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European Child & Adolescent Psychiatry

, Volume 24, Issue 2, pp 127–140 | Cite as

Comorbidity of ADHD and incontinence in children

  • Alexander von Gontard
  • Monika EquitEmail author
Review

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.

Keywords

ADHD Nocturnal enuresis Daytime urinary incontinence Faecal incontinence Enuresis Comorbidity 

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

Notes

Conflict of interest

The authors have no conflicts of interest to declare.

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© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of Child and Adolescent PsychiatrySaarland University HospitalHomburgGermany

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