title: Incontinence in children with autism spectrum disorder.
abstract: BACKGROUND
  Autism spectrum disorder (ASD) and incontinence (nocturnal enuresis (NE), daytime urinary incontinence (DUI), fecal incontinence (FI)) are relevant disorders in childhood. In general, children with special needs such as intellectual disability (ID) or ASD are more often affected by incontinence than typically developing children.
  
  
  OBJECTIVE
  In the few studies conducted on children with ASD, gastrointestinal (GI) symptoms have received more attention than NE, DUI and lower urinary tract symptoms (LUTS). The aim of the present study was to assess the prevalence of incontinence, LUTS and psychological symptoms/disorders in children with ASD compared to controls.
  
  
  METHODS
  Forty children with ASD (12 children with infantile or childhood autism, 15 with atypical autism and 13 with Asperger's syndrome) (mean age 11.3 years) and 43 age-matched control children (mean age 10.7 years) were assessed. A questionnaire referring to incontinence and the International Consultation on Incontinence Questionnaire-Pediatric LUTS (ICIQ-CLUTS) were administered. Child psychopathology was assessed with the Child Behavior Checklist (CBCL/4-18). Child psychiatric ICD-10 diagnoses were based on a structured psychiatric interview (Kinder-DIPS).
  
  
  RESULTS
  Children with ASD showed increased rates of NE (30.0% vs 0%) and DUI (25.0% vs 4.7%) compared to controls. Among children with ASD, daytime bladder control (≥5 years of age: 20.5% vs 0%) and bowel control (≥4 years of age: 42.5% vs 7.5%) were delayed compared to controls. Children with ASD had a higher LUTS score. Additionally, children with ASD were more often affected by psychological symptoms and disorders. Rates of clinically relevant externalizing symptoms (32.5% vs 0%), internalizing symptoms (67.5% vs 9.3%) and total problem score (70.0% vs 2.1%) were higher in children with ASD than the controls (see table). Children with ASD had more ICD-10 diagnoses than the controls (47.5% vs 4.7%).
  
  
  CONCLUSIONS
  The present study showed that children with ASD are more at risk of DUI and NE than healthy controls. In addition, children with ASD had more LUTS, especially urgency and postponement, and they needed a longer time to become dry and continent. Additionally, according to the parental CBCL questionnaire, children with ASD showed higher rates of clinically relevant psychological symptoms (externalizing and internalizing symptoms), and according to the psychiatric interview, they had higher rates of comorbid psychological disorders.
  
  
  CONCLUSIONS
  Autism spectrum disorder is an incapacitating disorder with significant impairment in social functioning. In most cases, psychological symptoms and disorders co-occur. Additionally, children with ASD are at a greater risk of being affected by different forms of incontinence and LUTS. Therefore, screening for incontinence and, if indicated, treatment of these disorders is recommended.
authors.affiliation: Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany. Electronic address: alexander.gontard@uks.eu.
authors.forename: A
authors.initials: A
authors.lastname: von Gontard
authors.affiliation: Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany. Electronic address: maike.pirrung@t-online.de.
authors.forename: M
authors.initials: M
authors.lastname: Pirrung
authors.affiliation: Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany. Electronic address: Justine.niemczyl@uks.eu.
authors.forename: J
authors.initials: J
authors.lastname: Niemczyk
authors.affiliation: Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany. Electronic address: monika.equit@uks.eu.
authors.forename: M
authors.initials: M
authors.lastname: Equit
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000067877:Autism Spectrum Disorder / Q000150:complications* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D053207:Diurnal Enuresis / Q000150:complications / Q000453:epidemiology*; D005242:Fecal Incontinence; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D053206:Nocturnal Enuresis / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D011795:Surveys and Questionnaires
keywords: Autism spectrum disorder; Daytime urinary incontinence; Fecal incontinence; Lower urinary tract symptoms; Nocturnal enuresis