title: Association of attention deficit and elimination disorders at school entry: a population based study.
abstract: OBJECTIVE
  Attention deficit/hyperactivity disorder is a common comorbid disorder in children with nocturnal enuresis, daytime urinary incontinence and fecal incontinence. We assessed the specific association of these conditions in a population based sample. We hypothesized that children with elimination disorders have a higher rate of attention deficit/hyperactivity disorder, and that children with daytime urinary incontinence are more strongly affected than those with nocturnal enuresis.
  
  
  METHODS
  All children in a defined geographic area (Saarpfalz Kreis) were examined at school entry. Mean age was 6.22 years in 734 boys and 6.18 years in 645 girls. A questionnaire regarding elimination problems and the attention problems scale of the Child Behavior Checklist were administered as an interview to parents. Participation rate was 99.1% (1,379 parents).
  
  
  RESULTS
  Of the children 71 (5.1%) had attention deficit/hyperactivity disorder problems of clinical relevance (7.1% of boys and 2.9% of girls). A total of 185 children (13.4%) were wet (nocturnal enuresis in 9.1% and daytime urinary incontinence in 4.4%) and 19 (1.4%) had fecal incontinence. Attention deficit/hyperactivity disorder symptoms were more common in children with urinary incontinence than nonwetting children (16.8% vs 3.4%). When controlled for confounding variables, only children with daytime urinary incontinence (but not nocturnal enuresis) had a significantly higher risk of attention deficit/hyperactivity disorder symptoms (OR 4.4).
  
  
  CONCLUSIONS
  Attention deficit/hyperactivity disorder symptoms were increased in children with urinary incontinence in this population based sample. Children with daytime urinary incontinence were at greater risk for attention deficit/hyperactivity disorder than those with nocturnal enuresis. Screening and referral for specialized treatment of both disorders are recommended.
authors.affiliation: Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany. alexander.von.gontard@uks.eu
authors.forename: A
authors.initials: A
authors.lastname: von Gontard
authors.forename: A M
authors.initials: AM
authors.lastname: Moritz
authors.forename: S
authors.initials: S
authors.lastname: Thome-Granz
authors.forename: C
authors.initials: C
authors.lastname: Freitag
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003248:Constipation / Q000453:epidemiology; D053207:Diurnal Enuresis / Q000453:epidemiology*; D005242:Fecal Incontinence / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D053206:Nocturnal Enuresis / Q000453:epidemiology*; D012307:Risk Factors