Attention Deficit‐Hyperactivity Disorder Symptoms and Daytime Voiding Symptoms in Children with Primary Enuresis: An Observational Study to Evaluate the Effectiveness of Desmopressin Treatment

Abstract

Purpose. To evaluate the effectiveness of presence of desmopressin in treating primary enuresis (PE) for children with attention deficit-hyperactivity disorder (ADHD) symptoms. Materials and Methods. Children aged from 5 to 12 years with the chief complaint of PE treated with desmopressin were enrolled in pediatric urology clinics. The parent-reported SNAP-IV questionnaire was used to evaluate ADHD symptoms (cut-off value: 90th percentile). Voiding symptoms were assessed by the Dysfunctional Voiding Scoring System (DVSS) questionnaire. The responses to desmopressin were analyzed in children with and without ADHD symptoms. Results. The study sample comprised 68 children; 27 (39.7%) presented with ADHD symptoms and 41 (60.3%) with non-ADHD symptoms. The children collected from a tertiary referral center may explain the high prevalence of ADHD symptoms in the present study. The total DVSS score in the ADHD symptoms group was significantly higher than in the non-ADHD symptoms group (7.72 versus 5.65, P = 0.05). In the ADHD symptoms group, there were significantly higher score in the “pee 1-2 times/day” and “can't wait” subscales of DVSS and lower sleep quality based on the Pediatric Sleep Quality questionnaire, as well as significantly lower peak flow rate and voided volume. The responses to desmopressin for enuresis were comparable between children with ADHD and non-ADHD symptoms. Conclusions. Approximately 39.7% of PE children presented with ADHD symptoms at urologic clinics. PE children with ADHD symptoms had higher risk of daytime LUTS and comparable response to desmopressin treatment for PE. To evaluate ADHD symptoms and daytime voiding symptoms is important in children with PE.

Optimising the management of children with concomitant bladder dysfunction and behavioural disorders

“…This suggests that early pharmacological treatment for nocturnal enuresis is more effective than behavioural modification in children with ADHD. A similar finding was reported by Yang [ 74 ] with the use of desmopressin in ADHD and non-ADHD children with nocturnal enuresis.…”

Clinical usefulness of the attention-deficit hyperactivity disorder rating scale-IV in the treatment of enuretic children undiagnosed with developmental disorders

“…Yang et al analyzed DVSS subscale scores of NE children with and without ADHD. The ADHD group had significantly higher urinary urgency cannot wait and low-frequency urination urinating 1-2 times/day scores than the non-ADHD group 20 . In contrast, in this study, ADHD-RS hyperactivity and impulsivity scores were significantly correlated with DVSS subscale scores, including incontinence during the day, large-volume DI, and low-frequency urination 1-2 times daily , whereas urinary urgency was not correlated with total ADHD-RS, hyperactivity, impulsivity, and inattention scores.…”

“…DVSS were significantly higher for children with ADHD than for healthy children [20][21][22] ; therefore, assessing ADHD characteristics and LUTS is highly important in children with NE. In this study, there is a significant correlation between higher ADHD-RS scores and higher DVSS even in children with NE not diagnosed with ADHD, similar to previous findings for children with ADHD [20][21][22] .…”

“…The presence of ADHD complications in children with NE does not influence the therapeutic effects of pharmacotherapy, such as the use of desmopressin 20,22 . However, in this study, children with NR had significantly higher ADHD-RS scores than those with PR or CR 6 months after treatment initiation.…”