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Attention deficit and hyperactivity disorder and nocturnal enuresis co-occurrence in the pediatric population: a systematic review and meta-analysis

  • Systematic Review/Meta-analysis
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Abstract

Background

Attention deficit and hyperactivity/impulsivity disorder (ADHD) and enuresis are common behavioral disorders in childhood, impacting adolescence and adult life. Enuresis (NE) is an incontinence disorder frequently observed in children with ADHD. The relationship between ADHD and NE has been a matter of debate.

Objectives

We aimed to verify the relationship between ADHD and enuresis and how these conditions can modify each other during development. Using PRISMA guidelines, under the PROSPERO registration number CRD42020208299, we systematically searched the literature and conducted a meta-analysis to answer the following question: how frequent is ADHD and enuresis comorbidity? Twenty-five studies were fully read, and data from seven less heterogeneous case-control studies were pooled to estimate enuresis prevalence comparing ADHD and control samples, whereas six studies were combined to evaluate ADHD frequencies in children with and without enuresis.

Results

We found the ADHD rates in children with enuresis are similar to the enuresis rates in the group of children with ADHD. The presence of ADHD and enuresis comorbidity does not seem to play a role in gender distribution and the presence of other comorbidities in comparison to controls. However, enuresis seems to persist for more time in children with ADHD.

Limitations

The selected papers differed in study type, research question, samples, and controls utilized.

Conclusions

Our systematic review with meta-analysis supports the reciprocal association between enuresis and ADHD. Further

studies are necessary to build more robust evidence.

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Funding

This work was partially supported by the Brazilian National Council of Research Development (CNPq - Grant # 302153/2019-5), Coordination of High Education Level Personnel (CAPES), and Foundation of Research of Minas Gerais (FAPEMIG).

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Author notes

  1. Ana Cecília de Sena Oliveira and Bruno da Silva Athanasio contributed equally to this work.

Authors and Affiliations

  1. Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil

    Ana Cecília de Sena Oliveira, Bruno da Silva Athanasio & Ana Cristina Simões e Silva

  2. Unit of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, UFMG, Avenida Alfredo Balena, 190, 2nd floor, room #281, Belo Horizonte, MG, 30130, Brazil

    Flávia Cristina de Carvalho Mrad, Monica Maria de Almeida Vasconcelos, Débora Marques Miranda & Ana Cristina Simões e Silva

  3. Neurosciences of Physical Activity and Sports Research Group, Department of Sports, UFMG, Belo Horizonte, MG, Brazil

    Maicon Rodrigues Albuquerque

Authors
  1. Ana Cecília de Sena Oliveira
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  2. Bruno da Silva Athanasio
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  7. Ana Cristina Simões e Silva
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Contributions

ACSO and BSA did the literature revision, selection of main articles, and data extraction, and wrote the first draft. FCCM and MMAV helped in data extraction and data analysis and in the writing of the first draft. MAR checked  the data analysis and performed the meta-analysis. ACSS and DMM conceptualized the study, did general supervision, and revised the manuscript. ACSS submitted the final version of the manuscript, which is approved by all the authors.

Corresponding author

Correspondence to Ana Cristina Simões e Silva.

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de Sena Oliveira, A.C., Athanasio, B.d.S., Mrad, F.C.d.C. et al. Attention deficit and hyperactivity disorder and nocturnal enuresis co-occurrence in the pediatric population: a systematic review and meta-analysis. Pediatr Nephrol 36, 3547–3559 (2021). https://doi.org/10.1007/s00467-021-05083-y

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