title: Nocturnal incontinence in children with fetal alcohol spectrum disorders (FASD) in a South African cohort.
abstract: BACKGROUND
  Fetal alcohol spectrum disorders (FASD) are one of the leading preventable causes of intellectual disabilities (ID). Not much is known about the topic of pediatric incontinence related to FASD, for example nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI). So far, incontinence problems have been examined among children with other specific syndromes.
  
  
  OBJECTIVE
  The aim of the present study is to investigate the possible presence of incontinence among children with FASD in a South African cohort.
  
  
  METHODS
  The South African version of the combined questionnaire including the "Parental Questionnaire: Enuresis/Urinary Incontinence" and "Encopresis Questionnaire - Screening Version"; and lower urinary tract symptoms (LUTS) were assessed by the "International-Consultation-on-Incontinence-Questionnaire - Pediatric Lower Urinary Tract Symptom" (ICIQ-CLUTS) among 99 interviewees (e.g. mothers, grandparents) of children with FASD. Moreover, scores on the "Griffiths Mental Development Scales - Extended Revised" (GMDS-ER) were obtained of all included children for further statistical analysis.
  
  
  RESULTS
  The overall incontinence rate was 20% (n = 20), in children diagnosed within the FASD spectrum (fetal alcohol syndrome or FAS n = 17, partial fetal alcohol syndrome or pFAS, n = 1, alcohol related neurodevelopmental disorder or ARND n = 2). NE affected 16% (n = 16) of children with a FASD (FAS n = 13, pFAS n = 1, and ARND n = 2). DUI was reported in one child (FAS), and FI in 4% (n = 4) of children (again, only FAS). No indication of lower urinary tract symptoms (LUTS) in the clinical range was reported (sample mean score = 5.17). Based on the GMDS-ER, 88% of the children scored lower than 10th percentile.
  
  
  CONCLUSIONS
  This is a first study to examine the problems of incontinence among children diagnosed within the spectrum of FASD. The rates for children with a FASD are lower than the rates for many children with special needs, but much higher than for typically developing children. Children with a FASD are mainly affected by NE.
  
  
  CONCLUSIONS
  The problem of incontinence among children with a FASD in South Africa needs to be assessed and considered for clinical management. Future research is necessary to examine problems of incontinence in relation to cognitive and behavioral functioning among children with a FASD, as well as identifying possible causes.
authors.affiliation: Governor Kremers Centre - Maastricht University Medical Centre+, Maastricht, The Netherlands; Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands. Electronic address: sylvia.roozen@maastrichtuniversity.nl.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Roozen
authors.affiliation: Governor Kremers Centre - Maastricht University Medical Centre+, Maastricht, The Netherlands; Foundation for Alcohol Related Research, Bellville, South Africa; Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
authors.forename: Leana
authors.initials: L
authors.lastname: Olivier
authors.affiliation: Governor Kremers Centre - Maastricht University Medical Centre+, Maastricht, The Netherlands; Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
authors.forename: Justine
authors.initials: J
authors.lastname: Niemczyk
authors.affiliation: Governor Kremers Centre - Maastricht University Medical Centre+, Maastricht, The Netherlands; 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 Work and Social Psychology, Maastricht University, Maastricht, The Netherlands; Faculty of Psychology and Education Science, Open University of the Netherlands, Heerlen, The Netherlands.
authors.forename: Gjalt-Jorn Y
authors.initials: GY
authors.lastname: Peters
authors.affiliation: Governor Kremers Centre - Maastricht University Medical Centre+, Maastricht, The Netherlands; Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands.
authors.forename: Gerjo
authors.initials: G
authors.lastname: Kok
authors.affiliation: Foundation for Alcohol Related Research, Bellville, South Africa; Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa; Department of Human Genetics, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Denis
authors.initials: D
authors.lastname: Viljoen
authors.affiliation: Governor Kremers Centre - Maastricht University Medical Centre+, Maastricht, The Netherlands.
authors.forename: Leopold
authors.initials: L
authors.lastname: Curfs
mesh_terms: D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D003906:Developing Countries; D053207:Diurnal Enuresis / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D053206:Nocturnal Enuresis / Q000175:diagnosis / Q000453:epidemiology*; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013019:South Africa; D011795:Surveys and Questionnaires
keywords: Daytime urinary incontinence; Fecal incontinence; Fetal alcohol spectrum disorder(s); Fetal alcohol syndrome; Nocturnal enuresis