Editorials For Clinical Practice
CHADIS Co-Director and President, Dr. Barbara Howard is a regular contributor to the Behavioral Consult column of Pediatric News and an Assistant Professor of Pediatrics at The Johns Hopkins University School of Medicine.
Dr. Howard is a developmental-behavioral pediatrician trained by Dr. T. Berry Brazelton at Harvard University. She is a national speaker on child behavior problems and is a past president of the Society for Developmental and Behavioral Pediatrics. She was a contributing author for Bright Futures, Diagnostic and Statistical Manual for Primary Care and Bright Futures in Practice: Mental Health and has served on national committees of the American Academy of Pediatrics.
Kids` Daytime Wetting Accidents Linked To Adhd
New York: Children who wet themselves are more than four times as likely as other kids to also have attention deficit/hyperactivity disorder , according to the results of a new German study.
“I think a lot of us have known this for a long time,” that children with ADHD also struggle with bladder control, said Dr. Peter Jensen, a professor of psychiatry and psychology and the vice chair for research at the Mayo Clinic in Rochester, Minnesota.
But there are few studies that have looked specifically at the link between the two disorders, said Jensen, who was not involved in the German research.
ADHD is a common behavioral disorder that involves problems paying attention and controlling impulses, and has been diagnosed in nearly one out of every 10 children in the United States.
About two or three out of every 100 seven-year-olds have daytime wetting accidents, the authors note in their study.
The researchers, led by Dr. Alexander von Gontard at Saarland University Hospital in Homburg, Germany, surveyed the parents of more than 1,300 children five to seven years old.
They found that 49 of the kids wet themselves during the day, and 18 of them — nearly 37 percent — also had symptoms of ADHD.
Of the 1,194 children who did not have incontinence, just 40 of those — or about three percent — screened positive for ADHD.
The study, published in the Journal of Urology, did not determine whether one condition causes the other, nor if they share the same underlying causes.
Kids’ Daytime Wetting Accidents Linked To Adhd
NEW YORK – Children who wet themselves are more than four times as likely as other kids to also have attention deficit/hyperactivity disorder , according to the results of a new German study.
“I think a lot of us have known this for a long time,” that children with ADHD also struggle with bladder control, said Dr. Peter Jensen, a professor of psychiatry and psychology and the vice chair for research at the Mayo Clinic in Rochester, Minnesota.
But there are few studies that have looked specifically at the link between the two disorders, said Jensen, who was not involved in the German research.
ADHD is a common behavioral disorder that involves problems paying attention and controlling impulses, and has been diagnosed in nearly one out of every 10 children in the United States.
About two or three out of every 100 seven-year-olds have daytime wetting accidents, the authors note in their study.
The researchers, led by Dr. Alexander von Gontard at Saarland University Hospital in Homburg, Germany, surveyed the parents of more than 1,300 children five to seven years old.
They found that 49 of the kids wet themselves during the day, and 18 of them — nearly 37 per cent — also had symptoms of ADHD.
Of the 1,194 children who did not have incontinence, just 40 of those — or about three per cent — screened positive for ADHD.
The study, published in the Journal of Urology, did not determine whether one condition causes the other, nor if they share the same underlying causes.
Read Also: Can Autism Get Worse With Age
Does Your Child Have Adhd Here Are 4 Surprising Adhd Symtpoms In Kids
Attention deficit hyperactivity disorder most often referred to simply as ADHD is a mental health condition characterized by a combination of inattention, hyperactivity, and impulsiveness. ADHD affects over 9% of American children, according to theCenters for Disease Control and Prevention thats roughly 6 million children. About 4 million of those children are between the ages of 6 and 11.
ADHD affects more boys than girls , and difficulty paying attention in school is a prominent symptom, but its not the only symptom of ADHD in kids. The condition may affect children in many different ways, which may make it difficult for parents to spot the signs of ADHD, especially in younger children.
Undiagnosed and untreated ADHD can negatively affect your childs quality of life, especially his or her school performance. Thats why our health care professionals atNextStep 4 ADHD recommend you visit us as soon as you spot the signs or symptoms of ADHD in your child.
Continue reading to learn more about the common symptoms of ADHD in children and how we can help.
On This Page…
What Is Pediatric Daytime Wetting
Daytime wetting or incontinence means that a child who should be potty trained wets their pants during the daytime hours. Most children are potty trained between the ages of 2 and 4, though a child can have daytime accidents for several months or even years afterward.
Children with medical conditions such as cerebral palsy, Down syndrome or ADHD may be older before they are potty trained.
Daytime wetting is more common in females than it is in males.
You May Like: What Is High Functioning Autism
What Are Psychological Reasons For Daytime Wetting
If your child suddenly starts wetting during the daytime hours at daycare or school, the cause could also be psychological or behavioral. Some causes may be:
- Fear of missing out Children in preschool and the early grades may be afraid they’ll miss something socially if they go to the restroom. Or, they’re so engrossed in their activities that they don’t realize they need to go. Similarly, at home, some children are so captivated with their play or video games that they don’t take time to go to the bathroom. While they may say, “I didn’t feel it,” it is more that they ignore the feelings.
- Bullying Some children are scared to use the restroom at school because they might get “picked on” for some reason. Look for signs of bullying and talk to your child if you are concerned.
- Academic stress Some children are so afraid they’ll miss important information during class that they delay going to the restroom. Doctors see school stress and urinary issues in children of all ages, including teens hoping to get into certain colleges.
Association Between Adhd Types And Enuresis
The majority of selected studies did not find or did not address any association between enuresis and ADHD subtype. Only four studies found such association . A cross sectional study that screened ADHD children for enuresis and found it to be more frequent among ADHD-I children when compared with other subtypes . A study with similar design, in spite of not finding significant difference between ADHD subtypes, found that ADHD children with enuresis scored higher in assessment of clinical symptoms of inattention in comparison with non-enuretic ADHD children .
Three case-control studies screened children with nocturnal enuresis and those without for ADHD . One of them showed that ADHD-C and ADHD-I are more frequent in the enuresis group and the other found that only ADHD-I was more frequent in the enuretic group ). Finally, another case control study that screened children with enuresis for ADHD found that 60% of the enuretic children had ADHD-I .
Recommended Reading: How To Set Up A Classroom For Autistic Students
Studies Characteristics And Methodological Issues
Selected papers differed in study type, research question and controls utilized. For clarity in qualitative synthesis, articles were separated according to subjects and controls as follows: studies with ADHD subjects screened for enuresis studies with enuresis subjects screened for ADHD studies that screened ADHD and non-ADHD subjects for NE studies that screened enuresis and non-enuresis subjects for ADHD . Whenever necessary, differences in study designs within these categories were highlighted.
Studies that screened attention deficit hyperactivity disorder patients for enuresis
Studies that screened patients with enuresis for attention deficit hyperactivity disorder
Studies that screened attention deficit hyperactivity disorder and non-ADHD patients for enuresis
Studies that screened patients with enuresis and without for attention deficit hyperactivity disorder
Enuresis and attention deficit hyperactivity disorder co-occurrence by ADHD subtypes
What Can I Do
Below are some things that you can try out initially.
- Make sure your child drinks normally until about an hour before they go to bed. After this allow small mouthfuls of water to relieve thirst. Avoid fizzy or caffeine based drinks as these will stimulate the kidneys and lead to more urine being produced.
- Ensure that going to the toilet is part of your childs bedtime routine every night. Encourage them to sit long enough to fully empty their bladder.
- You may sometimes find it helpful lifting your child from their bed and sitting them on the toilet. Older children may try waking themselves up .
- Make sure that you praise and encourage your childs steps towards dry nights – tell them well done for any dry nights – this often helps.
- Set up a positive reward system for behaviour that is likely to contribute to night time dryness, without focusing on the actual bed-wetting. For example, rewards may be given for: drinking recommended levels of fluid during the day, using the toilet to pass urine before going to bed/sleep, engaging in management .
Recommended Reading: How To Discipline A High Functioning Autistic Child
Incontinence Supplies Through Insurance
You dont have to constantly worry about your childs sheets and mattress if youre prepared with incontinence supplies.
Incontinence products can be expensive, but you may qualify to receive your products at no cost to you through your insurance. Aeroflow Urology provides items such as diapers, pull-ups, and bed pads that can make a major difference when it comes to saving furniture or reducing the amount of time spent on clean-up.
Simply fill out our qualify form and our Continence Care Specialists will be in touch with you if you qualify.
Search Methods For Identification Of Studies
Search was carried out by two independent authors, BSA and ACSO, in three databases: PUBMED, Scopus and SciELO. Articles published until June 2020 were included in this review. No language restrictions were applied. The search terms utilized were ADHD and enuresis. The search combinations used was: OR ) AND .
Duplicates were excluded and studies were initially extracted for abstract screening. Those found relevant were retrieved for full text read. Whenever necessary, further data were requested to authors. Disagreements on eligibility were resolved in discussions between authors who extracted data from studies defined eligible.
To address potential bias, studies were assessed for level of evidence. Case control and cohort studies were evaluated according to the Ottawa-Newcastle Scale . For cross sectional studies, authors addressed potential bias in the Discussion section.
Read Also: Diagnosis Of Autism Age
Is There Evidence That Pharmacotherapy To Primarily Treat Behavioural Disorders May Show Benefit In Aspects Of Bladder Dysfunction
Stimulants and effects on bladder function
Stimulants include such medications as methylphenidate, lisdexamfetamine, guanfacine and dextroamphetamine, with predominant use as a first-line medical therapy in ADHD. Two case series looked at the use of stimulants and resolution of nocturnal enuresis in children with ADHD. Williamson reported on 3 children aged 9, 11 and 15 treated with 3 different stimulants and nocturnal enuresis resolved immediately after starting stimulants. In one child, symptoms recurred when stimulant treatment was ceased. The hypothesis proposed by these authors was that stimulants might decrease sleep arousal threshold allowing children to awaken and exert continence control. Ferrara also found nocturnal enuresis was adequately treated in six out of nine children with concurrent ADHD and nocturnal enuresis once methylphenidate was started or the dosage was increased. Bahali reported a case of a 7-year-old girl where nocturnal enuresis resolved with stimulant treatment though atomoxetine, a noradrenaline reuptake inhibitor, prescribed to help moderate her ADHD symptoms.
In slightly contrary findings, Ferrara et al. reported that nine children with ADHD and nocturnal enuresis responded well to increasing doses of methylphenidate alone to treat both disorders, while desmopressin was not effective in treating those children who were not medically treated for ADHD.
Clonidine and effects on bladder function
Is There Evidence That Pharmacotherapy To Primarily Treat Bladder Dysfunction May Have A Beneficial Effect On Behavioural Disorders
Tricyclic antidepressants and effects on bladder function
Although tricyclic antidepressants are third-line therapy for nocturnal enuresis, there are reports that there are good behavioural side-effects in children who take imipramine, making them calmer and more focused . Similar effects were noted for those taking reboxetine . It is thought that the bladder effects of TCAs are due to their direct anticholinergic effects on the bladder detrusor . Desipramine has been shown to have some effectivity in both overactive bladder and in ADHD treatment . Imipramine has been used as a third-line therapy for nocturnal enuresis for some time. A study by Gepertz found 64.6% of children with nocturnal enuresis refractory to other treatments responded well to imipramine and seven children that had concurrent ADHD had a good behavioural response, as well. Imipramine was found to be effective in resolving risperidone-induced nocturnal enuresis in one study .
In summary, there is large-volume good-quality evidence, including a Cochrane review for the use of TCA in managing nocturnal enuresis, and it is already a recommended third-line treatment. Our review suggests that there may be beneficial effects on behavioural disorders, as well.
Read Also: Can Autism Be Diagnosed In Utero
How Should Parents Respond When A Child Wets Their Pants During The Day
If your child is having an increased amount of daytime accidents, here are ways you can help:
- Don’t scold your child for wetting or accidents.
- Set a bathroom schedule. Encourage your child to use the toilet every two hours. “Often, children say they don’t need to go, but encourage them to sit on the toilet anyway,” advises Traylor. “We see a lot of improvement with this. In many cases, going to the bathroom every two hours fixes daytime wetting issues.”
- Teach your children to relax and take their time when going to the bathroom, so they’re more likely to empty the bladder completely.
- Encourage your child to eat plenty of fruits and vegetables, drink water and enjoy lots of physical activity.
- Limit soda and tea. Drinking caffeinated beverages can increase urine output and make the bladder more active.
- Send a doctor’s note to school asking that your child be allowed to go to the restroom when needed and to take as long as necessary.
- Send children to daycare or school with a change of clothes.
- Don’t stress. “Stress is contagious. Often, when parents stress about their kids’ potty habits, the kids stress too,” says Traylor. “Know that it will be okay this can be treated.”
What Are The Signs You Need To Consult A Physician About Your Child’s Daytime Wetting
Daytime wetting and accidents may resolve with your attention to the issue. It may take several months for your efforts to have a clear effect on your child’s behavior. Being patient and persistent is key. You should contact your physician for advice if:
- You notice blood in your child’s urine or stool.
- Your child’s constipation does not resolve with improved diet, water, exercise and a regular bathroom/potty schedule.
- An older child suddenly starts having accidents. In rare cases, some children develop spinal issues that lead to urinary incontinence.
Don’t Miss: Autism Behavior Services Inc
What Is Urinary Incontinence
Urinary incontinence is the loss of bladder control. In children under age 3, its normal to not have full bladder control. As children get older, they become more able to control their bladder. When wetting happens in a child who is old enough to control his or her bladder, its known as enuresis. Enuresis can happen during the day or at night. Enuresis can be frustrating. But its important to be patient and remember that its not your childs fault. A child does not have control over enuresis. And there are many ways to treat enuresis and help your child.
Do Children Wet Their Pants For Attention
Many parents wonder if their once potty-trained kids are deliberately wetting their pants during the daytime. Traylor says she does not see intentional wetting among patients too often. Still, when it does happen, the child is usually trying to get attention due to some type of psychological stress.
“If we think children are intentionally wetting or deliberately urinating on the floor, we try to figure out what’s going on,” says Traylor. “Some children do this because they’re dealing with a lot of stress or changes at home.”
Recommended Reading: Is Jenny Mccarthy’s Son Still Autistic
Autism Adhd And Bedwetting
We often receive queries from parents who have a child or teenager diagnosed with autism or ADHD. One certain point is most children with autism or ADHD are suffering from the same factors that cause bedwetting in children without those conditions: Small bladder capacity, too much urine at night , very deep sleep and constipation.
To start off we advise following the steps on the Bedwetting Cured DVD. Then add in a bedwetting alarm.
Special factors to consider: Some children with autism or ADHD may react differently to an alarm sound. We have found most children can usually use any of the bedwetting alarms because we offer alarm options which give you both a choice: Alarms which do not attach to the body, others which can be recorded with a message and others which have a vibration setting.
Most children who wet the bed need a very loud alarm to wake them. Although these children are sometimes sensitive to noises we have found that the standard loud alarm will suit most children even those with ADHD or Autism.
Perhaps try making recording the alarm sound, or setting the alarm to come on, a fun night time ritual to reduce anxiety.
Vibration with sound may be used for deaf children who wet at night. The parents will hear the alarm and the vibration will help the child respond. Several of our alarms have a vibration option.
Daytime Wetting
Query and Feedback from a mother in QLD
Information