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Systematic review and meta-analysis: relationships between attention-deficit/hyperactivity disorder and urinary
Behrang Mahjani1,2,3,4, Lotta Renström Koskela5, Christina Gustavsson Mahjani1,2,3
1Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Insights
Children with attention-deficit/hyperactivity disorder (ADHD) frequently experience lower urinary tract symptoms (LUTS). This study found a significant association between ADHD and LUTS, highlighting the need for clinical awareness and integrated management strategies.
Area of Science:
- Pediatric Urology
- Child and Adolescent Psychiatry
- Behavioral Health
Background:
- Lower urinary tract symptoms (LUTS), including urinary frequency, urgency, and overactive bladder, are prevalent in children.
- Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood.
- The co-occurrence of LUTS and ADHD in children warrants investigation due to potential impacts on clinical management and quality of life.
Purpose of the Study:
- To systematically review and perform a meta-analysis on the relationship between LUTS and ADHD in pediatric populations.
- To quantify the association between ADHD and LUTS in children.
- To explore factors influencing the relationship, such as age and symptom severity.
Main Methods:
- Systematic literature search of PubMed, CENTRAL, and PsycNet for articles published between January 1990 and July 2019.
- Inclusion of studies examining LUTS in children with and without ADHD.
- Random-effects meta-analysis to pool odds ratios and mean scores for LUTS in children with ADHD compared to controls.
Main Results:
- Children with LUTS had a significantly higher odds of having ADHD (OR 2.99).
- Children with ADHD exhibited significantly higher overall LUTS scores compared to controls.
- Increased ADHD severity positively correlated with LUTS severity; younger age was associated with higher LUTS scores.
Conclusions:
- There is a clinically significant association between ADHD and LUTS in children.
- Clinicians should consider the potential co-occurrence of ADHD and LUTS in pediatric assessments.
- Awareness of this association can inform improved diagnostic and treatment strategies for affected children.
Abstract:
Lower urinary tract symptoms (LUTS), e.g., urinary frequency, pressure, urgency, and overactive bladder syndrome, are commonly reported in children with attention-deficit/hyperactivity disorder (ADHD). Understanding the co-occurrence of these conditions has implications regarding clinical approaches, treatments, and improved quality of life. We conducted a systematic review and meta-analysis to examine the relationships between LUTS and ADHD in children. We searched for articles published between January 1990 and July 2019, in PubMed, CENTRAL, and PsycNet. Two authors independently screened all articles and extracted data. We performed random-effect meta-analyses for ADHD with pooled outcomes for LUTS. We identified 119 relevant articles in the literature and 18 articles fulfilled the inclusion criteria for the systematic review, of which, 5 articles had sufficient data for meta-analysis. Examining ADHD among individuals with LUTS, the odds ratio was 2.99 (95% CI 1.13, 7.88, p < 0.001), compared to controls. In multiple studies, the mean overall score for LUTS, using a standardized measure, was significantly higher in patients with ADHD in comparison to controls, and the severity of ADHD was positively associated with the severity of LUTS. Younger age in children was correlated with a higher LUTS score. Different subtypes of urinary incontinence demonstrated differences in behavioral problems and psychiatric comorbidity. Sex differences in LUTS were not consistent across articles. Our results indicate clinically significant associations between ADHD and LUTS in children. Because LUTS and ADHD are common disorders in children, clinicians should be aware of these associations as they inform optimal assessment and treatment strategies.
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