Skip to main content
Log in

Incontinence and parent-reported oppositional defiant disorder symptoms in young children—a population-based study

Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Oppositional defiant disorder (ODD) and incontinence are common disorders of childhood. We have examined associations between ODD symptoms and incontinence in a representative sample of young children.

Methods

A questionnaire with seven questions referring to incontinence, eight DSM-IV items of ODD, 15 items of the Home Situations Questionnaire and six items regarding eating, drinking or toileting refusal was administered to the parents of 718 children at school-entry from a defined geographical area at school-entry.

Results

Of the 718 6-year-old children included in the analysis, 8.2 % had nocturnal enuresis (NE), 1.5 % had daytime urinary incontinence (DUI) and 1.1 % had faecal incontinence (FI). Significantly more boys than girls had NE (12 vs. 4.3 %). Overall, 6.7 % of children had ODD symptoms. Rates of ODD symptoms were significantly higher in incontinent children (19.5 %) than in continent children (5.2 %), with the highest rate of ODD symptoms in children with DUI (36.4 %). Children with incontinence (mean 6.1 episodes) or ODD symptoms (mean 8.4 episodes) showed non-compliant behaviours in more problem situations than continent children (mean 4.5 episodes) or children without ODD symptoms (mean 4.5 episodes).

Conclusions

Incontinence and ODD are common comorbid disorders at school-entry age. Boys are more affected by both disorders. Children with DUI have the highest rate of ODD symptoms. As ODD symptoms affect many daily family situations, ODD needs to be diagnosed and treated in children with incontinence, as it can negatively affect compliance.

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

Abbreviations

ALSPAC:

Avon Longitudinal Study of Parents and Children

CBCL:

Child Behavior Checklist

DISYPS-II:

Diagnostik-System für psychische Störungen nach ICD-10 und DSM-IV für Kinder und Jugendliche–II

DSM-IV-TR:

Diagnostic and statistical manual of mental disorders – 4th edn (text revision)

DSM-5:

Diagnostic and statistical manual of mental disorders–5th edn

HSQ-D:

Home Situations Questionnaire (German version)

ICCS:

International Children’s Continence Society

ICD-10:

International Classification of Diseases

References

  1. Austin PF, Bauer S, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, Vande Walle J, 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 (ICCS). J Urol 191:1863–1865

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. von Gontard A, Moritz AM, Thomé-Granz S (2011) Association of attention deficit and elimination disorders at school entry—a population-based study. J Urol 185:2027–2032

    Article  Google Scholar 

  4. 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 

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

    Article  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  8. 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 

  9. Heron J, Joinson C, Croudace T, von Gontard (2008) Trajectories of daytime wetting and soiling in a United Kingdom 4 to 9-year-old population birth cohort study. J Urol 179:1970–1975

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. Kuschel A, Lübke A, Köppe E, Miller Y, Hahlweg K, Sanders MR (2004) Häufigkeit psychischer Auffälligkeiten und Begleitsymptome bei drei- bis sechsjährigen Kindern: Ergebnisse der Braunschweiger Kindergartenstudie. Z Kinder Jugendpsychiatr Psychother 32:97–106

    Article  CAS  PubMed  Google Scholar 

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

    Google Scholar 

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

    Book  Google Scholar 

  14. 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 

  15. Earls F (1982) Application of DSM-II in an epidemiological study of preschool children. Am J Psychiatry 37:242–243

    Google Scholar 

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

    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 Discip 53:695–705

    Article  Google Scholar 

  18. von Gontard A, Baeyens D, van Hoecke E, Warzack WJ, Bachmann C (2011) Psychological and psychiatric issues in urinary and fecal incontinence. J Urol 185:1432–1437

    Article  Google Scholar 

  19. 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 

  20. 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 

  21. 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 

  22. Von Gontard A, Heron J, Joinson C (2010) Factors associated with low and high voiding frequency in children with diurnal urinary incontinence. BJU Int 105:396–401

    Article  Google Scholar 

  23. Baeyens D, Roeyers H, Hoebeke P, Verté S, van Hoecke E, Vande Walle J (2004) Attention deficit/hyperactivity disorder in children with nocturnal enuresis. J Urol 171:2576–2579

    Article  PubMed  Google Scholar 

  24. Baeyens D, Roeyers H, D'Haese L, Pieters F, Hoebeke P, Walle JV (2006) The prevalence of ADHD in children with enuresis: comparison between a tertiary and non-tertiary care sample. Acta Paediatr Int J Paediatr 95:347–352

    Article  Google Scholar 

  25. Kuhn S, Natale N, Siemer S, Stöckle M, von Gontard A (2009) Clinical differences in daytime wetting subtypes: Urge incontinence and postponed voiding. J Urol 182:1967–1972

    Article  PubMed  Google Scholar 

  26. Steiner H, Remsing L, Work Group on Quality Issues (2007) Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. J Am Acad Child Psy 46:126–141

    Article  Google Scholar 

  27. 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 

  28. 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 

  29. Joinson C, Heron J, Butler R, Croudace T (2009) Development of nighttime bladder control from 4–9 years: association with dimensions of parent rated child maturational level, child temperament and maternal psychopathology. Longitudinal Life Course Stud 1:73–94

    Google Scholar 

  30. Martel MM, Gremillion ML, Roberts B (2012) Temperament and common disruptive behavior problems in preschool. Pers Individ Differ 53:874–879

    Article  Google Scholar 

  31. Lettgen B, von Gontard A, Heiken-Löwenau C, Gaebel C, Schmitz I, Olbing H (2002) Urge incontinence and voiding postponement in children: somatic and psycho-social factors. Acta Paediatr 91:978–984

    Article  CAS  PubMed  Google Scholar 

  32. Döpfner M, Steinhausen HC, Lehmkuhl G (2002) Kinder-Diagnostik-System KIDS, Mappe 1: Aufmerksamkeit- und Hyperaktivitätsstörungen. Hogrefe, Göttingen

    Google Scholar 

  33. 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, Bern

    Google Scholar 

  34. 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 23:414–423

    Google Scholar 

  35. Bryant-Waugh R (2000) Overview of the eating disorders. In: Lask B, Bryant-Waugh R (eds) Anorexia nervosa and related eating disorders in childhood and adolescence, 2nd edn. Psychology Press, Hove, pp 27–40

    Google Scholar 

  36. Goyette DH, Conners CK, Ulrich RF (1978) Normative data for rivesd Conners parent ans teacher rating scales. J Abnorm Child Psych 6:221–236

    Article  CAS  Google Scholar 

  37. Achenbach TM (1991) Manual for the Child Behavior Checklist/4–18 and 1991 profile. Department of Psychiatry, University of Vermont, Burlington

  38. Altepeter TS, Breen M (1989) The Home Situations Questionnaire (HSQ) and the School Situations Questionnaire (SSQ): Normative data and an evaluation of psychometric properties. J Psychoeduc Assess 7:312–322

    Article  Google Scholar 

  39. 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 

  40. 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 

  41. 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 

  42. Tröster H, Reinike D (2007) Prävalenz von Verhaltens- und Entwicklungsauffälligkeiten im Kindergartenalter. Kindheit Entwicklung 16:171–179

    Article  Google Scholar 

  43. 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 Discip 52:47–55

    Article  Google Scholar 

  44. Hembree-Kigin TL, McNeil CB (1995) Parent child interaction therapy. Plenum Press, New York

    Book  Google Scholar 

  45. Zink S, Freitag CM, von Gontard A (2008) Behavioral comorbidity differs in subtypes of enuresis and urinary incontinence. J Urol 179:295–298

    Article  PubMed  Google Scholar 

  46. Breuer D, Döpfner M (1997) The assessment of problem situations within the family. Prax Kinderpsychol Kinderpsychiatr 46:583–596

    CAS  PubMed  Google Scholar 

  47. van den Berg MM, Benninga MA, Di Lorenzo C (2006) Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol 101:2401–2409

    Article  PubMed  Google Scholar 

  48. Niemczyk J, Equit M, El Khatib D, von Gontard (2014) Toilet refusal syndrome in preschool children—do different subtypes exist? J Pediatr Gastroenterol Nutr 58:303–306

    Article  PubMed  Google Scholar 

  49. Equit M, Pälmke M, Becker N, Moritz AM, Becker S, von Gontard A (2013) Eating problems in young children—A population-based study. Acta Paediatr 102:149–155

    Article  PubMed  Google Scholar 

  50. Van Hoecke E, Baeyens D, Vanden Bossche H, Hoebeke P, Vande Walle J (2007) Early detection of psychological problems in a population of children with enuresis: construction and validation of the short screening instrument for psychological problems in enuresis. J Urol 178:2611–2615

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Monika Equit.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

von Gontard, A., Niemczyk, J., Thomé-Granz, S. et al. Incontinence and parent-reported oppositional defiant disorder symptoms in young children—a population-based study. Pediatr Nephrol 30, 1147–1155 (2015). https://doi.org/10.1007/s00467-014-3040-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-014-3040-z

Keywords

Navigation