title: The impact of monosymptomatic nocturnal enuresis on attachment parameters.
abstract: OBJECTIVE
  This study assesses the impact of monosymptomatic nocturnal enuresis (MSNE) on the child's perception of quality of attachment to a caregiver and the caregiver's perception of dissociative behavior.
  
  
  METHODS
  The study group comprised 47 boys and 63 girls (mean age 11.7 years; range 9-18 years). Subjects were classified into two groups as follows: Group I (normal children without nocturnal enuresis); or Group II (children with MSNE). MSNE was defined as more than three wet episodes per week without day-time enuresis, urge incontinence, frequency or dysuria. The Adolescent Attachment Questionnaire (AAQ) was administered to the children and the Child Dissociative Checklist (CDC) to the caregiver. Comparison groups were divided by gender, feeding method and type of caregiver. The AAQ and CDC scores in each subgroup were compared between the enuretic and non-enuretic groups.
  
  
  RESULTS
  Mean scores for attachment pathology were significantly higher in the enuretic (n = 50) than the non-enuretic group (n = 60) (p < 0.05). The most significant attachment pathology was evident for the AAQ Angry Distress dimension in the nocturnally enuretic group. Caregivers' CDC scores did not differ significantly between the two groups. Highest mean dissociation scores were evident for those children whose caregiver was not a biologic parent or grandparent.
  
  
  CONCLUSIONS
  MSNE may negatively impact the child's perception of the quality of attachment. Caregivers reported no significant dissociative behavior in nocturnally enuretic children. With prolonged nocturnal enuresis, physicians should be aware of the possibility of anger and distress within the child-caregiver relationship. In such cases, the modified treatment protocol should include psychologic counseling and support.
authors.affiliation: Pediatric Urology, Hamot Medical Center, Erie, Pennsylvania 16507, USA. schobermd@aol.com
authors.forename: Justine M
authors.initials: JM
authors.lastname: Schober
authors.forename: Ruthann
authors.initials: R
authors.lastname: Lipman
authors.forename: John D
authors.initials: JD
authors.lastname: Haltigan
authors.forename: Phyllis J
authors.initials: PJ
authors.lastname: Kuhn
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D017028:Caregivers; D016022:Case-Control Studies; D002648:Child; D003858:Dependency, Psychological; D004775:Enuresis / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D010553:Personality Development; D011379:Prognosis; D011788:Quality of Life; D012016:Reference Values; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D018434:Sickness Impact Profile; D013315:Stress, Psychological; D011795:Surveys and Questionnaires