Northern County Psychiatric Associates
Psychiatric Services For Children, Adolescents, Adults and Families
Kids and Teens
AD/HD and Bedwetting
(bedwetting) and Attention Deficit Hyperactivity Disorder (AD/HD or ADD)
are both common conditions that can affect children and adolescents.
Although there is no evidence that either one causes the other, children
with AD/HD appear to have a higher incidence of enuresis. The child with
AD/HD may feel different and unaccepted. Enuresis might exacerbate these
feelings. There are several medically accepted treatments for enuresis.
Some of them require impulse control and cooperation. Might this be more
difficult for individuals with AD/HD? Individuals with AD/HD may be taking
medications for the condition. How might these medications affect their
all wet the bed at some point in our lives.
When a baby’s bladder fills to a certain point, the bladder
muscles contract, and the baby urinates. Over time, the young child’s
nervous system matures. The feedback circuits between the brain and the
bladder enable the child to realize when his or her bladder is full. The
child becomes physically able to delay urination until he or she decides
that it is the appropriate time and place to void. Different children
develop the neurological and emotional capacity to control their bladders
at different ages. In many cases, children learn to control their bladders
during the day before they master nighttime dryness. Occasional episodes
of daytime or nighttime bladder accidents after five may be a normal part
of growing up. . However, if a child continues to have regular trouble
controlling his bladder after age five, he meets the criteria for
(nocturnal enuresis) usually does not occur while the child is dreaming.
It is more likely to happen during the deeper phases of sleep.
How common is
bedwetting? The reported incidence varies depending on the study. Children
do not like to admit to this problem. Thus the actual incidence may
actually be higher than some estimates.
At age five the incidence is between 5-20%. It is much more
frequent in boys than in girls. The incidence drops significantly with
age. A general rule of thumb is that about 15% of children achieve
nighttime dryness each year after age 5.
At age 5, enuresis affects 7% of boys and 3% of girls. By age 10,
it affects 3% of boys and 2% of girls. About 1% of adolescents still
experience enuresis. That 1%
may not sound like much, but it translates into a large number of
adolescents and young adults with an
embarrassing—sometimes-humiliating—problem. What causes enuresis? We
do not know an exact cause of nighttime enuresis.
enuresis: If the enuresis is related to a specific physical or emotional
issue, the causative factor must be addressed. For the majority of
children, there is not specific cause. It is often best to counsel the
families of young children to wait and see whether the child becomes dry
within the next year or two. Parents should not be harsh or judgmental.
Sometimes it is the emotional reaction of the parent that causes the
psychological hurt, more than the bedwetting itself. The child is often
the best one to determine whether the bedwetting is a problem. Does the
bedwetting bother him? Does it interfere with sleepovers or camping trips?
The incidence of enuresis declines by about 15% per year after age five.
Bladder capacity increases, an overactive bladder may normalize, the child
learns to recognize the signal that it is time to void, and stressful
events may fade.
children do require extra intervention for their bedwetting. Initial
interventions may include:
AD/HD is also a common childhood condition. . Individuals with inattentive
ADHD have difficulty paying attention and staying organized. Individuals
with impulsive or combined ADHD have difficulty with attention and
organization but also are overly active and impulsive ADHD affects 3-5% of
school-aged children. Although
most children with enuresis experience remission of their enuresis by age
18, a higher percentage of individuals with AD/HD continue to experience
inattention and impulsivity well into adulthood. For years, clinicians
have anecdotally noted an increased incidence of enuresis in children with
AD/HD. Others have observed
that their patients with enuresis have an increased incidence of AD/HD.
Because both conditions are fairly common, it would be important to have
more systematic studies that looked at the relationship between enuresis
article in the Southern Medical Journal published in 1997compared a fairly
large group of 6-year-old children with AD/HD to a non-AD/HD control group
selected from a pediatric clinic population.
They found that the 6-year-olds with AD/HD had 2.7 times higher
incidence of enuresis and a 4.5 times higher incidence of diurnal
(daytime) enuresis as compared to a control group Other authors have cited
higher rates of enuresis in children with ADHD. However, these studies did
not have control groups or were not selected randomly.
enuresis may be more upsetting for a child with AD/HD.
A non-AD/HD child, who is successful in most spheres, may be able
to accept his bedwetting more easily. Later, such a child may find it
easier to cooperate with behavioral interventions. However the child with
ADHD already feels different from his peers. His disorganization and
impulsivity may lead to peer rejection and shame. Such a child may cover
his shame with a false appearance of bravado. And although he may be more
ashamed of his bedwetting, his inattention and disorganization may make it
more difficult for him to cooperate with some behavioral treatments.
Individuals with AD/HD are more likely to have sleep problems. Some of
them sleep deeply and have difficulty waking up to go to the bathroom when
their bladder is full.
the child with both AD/HD and enuresis: This child should have a
complete physical exam. It is important to always ask an individual with
AD/HD about current and past bedwetting problems. Don’t neglect to ask
adolescents about this too. They will rarely volunteer this information on
their own. Ask what they and their parents have tried in the past. Some
children and teens with AD/HD are veterans of many types of therapy. They
may already expect the treatment to fail. The behavioral techniques listed
earlier in the article are still useful for these children and teens.
Since these children have often experienced teasing and criticism, one
should be especially careful to avoid punitive behavioral techniques. One
may have to modify behavioral interventions to accommodate the child’s
shorter attention span. You may need to prioritize symptoms. If the child
has a myriad of behavior difficulties, the family cannot address all of
them at once. Which ones are the most important to the child and the
parent? Some children and families opt to wait a while longer before
starting behavioral or medical interventions.
When the family
decides that this is the time to treat the enuresis, they may have to back
off with some of their other behavioral goals to avoid being overwhelmed.
The child and family should be made aware that there are several ways to
treat the enuresis. If one does not work, you are not a failure. You still
have plan B, plan C, etc.
Medication for children with both AD/HD and enuresis. Some children with AD/HD may also have other psychiatric disorders and may be on several medications. A few of these medications might exacerbate the enuresis. It is important to consider all medications and all medical conditions before proceeding with treatment. DDAVP help the enuresis of some children and teens with AD/HD.. In other cases, one may want to consider one of the tricyclic antidepressants for the enuresis. This class of medication seems to work well with some of the “deep sleeper” kids.. You may be able to treat both the AD/HD and the enuresis with one medication. Several studies have shown that the tricyclics by themselves are an effective medical treatment for AD/HD in children and adults In some cases, one can combine stimulants and tricyclics. Such cases may require more frequent medical monitoring.
Our practice has experience in the treatment of Attention Deficit disorder (ADD or ADHD), Depression, Separation Anxiety Disorder, Obsessive-Compulsive Disorder, and other psychiatric conditions. We are located in Northern Baltimore County and serve the Baltimore County, Carroll County and Harford County areas in Maryland. Since we are near the Pennsylvania border, we also serve the York County area. Our services include psychotherapy, psychiatric evaluations, medication management, and family therapy. We treat children, adults, and the elderly.