enuresis A childhood disorder marked by repeated bed-wetting or wetting of one’s clothes.

At the time of her initial assessment, Amber was in second grade. She was referred to the clinic by her father, Mr. Dillon, who was quite upset about his daughter’s problems. During the telephone screening interview, he reported that Amber was wetting her bed more at night and often needed to urinate during school. She was also experiencing minor academic problems….

During [her] assessment session … Amber said that she was getting into a lot of trouble at home and that her parents were mad at her. When asked why they were mad, Amber said she wasn’t doing well in school and that she felt “nervous.” … She said her grades had been getting worse over the course of the school year and that she was having trouble concentrating on her assigned work. She had apparently been a very good student the year before, especially in reading, but was now struggling with different subjects….

[Amber acknowledged that] she wet her bed at night about once or twice a week. In addition, she often had to use the bathroom at school, going about three or four times a day. This was apparently a source of annoyance for her team teacher…. On one occasion, Amber said that she didn’t make it to the bathroom in time and slightly wet her pants. Fortunately, this was not noticeable, but Amber was quite embarrassed about the incident. In fact, she now placed a wad of toilet tissue in her underwear to diminish the results of any possible mishaps in the future….

[In a separate assessment interview, the psychologist asked Amber’s parents] if any significant changes were going on at home. The question seemed to strike a nerve, as both parents paused and looked at each other nervously before answering. Finally, Mr. Dillon said that he and his wife had been having marital problems within the past year and that they were fighting more than usual. In fact, the possibility of divorce had been raised and both were now considering separation.

(Kearney, 1998, pp. 60–62)

encopresis A childhood disorder characterized by repeated defecating in inappropriate places, such as one’s clothing.

Child Abuse

A problem that affects all too many children and has an enormous impact on their psychological development is child abuse, the nonaccidental use of excessive physical or psychological force by an adult on a child, often with the intention of hurting or destroying the child. At least 5 percent of children in the United States are physically abused each year (Mash & Wolfe, 2012). Surveys suggest that 1 of every 10 children is the victim of severe violence, such as being kicked, bitten, hit, beaten, or threatened with a knife or a gun. In fact, some researchers believe that physical abuse and neglect are the leading causes of death among young children.

Overall, girls and boys are physically abused at approximately the same rate. Although such abuse is perpetrated in all socioeconomic groups, it is apparently more common among the poor (RomeroMartínez et al., 2014; Fowler et al., 2013).

Abusers are usually the child’s parents (Ben-Natan et al., 2014; Humphrey, 2006). Clinical investigators have learned that abusive parents often have poor impulse control, low self-esteem, higher levels of depression, and weak parenting skills (Easterbrooks et al., 2013; Tolan et al., 2006; Mammen et al., 2002). Many were abused themselves as children and have had poor role models (Romero-Martínez et al., 2014; McCaghy et al., 2006). In some cases, they are dealing with stressors such as marital discord or unemployment (Bor et al., 2013; Faust et al., 2008).

Studies suggest that the victims of child abuse may suffer both immediate and long-term psychological effects. Research has shown, for example, that they may have psychological symptoms such as anxiety, depression, or bed-wetting, and that they tend to display more performance and behavior problems in school (Keeshin et al., 2014; Buckingham & Daniolos, 2013). Long-term negative effects include lack of social acceptance, a higher number of medical and psychological disorders during adulthood, more abuse of alcohol and other substances, more impulsive and risk-taking behaviors, more arrests during adolescence and adulthood, a greater risk of becoming criminally violent, a higher unemployment rate, and a higher suicide rate (Afifi et al, 2014; Sujan et al., 2014; Faust et al., 2008). Finally, as many as one-third of those who are abused grow up to be abusive, neglectful, or inadequate parents themselves (RomeroMartínez et al., 2014; Yaghoubi-Doust, 2013; Heyman & Slep, 2002).

Two forms of child abuse have received special attention: psychological and sexual abuse. Psychological abuse may include severe rejection, excessive discipline, scapegoating and ridicule, isolation, and refusal to provide help for a child with psychological problems. It probably accompanies all forms of physical abuse and neglect and often occurs by itself. Child sexual abuse, the use of a child for gratification of adult sexual desires, may occur outside or within the home (Murray, Nguyen, & Cohen, 2014; Faust et al., 2008). Surveys suggest that at least 13 percent of women were forced into sexual contact with an adult male during childhood, many of them with their father or stepfather (Mash & Wolfe, 2012). At least 4 percent of men were also sexually abused during childhood. Child sexual abuse appears to be equally common across all socioeconomic classes, races, and ethnic groups (Murray et al., 2014; McCaghy et al., 2006).

A variety of therapies have been used in cases of child abuse, including groups sponsored by Parents Anonymous, which help parents to develop insight into their behavior, provide training on alternatives to abuse, and teach coping and parenting skills (PA, 2014; Miller et al., 2007; Tolan et al., 2006). In addition, prevention programs, often in the form of home visitations and parent training, have proved promising (Beasley et al., 2014; Rubin et al., 2014).

Research suggests that the psychological needs of children who have been abused should be addressed as early as possible (Murray et al., 2014; Gray et al., 2000; Roesler & McKenzie, 1994). Clinicians and educators have launched valuable early detection programs that (1) educate all children about child abuse, (2) teach them skills for avoiding or escaping from abusive situations, (3) encourage children to tell another adult if they are abused, and (4) assure them that abuse is never their own fault (Miller et al., 2007; Goodman-Brown et al., 2003; Finkelhor et al., 1995).