***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: To determine whether changes in attitude and behavior occur after treatment of nocturnal enuresis , we r and omly assigned 121 children aged 8 to 14 years to receive conditioning therapy ( n = 66 ) or a 3-month waiting period ( n = 55 ) . All children completed the Piers-Harris Self-Concept Scale ( P-H ) , the State-Trait Anxiety Scale ( STAIC ) , and the Nowicki-Strickl and Locus of Control test ( NSLC ) at entry and after treatment or delay . Parents completed the Achenbach Child Behavior Checklist ( CBCL ) . There were no significant group differences in background demographic variables . Significant improvements in the P-H Scale ( P = 0.04 ) and three of its subscales occurred in children in the treatment group compared with those in whom treatment was delayed . The changes were greatest for those who had the largest decreases in wetting frequency . Changes in CBCL , STAIC , and NSLC scores were not statistically significant . We conclude that there may be mental health benefits in children helped to master the symptom of enuresis , which in this age group is probably a chronic stressor This study assessed change in the frequency of primary nocturnal enuresis as produced by either behavioral conditioning with a urine alarm , pharmacotherapy with imipramine hydrochloride , or assignment to a clinical waiting list . The study also investigated the effect of treatment method and outcome on subjects ' level of emotional and behavioral adjustment .  An attempt was made to identify pretreatment predictors of treatment outcome and premature withdrawal from the treatment program . The results indicated a significantly more effective outcome for the conditioning approach . Comparison of pre- and post-treatment measures of adjustment provided insufficient evidence to support the hypotheses that either change in the frequency of nighttime wetting or the method of treatment received would influence the subject 's level of emotional and behavioral adjustment . The enuresis tolerance scale was found to be a highly significant predictor of early termination from conditioning treatment Fifty children with primary nocturnal enuresis were r and omised for a study comparing desmopressin ( DDAVP ) and enuresis alarm .  Forty six completed the trial , 24 of whom were treated with 20 micrograms intranasal desmopressin nightly and 22 with enuresis alarm for three months . Failures were crossed over and relapses were continued on the same treatment for a further three months . The improvement rate was 70 % in the group given desmopressin and 86 % in the group treated with alarm ; the difference was not significant . During the first week of treatment the group given desmopressin was significantly dryer , and at the end of the study 10 of these patients relapsed compared with one patient in the group given the alarm .  No serious side effects were observed . This study confirms the role of conditioning treatment as preferable in long term treatment of nocturnal enuresis . When this fails or when a safe drug with rapid effect is needed , however , desmopressin is a useful alternative Abstract It has been suggested that intermittent reinforcement may be of value in reducing the rate of relapse  in bedwetting conditioning therapy . An experiment was conducted with 30 enuretic boys to examine acquisition and extinction parameters of continuous ( 100 % ) , intermittent ( 70 % variable ratio ) , and “ placebo ” ( 0 % ) reinforcement schedules . Reinforced trials were administered as in the typical Mowrer conditioning procedure . Non-reinforced trials were achieved by means of a time delay with the subsequent alarm being activated in the parent 's room rather than in the child 's room . These procedures required the development of a new conditioning device which could be programmed to automatically administer the desired schedule of reinforcement . The results of the field investigation revealed that continuous reinforcement ( CR ) and intermittent reinforcement ( IR ) groups attained acquisition in approximately the same number of trials and with essentially the same success rate . Relapse rate was significantly greater in the CR group than in the IR group . The placebo group showed no improvement over the 6 weeks of treatment . The results of this study may be interpreted as supporting the tenet that relapse can be viewed and treated as an extinction of the acquired response The effect on nocturnal activity of the wire mesh element within the ' buzzer and pad ' enuresis alarm device was studied using healthy adult volunteers in a single or double cross-over design . On the nights when the mesh was in the bed there was less activity , supporting the finding of improved polygraphic sleep on the mesh and suggesting an unexpected therapeutic mechanism Forty four children with daytime wetting were included in a r and omly controlled trial of two alarm devices , a contingent one that sounded when wetting occurred and a non-contingent one that went off from time to time unrelated to wetting events . A quota allocation system ensured comparability between treatment groups . Two thirds responded to an alarm by becoming dry . The non-contingent alarm produced as good a response as the contingent one and is recommended for routine use in children with diurnal enuresis . Twenty three per cent of those who responded to treatment relapsed up to two years after completion of the trial BACKGROUND Previous studies have suggested changes in self-concept with successful treatment of primary nocturnal enuresis ( PNE ) , but behavioral changes have not been reported as a consistent associated finding . OBJECTIVE To determine if self-concept and behavior change after 6 months of treatment of monosymptomatic PNE by conditioning alarm or desmopressin acetate ( DDAVP ) . DESIGN R and omized , controlled trial in an inner-city hospital clinic . Subjects were 182 children referred or recruited through media publicity , r and omly assigned both to 1 of 8 pediatricians and 1 of 3 treatment groups  ( alarm , DDAVP , or placebo ) . Included were children > 7 years old with PNE , no daytime symptoms , bladder capacity > 50 % expected , and wetting > 3 times a week . Excluded were children with central nervous system disorders or developmental delays , and those currently on DDAVP or alarm . Subjects completed the Piers-Harris Children 's Self-Concept Scale and Harter 's Perceived Competence Scale for Children ( PCSC ) at initial visit and after 6 months of treatment . Parents completed the Achenbach Child Behavior Checklist ( CBCL ) at the same times . RESULTS After 6 months of treatment the Piers-Harris total score showed a highly significant treatment by period interaction effect for DDAVP , a significant effect for alarm , and no effect for placebo . For children who achieved 75 % dryness the CBCL showed a treatment by improvement interaction effect that was highly significant for DDAVP and placebo with no effect for alarm . For the PCSC there were no treatment or outcome interaction effects . After 6 months of treatment there were significant changes over time unrelated to outcome or treatment in the Piers-Harris Subscales and in the CBCL Internalizing and Externalizing Scores , and the Social Thought and Attention Problems Subscales . The PCSC was more stable with no changes in total score , and positive changes over time in only 2 Subscales , Scholastic and Social . CONCLUSION Children 's self-concept improved with the type of treatment and amount of success . Parents ' perceptions of behavior improve with type of treatment and amount of success . Children rate their self-concept and some physical attributes better after treatment with any of DDAVP , alarm , or placebo regardless of outcome . Frequent follow-up with emotional support and encouragement appear to be important components of an efficacious intervention for children with nocturnal enuresis Abstract Sixty‐four enuretic children with a mean age of 8.4 years were assessed over an 8‐week study to observe their response to a number of commonly used methods of treatment for enuresis . This was a double‐blind study with patients being assigned to one of eight possible treatment conditions . Imipramine , an alarm device , r and om awakening , and placebo were compared . These treatments were also studied in combination . The most practical and efficacious treatment was the individual use of either alarm or imipramine . R and om awakening and r and om awakening plus placebo were indistinguishable from placebo and were not at all effective Abstract One hundred and fifteen enuretic children were assigned to five treatment groups . Three groups received Mowrer-type continuous signal ( C.S. ) , Twin-Signal ( T.S. ) or intermittent Twin Signal ( T.S.-I.R. ) conditioning treatment , and two groups were given “ placebo ” or “ arousal ” control treatments . Over a one-month period , there was no difference between conditioning and control procedures , and it was concluded that further research is needed to determine the basis of treatment response . There was no evidence in support of the escape training hypothesis , and the twin-signal modification to st and ard bell- and -pad treatment is not recommended . The investigation confirmed the success of conditioning treatment in bringing about the initial arrest of enuresis ( i.e. in 81.4 per cent of the cases ) but the relapse rate was high . The investigation provided tentative evidence that intermittent conditioning treatment offers one way of reducing the frequency of relapse . The problem of obtaining satisfactory parental co-operation in a badly housed working-class population was apparent , and ways of reducing the dem and s that treatment imposes on parents are indicated . The results are discussed with regard to theories of  conditioning treatment  of nocturnal enuresis , and possible improvements in this technique of treatment Arousal Training is a fast , simple , and effective form of bibliotherapy for nocturnal enuresis with non- clinical children between 6 and 12 years of age . The parents act as therapists . They reward the operant behavior-pattern following the urine alarm . The success rate is 98 % ( N = 41 ) , which is significantly high when compared to the control conditions ( 79 % , N = 86 ) . There was a response rate of 100 % and no drop-out from therapy . All parents ( N = 127 ) completed and returned the record . The results of a follow-up of this bibliotherapy ( N = 113 ) 2 1/2 years later are presented . The success rate of Arousal Training  was still significantly higher ( 92 % continent ) when compared to the urine device with specific instructions ( 77 % ) and urine alarm only ( 72 % ) . Arousal Training is the treatment of choice for non- clinical enuretic children between 6 and 12 years of age The mode of action of the enuresis alarm is not clear . Earlier work suggested that the wire mesh itself may alter sleep and in this way affect nocturnal enuresis .  Seven healthy males have been studied within a two-period cross-over design in which their nocturnal motility , on and off an enuresis wire mesh , was recorded using a motility bed . There were no order , treatment or day effects in any of the variables studied . However , the mean hourly motility for each subject averaged over the three nights shows a substantial trend towards increased motility on the mesh . This lends some support to the hypothesis and merits further study Abstract Bedwetting has been a major and unsolved problem for the severely retarded . To solve this problem , an intensive training program was design ed similar to a recently developed program for daytime toilet training of the retarded . Some distinctive features of the new procedure were frequent positive reinforcement for correct toileting , a negative reinforcer for accidents , positive practice in night time toileting , increased level of urination by forcing drinking , immediate detection of correct and incorrect toileting , and Positive Practice for accidents . Of twelve retarded adult bedwetters , the average bedwetter required only one night of intensive training . Several days of apparatus monitoring were used following the training but proved unnecessary for two-thirds of the trainees . Accidents were reduced by about 85 % during the first week after training , and almost entirely ( 95 % ) during the fifth week with no relapse during a 3 month follow-up . No reduction of accidents result ed when the same bedwetters were given a control procedure that provided no positive or negative reactions other than the sounding of an alarm upon bedwetting . The Dry-Bed procedure appears to be a very rapid solution to the problem of enuresis among the retarded and may be applicable to other difficult population s and also to normals Seventy‐one children with nocturnal enuresis were enrolled in a controlled trial . The children were allocated to two matched groups . Children in both groups used an enuresis alarm until the end of treatment . Children in the first group were treated with 40/^g of intranasal desmopressin ( Desmospray ) for up to 6 weeks at the start of treatment with the alarm . During the observation period before treatment there were 2.3 dry nights per week in both groups . At the end of treatment there was a significant difference in the mean number of dry nights per week between the two groups ( 6.3 in the alarm and desmopressin group and 4.8 in the alarm group ) and also in the number of children becoming reliably dry . The combination of desmopressin and alarm was particularly helpful for children with severe wetting and those with family and behavioural problems .  Desmopressin , enuresis alarm , nocturnal Results 2 1/2 years after an enuresis nocturna training  are presented , including rate of success , percentage and duration of relapse for 113 children ( mean age 11.6 year at the start of the training ) . The bibliotherapeutic treatment by parents did not require any intervention by a professional . Behaviour of parents in the event of a relapse differed between training conditions . Children in the Arousal condition recovered faster from a relapse , 90 % of their parents used the  Arousal training  again at relapse or did not intervene at all and none of them consulted a professional . Clearly they had confidence in the method of Arousal training : combining the alarm device with reinforcement for correct behaviour at the time the alarm goes off . Parents in control conditions did not use the  alarm device as often as the parents in the Arousal condition , but tried other means with less success , including consulting professionals Predictors of premature withdrawal from a 12-week program of behavioral conditioning for childhood nocturnal enuresis were examined for 47 children treated at a university outpatient clinic . All children were administered the Piers-Harris  Children  's  Self-Concept Scale ;  parents completed the 55-item Behavior Problem Checklist and the Tolerance Scale for Enuresis . Par 
    Output:
    
REVIEW ER 'S CONCLUSIONS Alarm interventions are an effective treatment for  nocturnal bedwetting in children .
Desmopressin and tricyclics appeared as effective while on treatment , but this effect was not sustained after treatment stopped , and alarms may be more effective in the long term .