Comorbidity of ADHD and incontinence in children

Abstract

ADHD and incontinence are common childhood disorders which co-occur at much higher rates than expected by chance. The aim of this review was to provide an overview both of the comorbidity of nocturnal enuresis (NE), daytime urinary incontinence (DUI) and faecal incontinence (FI) in children with ADHD; and, vice versa, of the co-occurrence of ADHD in children with NE, DUI and FI. Most clinical studies have focussed on the association of ADHD and NE. Population-based studies have shown that children with DUI have an even greater risk for ADHD than those with NE. While children with FI have the highest overall comorbidity rates of psychological disorders, these are heterogeneous with a wide range of internalising and externalising disorders--not necessarily of ADHD. Genetic studies indicate that ADHD and NE, DUI and FI do not share the same genetic basis. The comorbidity is conferred by non-genetic factors. Possible aetiological and pathogenetic links between ADHD and incontinence are provided by neurophysiological, imaging and pharmacological studies. The co-occurrence has clinical implications: children with ADHD and NE, DUI and FI are more difficult to treat, show lower compliance and have less favourable treatment outcomes for incontinence. Therefore, both groups of disorders have to be assessed and treated specifically.

Neuropsychological functioning related to specific characteristics of nocturnal enuresis

“…Since previous studies have identified a high comorbidity with (neuro)psychological and/or motor difficulties [3,4], this might play a role in the pathogenesis, especially in refractory cases. Psychological problems are even more common in children with daytime incontinence [2,5]. This is the first study excluding the children with daytime incontinence.…”

Mental disorders in children and adolescents with lower urinary tract dysfunction

“…Areas of the brain such as the insula, the anterior cingulate cortex, and the prefrontal cortex are responsible for bladder control and monitoring 9 and have been implicated in ADHD and LUTD. 8 Hyde et al 10 considered enuresis during childhood a premorbid developmental marker of schizophrenia. In a group of patients with schizophrenia, 21% had enuresis during childhood versus 11% of their siblings and 7% of healthy controls.…”

Incontinence and psychological problems in children: a common central nervous pathway?

“…Moreover, between 20 and 30 % of the children with nocturnal enuresis have at least one psychological/psychiatric disorder, which is twofold the rate of children without nocturnal enuresis [12]. ADHD is the most prevalent and the most investigated comorbid psychological disorder [13,14]. Research on other psychological disorders may be less, but they are of at least equal importance.…”