first). There may be cultural differences in
154:
A wearable alarm is a design in which the child or patient wears the moisture sensor in or on their underwear or pajamas. This type of sensor will detect moisture almost immediately. The sensor is attached to the alarm unit with an electricity conducting wire or cable that can be worn under the
120:
Sensors are usually classified in terms of their attachment mechanisms to the briefs or other urine absorbing medium. The major sensor attachment categories are mechanical clips, sticky tape or pads for flat surface sensors, magnetic attachment, and wiring sewed into special briefs.
185:
individual, lack of supervision, inconsistent use, family stress, abnormal scores on behavioral checklists, psychiatric disorders in the individual, failure to awaken in response to the alarm, unsatisfactory housing conditions, and more than one wetting episode per night.
68:
The enuresis alarm utilizes both classical and operant conditioning to provide a means of causing the sleeping individual to be regularly awakened immediately after the onset of urination so they can void in the toilet and prevent bed wetting.
56:
the intention of causing the individual to wake, cease voiding, and arise to void. Parents are advised to wake their child when the alarm is activated—otherwise, children are prone to turn it off and go back to sleep.
163:
A wireless bedwetting alarm is one in which the sensor and the alarm unit communicate by a means other than a wire. The transmitter, which senses the moisture, is directly attached to the child's
454:
176:
larger amount of urine before the sensor can detect moisture. The person must be on the pad for it to sense moisture.
35:
The enuresis alarm methodology originated from French and German physicians in the first decade of the 20th century.
259:
Walle, Johan; Rittig, Soren; Bauer, Stuart; Effert, Paul; Marschall-Kehrel, Daniela; Tekgul, Serdar (June 2012).
459:
94:
paradigm the alarm sound serves as a noxious stimuli added to the environment, effectively implementing a
78:
36:
91:
95:
44:
40:
227:
Mowrer, O.H.; Mowrer, Willie Mae (July 1938). "Enuresis -- A method for its study and treatment".
24:
430:
334:
290:
356:
420:
412:
326:
280:
272:
236:
146:
130:
425:
400:
285:
260:
240:
384:
Nijman, R.; Bower, W.; Butler, U.; Ellsworth, P.; Tegkul, S.; Von
Gontard, A. (2008).
448:
330:
317:
Lovibond, S.H. (1963). "The mechanism of conditioning treatment of enuresis".
276:
164:
155:
shirt. Many wearable alarms vibrate as well as sound to wake deep sleepers.
416:
386:
Diagnosis and management of urinary incontience and encopresis in childhood
338:
294:
434:
213:. Philadelphia: Spastics International Medical Publications. p. 196.
129:
the sensor's wire (or cable) runs from the sensor (located at the
261:"Practical consensus guidelines for the management of enuresis"
401:"Predicting treatment outcome in nocturnal enuresis"
8:
16:Behavioral treatment for nocturnal enuresis
424:
284:
222:
220:
145:
399:Devlin, J.B.; O'Cathain, C (Nov 1990).
254:
252:
250:
204:
202:
200:
198:
194:
312:
310:
308:
306:
304:
379:
377:
350:
348:
7:
125:typically used for wireless alarms.
229:American Journal of Orthopsychiatry
241:10.1111/j.1939-0025.1938.tb06395.x
14:
405:Archives of Disease in Childhood
319:Behaviour Research and Therapy
265:European Journal of Pediatrics
103:Conditioning theory dissonance
23:is a behavioral treatment for
1:
331:10.1016/0005-7967(63)90003-2
211:Bladder Control and Enuresis
180:Factors of treatment success
476:
277:10.1007/s00431-012-1687-7
209:Turner, R. Keith (1973).
150:Wireless Bedwetting Alarm
417:10.1136/adc.65.10.1158
151:
79:classical conditioning
73:Classical conditioning
37:Meinhard von Pfaundler
149:
388:. pp. 965–1058.
357:"Bed-wetting Alarms"
92:operant conditioning
86:Operant conditioning
455:Urologic procedures
96:positive punishment
152:
131:point of urination
25:nocturnal enuresis
411:(10): 1158–1161.
51:Treatment process
45:Willie Mae Mowrer
467:
439:
438:
428:
396:
390:
389:
381:
372:
371:
369:
367:
352:
343:
342:
314:
299:
298:
288:
256:
245:
244:
224:
215:
214:
206:
21:bedwetting alarm
475:
474:
470:
469:
468:
466:
465:
464:
460:Sleep disorders
445:
444:
443:
442:
398:
397:
393:
383:
382:
375:
365:
363:
354:
353:
346:
316:
315:
302:
258:
257:
248:
226:
225:
218:
208:
207:
196:
191:
182:
173:
171:Pad-type alarms
161:
159:Wireless alarms
144:
142:Wearable alarms
139:
137:Types of alarms
114:
105:
88:
75:
66:
53:
33:
17:
12:
11:
5:
473:
471:
463:
462:
457:
447:
446:
441:
440:
391:
373:
344:
300:
271:(6): 971–983.
246:
235:(3): 436–459.
216:
193:
192:
190:
187:
181:
178:
172:
169:
160:
157:
143:
140:
138:
135:
113:
110:
104:
101:
87:
84:
74:
71:
65:
62:
52:
49:
32:
29:
15:
13:
10:
9:
6:
4:
3:
2:
472:
461:
458:
456:
453:
452:
450:
436:
432:
427:
422:
418:
414:
410:
406:
402:
395:
392:
387:
380:
378:
374:
362:
358:
355:Alli, Renee.
351:
349:
345:
340:
336:
332:
328:
324:
320:
313:
311:
309:
307:
305:
301:
296:
292:
287:
282:
278:
274:
270:
266:
262:
255:
253:
251:
247:
242:
238:
234:
230:
223:
221:
217:
212:
205:
203:
201:
199:
195:
188:
186:
179:
177:
170:
168:
166:
158:
156:
148:
141:
136:
134:
132:
126:
122:
118:
111:
109:
102:
100:
97:
93:
85:
83:
80:
72:
70:
63:
61:
57:
50:
48:
46:
42:
38:
30:
28:
26:
22:
408:
404:
394:
385:
364:. Retrieved
360:
322:
318:
268:
264:
232:
228:
210:
183:
174:
162:
153:
127:
123:
119:
115:
106:
89:
76:
67:
64:Conditioning
58:
54:
41:Orval Mowrer
34:
20:
18:
366:18 November
449:Categories
189:References
325:: 17–21.
165:underwear
339:14156709
295:22362256
435:2248510
426:1792316
286:3357467
112:Sensors
90:In the
31:History
433:
423:
337:
293:
283:
361:WebMD
99:bed.
431:PMID
368:2014
335:PMID
291:PMID
77:The
43:and
421:PMC
413:doi
327:doi
281:PMC
273:doi
269:171
237:doi
451::
429:.
419:.
409:65
407:.
403:.
376:^
359:.
347:^
333:.
321:.
303:^
289:.
279:.
267:.
263:.
249:^
231:.
219:^
197:^
27:.
19:A
437:.
415::
370:.
341:.
329::
323:1
297:.
275::
243:.
239::
233:8
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
