A Survey of Voiding Dysfunction in Children With Attention Deficit-Hyperactivity Disorder

Duel, Barry P.; Steinberg-Epstein, Robin; Hill, Maryann; Lerner, Marc

doi:10.1097/01.ju.0000091219.46560.7b

Cited by 104 publications

(71 citation statements)

References 3 publications

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“…Also, the presence of psychological and behavioural disorders leads to less favourable treatment outcomes. For instance, children with attention deficit hyperactivity disorder (ADHD) tend to have more significant LUTS 15,16 and are more challenging to treat. In those cases, it is essential to treat both ADHD and BBD for optimal response to treatment.…”

Section: Psychosocial Burden and Association With Behavioural And Neumentioning

confidence: 99%

Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem

Santos

Lopes

Koyle

2017

CUAJ

131

126

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Bladder and bowel dysfunction (BBD) describes a spectrum of lower urinary symptoms (LUTS) accompanied by fecal elimination issues that manifest primarily by constipation and/or encopresis. This increasingly common entity is a potential cause of significant physical and psychosocial burden for children and families. BBD is commonly associated with vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTIs), which at its extreme may lead to renal scarring and kidney failure. Additionally, BBD is frequently seen in children diagnosed with behavioural and neuropsychiatric disorders such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Patients with concomitant BBD and neuropsychiatric disorders have less favourable treatment outcomes. Early diagnosis and treatment of BBD are critical to avoid secondary comorbidities that can adversely impact children's kidney and bladder function, and psychosocial well-being. The majority of patients will improve with urotherapy, adequate fluid intake, and constipation treatment. Pharmacological treatment must only be considered if no improvement occurs after intensive adherence to at least six months of urotherapy ± biofeedback and constipation treatment. Anticholinergics remain the mainstay of medical treatment. Selective alpha-blockers appear to be effective for improving bladder emptying in children with non-neurogenic detrusor overactivity (DO), incontinence, recurrent UTIs, and increased post-void residual (PVR) urine volumes. Alpha-1 blockers can also be used in combination with anticholinergics when overactive bladder (OAB) coexists with functional bladder outlet obstruction. Minimally invasive treatment with onabotulinumtoxinA bladder injections, and recently neurostimulation, are promising alternatives for the management of BBD refractory to behavioural and pharmacological treatment.In this review, we discuss clinical presentation, diagnostic approach, and indications for behavioural, pharmacological, and surgical treatment of BBD in children based on a thorough literature review. Expert opinion will be used when scientific evidence is unavailable.

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Section: Psychosocial Burden and Association With Behavioural And Neumentioning

confidence: 99%

Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem

Santos

Lopes

Koyle

2017

CUAJ

131

126

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“…16 Attention-deficit disorders (ADDs) somewhat confound the issue, because here the wetting constitutes the comorbidity. 17,18 The prevalence of ADDs is higher in boys than in girls, and the wetting consists of uncontrolled voidings at daytime, or nighttime, or both, quite different from the small amounts of urine lost in functional urinary incontinence. 19 Achenbach's Child Behavior Checklist (CBCL) 20,21 was incorporated in a multicenter prospective study comparing different treatment modalities for NNBSD: the European Bladder Dysfunction Study (EBDS).…”

mentioning

confidence: 99%

Behavior Profiles in Children With Functional Urinary Incontinence Before and After Incontinence Treatment

Bael

Winkler²,

Lax

et al. 2008

Pediatrics

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Since the 1980s, urinary incontinence and bed-wetting started to be seen as functional problems, with behavioral problems secondary to the bed-wetting. Behavioral problems in bed-wetting is studied extensively, but much less has been studied regarding behavioral problems in functional incontinence. What This Study AddsAbnormal behavior scores in children with functional incontinence were studied prospectively, before and after treatment for incontinence, as part of a randomized controlled trial. ABSTRACTOBJECTIVE. The purpose of this work was to analyze prospectively the prevalence of behavioral disorders in children with urinary incontinence because of nonneuropathic bladder-sphincter dysfunction before and after treatment for incontinence. METHODS.A total of 202 children with nonneuropathic bladder-sphincter dysfunction were enrolled in the European Bladder Dysfunction Study, in branches for urge syndrome (branch 1) and dysfunctional voiding (branch 2); 188 filled out Achenbach's Child Behavior Checklist before treatment and 111 after treatment. Child Behavior Checklist scales for total behavior problems were used along with subscales for externalizing problems and internalizing problems.RESULTS. After European Bladder Dysfunction Study treatment, the total behavior problem score dropped from 19% to 11%, the same prevalence as in the normative population; in branch 1 the score dropped from 14% to 13%, and in branch 2 it dropped from 23% to 8%. The prevalence of externalizing problems dropped too, from 12% to 8%: in branch 1 it was unchanged at 10%, and in branch 2 it dropped from 14% to 7%. The decrease in prevalence of internalizing problems after treatment, from 16% to 14%, was not significant.CONCLUSION. More behavioral problems were found in dysfunctional voiding than in urge syndrome, but none of the abnormal scores related to the outcome of European Bladder Dysfunction Study treatment for incontinence. With such treatment, both the total behavior problem score and the score for externalizing problems returned to normal, but the score for internalizing problems did not change. The drops in prevalence are statistically significant only in dysfunctional voiding. F UNCTIONAL URINARY INCONTINENCE is a leading symptom of both urge syndrome and dysfunctional voiding. These 2 clinical entities occur mainly in girls, 1-3 as manifestations of nonneuropathic bladder-sphincter dysfunction (NNBSD), and have always been associated with behavior problems; the International Classification of Diseases, 10th Revision, lists both "enuresis of nonorganic origin" and "urinary incontinence of nonorganic origin" in the category of mental and behavioral disorders. 4,5 For primary monosymptomatic nocturnal enuresis (MNE), this association has been studied quite extensively, [6][7][8][9][10][11][12] and in terms of temperament, emotional stress, and anxiety, most studies indicate that children with MNE are not different from those without. The only specific links between MNE and behavior problems belong to the domain of secondary...

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“…[11][12][13] Most recently in 2013, Peeters et al 14 reported that a large number of children presenting with defecation disorders also fall into the autism spectrum disorder.…”

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confidence: 99%

Association of Constipation and Fecal Incontinence With Attention-Deficit/Hyperactivity Disorder

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Several studies have shown that behavioral problems can be associated with defecation and voiding disorders, although few studies have looked directly at a link between a diagnosis of attention-deficit/hyperactivity disorder (ADHD) and constipation or fecal incontinence. WHAT THIS STUDY ADDS:We identified an increased risk for both constipation and fecal incontinence in children with ADHD. In patients with concomitant ADHD and defecation disorders, more aggressive medical and behavioral treatment of the constipation or fecal incontinence may be warranted. abstract OBJECTIVE: Functional constipation and fecal incontinence are common childhood gastrointestinal conditions. Both conditions may be associated with behavioral problems. Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral disorder of childhood, characterized by shortened attention span and hyperactivity. We hypothesize that a diagnosis of ADHD increases the risk for functional constipation and fecal incontinence. METHODS:A retrospective cohort study of children was performed by using the military health system database. Children of active-duty military personnel, aged 4 to 12 years, from October 2005 to September 2007, were included. ADHD, constipation, and fecal incontinence were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Relative risks and adjusted incidence rate ratios (IRRs) were calculated. A subgroup analysis of subjects receiving medical therapy was performed.RESULTS: There were 742 939 children identified in the study, 32 773 (4.4%) of whom had ADHD. Children with ADHD had an increased prevalence of constipation (4.1% of children with ADHD vs 1.5% children without ADHD; P , .001) and fecal incontinence (0.9% of children with ADHD vs 0.15% of children without ADHD; P , .0001). Children with ADHD had more visits than those without ADHD for both constipation (IRR 3.39; 95% confidence interval 2.59-4.43) and fecal incontinence (IRR 7.74; 95% confidence interval 5.01-11.98). Children with ADHD receiving medicinal therapy did not differ significantly from children with ADHD not receiving medicinal therapy on rates of constipation visits (P = .57) or fecal incontinence visits (P = .32). CONCLUSIONS:Children with ADHD are significantly more likely to have constipation and fecal incontinence. Medical therapy for ADHD does not impact visit rates for defecation disorders.

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A Survey of Voiding Dysfunction in Children With Attention Deficit-Hyperactivity Disorder

Abstract: Children with ADHD have significantly higher rates of incontinence, constipation, urgency, infrequent voiding, nocturnal enuresis and dysuria than those without ADHD. Further study is needed to discern the cause of this difference and develop appropriate treatment strategies.

Cited by 104 publications

References 3 publications

Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem

Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem

Behavior Profiles in Children With Functional Urinary Incontinence Before and After Incontinence Treatment

Association of Constipation and Fecal Incontinence With Attention-Deficit/Hyperactivity Disorder

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