Systematic review and meta-analysis: relationships between attention-deficit/hyperactivity disorder and urinary symptoms in children

Abstract

Lower urinary tract symptoms (LUTS), e.g., urinary frequency, pressure, urgency, and overactive bladder syndrome, are commonly reported in children with attention-deficit/hyperactivity disorder (ADHD). Understanding the co-occurrence of these conditions has implications regarding clinical approaches, treatments, and improved quality of life. We conducted a systematic review and meta-analysis to examine the relationships between LUTS and ADHD in children. We searched for articles published between January 1990 and July 2019, in PubMed, CENTRAL, and PsycNet. Two authors independently screened all articles and extracted data. We performed random-effect meta-analyses for ADHD with pooled outcomes for LUTS. We identified 119 relevant articles in the literature and 18 articles fulfilled the inclusion criteria for the systematic review, of which, 5 articles had sufficient data for meta-analysis. Examining ADHD among individuals with LUTS, the odds ratio was 2.99 (95% CI 1.13, 7.88, p < 0.001), compared to controls. In multiple studies, the mean overall score for LUTS, using a standardized measure, was significantly higher in patients with ADHD in comparison to controls, and the severity of ADHD was positively associated with the severity of LUTS. Younger age in children was correlated with a higher LUTS score. Different subtypes of urinary incontinence demonstrated differences in behavioral problems and psychiatric comorbidity. Sex differences in LUTS were not consistent across articles. Our results indicate clinically significant associations between ADHD and LUTS in children. Because LUTS and ADHD are common disorders in children, clinicians should be aware of these associations as they inform optimal assessment and treatment strategies.

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Data are available in the literature and are also from the authors upon request.

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Open access software was used for the analysis.

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Funding

DEG, MJ, JDB, BM receive support from the Beatrice and Samuel A. Seaver Foundation; additional support from the Mindworks Charitable Lead Trust (DEG); the Stanley Center for Psychiatric Research (DEG).

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BM had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: OA, JDB, DEG, CMH, MJ, LRK, BM. Acquisition, analysis, or interpretation of data: OA, AB, JDB, DEG, MJ, LRK, BM, CGM. Drafting of the manuscript: AB, JDB, DEG, MJ, LRK, BM, CGM. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: BM. Obtained funding: DEG. Study supervision: OA, DEG, LRK.

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Correspondence to Dorothy E. Grice.

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Mahjani, B., Koskela, L.R., Mahjani, C.G. et al. Systematic review and meta-analysis: relationships between attention-deficit/hyperactivity disorder and urinary symptoms in children. Eur Child Adolesc Psychiatry (2021). https://doi.org/10.1007/s00787-021-01736-3

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Keywords

  • Attention-deficit/hyperactivity disorder
  • Lower urinary tract symptoms
  • Overactive bladder