title: Incontinence in children with treated attention-deficit/hyperactivity disorder.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421 Homburg, Germany. Electronic address: justine.niemczyk@uks.eu.
authors: J
authors: J
authors: Niemczyk
authors: Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421 Homburg, Germany.
authors: M
authors: M
authors: Equit
authors: Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421 Homburg, Germany.
authors: L
authors: L
authors: Hoffmann
authors: Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421 Homburg, Germany.
authors: A
authors: A
authors: von Gontard
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D016022:Case-Control Studies; D002648:Child; D053207:Diurnal Enuresis / Q000453:epidemiology*; D005242:Fecal Incontinence / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D053206:Nocturnal Enuresis / Q000453:epidemiology*; D015995:Prevalence
keywords: Attention-deficit/hyperactivity disorder; Daytime urinary incontinence; Delayed bladder and bowel control; Enuresis; Fecal incontinence; Functional incontinence