Sleep and Elimination disorders slides

Sleep and Elimination disorders slides - Sleep and...

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Unformatted text preview: Sleep and Elimination disorders: History • Used to be attributed to laziness and stubbornness of the child • Freud—underlying psychological conflicts, related to later personality problems • No longer prominent theories • Medical problems Sleep: Sleep: • Primary activity of brain in early years • Serves fundamental role in brain development and regulation • Sleep patterns and needs change • Problems can co­occur with many other mental health disorders • Problems can cause emotional or behavioral problems Sleep disorders: Sleep disorders: • Primary—abnormalities in the body’s ability to regulate sleep­wake mechanisms and the timing of sleep • As opposed to those related to mental or medical disorder or substance use • Must cause distress or impairment Dyssomnias: Dyssomnias: • Disorders of initiating or maintaining sleep • • • • or not getting enough Common during periods of development Often resolve themselves But, can impact behavior or emotions Protodyssomnia—difficulty initiating or maintaining sleep Dyssomnias continued: • Hypersomnia—excessive sleepiness • Narcolepsy—attacks of sleep during the day with loss of muscle tone • Breathing­related sleep disorder—sleep disruption caused by breathing problems • Circadian rhythm sleep disorder— mismatch between sleep­wake cycle of person and the environment Parasomnias: Parasomnias: • Disorders in which behavioral or physiological events intrude on ongoing sleep • Arousal at inappropriate times in the sleep­wake cycle • Unusual behaviors while asleep • Common during early to mid­childhood Parasomnias continued: • Nightmares—occur during REM sleep, awakening with detailed recall of scary dreams • Sleep terrors—during deep sleep, hard to arouse, abrupt awakening with autonomic arousal, no memory of a dream • Sleepwalking—during deep sleep, walking around while asleep, no recall the next day Treatments: Treatments: • Many go away on own or don’t need • • • • • treatment Behavioral interventions Good sleep hygiene Reinforcement for bedtime routines Reduction of daytime stress Afternoon nap Elimination disorders: Elimination disorders: • Attention directed away from child’s • • • • personality or trauma; medical problem For some, problems are chronic, distressing, and impairing Implications for self­competence and self­ esteem, teasing, embarrassment Extreme cases—can precipitate abuse Good news! Early referral and treatment can virtually eliminate long term problems Enuresis: Enuresis: • • • Discharge of urine in day or night Usually involuntary DSM­IV diagnosis – 5 years old or developmental equivalent – Frequent (2x/week for 3 months) or accompanied by significant distress – Not due to medical condition or meds – Nocturnal, diurnal, or both Enuresis: • Prevalence – 13­33% of 5 year olds wet their beds – More boys than girls – Daytime wetting less common – 85% have primary enuresis (never attained dryness) – More common among less educated, lower SES groups and institutionalized children Enuresis: • Causes: – Usually not one specific cause – Signals that wake child up when bladder is full aren’t working properly – Deficiency of hormone needed to concentrate urine during the night – Primary enuresis is inherited, not caused by stress or trauma Enuresis: • Treatment – Bell and pad—behavioral intervention based on classical conditioning – Dry bed training – Full­spectrum home training – Nasal spray – Psychological methods are very effective! Encopresis: Encopresis: • Passage of feces into inappropriate places like pants or floor • Usually involuntary • DSM­IV diagnosis – 4 years old or developmental equivalent – 1x/month for 3 months – Not due to organic or medical condition – With or without constipation Encopresis: • Prevalence – 1.5­3% of children – More boys than girls – Decreases rapidly with age – Primary or secondary – 1 in 5 have significant psychological problems, probably as a result of the encopresis Encopresis: • Causes – Suppression of bowel signals – Constipation or pain avoidance – Contracting instead of relaxing – Medical and behavioral – Fiber, laxatives to relieve constipation – Behavioral methods to establish better toileting routines • Treatments ...
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