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Published on: June 12, 2020
Association of constipation and fecal incontinence with attention-deficit/hyperactivity disorder
Connor McKeown1, Elizabeth Hisle-Gorman, Matilda Eide
1Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814. cade.nylund@usuhs.edu.
Insights
Children with attention-deficit/hyperactivity disorder (ADHD) have a higher risk of developing functional constipation and fecal incontinence. ADHD medication did not affect the rates of these defecation disorders.
Area of Science:
- Pediatric Gastroenterology
- Child Psychiatry
- Behavioral Pediatrics
Background:
- Functional constipation and fecal incontinence are prevalent pediatric gastrointestinal issues.
- Behavioral problems, including attention-deficit/hyperactivity disorder (ADHD), are often associated with these conditions.
Purpose of the Study:
- To investigate the hypothesis that a diagnosis of ADHD increases the risk for functional constipation and fecal incontinence in children.
Main Methods:
- A retrospective cohort study analyzed data from the military health system database for children aged 4-12 years.
- Diagnostic codes for ADHD, constipation, and fecal incontinence were used to identify cases.
- Relative risks and incidence rate ratios (IRRs) were calculated, with a subgroup analysis for children receiving medical therapy for ADHD.
Main Results:
- Children with ADHD showed a significantly higher prevalence of constipation (4.1% vs 1.5%) and fecal incontinence (0.9% vs 0.15%) compared to those without ADHD.
- Children with ADHD had substantially more healthcare visits for constipation (IRR 3.39) and fecal incontinence (IRR 7.74).
- Medical therapy for ADHD did not significantly alter visit rates for constipation or fecal incontinence.
Conclusions:
- Children diagnosed with ADHD are significantly more prone to experiencing constipation and fecal incontinence.
- Current medical therapies for ADHD do not appear to influence the frequency of visits for these defecation disorders.
Objective:
Functional constipation and fecal incontinence are common childhood gastrointestinal conditions. Both conditions may be associated with behavioral problems. Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral disorder of childhood, characterized by shortened attention span and hyperactivity. We hypothesize that a diagnosis of ADHD increases the risk for functional constipation and fecal incontinence.
Methods:
A retrospective cohort study of children was performed by using the military health system database. Children of active-duty military personnel, aged 4 to 12 years, from October 2005 to September 2007, were included. ADHD, constipation, and fecal incontinence were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Relative risks and adjusted incidence rate ratios (IRRs) were calculated. A subgroup analysis of subjects receiving medical therapy was performed.
Results:
There were 742,939 children identified in the study, 32,773 (4.4%) of whom had ADHD. Children with ADHD had an increased prevalence of constipation (4.1% of children with ADHD vs 1.5% children without ADHD; P < .001) and fecal incontinence (0.9% of children with ADHD vs 0.15% of children without ADHD; P < .0001). Children with ADHD had more visits than those without ADHD for both constipation (IRR 3.39; 95% confidence interval 2.59-4.43) and fecal incontinence (IRR 7.74; 95% confidence interval 5.01-11.98). Children with ADHD receiving medicinal therapy did not differ significantly from children with ADHD not receiving medicinal therapy on rates of constipation visits (P = .57) or fecal incontinence visits (P = .32).
Conclusions:
Children with ADHD are significantly more likely to have constipation and fecal incontinence. Medical therapy for ADHD does not impact visit rates for defecation disorders.
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