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


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.


ADHD Nocturnal enuresis Daytime urinary incontinence Faecal incontinence Enuresis Comorbidity 



Anterior cingulated cortex


Attention-deficit/hyperactivity disorder


Child behaviour checklist


Central nervous system


Diagnostic and statistical manual IV/5


Daytime urinary incontinence


Enteric nervous system


Faecal incontinence or encopresis


Hyperkinetic disorder


International children’s continence society


International classification of diseases




Nocturnal enuresis


Oppositional defiant disorder


Odds ratio


Periaqueductal grey


Prefrontal cortex


Pontine micturition centre


Prepulse inhibition


Tricyclic antidepressant


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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