title: Neuropsychological functioning related to specific characteristics of nocturnal enuresis.
abstract: BACKGROUND
  There is a high comorbidity demonstrated in the literature between nocturnal enuresis and several neuropsychological dysfunctions, with special emphasis on attention deficit hyperactivity disorder (ADHD). However, the majority of the psychological studies did not include full non-invasive screening and failed to differentiate between monosymptomatic nocturnal enuresis (MNE) and non-MNE patients.
  
  
  OBJECTIVE
  The present study primarily aimed to investigate the association between nocturnal enuresis and (neuro)psychological functioning in a selective homogeneous patient group, namely: children with MNE and associated nocturnal polyuria (NP). Secondly, the study investigated the association between specific characteristics of nocturnal enuresis (maximum voided volume, number of wet nights and number of nights with NP) and ADHD-inattentive symptoms, executive functioning and quality of life.
  
  
  METHODS
  The psychological measurements were multi-informant (parents, children and teachers) and multi-method (questionnaires, clinical interviews and neuropsychological testing).
  
  
  RESULTS
  Thirty children aged 6-16 years (mean 10.43 years, SD 3.08) were included. Of them, 80% had at least one psychological, motor or neurological difficulty. The comorbid diagnosis of ADHD, especially the predominantly inattentive presentation, was most common. According to the teachers, a low maximum voided volume (corrected for age) was associated with more attention problems, and a high number of nights with NP was associated with more behaviour-regulation problems. No significant correlations were found between specific characteristics of enuresis and quality of life. Details are demonstrated in Table.
  
  
  CONCLUSIONS
  The children were recruited from a tertiary referral centre, which resulted in selection bias. Moreover, NP was defined as a urine output exceeding 100% of the expected bladder capacity for age (EBC), and not according to the expert-opinion-based International Children's Continence Society norm of 130% of EBC. The definition for NP of a urine output exceeding 100% of the EBC is more in line with the recent findings of the Aarhus group.
  
  
  CONCLUSIONS
  For children with MNE and associated NP, a high comorbidity with the predominantly inattentive presentation of ADHD was demonstrated. Children experienced problems with daytime functioning in relation to their wetting problem at night. According to the teachers, a low maximum voided volume was associated with more attention problems, and a high number of nights with NP was associated with more behaviour-regulation problems. Although comorbidity is still the appropriate word to use, the observation favours a more complex pathogenesis of enuresis with a common pathway in the central nervous system, including: neurotransmitters, influencing neuropsychological functioning as well as sleep, circadian rhythm of diuresis and bladder function control.
authors.affiliation: Department of Pediatric Nephrology/Urology, University Hospital Ghent, Ghent, Belgium. Electronic address: charlotte.vanherzeele@ugent.be.
authors.forename: C
authors.initials: C
authors.lastname: Van Herzeele
authors.affiliation: Child Neurology & Metabolism, Pediatric Sleep Center, University Hospital Ghent, Ghent, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Dhondt
authors.affiliation: Department of Data-Analysis, University Ghent, Ghent, Belgium.
authors.forename: S P
authors.initials: SP
authors.lastname: Roels
authors.affiliation: Department of Pediatric Nephrology/Urology, University Hospital Ghent, Ghent, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Raes
authors.affiliation: Department of Pediatric Nephrology/Urology, University Hospital Ghent, Ghent, Belgium.
authors.forename: L-A
authors.initials: LA
authors.lastname: Groen
authors.affiliation: Department of Pediatric Nephrology/Urology, University Hospital Ghent, Ghent, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Hoebeke
authors.affiliation: Department of Pediatric Nephrology/Urology, University Hospital Ghent, Ghent, Belgium.
authors.forename: J Vande
authors.initials: JV
authors.lastname: Walle
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D002648:Child; D002940:Circadian Rhythm / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D053206:Nocturnal Enuresis / Q000150:complications / Q000503:physiopathology / Q000523:psychology*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014554:Urination / Q000502:physiology*
keywords: Child; Child psychology; Enuresis; Polyuria