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Comorbidity of ADHD and incontinence in children

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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.

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Abbreviations

ACC:

Anterior cingulated cortex

ADHD:

Attention-deficit/hyperactivity disorder

CBCL:

Child behaviour checklist

CNS:

Central nervous system

DSM-IV/5:

Diagnostic and statistical manual IV/5

DUI:

Daytime urinary incontinence

ENS:

Enteric nervous system

FI:

Faecal incontinence or encopresis

HKD:

Hyperkinetic disorder

ICCS:

International children’s continence society

ICD-10:

International classification of diseases

MPH:

Methylphenidate

NE:

Nocturnal enuresis

ODD:

Oppositional defiant disorder

OR:

Odds ratio

PAG:

Periaqueductal grey

PFC:

Prefrontal cortex

PMC:

Pontine micturition centre

PPI:

Prepulse inhibition

TCA:

Tricyclic antidepressant

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  1. Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany

    Alexander von Gontard & Monika Equit

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  1. Alexander von Gontard
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  2. Monika Equit
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Correspondence to Monika Equit.

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von Gontard, A., Equit, M. Comorbidity of ADHD and incontinence in children. Eur Child Adolesc Psychiatry 24, 127–140 (2015). https://doi.org/10.1007/s00787-014-0577-0

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