title: Enuresis and Hyperactivity-Inattention in Early Adolescence: Findings from a Population-Based Survey in Tokyo (Tokyo Early Adolescence Survey).
abstract: BACKGROUND
  Enuresis (9% at age 9.5) negatively affects children's psychosocial status. Clinically-diagnosed enuresis (2% at the age) is associated with hyperactivity-inattention, and common neural bases have been postulated to underlie this association. It is, however, unclear whether this association is applicable to enuresis overall among the general population of early adolescents when considered comorbid behavioral problems. We aimed to examine whether enuresis correlates with hyperactivity-inattention after controlling for the effects of other behavioral problems.
  
  
  METHODS
  Participants were 4,478 children (mean age 10.2 ± 0.3 years old) and their parents from the Tokyo Early Adolescence Survey (T-EAS), a population-representative cross-sectional study conducted in Tokyo, Japan conducted from 2012 to 2015. Children's enuresis and behavioral problems, including hyperactivity-inattention (as measured by the Strength and Difficulties Questionnaire), were examined using parent-reporting questionnaires. Multivariate linear regression was used to explore whether enuresis predicts hyperactivity-inattention.
  
  
  RESULTS
  The hyperactivity-inattention score was significantly higher in the enuretic group than the non-enuretic group (enuretic: M (SD) = 3.8 (2.3), non-enuretic: M (SD) = 3.0 (2.1), Hedge's g = 0.39, p < .001). This association remained significant even after controlling for other behavioral problems and including sex, age, intelligence quotient (IQ), low birth weight and parents' education (β = .054 [95% CI: .028-.080], p < .001).
  
  
  CONCLUSIONS
  Enuresis was independently associated with hyperactivity-inattention in early adolescents among general population even when other behavioral problems were considered. These results suggest that, as with clinically-diagnosed cases, enuresis may predict need for screening and psychosocial support for hyperactivity-inattention.
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.|Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Kanata
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.|University of Tokyo Institute for Diversity and Adaptation of Human Mind (UTIDAHM), The University of Tokyo, Tokyo, Japan.|Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Koike
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.|Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Ando
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nishida
authors.affiliation: Faculty of Human Sciences, Division of Psychology, University of Tsukuba, Tsukuba, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Usami
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
authors.forename: Syudo
authors.initials: S
authors.lastname: Yamasaki
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.|Department of Evolutionary Studies of Biosystems, School of Advanced Sciences, SOKENDAI (The Graduate University for Advanced Studies), Hayama, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Morimoto
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Toriyama
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Fujikawa
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Sugimoto
authors.affiliation: Laboratory of Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Sasaki
authors.affiliation: Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto University, Kyoto, Japan.
authors.forename: Toshiaki A
authors.initials: TA
authors.lastname: Furukawa
authors.affiliation: Department of Evolutionary Studies of Biosystems, School of Advanced Sciences, SOKENDAI (The Graduate University for Advanced Studies), Hayama, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Hiraiwa-Hasegawa
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kiyoto
authors.initials: K
authors.lastname: Kasai
mesh_terms: D000367:Age Factors; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006948:Hyperkinesis / Q000453:epidemiology* / Q000523:psychology; D008297:Male; D053206:Nocturnal Enuresis / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D000066553:Problem Behavior / Q000523:psychology; D012720:Severity of Illness Index; D012737:Sex Factors; D014041:Tokyo