title: Specific behavioral comorbidity in a large sample of children with functional incontinence: Report of 1,001 cases.
abstract: OBJECTIVE
  Psychological comorbidity among children with functional incontinence is high: 20-30% of children with nocturnal enuresis (NE), 20-40% of those with daytime urinary incontinence (DUI) and 30-50% of those with fecal incontinence (FI) have clinically relevant comorbid disorders. The aim of this study was to analyze specific comorbid behavioral symptoms for different subtypes of incontinence in a large group of children.
  
  
  METHODS
  All 1,001 consecutive children and adolescents (67.5% boys) with a mean age of 8.5 years presented at a tertiary outpatient department between 2004 and 2011 were examined with a full pediatric and child psychiatric assessment. Prevalence of different subforms of incontinence and associated behavioral symptoms were analyzed. The internalizing, externalizing, and total problem scores of the Child Behavior Checklist (CBCL) were evaluated.
  
  
  RESULTS
  Of all children, 70.1% (702 children) had NE, 36.1% (361 children) had DUI, and 36.8% (368 children) were affected by FI. More than 43% of all children had clinically relevant psychological symptoms (CBCL total score, cut-off at 90th percentile). Children with non-retentive FI had highest rates of clinically relevant psychological symptoms (58.8%). Children with combined subtypes of incontinence (any combination of NE, DUI, and FI) were more affected by psychological comorbidities than children with isolated subtypes (NE or DUI or FI).
  
  
  CONCLUSIONS
  Children with incontinence have high rates of comorbid behavioral symptoms-three to six times higher than norms. Especially children with FI and combined subtypes of incontinence were affected. As behavioral symptoms and disorders will interfere with incontinence treatment, a general screening is recommended.
authors.affiliation: Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: von Gontard
authors.affiliation: Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
authors.forename: Justine
authors.initials: J
authors.lastname: Niemczyk
authors.affiliation: Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
authors.forename: Michaela
authors.initials: M
authors.lastname: Weber
authors.affiliation: Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Equit
mesh_terms: D000293:Adolescent; D001526:Behavioral Symptoms / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000523:psychology
keywords: Child Behavior Checklist; behavioral comorbidity; children; constipation; daytime urinary incontinence; fecal incontinence; nocturnal enuresis; non-retentive fecal incontinence; urge incontinence; voiding postponement