Skip to main content

Advertisement

Log in

Prevalence of incontinence, attention deficit/hyperactivity disorder and oppositional defiant disorder in preschool children

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Externalizing disorders as attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are common in children with nocturnal enuresis (NE), daytime urinary incontinence (DUI) and faecal incontinence (FI). We examined the prevalence rates of ADHD, ODD and incontinence in a defined geographical area and analysed the association between externalizing disorders and subtypes of incontinence. 1,676 parents of children who were presented at the mandatory school-entry medical examination completed a questionnaire with all DSM-IV items of ADHD, ODD and six questions regarding incontinence. 50.2 % were male and mean age was 5.7 years. 9.1 % had at least one subtype of incontinence (8.5 % had NE, 1.9 % DUI and 0.8 % FI). Boys were significantly more affected by incontinence overall, NE, FI and ADHD than girls. 6.4 % had ADHD, 6.2 % had ODD and 2.6 % were affected by ADHD and ODD. 10.3 % of the children with incontinence had ADHD and 10.3 % ODD. Children with FI were significantly more affected by externalizing disorders (50 %) than children with isolated NE (14.5 %), children with DUI (9.5 %) and continent children (9.5 %). Children with incontinence, especially those with FI, are at much higher risk of externalizing disorders. An additional effect of children with both ADHD and ODD having higher rates of incontinence than children with only one disorder could not be found. However, these children represent a high-risk group with lower compliance to treatment and worse outcome. Therefore, screening not only for ADHD but also for ODD should be implemented for all children with incontinence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. World Health Organisation (WHO) (1993) The ICD-10 classification of mental and behavioural disorders—diagnostic criteria for research. WHO, Geneva

    Google Scholar 

  2. American Psychiatric Association (APA) (2013) Diagnostic and statistical manual of mental disorders—fifth edition (DSM 5). APA, Washington, DC

    Google Scholar 

  3. Nevéus T, von Gontard A, Hoebeke P, Hjälmås K, Bauer S, Bower W, Jørgensen TM, Rittig S, Walle JV, Yeung C, Djurhuus JC (2006) The standardization of terminology of lower urinary tract function in children and adolescents: report from the standardisation committee of the international children’s continence society. J Urol 176:314–324

    Article  PubMed  Google Scholar 

  4. Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, Walle JV, von Gontard A, Wright A, Yang SS, Nevéus T (2014) The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the international children’s continence society. J Urol 191:1863–1865

    Article  PubMed  Google Scholar 

  5. Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS (2006) Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 130:1527–1537

    Article  PubMed  Google Scholar 

  6. Equit M, Klein A, Braun-Bither K, Gräber S, von Gontard A (2014) Elimination disorders and anxious-depressed symptoms in preschool children: a population-based study. Eur Child Adolesc Psychiatry 23:417–423

    PubMed  Google Scholar 

  7. Butler RJ, Golding J, Northstone K (2005) Nocturnal enuresis at 7.5 years old: prevalence and analysis of clinical signs. BJU Int 96:404–410

    Article  PubMed  Google Scholar 

  8. Sureshkumar P, Jones M, Caldwell PHY, Craig JC (2009) Risk factors for nocturnal enuresis in school-age children. J Urol 182:2893–2899

    Article  PubMed  Google Scholar 

  9. Von Gontard A, Moritz AM, Thome-Granz S, Freitag C (2011) Association of attention deficit and elimination disorders at school entry: a population based study. J Urol 186:2027–2032

    Article  Google Scholar 

  10. Joinson C, Heron J, Von Gontard A (2006) Psychological problems in children with daytime wetting. Pediatrics 118:1985–1993

    Article  PubMed  Google Scholar 

  11. Sureshkumar P, Craig JC, Roy LP, Knight JF (2000) Daytime urinary incontinence in primary school children: a population-based survey. J Pediatr 137:814–818

    Article  CAS  PubMed  Google Scholar 

  12. Joinson C, Heron J, Butler U, Von Gontard A (2006) Psychological differences between children with and without soiling problems. Pediatrics 117:1575–1584

    Article  PubMed  Google Scholar 

  13. Van Der Wal MF, Benninga MA, Hirasing RA (2005) The prevalence of encopresis in a multicultural population. J Pediatr Gastroenterol Nutr 40:345–348

    Article  PubMed  Google Scholar 

  14. American Psychiatric Association (APA) (2000) Diagnostic and statistical manual of mental disorders, text revision (DSM-IV-TR). American Psychiatric Association, Washington, DC

    Book  Google Scholar 

  15. Egger HL, Angold A (2006) Common emotional and behavioral disorders in preschool children: presentation, nosology, and epidemiology. J Child Psychol Psychiatry Allied Disciplines 47:313–337

    Article  Google Scholar 

  16. Egger HL, Kondo D, Angold A (2006) The epidemiology and diagnostic issues in preschool attention-deficit/hyperactivity disorder: a review. Infants Young Children 19:109–122

    Article  Google Scholar 

  17. Wichstrøm L, Berg-Nielsen TS, Angold A, Egger HL, Solheim E, Sveen TH (2012) Prevalence of psychiatric disorders in preschoolers. J Child Psychol Psychiatry Allied Disciplines 53:695–705

    Article  Google Scholar 

  18. Lavigne JV, LeBailly SA, Hopkins J, Gouze KR, Binns HJ (2009) The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds. J Clin Child Adolesc 38:315–328

    Article  Google Scholar 

  19. Von Gontard A, Baeyens D, Van Hoecke E, Warzak WJ, Bachmann C (2011) Psychological and psychiatric issues in urinary and fecal incontinence. J Urol 185:1432–1436

    Article  Google Scholar 

  20. Baeyens D, Roeyers H, Vande Walle J, Hoebeke P (2005) Behavioural problems and attention-deficit hyperactivity disorder in children with enuresis: a literature review. Eur J Pediatr 164:665–672

    Article  PubMed  Google Scholar 

  21. Joinson C, Heron J, Emond A, Butler R (2007) Psychological problems in children with bedwetting and combined (day and night) wetting: a UK population-based study. J Pediatr Psychol 32:605–616

    Article  PubMed  Google Scholar 

  22. Cox DJ, Morris JB Jr, Borowitz SM, Sutphen JL (2002) Psychological differences between children with and without chronic encopresis. J Pediatr Psychol 27:585–591

    Article  PubMed  Google Scholar 

  23. Von Gontard A, Equit M. Comorbidity of ADHD and incontinence in children—a review. Eur Child Adolesc Psychiatry (in press)

  24. Tröster H, Reineke D (2007) Prevalence of behavior problems and developmental retardation in preschool age. Kindh Entwickl 16:171–179

    Article  Google Scholar 

  25. Rockhill CM, Collett BR, McClellan JM, Speltz ML (2006) Oppositional defiant disorder. In: Luby JL (ed) Handbook of preschool mental health—development, disorders, and treatment. The Guilford Press, New York, pp 80–114

    Google Scholar 

  26. Biederman J, Santangelo SL, Faraone SV, Kiely K, Guite J, Mick E, Reed ED, Kraus I, Jellinek M, Perrin J (1995) Clinical correlates of enuresis in ADHD and Non-ADHD children. J Child Psychol Psychiatry Allied Disciplines 36:865–877

    Article  CAS  Google Scholar 

  27. Elia J, Takeda T, Deberardinis R, Burke J, Accardo J, Ambrosini PJ, Blum NJ, Brown LW, Lantieri F, Berrettini W, Devoto M, Hakonarson H (2009) Nocturnal enuresis: a suggestive endophenotype marker for a subgroup of inattentive attention-deficit/hyperactivity disorder. J Pediatr 155(239–244):e5

    PubMed  Google Scholar 

  28. Döpfner M, Görtz-Dorten A, Lehmkuhl G (2009) Diagnostik-System für psychische Störungen nach ICD-10 und DSM-IV für Kinder und Jugendliche—II. Huber, Hogrefe AG

    Google Scholar 

  29. Erhart M, Döpfner M, Ravens-Sieberer U (2008) Psychometric properties of two ADHD questionnaires: comparing the conners’ scale and the FBB-HKS in the general population of german children and adolescents. Results of the BELLA study. Eur Child Adolesc Psychiatry 17:106–115

    Article  PubMed  Google Scholar 

  30. Jans T, Weyers P, Schneider M, Hohage A, Werner M, Pauli P, Warnke A (2009) The Kiddie-SADS allows a dimensional assessment of externalizing symptoms in ADHD children and adolescents. Atten Defic Hyperact Disord 1:215–222

    Article  PubMed  Google Scholar 

  31. Görtz-Dorten A, Ise E, Hautmann C, Walter D, Döpfner M (2014) Psychometric properties of a german parent rating scale for oppositional defiant and conduct disorder (FBB-SSV) in clinical and community samples. Child Psychiatry Hum Dev 45:388–397

    Article  PubMed  Google Scholar 

  32. Park S, Kim B, Kim J, Hong S, Shin M, Yoo HJ, Cho S (2013) Nocturnal enuresis is associated with attention deficit hyperactivity disorder and conduct problems. Psychiatry Investig 10:253–258

    Article  PubMed Central  PubMed  Google Scholar 

  33. Lavigne JV, Gibbons RD, Christoffel KK, Arend R, Rosenbaum D, Binns H, Dawson N, Sobel H, Isaacs C (1996) Prevalence rates and correlates of psychiatric disorders among preschool children. J Am Acad Child Adolesc Psychiatry 35:204–214

    Article  CAS  PubMed  Google Scholar 

  34. Von Gontard A, Niemczyk J, Weber M, Equit M. Specific behavioural comorbidity in a large sample of children with functional incontinence—report of 1,001 cases. Neurourol Urodynam (in press)

  35. Crimmins CR, Rathbun SR, Husmann DA (2003) Management of urinary incontinence and nocturnal enuresis in attention-deficit hyperactivity disorder. J Urol 170:1347–1350

    Article  CAS  PubMed  Google Scholar 

  36. Bael A, Winkler P, Lax H, Hirche H, Gäbel E, Vijverberg M, Van Zon R, Van Hoecke E, Van Gool JD (2008) Behavior profiles in children with functional urinary incontinence before and after incontinence treatment. Pediatrics 121:e1196–e1200

    Article  PubMed  Google Scholar 

  37. Joinson C, Heron J, Von Gontard A, Butler U, Golding J, Emond A (2008) Early childhood risk factors associated with daytime wetting and soiling in school-age children. J Pediatr Psychol 33:739–750

    Article  PubMed  Google Scholar 

  38. Stringaris A, Maughan B, Goodman R (2010) What’s in a disruptive disorder? Temperamental antecedents of oppositional defiant disorder: findings from the Avon longitudinal study. J Am Acad Child Adolesc Psychiatry 49:474–483

    PubMed  Google Scholar 

  39. Mustillo S, Worthman C, Erkanli A, Keeler G, Angold A, Costello EJ (2003) Obesity and psychiatric disorder: developmental trajectories. Pediatrics 111:851–859

    Article  PubMed  Google Scholar 

  40. Yang T, Huang K, Chen S, Chang H, Yang H, Guo Y (2013) Correlation between clinical manifestations of nocturnal enuresis and attentional performance in children with attention deficit hyperactivity disorder (ADHD). J Formosan Med Assoc 112:41–47

    Article  PubMed  Google Scholar 

  41. Baeyens D, Roeyers H, Demeyere I, Verté S, Hoebeke P, Vande Walle J (2005) Attention-deficit/hyperactivity disorder (ADHD) as a risk factor for persistent nocturnal enuresis in children: a two-year follow-up study. Acta Paediatr 94:1619–1625

    Article  PubMed  Google Scholar 

  42. Duel BP, Steinberg-Epstein R, Hill M, Lerner M, Koff S, De Gennaro M, De Jong T, Diamond D (2003) A survey of voiding dysfunction in children with attention deficit-hyperactivity disorder. J Urol 170:1521–1524

    Article  PubMed  Google Scholar 

  43. Von Gontard A (2012) Enuresis. In: Rey JM (ed) IACAPAP e-textbook of child and adolescent mental health. International Association for Child and Adolescent Psychiatry and Allied Professions, Geneva

    Google Scholar 

  44. Von Gontard A (2012) Encopresis. In: Rey JM (ed) IACAPAP e-textbook of child and adolescent mental health. International Association for Child and Adolescent Psychiatry and Allied Professions, Geneva

    Google Scholar 

  45. Moriyama TS, Cho AJM, Verin RE, Fuentes J, Polanczyk GV (2012) Attention deficit hyperactivity disorder. In: Rey JM (ed) IACAPAP e-textbook of child and adolescent mental health. International Association for Child and Adolescent Psychiatry and Allied Professions, Geneva

    Google Scholar 

  46. Keenan K, Boeldt D, Chen D, Coyne C, Donald R, Duax J, Hart K, Perrott J, Strickland J, Danis B, Hill C, Davis S, Kampani S, Humphries M (2011) Predictive validity of DSM-IV oppositional defiant and conduct disorders in clinically referred preschoolers. J Child Psychol Psychiatry Allied Disciplines 52:47–55

    Article  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Justine Niemczyk.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Niemczyk, J., Equit, M., Braun-Bither, K. et al. Prevalence of incontinence, attention deficit/hyperactivity disorder and oppositional defiant disorder in preschool children. Eur Child Adolesc Psychiatry 24, 837–843 (2015). https://doi.org/10.1007/s00787-014-0628-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-014-0628-6

Keywords

Navigation