An evaluation of parental attitudes and attachment in children with primary monosymptomatic nocturnal enuresis: A case-control study

Published:November 19, 2022DOI:



      Enuresis is a common childhood disorder associated with the lack of bladder control that would be expected based on the child’s age or developmental stage. Enuresis affects the lives of both children and their parents due to the burden it entails in daily life.


      In this study, we aimed to evaluate the dimensions of attachment between children with enuresis and their mothers, as well as the relationship with parental attitudes.


      This study included 70 children were diagnosed with primary monosymptomatic nocturnal enuresis (PMNE) based on the guidelines of the International Children's Continence Society (ICCS) along with 70 children with not enuresis and any psychiatric disorders. We asked the mothers of all participants to complete the Parental Attitude Research Instrument, and the children to complete The Experiences in Close Relationships Scale Revised – Middle Childhood.


      Both groups in our study were well balanced in terms of gender, age, and sociodemographic data. Children with enuresis were found to score higher on the anxiety and avoidance dimensions of the attachment scale with statistical significance (p < 0.01). Also, on the scale completed by the mothers of children with enuresis, the subtests indicating overprotective parenting and strict discipline presented significant differences (p < 0.01).


      Data obtained in our study demonstrate that enuresis can have a negative effect on the mother-child attachment and parental attitudes. The use of harsh language or punishment by the mother in response to the failure of the child to achieve nocturnal dryness may affect the attachment between the mother and the child, and cause the child to experience negative emotions such as shame, anxiety, embarrassment, frustration, and loneliness.


      Summary TableClinical properties of the patient and control groups.
      PMNE group Control group p
      mean ± std mean ± std
      PARI Overprotective parenting 47.58 ± 8.29 39.48 ± 9.61 <0.01
      Strict Discipline 39.35 ± 8.11 34.04 ± 8.05 0,001
      ECR-RC Middle Childhood Anxiety 52.73 ± 16.43 32.88 ± 7.98 <0.01
      Avoidance 40.26 ± 14.27 29.48 ± 9.18 <0.01
      ECR-RC Middle Childhood: The Experiences in Close Relationships Scale Revised – Middle Childhood; PARI: Parental Attitude Research Instrument; PMNE: Primary Monosymptomatic Nocturnal Enuresis; STD: standard deviation.


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