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Incontinence in children with treated attention-deficit/hyperactivity disorder

J Niemczyk¹, M Equit¹, L Hoffmann¹

¹Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421 Homburg, Germany.

Journal of Pediatric Urology

|April 13, 2015

Insights

Children treated for Attention-deficit/hyperactivity disorder (ADHD) showed similar incontinence rates to controls, but achieved bladder and bowel control later. ADHD treatment may improve incontinence outcomes, highlighting the need for screening in both conditions.

Area of Science:

Pediatric neurology
Child psychiatry
Urology

Background:

Attention-deficit/hyperactivity disorder (ADHD) and childhood incontinence are prevalent and associated conditions.
ADHD can negatively impact adherence and outcomes in incontinence therapy.

Purpose of the Study:

To compare the prevalence of incontinence, age of achieving bladder and bowel control, and psychological symptoms in children treated for ADHD versus a control group.
To investigate the association between ADHD and incontinence.

Main Methods:

A case-control study involving 40 children treated for ADHD and 43 matched controls.
Parents completed validated questionnaires assessing psychopathology, incontinence, and lower urinary tract symptoms.
Standardized instruments were used for ICD-10 diagnoses and IQ assessment.

Main Results:

Incontinence rates did not significantly differ between the ADHD and control groups.
Children with ADHD exhibited higher rates of clinical psychopathology and delayed daytime/nighttime bladder and bowel control.
More children with ADHD had co-occurring ICD-10 disorders compared to controls.

Conclusions:

Standard ADHD treatment is associated with similar incontinence rates to the general population.
Delayed continence in ADHD may suggest maturational deficits.
Children with ADHD show increased psychological symptoms; screening for both ADHD and incontinence is recommended.

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Abstract

Introduction:

Attention-deficit/hyperactivity disorder (ADHD) and incontinence (nocturnal enuresis, daytime urinary incontinence and fecal incontinence) are common disorders in childhood. Both disorders are strongly associated with each other.

Objective:

ADHD can affect compliance to incontinence therapy in a negative way; it can also affect outcome. The aim of the present study was to assess the prevalence of incontinence, age of bladder and bowel control, and psychological symptoms in children having treatment for ADHD compared to a control group.

Study Design:

Forty children having treatment for ADHD (75% boys, mean age 11.4 years) and 43 matched controls (60.5% boys, mean age 10.7 years) were assessed. Their parents filled out questionnaires to assess: child psychopathology (Child Behavior Checklist), incontinence (Parental Questionnaire: Enuresis/Urinary Incontinence; Encopresis Questionnaire - Screening Version) and symptoms of the lower urinary tract (International-Consultation-on-Incontinence-Questionnaire - Pediatric Lower Urinary Tract Symptoms). The ICD-10 diagnoses and children's IQ were measured by standardized instruments (Kinder-DIPS, Coloured Progressive Matrices/Standard Progressive Matrices).

Results:

Rates of incontinence in the ADHD group (5% nocturnal enuresis, 5% daytime urinary incontinence, 2.5% fecal incontinence) did not differ significantly from incontinence rates in the control group (4.7% daytime urinary incontinence). More children in the ADHD group had Child Behavior Checklist scores in the clinical range. Further ICD-10 disorders were present in eight children with ADHD and in one control child. More children with ADHD had delayed daytime and nighttime bladder control, as well as delayed bowel control, than the controls.

Discussion:

The present study showed that if children are treated for their ADHD, according to standard practice guidelines, incontinence rates are similar to those without ADHD. More children with ADHD reached continence at a later age than the controls, which could be an indicator of maturational deficits in the central nervous system. Additionally, children with ADHD showed higher rates of clinically relevant psychological symptoms.

Conclusion:

This study provides further information of the association between ADHD and incontinence. Treatment of ADHD may be associated with positive effects on incontinence outcomes. Therefore, children with ADHD should always be screened for incontinence problems and children with incontinence problems should also be screened for ADHD if symptoms of hyperactivity, inattention and/or impulsivity are also present.

Keywords:

Attention-deficit/hyperactivity disorder Daytime urinary incontinence Delayed bladder and bowel control Enuresis Fecal incontinence Functional incontinence

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