Objectives
To investigate whether voiding dysfunction (VD) in children with attention deficit
hyperactivity disorder (ADHD) could be treated successfully using individualized therapy.
We also sought to describe the spectrum of voiding symptoms experienced by children
with ADHD. ADHD is diagnosed in 3-5% of children. These children have a greater incidence
of VD than non-ADHD controls, and it is less amenable to treatment.
Methods
A comprehensive history assessed the nature of the voiding disorder. A physical examination,
screening urologic ultrasonography, and urinalysis were routinely performed, with
electromyography combined with uroflowmetry performed for certain cases. Treatment
was individualized to include behavioral modification, bowel and diet management,
biofeedback, pharmacotherapy, and close follow-up.
Results
A total of 75 children with ADHD were referred because of VD. The 75 children (39
boys and 36 girls) were 5-16 years old. Of the 75 children, 60 were taking medication
for ADHD. All the children had daytime wetting (>1/d, 5-7 d/wk) and urgency. In addition,
88% had frequency and 87% had sleep enuresis. Of the 75 families, 56 proceeded with
our prescribed program. Of the 56 children, 47 (83.9%) had complete resolution or
improvement of the daytime symptoms. Of the 17 patients (30.4%) with complete resolution,
9 responded to behavior modification and anticholinergics and 8 needed biofeedback.
Of the 30 patients with a partial response (53.6%), 9 responded to behavior modification
alone, 15 to behavior modification and anticholinergics, and 6 required all 3 modalities.
Of the 56 children, 9 failed to respond to any of the 3 modalities.
Conclusions
Diurnal symptoms constituted the most common referred complaint in children with ADHD.
VD can be successfully treated if the treatment is individualized. Multimodal treatment,
including behavior modification combined with anticholinergic agents and/or biofeedback,
appears to be effective in managing VD in most of these challenging cases.
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Article info
Publication history
Published online: March 29, 2010
Accepted:
January 18,
2010
Received:
November 30,
2009
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
