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Children with nocturnal enuresis and attention deficit hyperactivity disorder: a separate entity?

  • Larisa Kovacevic 1,
  • Cortney Wolfe-Christensen 2,
  • Aliza Rizwan 1,
  • Hong Lu 1,
  • Yegappan Lakshmanana 1
1 Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA 2 Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA

Publication: Journal of Pediatric Urology, Available online 2017 Aug 03 In Press, Corrected Proof

Commentary by Charlotte van Herzeele

Besides the wetting problem, 20 – 30% of children with enuresis suffer from a comorbid psychological disorder(1). Attention deficit hyperactivity disorder (ADHD) is the most present comorbid disorder of enuresis. The authors attempt to illuminate a piece of the complex association between enuresis and ADHD by demonstrating that the presence of ADHD was associated with more severe enuresis and associated voiding symptoms. The authors describe several explaining theories such as a brain stem inhibition deficit, impaired central adrenergic stimulation and behavioral factors.
Moreover, it is suggested that children with enuresis and ADHD are more responsive to pharmacological intervention compared to children with enuresis and without ADHD. This finding could influence the treatment choice in the future of children with a combined pathology of enuresis and ADHD. However, in families with ADHD adherence is extremely challenged, therefore these findings should be investigated in the future with special emphasis on the role of adherence.
The authors identified limitations of their study: future studies should use a comprehensive psychological assessment to diagnose ADHD and investigate the role of different representations of ADHD. Children with mainly attentional problems might differ from those with mainly impulsivity and hyperactivity symptoms. Previous literature demonstrated comorbidity of ADHD in children with enuresis and an overrepresentation of the predominantly inattentive presentation of ADHD(2).
This study is well performed and gives more information regarding the association of enuresis and ADHD but a larger comprehensive study is needed in the future to investigate if the combined pathology enuresis and ADHD should be considered as a separate entity.
von Gontard A, Baeyens D, Van Hoecke E, Warzak WJ, Bachmann C. Psychological and psychiatric issues in urinary and fecal incontinence. J Urol. 2011;185(4):1432-6.
Baeyens D, Roeyers H, Hoebeke P, Verte S, Van Hoecke E, Walle JV. Attention deficit/hyperactivity disorder in children with nocturnal enuresis. J Urol. 2004;171(6 Pt 2):2576-9.