I swear by the Malem alarm. Best $100 ever spent. EVER. DD1 was 5 turning 6 when we used it. Took about a month to really take hold. Yes, it trains the body to recognize when the bladder is full and signals the body to either wake up or hold it. Many nights DD1 will wake up to go to the bathroom at least once. But she's also not waking up multiple times a night (she was when we first started using the alarm). So I'd say it helped her in both ways...the waking and the ability to hold longer. Once we quit the alarm (you are supposed to continue using it until you've had 14 consecutive dry days) I think she had 1 or 2 random accidents and then has been dry ever since.
Yes a parent can wake their child but IMO this just trains the parent to wake the kid and not the kid to recognize the urge/need and wake themselves. We used the basic alarm that sounds and vibrates on just one setting. DD1 is a very VERY deep sleeper and we found the basic model enough to wake her (and us!). We were very low pressure with it. We explained it to DD1, let her decide if she wanted to try it, and gave her permission to let us know if she wanted to quit it at any time. She tends to be an anxious child already and didn't want her to feel like a failure. She stuck with it and was really proud of herself.
Mom to two amazing DDs ('07 & '09) and a fur baby.
Gluten free since Nov '11 after non-celiac gluten sensitive diagnosis. Have had great improvement or total elimination of: migraines, bloating/distention, heartburn, cystic acne, canker sores, bleeding gums, eczema on elbows, dry skin and scalp, muscle cramps, PMS, hair loss, heart palpitations, fatigue. I'm amazed.