Cognitive disengagement and emotional-behavioral profiles in children with voiding dysfunction: a controlled clinical...

Voiding dysfunction (VD) is a common condition in childhood that is associated with lower urinary tract symptoms and bowel dysfunction. It may also adversely affect patients' emotional, behavioral, and social functioning. This cross-sectional case-control study evaluated emotional and behavioral problems, attention-related symptoms, and cognitive disengagement syndrome (CDS) in children with VD and examined their relationship with lower urinary symptoms severity and constipation. VD was diagnosed according to International Children's Continence Society criteria using voiding diaries, imaging findings, and Dysfunctional Voiding Symptom Score (DVSS ≥ 9). Emotional and behavioral symptoms were assessed using the Strengths and Difficulties Questionnaire, and attention-related and CDS symptoms were evaluated with the Barkley Child Attention Scale (BCAS). The study population included 72 children aged 6-12 years with VD and 46 age- and sex-matched healthy controls. Children with VD showed significantly more severe attention-deficit/hyperactivity disorder (ADHD) symptoms, emotional problems, behavioral difficulties, and peer problems, as well as higher total difficulty scores compared with controls. Increasing DVSS were positively associated with greater emotional-behavioral difficulties and poorer quality of life. Children with both daytime and nighttime urinary incontinence and those with concomitant constipation exhibited the highest psychosocial burden. In contrast, CDS-related symptoms did not differ significantly between children with VD and healthy controls. Conclusion: These findings indicate that VD is associated with a substantial emotional and behavioral burden, particularly attention-related difficulties, whereas CDS does not appear to be specifically linked to VD. Routine psychological screening and a multidisciplinary, biopsychosocial approach may improve symptom management and quality of life in affected children.