Characterization and management of voiding dysfunction in children with attention deficit hyperactivity disorder
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Published on: June 12, 2020
Jonathan D Kaye1, Lane S Palmer
1Division of Urology, Schneider Children's Hospital of the North Shore-Long Island Jewish Health System, Long Island, New York 11042, USA.
Insights
Individualized therapy effectively treated voiding dysfunction (VD) in children with attention deficit hyperactivity disorder (ADHD). Most children experienced symptom improvement or resolution with tailored treatments, including behavioral modification and medication.
Area of Science:
- Pediatric urology
- Child psychology
- Neurodevelopmental disorders
Background:
- Attention deficit hyperactivity disorder (ADHD) is associated with a higher incidence of voiding dysfunction (VD) compared to the general population.
- VD in children with ADHD is often more challenging to treat.
- Common symptoms include daytime wetting, urgency, frequency, and sleep enuresis.
Purpose of the Study:
- To determine the efficacy of individualized therapy for treating VD in children with ADHD.
- To characterize the range of voiding symptoms observed in children with ADHD.
Main Methods:
- A cohort of 75 children with ADHD and VD underwent a comprehensive evaluation including history, physical examination, and urologic assessments.
- Treatment plans were individualized, incorporating behavioral modification, bowel/diet management, biofeedback, and pharmacotherapy.
- Follow-up assessments monitored treatment response.
Main Results:
- Of 56 children who adhered to treatment, 83.9% showed complete resolution or improvement of daytime voiding symptoms.
- Complete resolution was achieved in 30.4% of patients, with varying treatment modalities.
- Partial response was observed in 53.6%, often requiring multimodal approaches.
Conclusions:
- Individualized therapy is a successful approach for managing VD in children with ADHD.
- Multimodal treatment, combining behavioral modification with anticholinergic agents and/or biofeedback, is effective for most cases.
- Diurnal voiding symptoms are the most frequent complaint leading to referral in this population.
Objectives:
To investigate whether voiding dysfunction (VD) in children with attention deficit hyperactivity disorder (ADHD) could be treated successfully using individualized therapy. We also sought to describe the spectrum of voiding symptoms experienced by children with ADHD. ADHD is diagnosed in 3-5% of children. These children have a greater incidence of VD than non-ADHD controls, and it is less amenable to treatment.
Methods:
A comprehensive history assessed the nature of the voiding disorder. A physical examination, screening urologic ultrasonography, and urinalysis were routinely performed, with electromyography combined with uroflowmetry performed for certain cases. Treatment was individualized to include behavioral modification, bowel and diet management, biofeedback, pharmacotherapy, and close follow-up.
Results:
A total of 75 children with ADHD were referred because of VD. The 75 children (39 boys and 36 girls) were 5-16 years old. Of the 75 children, 60 were taking medication for ADHD. All the children had daytime wetting (>1/d, 5-7 d/wk) and urgency. In addition, 88% had frequency and 87% had sleep enuresis. Of the 75 families, 56 proceeded with our prescribed program. Of the 56 children, 47 (83.9%) had complete resolution or improvement of the daytime symptoms. Of the 17 patients (30.4%) with complete resolution, 9 responded to behavior modification and anticholinergics and 8 needed biofeedback. Of the 30 patients with a partial response (53.6%), 9 responded to behavior modification alone, 15 to behavior modification and anticholinergics, and 6 required all 3 modalities. Of the 56 children, 9 failed to respond to any of the 3 modalities.
Conclusions:
Diurnal symptoms constituted the most common referred complaint in children with ADHD. VD can be successfully treated if the treatment is individualized. Multimodal treatment, including behavior modification combined with anticholinergic agents and/or biofeedback, appears to be effective in managing VD in most of these challenging cases.
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