Search

Objective To explore the clinical characteristics and related factors of emotional and behav-ioral abnormality in children with family primary nocturnal enuresis( FPNE). Methods From September 2021 to September 2022, clinical data were collected from 306 children with primary nocturnal enuresis at our enure-sis clinic. General information questionnaire, strengths and difficulties questionnaire and Pediatric Sleep Ques-tionnaire ( PSQ). Children with PNE were divided into family primary nocturnal enuresis group ( FPNE group, n =45 ) and sporadic primary nocturnal enuresis group ( SPNE group, n = 261 ) according to whether family mem-bers of the third generation were involved. The clinical characteristics, emotional and behavioral changes of FPNE group were analyzed. Results The incidences of severe NE, non-monosymptomatic nocturnal enuresis ( NMNE), abnormal stool and nocturnal micturition twice in FPNE group were(68%, 75%, 48% and 42% respectively) significantly higher than sporadic enuresis group ( SPNE group) ( 57%, 47%, 24% and 11 % re-spectively). The difference was statistically significant( P < 0. 05 ) . The number of enuresis children aged 13 —16 years was 44. 4% ( 20/45) in FPNE group and it was significantly higher than 19. 2% ( 50/261) in SPNE group. The difference was statistically significant( P < 0. 05 ). In FPNE group, 46. 7% (21/45 ) children were au-tosomal dominant, 33. 3% ( 15/45 ) children were autosomal stealth inheritance and 20. 0% ( 9/45) children showed polygenic inheritance. The total scores of emotional symptoms, hyperactivity symptoms and difficulties in FPNE group were higher than those in SPNE group. The difference is statistically significant (P <0. 05 ) . No sig-nificant inter-group difference existed in scores of conduct problems, peer communication or society ( P > 0. 05 ). Logistic regression analysis indicated that age, poor academic performance and high total score of PSQ were the influencing factors of emotional symptoms in FPNE group. Poor academic performance, abnormal stool, bladder dysfunction and high total score of PSQ were the influencing factors of hyperactivity symptoms in FPNE children. Conclusion There are many ways of inheritance of FPNE, among which autosomal dominant inheritance is the most common, the incidence of emotional symptoms and hyperactive symptoms is high, and clinical symptoms are more serious, the risk of frequent and urgent urination is higher, and it is not easy to cure with age. [ABSTRACT FROM AUTHOR]

Background: Provisional Tic Disorder (PTD) is common in childhood. The received wisdom among clinicians is that PTD is short-lived and mild, with at most a few tics, and rarely includes complex tics, premonitory phenomena or comorbid illnesses. However, such conclusions come from clinical experience, with biased ascertainment and limited follow-up., Methods: Prospective study of 89 children with tics starting 0-9 months ago (median 4 months), fewer than half from clinical sources. Follow-up at 12 (± 24, 36, 48) months after the first tic., Results: At study entry, many children had ADHD (39), an anxiety disorder (27), OCD (9) or enuresis (17). All had at least two current tics, with a mean total since onset of 6.9 motor and 2.0 phonic tics. Forty-one had experienced a complex tic, and 69 could suppress some tics. Tics were clinically meaningful: 64 had tics severe enough for a clinical trial, and 76 families sought medical attention for the tics. At 12 months, 79 returned, and 78 still had tics. Of these, 29 manifested no tics during history and extended examination, but only via audio-visual monitoring when the child was seated alone. Only 12/70 now had plans to see a doctor for tics. Most who returned at 2-4 years still had tics known to the child and family, but medical impact was low., Conclusions: Our results do not contradict previous data, but overturn clinical lore. The data strongly argue against the longstanding but arbitrary tradition of separating tic disorders into recent-onset versus chronic., Competing Interests: Declaration of competing interest No relevant conflicts., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Aims: Children with nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are at risk for behavioral problems, overweight, and obesity. The aim of this study was to analyze the specific behavioral and weight comorbidity in subtypes of incontinence., Methods: A total of 1638 consecutive patients presented to a tertiary incontinence clinic from 2012 to 2018 was examined prospectively according to ICCS criteria. Behavioral symptoms were measured with the Child Behavior Checklist (CBCL). Psychiatric disorders were diagnosed according to ICD-10 criteria. Weight categories were calculated according to WHO recommendations., Results: The mean age was 7.8 years, 67% of patients were male. Fifty-seven percent had NE (n = 934), 33% DUI (n = 547), and 40% FI (n = 656). Boys had significantly higher rates of NE and FI than girls. Of all children, 39.2% (n = 539) had a clinically relevant CBCL total score. A total of 28.3% (n = 463) had an ICD-10 psychiatric diagnosis, mainly ODD and ADHD, and 28.6% (n = 463) were overweight or obese. Boys were more often affected by behavioral symptoms, psychiatric disorders, and overweight/obesity. Children with NE had the highest rate of overweight/obesity. Except for primary nonmonosymptomatic NE, subtypes of incontinence did not differ regarding behavioral symptoms and weight categories. However, overweight/obesity was significantly associated with behavioral and psychiatric parameters., Conclusions: Behavioral symptoms and psychiatric disorders, as well as overweight/obesity are important risk factors associated with incontinence, but the interaction between these factors is complex. In clinical settings, all children with incontinence should be screened with behavioral questionnaires. Also, weight should be measured, and overweight/obesity should be addressed., (© 2020 Wiley Periodicals, Inc.)

The MacDonald triad posits that animal cruelty, fire setting, and bed wetting in childhood is indicative of later aggressive and violent behavior in adults. Researchers refer to this phenomenon as a precursor to later antisocial behaviors including serial and sexual murder; while practitioners cite the triad in clinical formulations and risk assessments. However, there is yet to be a critical review and consolidation of the literature that establishes whether there is empirical support. This article explores the validity of the triad. We conducted a narrative review of the relevant studies examining the MacDonald triad and its individual constituents. There is evidence that any one of the triad behaviors could predict future violent offending, but it is very rare to find all three behaviors together as predictors. Thus, the empirical research on the MacDonald triad does not fully substantiate its premise. Rather, it would appear that the triad, or its individual constituents, is better used as an indicator of dysfunctional home environments, or poor coping skills in children. Future research is needed with robust and rigorous methodologies (e.g., adequate control groups, longitudinal designs) to fully establish the MacDonald triad's validity. Finally, further consideration is needed as to whether the triad behaviors are more indicative of other problematic outcomes (e.g., maladaptive coping to life stressors).

Background and Aims: The objective of this update of the EAU-ESPU guidelines recommendations for nocturnal enuresis was to review the recent published literature of studies, reviews, guidelines regarding the etiology, diagnosis and treatment options of nocturnal enuresis and transform the information into a practical recommendation strategy for the general practitioner, pediatrician, pediatric urologist and urologist., Material and Methods: Since 2012 a monthly literature search using Scopus® was performed and the relevant literature was reviewed and prospectively registered on the European Urology bedwetting enuresis resource center (http://bedwetting.europeanurology.com/). In addition, guideline papers and statements of the European Society for Paediatric Urology (ESPU), the European Association of Urology (EAU), the National Institute for Health and Care Excellence (NICE) and the International Children Continence Society (ICCS) were used to update the knowledge and evidence resulting in this practical recommendation strategy. Recommendations have been discussed and agreed within the working group of the EAU-ESPU guidelines committee members., Results: The recommendations focus to place the child and his family in a control position. Pragmatic analysis is made of the bedwetting problem by collecting voiding and drinking habits during the day, measuring nighttime urine production and identification of possible risk factors such as high-volume evening drinking, nighttime overactive bladder, behavioral or psychological problems or sleep disordered breathing. A questionnaire will help to identify those risk factors., Conclusion: Motivation of the child is important for success. Continuous involvement of the child and the family in the treatment will improve treatment compliance, success and patient satisfaction., (© 2019 Wiley Periodicals, Inc.)

This study investigated the influence of refugee status on the occurrence of enuresis. It was performed among school children aged 6 to 11 years and their parents in the Vukovarsko-srijemska County (eastern Croatia), which had many displaced persons and refugees (mostly women and children) in the 1990s due to the wars in Croatia and Bosnia and Herzegovina. A specially designed questionnaire (about the child's age and gender, the child's enuresis history and that of the parents, and data on parental refugee status in childhood) was completed by one of the parents. Adequate data were collected for 3046 children. The prevalence of enuresis among the studied children was quite low (2.3%) but the prevalence distribution according to gender, the decline by age, and the higher odds ratio for paternal enuresis were in line with the results of other studies. The prevalence of parental enuresis in childhood was higher than their children's enuresis (mothers: 5.8%, fathers: 3.6%, p < 0.001), and significantly higher among parents who had been refugees (mothers: p = 0.001, fathers: p = 0.04). Parental refugee status had no influence on the children's enuresis. The results suggest that refugee status is a risk factor for the occurrence of enuresis in childhood.

Context: Enuresis is a common and possibly underestimated condition. While 5-10% of school-aged children suffer from the condition, a lack of background knowledge may impede timely child-adapted and successful therapy., Objective: To provide a comprehensive overview of the pathophysiology, diagnosis, and treatment of enuresis., Evidence Acquisition: Guideline and position papers from the European Society of Pediatric Urology, the European Association of Urology, and the International Children's Continence Society were acquired. PubMed was searched for literature on enuresis, and all papers published in the last 5 yr were considered. The most relevant information from the papers with the highest level of evidence was extracted and incorporated into the review., Evidence Synthesis: An altered antidiuretic hormone profile, arousal failure, and delayed bladder maturation are the main pathophysiological factors in primary enuresis. Coexisting constipation, obstructive airway disease, attention deficit hyperactivity disorder, obesity, and genetic preconditions influence its prevalence. Diagnosis relies on history-taking and simple noninvasive examinations to differentiate monosymptomatic enuresis and patients with daytime symptoms. It is essential to exclude daytime voiding symptoms, overactive bladder, dysfunctional voiding, and urinary tract infections. Further imaging is indicated in complex cases with a suspicion of underlying congenital malformations or systemic or endocrine diseases and in children refractory to initial therapy. In secondary enuresis, psychological causes should also be taken into consideration. While desmopressin melt tablets and alarm systems constitute the mainstays of treatment in monosymptomatic enuresis, anticholinergics and urotherapy play an additional role in nonmonosymptomatic enuresis. For therapy-refractory cases, after a thorough re-investigation to identify any missed comorbidities and anatomical or functional causes of enuresis, combination therapy and stationary urotherapy might be promising options., Conclusions: While enuresis seems to be an often underestimated condition in terms of the suffering that children and their families, there are efficacious therapy options once a correct and full diagnosis is made., Patient Summary: This article reviews primary and secondary nocturnal enuresis, which is the medical term for the condition whereby children wet their beds regularly after their first birthday. We describe the background of enuresis,including its complex underlying mechanisms, as well as diagnosis and treatment in the light of current scientific publications. We conclude that while enuresis seems to be an often underestimated condition in terms of the suffering that children and their families may undergo, there are efficacious therapy options once a correct and full diagnosis is made., (Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Enuresis was historically viewed as a primarily psychiatric disorder, but this understanding has changed dramatically since the end of the last century, when it became clear that somatic factors, such as nocturnal polyuria as a result of vasopressin deficiency, nocturnal detrusor overactivity and high arousal thresholds, all play a crucial role in enuresis pathogenesis. It has also become clear that enuresis is inherited in the majority of cases, although the correlation between genotype and enuretic phenotype is not straightforward. The standard view of enuresis as being the result of either (i) nocturnal polyuria and high arousal thresholds; or (ii) nocturnal detrusor overactivity and high arousal thresholds has become well-established, but further research now complicates the picture. First, psychological/psychiatric problems are overrepresented in enuresis, and might in a minority of cases have a causal or aggravating role. Second, nocturnal polyuria is not always linked to vasopressin deficiency. Third, nocturnal detrusor overactivity is in itself pathogenetically heterogeneous, and could be linked to constipation. Fourth, the sleep of enuretic children might be "deep," but possibly also disturbed (by obstructed airways or a distended or contracting bladder). These children might have high arousal thresholds because of the enuresis instead of the other way around. The same might possibly be said about nocturnal polyuria. Taking these new insights into account, a new model of enuresis pathogenesis is presented, which is more complicated but hopefully also more true than the standard consensus., (© 2017 The Japanese Urological Association.)

The aim of our study was to find the reason of various forms of somatoform disorders (phobias, behavioral disorders, insomnia, tics, stuttering, enuresis, encopresis) in children and adolescents of various social status for diagnosis and treatment. We have examined 202 patients who referred to our clinic from 2012-2016. The age range was 2-18 years. After examination we have concluded the following recommendations: - to implement neuropsychological rehabilitation in order to stimulate mental development; - to work with speech therapist to improvement the speech; - to work individually with psychotherapist to improve the behavior; - to train the parent to manage the behavior at home; - to give the personal card containing information about exercises, games and puzzles to stimulate the development and in some cases to give individual educational program; - to give separate information to parents and in some cases to teachers of kindergartens and schools.

Case: Marcus is a 10-year-old boy who was followed by his pediatrician for several years. She knows him as a socially engaged, active athlete, playing soccer and baseball, out-going, and a good student. He has been in good health without a significant medical history.At the beginning of this academic year, a new student was placed in Marcus's fourth grade class. This student is disruptive, impulsive, and abusive. He has frequent violent outbursts, yelling, kicking, and throwing objects, including recently throwing a desk across the room. The school has made efforts to manage this student. The teacher sets up behavior contracts, and the school has temporarily suspended the child; however, the school is unable to remove the child from the classroom. Many students, including Marcus, have been significantly affected by this disruption.Marcus describes the classroom environment as "tense." He reports he is never sure what is going to make the student "so mad." Over the last 3-4 months, Marcus developed nightmares, enuresis, and trichotillomania. The hair pulling is the most distressing feature for both Marcus and his parents. Marcus acknowledges that he is usually unaware of the behavior at first but then finds the sensation is relaxing. Afterward, he is typically embarrassed by the behavior. There is a family history of anxiety in both parents.He has been seeing a psychologist with some mild improvement in his enuresis. However, the hair pulling has not improved and has worsened. They were seeking additional advice regarding the next steps.

Purpose: National statistics estimate that a quarter of American school children are regularly bullied, making this issue the main parental concern and the leading form of school violence. To our knowledge no study in the literature has examined the association of bullying with lower urinary tract symptoms. We evaluated the relationship between being bullied and lower urinary tract symptoms in the pediatric population., Materials and Methods: We accrued 100 patients from a pediatric urology practice in prospective case-control fashion. The degree of lower urinary tract symptoms was determined by the voiding severity score obtained by a single pediatric urologist. Using the Peer Relations Questionnaire and a thermometer scale we surveyed participants for evidence of victimization from bullying and school related anxiety. We then correlated voiding symptom severity with the degree of bullying., Results: After applying our study exclusion criteria we examined and analyzed data on 38 control children without lower urinary tract symptoms and on 38 children with lower urinary tract symptoms. Mean age was similar in the 2 groups. There were more females in the group with lower urinary tract symptoms (22 vs 13). Mean case voiding severity score was 3.82 (range 2 to 5). As measured by Bullied Index Score the degree of being bullied was significantly higher in the case group (4.76 vs 1.95, p <0.001), as was the anxiety level estimated by the thermometer score (3.68 vs 0.97, p <0.001). We also found that physical forms of bullying accounted for worse voiding severity scores (4.56 vs 3.67, p <0.01)., Conclusions: To our knowledge our study is the first to show that 1) bullying is significantly associated with pediatric lower urinary tract symptoms and 2) physical forms of bullying accompany worsened symptoms., (Copyright © 2015. Published by Elsevier Inc.)

Objective: To identify all reported cases of injury and other problems caused by using a Nintendo video gaming system., Design: Review., Data Sources and Review Methods: Search of PubMed and Embase in June 2014 for reports on injuries and other problems caused by using a Nintendo gaming system., Results: Most of the 38 articles identified were case reports or case series. Injuries and problems ranged from neurological and psychological to surgical. Traditional controllers with buttons were associated with tendinitis of the extensor of the thumb. The joystick on the Nintendo 64 controller was linked to palmar ulceration. The motion sensitive Wii remote was associated with musculoskeletal problems and various traumas., Conclusions: Most problems are mild and prevalence is low. The described injuries were related to the way the games are controlled, which varies according to the video game console., (© Jalink et al 2014.)

Enuresis and delayed bladder control are a common source of psychosocial concern for both parents and children. Different cultures have different norms with regard to parenting attitudes. The fact that in Turkey, parents consider enuresis or encopresis as a sign of laziness, misbehavior, or disobedience rather than a medical disorder may cause children to be exposed to physical and emotional violence and maltreatment by the family as a corrective strategy. We present a case in this paper which had a fatal outcome due to physical violence against a child as an educational measure and a toilet training method., (Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Objective: To report a previously undescribed condition in which children present with the sensation of wetness because of presumed urinary incontinence when they are actually completely dry. We have termed this entity "phantom" urinary incontinence (PUI)., Materials and Methods: Twenty children referred to our pediatric urology clinic were diagnosed with PUI between 2009 and 2013. Patient demographics, associated bladder and bowel symptoms, concomitant diagnoses, imaging, management, and treatment outcomes were evaluated., Results: Twenty children (18 females and 2 males) were diagnosed with PUI over a 5-year interval. Mean age at diagnosis was 6.9 ± 2.5 years (range, 4-12 years). Nineteen patients (95%) had concomitant lower urinary tract symptoms, and all were also diagnosed with constipation. Urgency (75%) and frequency (50%) were the most common associated bladder symptoms. Of the 18 girls, 13 (72%) had associated vaginitis. Fourteen children (70%) carried a parent-reported diagnosis of obsessive-compulsive disorder or obsessive-compulsive disorder personality traits. Patients were managed with timed voiding, dietary modifications, and a bowel regimen. Ninety percent children experienced improvement of bladder-bowel dysfunction and resolution of PUI at a mean follow-up of 14.4 months., Conclusion: Children with PUI have a high incidence of obsessive-compulsive traits. Phantom incontinence as well as associated lower urinary tract symptoms resolve with adherence to a strict bladder-bowel regimen., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Enuresis in childhood and adolescence is a common symptom that significantly affects the quality of life of the patients and their social environment. Advanced diagnostic and therapeutic measures have significantly improved the treatment of affected children in the last 10 years in Germany. With the help of an often sufficient non-invasive diagnostic assessment it is possible to assign the symptom to a diagnostic category. This category forms the basis for a successful therapy. A high level of motivation and willingness to cooperate of the children and their families are therapeutic premises. In present-day treatment of functional urinary incontinence urotherapy has the highest priority., (Georg Thieme Verlag KG Stuttgart · New York.)

Elimination disorders are common in childhood and adolescence. Enuresis is traditionally defined as wetting from the age of 5 years and encopresis as soiling from 4 years onwards - after all organic causes have been excluded. In the past decades, many subtypes of elimination disorders have been identified with different symptoms, etiologies, and specific treatment options. Unfortunately, the DSM-5 criteria did not integrate these new approaches. In contrast, classification systems of the International Children's Incontinence Society (ICCS) for enuresis and urinary incontinence as well as the ROME-III criteria for fecal incontinence offer new and relevant suggestions for both clinical and research purposes.

The research objective was to identify the factor structure of the pediatric symptom checklist (PSC) in children with voiding dysfunction and/or nocturnal enuresis who were seen in a pediatric urology clinic. Retrospective chart reviews were conducted for 498 consecutive patients, ages 6-16, who were seen over a 13-month period. The PSC, a 35-item measure used to screen for psychosocial difficulties, was completed by the patient's caregiver. Confirmatory factor analyses using three previous models were conducted. A four factor model comprised of internalizing, externalizing, attention problems, and chronic illness factors represented the best fit to the data. Within this population, the PSC appears to capture internalizing and externalizing problems, difficulties with attention, and possible side effects of a medical condition. This information could aid clinicians in assessing adjustment difficulties within this population and concurrently allow researchers to examine whether these specific factors are related to other relevant outcomes.

Psychological discomforts in pediatric patients, if not identified, and considered as personality traits can lead to abnormalities in the development. Identifying psychological problems and treating them with psychological intervention could avoid the raise of psychological disease in adulthood. The aim of this study is to evaluate the perception of self-image and interpersonal relationships of children affected by juvenile idiopathic arthritis (chronic pathology); to compare those data with those published in a previous research about enuretic children (functional pathology) and children affected by cleft palate (organic pathology). Forty children were tested using two Graphic Projective Tests: Machover test (Human Figure Drawing Test) and Corman test (Family Drawing Test) in order to assess specific disorders of their personality through the self-image perception and the emotional relationships with other members of family. Children affected by juvenile idiopathic arthritis show problems about the contact with the external world, underestimation of himself and inadequate perception of himself, exactly like children affected by enuresis and cleft lip and palate. Situation of discomfort, if not taken in consideration and seen as personality traits could easily become an emotional and behavioral chronic psychological disease.

We describe Pervasive Refusal Syndrome, an important but rare, debilitating condition that may present to paediatric services. Although previous reports have described improvement seen with care delivered in the mental health setting, we have demonstrated treatment predominately delivered in a paediatric ward environment associated with successful recovery.

Aim: This study was conducted to describe sleep problems in a sample of children with enuresis and to investigate the association between sleep and behavioural problems., Methods: In this cross-sectional study, 100 children with enuresis were recruited from paediatric enuresis clinic. The children's sleep problems and behaviours were assessed by the Children's Sleep Habits Questionnaire and Child Behaviour checklist., Results: The most frequently reported sleep problems were in daytime sleepiness, bedtime resistance and sleep anxiety subscales. Children with T-scores ≥ 60 in internalising, externalising and total behavioural problems had higher scores on daytime sleepiness subscale and total score than children with T-scores < 60. Multivariate logistic regression analysis revealed that daytime sleepiness subscale was significantly related to behavioural disturbances., Conclusions: Sleep problems are common among this sample of children with enuresis, and the presence of sleep disturbance such as daytime sleepiness could explain the association between enuresis and disturbed daytime behaviour., (© 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).)

Unlabelled: Study Type--Symptom Prevalence (prospective cohort) Level of Evidence 2a. What's known on the subject? and What does the study add? Nocturnal enuresis is a common childhood problem. Although its prevalence is known in many countries, no data are available from South Africa and it is difficult to extrapolate data from developed countries to a population with such diverse conditions and resource-poor settings. This study is the first to report on the 16% prevalence rate and the low level of parental knowledge of enuresis in South African children aged between 5 and 10 years., Objectives: • To establish the prevalence of NE in 5-10 year old South African children in a cross-sectional study using a parent-completed questionnaire. • To establish the parental perception and associated factors of mono-symptomatic nocturnal enuresis (MNE) treatment and treatment success rates in 5-10 year old children from South Africa., Patients and Methods: • A total of 4700 questionnaires were distributed to children at 37 selected schools willing to participate from South Africa. Parents anonymously filled out the questionnaire. • Data were reported as frequencies and percentages of NE in tables according to different gender and age groups. • The Chi-square test compared proportions between groups and Fisher's Exact test corrected for small numbers of observations (n ≤ 5). Age differences were determined using Student's t-test. A P-value ≤ 0.5 was considered to be statistically significant., Results: • The questionnaire's response rate was 72.1%, with 3389 children included in the study. • The overall prevalence of NE was 16.0%-14.4% of children suffered from mono-symptomatic NE (MNE). The prevalence of NE in boys was double that in that in girls. • Only 28.3% had received some form of treatment, whereas 13.5% had been medically treated by a doctor. Parents' awareness of treatment modalities available is outdated and most of the management of MNE was done by parents themselves, albeit with low success rates. • A positive family history was found in 50.5% of children suffering from MNE. • Constipation was a problem in 15.8% of children with enuresis., Conclusions: • This is the first study to estimate the prevalence of NE and report on the parental perception and possible associated factors of enuresis in children from South Africa. The study showed that South African children have a similar prevalence rate of NE (16%) when compared with other countries. • The possible associated factors with MNE in South Africa include constipation and a family history of enuresis. • Finally, there are low levels of parental knowledge of treatment modalities of MNE, leaving many children untreated., (© 2012 BJU INTERNATIONAL.)

Enuresis is a common condition during the childhood years. Although distressing to both children and parents, enuresis often goes unreported. Because of its common occurrence, psychiatric nurses should become knowledgeable about enuresis and understand how to assess and treat it when appropriate., (Copyright 2012, SLACK Incorporated.)

A retrospective study over seven years shows a high frequency of underlying psychological dimensions to enuresis, mainly regressive and passive, but also aggressive and erotic. It is therefore important to understand the meaning of this symptom and to take into account, in the treatment, underlying affective disorders.

Purpose of Review: The management of children with urinary incontinence and dysfunctional voiding problems can be very difficult at times. The present array of bladder-oriented treatments are marginally successful and for a long time patients were told that they would outgrow their symptoms. In this review, we look at the most recent findings in the urologic and psychiatric literature and try to piece together these two disparate fields and figure out how children who wet are best managed., Recent Findings: It became clear that children with attention deficit disorder were always more difficult to manage than those without neuropsychiatric problems. As the years have progressed and imaging technology has improved, we have begun to look into the active brain. This research has been conducted primarily in the fields of psychiatry and neuroscience, but there have been some seminal studies that point to a link between defects in the brain and functional urinary problems in children. In this review, we will attempt to outline the reasons why the traditional bowel program works and why there are such a large number of patients with neuropsychiatric problems who have functional urinary problems as children., Summary: Utilizing an approach that focuses on a treatment paradigm that is neurocentric instead of vesicocentric allows us to treat children who do not respond to the usual treatments and target the brain with centrally active medications such as tricyclics and serotonin reuptake inhibitors. Understanding that it is a problem in the central nervous system, and that in some cases it is necessary to treat the underlying neuropsychiatric problems to be able to get these children to remain dry is a very important step in the management of children with refractory wetting problems.

Background: There is significant variability of the age at which children achieve dryness., Objectives: We determine the age at achievement of micturational dryness and attitude of parents about enuresis among urban Nigerian children., Method: A total of 346 questionnaires were administered to parents of children between the ages of 12 - 180 months who came for routine paediatric care at the outpatient unit of Federal Medical Centre, Abeokuta., Results: At age 36 months, 86 (51.8 %) and 34 (20.5 %) out of 166 children had achieved dryness at daytime and night time respectively. Achievement of dryness was significantly related to low maternal education (p = 0.022) and low social class (p = 0.009). Twenty-four (26.7 %) children had nocturnal enuresis. Four (4.4 %) of these children also had diurnal enuresis. All the parents/guardians were aware about enuresis but only 9.8 % correctly identified it as a health problem. Even though none of the children with enuresis ever visited health facility for their problem, a statistically significant proportion of the parents desire to discuss with health practitioners (p = 0.015)., Conclusions: The proportion of children achieving dryness by age 36 months is very small when compared with children from developed parts of the world. There is also a high prevalence of enuresis which are not reported. Therefore, health workers in the tropics should as a routine enquire about enuresis in their daily paediatric care particularly for those children from polygamous homes and high social class.

Objective: To assess and identify the frequency and type of urinary incontinence (UI), as well as associated symptoms in persons with Prader-Willi syndrome (PWS). PWS is characterized by mental retardation, short stature, obesity and hypogonadism. The behavioural phenotype includes eating problems, temper outbursts, affective disorders, stereotypies and speech abnormalities. UI is common in children with mental retardation in general, but has not been reported systematically in children with PWS so far., Materials and Methods: The Dutch version of the 'Parental Questionnaire: Enuresis/Urinary Incontinence' was completed by 118 parents of children with PWS. This questionnaire includes items referring to day- and night-time wetting, toilet habits, observable voiding behaviours and reactions, urinary tract infections, stool habits and behavioural symptoms., Results: The rate of nocturnal enuresis in persons with PWS was 13.6% (16) at a mean age of 15.1 years. 3.8% (5) had additional daytime urinary incontinence, and 3.3% (4) had faecal incontinence. Lower urinary tract symptoms were commonly indicative of overactive bladder, dysfunctional voiding and postponement. Also, the rate of internalizing and externalizing behavioural problems was high., Conclusion: Urinary incontinence is more common in persons with PWS than in typically developing children, adolescents and adults. As lower urinary tract symptoms are common, detailed assessment and specific treatment of UI should be part of the care of all persons with PWS., (© 2010 THE AUTHORS. JOURNAL COMPILATION © 2010 BJU INTERNATIONAL.)

Aims: The aim of this study was to determine the psychometric properties of the German version of the Pediatric Enuresis Module to assess Quality of Life, Short Form (PEMQOL-SF) in a sample of parents of children with urinary incontinence., Methods: The parents of 88 children (63 male, 25 female, mean age: 9.3 [SD ± 2.5, range 6-18] years) with urinary incontinence were asked to complete the PEMQOL-SF. For evaluation of convergence validity, parents and children completed the respective versions of the DCGM-10 and the PinQ questionnaire., Results: Mean PEMQOL-SF scores were 72.2 [SD ± 14.1] (child impact scale) and 73.7 [SD ± 16.5] (family impact scale). The PEMQOL-SF had a Cronbach's alpha of 0.68 (child impact scale) and 0.80 (family impact scale), respectively. PEMQOL-SF child [family] impact scale scores correlated with the DCGM-10 with scores of r = 0.34 (r = 0.13; self-report version) and r = 0.63 (r = 0.48; proxy version) and with the PinQ with scores of r = -0.31 (r = -0.16; self-report version) and r = -0.63 (r = -0.54; proxy version), respectively., Conclusions: The psychometric properties of the PEMQOL-SF were good for the family impact scale, but poor for the child impact scale. In its present form, the PEMQOL-SF cannot be recommended for routine clinical use. Nevertheless, a reduction of questionnaire items could lead to better psychometric properties., (© 2010 Wiley-Liss, Inc.)

Background: Co-occurrence of oral language disorders and enuresis in children., Aim: To identify and analyze the relationship between instances of oral language disorders and enuresis in children., Method: Clinical, quantitative and qualitative study, with a descriptive/interpretative outline, presented through two distinct situations. "Situation 1" refers to a group of 120 children between 3:0 and 10:0 years old, independently of gender and age, from a philanthropic Institution in Greater São Paulo. "Situation 2" refers specifically to the evaluation of children who have oral language disorders and enuresis., Results: Results indicated that enuretic children present a higher percentage of oral language disorders when compared to non-enuretic children, especially phonological disorders and talking very little. These results support the studies on co-occurrence of enuresis and oral language disorders, presented in papers that attribute a bio-psychic etiology to this co-morbidity., Conclusion: Results indicated a relationship between enuresis and oral language disorders. Considering the interactions among language, body and psyche, it is suggested that speech therapists, when dealing with oral language disorders in children, also investigate the acquisition of their bladder sphincter control, in a bio-psychical approach.

Case: Paul is an 8-year-old boy with a long-standing history of encopresis and enuresis. Potty training was initiated when he was 2(1/2) years old. At this time, his mother was absent from the home for 6 weeks when she cared for her ill father in a different city. The process of teaching Paul to use the bathroom was described as "inconsistent" due to multiple caretakers.Paul never successfully mastered bowel and bladder control. He continues to wet and soil his clothes on a daily basis at home and school. According to his parents, he does not accept responsibility and comments about his soiling such as, "I didn't do it; someone else must have put it there." One of Paul's teachers commented that she could tell at the beginning of the school day whether he would maintain bowel and bladder control. If he was "agitated and talkative" in the early morning, he would often soil that day.He had a pediatric gastroenterological evaluation at the age of 5 years when he was having daily episodes of stool soiling. Physical examination revealed normal anal tone, normal placement of the anus, and moderate stool in the rectal vault. An abdominal radiograph revealed moderate stool throughout the colon. He was treated with Miralax and instructed to sit on the toilet twice daily. Paul did not respond to these interventions and was diagnosed with "overflow incontinence secondary to stool withholding." When he was taking Miralax, he had a normal barium enema radiograph. He was admitted to the hospital for a clean out with a polyethylene glycol/electrolyte solution. Although abdominal radiographs demonstrated absence of colonic stool for the following 5 months, he continued to soil his clothing. Play therapy and biofeedback did not change the chronic soiling and wetting pattern. An evaluation at the Continence Clinic resulted in a rigorous program including stooling after each meal, wearing a vibrating watch reminding him to void every 2 hours, drinking 60 ounces of water per day, tracking elimination patterns on a calendar, and a daily laxative (polyethylene glycol). A neuropsychological evaluation revealed a superior aptitude associated with unresolved early childhood issues of self-control, self-care, and frustration tolerance. Family therapy was initiated. However, daily fecal soiling and wetting persisted.Paul was born full-term without prenatal or perinatal complications. He was breast fed for 1 year and described as an easy baby. He achieved motor, social, and language milestone on time. Paul had difficulty with separation and aggression in preschool (e.g., biting). In school, teachers report inattention, fidgetiness, and difficulty following directions. He has been obese since age 3 years; his current body mass index is 29.

Objective: To compare parental psychopathology and psychiatric disorders in ADHD children with and those without enuresis., Method: The participants of the clinical sample interviewed according to DSM-IV diagnostic criteria were 35 children with ADHD and enuresis, 153 ADHD children without enuresis, 115 fathers, and 172 mothers., Results: Only ODD comorbidity was the predictor of enuresis. Conduct disorder, tic disorder, major depressive disorder, separation anxiety disorder, bruxism, generalized anxiety disorder, obsessive compulsive disorder, and nail biting were not statistically more frequent in ADHD children with enuresis than in the ADHD children without enuresis. The only parental psychiatric disorder that was related to the groups was father's major depressive disorder., Conclusion: Enuresis in ADHD has a relationship with ODD. Physicians who treat patients with ADHD and enuresis should routinely inquire about the presence of major depression in the fathers. (J. of Att. Dis. 2010; 13(5) 464-467).

Beware not to confuse talk about children with children's talk: this should be the golden rule for childhood professionals. Agitation and somatization disrupt the functioning of what is called the functional spheres. The child eats poorly, sleeps poorly, and has problems controlling his sphincters. He presents symptoms that the growing importance of education in today's modern world can no longer neglect. The diversity of the circumstances in which the child is recognized as "disruptive" shows just how much the borders between children and adults are permeable. The disruptive child is also a child disturbed by the adult world in which he is evolving. The author supports his hypotheses with several examples from his practice as a psychoanalyst.

Background: Despite a large scientific literature on early clinical precursors of schizophrenia, bipolar disorder and unipolar depression, few data are available on axis I disorders preceding the adult onset of these illnesses., Sampling and Methods: Disorders before the age of 18 years were retrospectively assessed with a structured interview in 3 groups of consecutive adult inpatients with DSM-IV diagnoses of schizophrenia (n = 197), major depressive disorder (n = 287) and bipolar disorder (n = 132). Only patients with adult onset of schizophrenia and of mania/hypomania were included. A sample of the general population served as control group (n = 300)., Results and Conclusion: The clinical groups significantly outnumbered the control sample on the majority of early axis I diagnoses. Schizophrenia was significantly associated (1) with attention deficit hyperactivity disorder (ADHD), ADHD inattentive subtype, ADHD hyperactive subtype and primary nocturnal enuresis, compared to unipolar depression, and (2) with social phobia and ADHD inattentive subtype, compared to bipolar disorder. Oppositional defiant disorder was significantly associated with bipolar disorder, compared to the other clinical and control groups. The ADHD hyperactive subtype predicted the adult onset of bipolar disorder compared to unipolar depression. Externalizing disorders seem of special importance as regards the clinical pathways toward schizophrenia.

There is comparatively little information about premorbid maturational brain abnormalities in schizophrenia (SCZ). We investigated whether a history of childhood enuresis, a well-established marker of neurodevelopmental delay, is associated with SCZ and with measures of brain abnormalities also associated with SCZ. A Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) based history of enuresis, volumetric brain MRI scans and neuropsychological testing were obtained in patients with SCZ, their non-psychotic siblings (SIB) and non-psychiatric controls (NC). The subjects were 211 patients (79.6% male), 234 of their SIB (43.2% male) and 355 controls (39.2% male). Frequency of enuresis was compared across groups and correlated with cognitive measures. Total and regional brain volumes were determined using voxel-based morphometry on matched subsets of probands (n = 82) with or without enuresis (n = 16, n = 66, respectively) and controls (n = 102) with or without enuresis (n = 11, n = 91, respectively). Patients with SCZ had higher rates of childhood enuresis (21%) compared with SIB (11%; chi(2) = 6.42, P = 0.01) or controls (7%; chi(2) = 23.65, P < 0.0001) and relative risk for enuresis was increased in SIB (lambda(S) = 2.62). Patients with enuresis performed worse on two frontal lobe cognitive tests [Letter Fluency (t = 1.97, P = 0.05, df = 200) and Category Fluency (t = 2.15, P = 0.03, df = 200)] as compared with non-enuretic patients. Voxel-based morphometry analysis revealed grey matter volume reductions in several frontal regions (right BA 9, right BA 10 and bilateral BA 45) and right superior parietal cortex (BA 7) in patients with a history of enuresis as compared with non-enuretic patients (all t > 3.57, all P < 0.001). The high frequency of childhood enuresis associated with SCZ and abnormalities in prefrontal function and structure in patients with a childhood history of enuresis suggest that childhood enuresis may be a premorbid marker for neurodevelopmental abnormalities related to SCZ. These findings add to the evidence implicating prefrontal dysmaturation in this disorder, potentially related to genetic risk factors.

Objectives: Previous studies based on clinical samples report that enuresis in children is associated with behavioural problems and reduced self-esteem, but the relationship between behavioural problems and enuresis remains controversial. This population-based study investigated the prevalence and behavioural correlates of enuresis in a group of preparatory school children., Methods: This cross-sectional survey involved 356 parents and their children aged 5-7 years, all residents of Istanbul, Turkey. Parents completed the Child Behaviour Checklist and socio-demographic data form (response rate: 90%). Fifty-three children with enuresis were compared with 303 non-symptomatic children. Differences in the mean scores and the percentages of children falling beyond pre-selected clinical thresholds were compared between the groups., Results: The prevalence of enuresis was 14.9%, and enuresis was more frequent among boys. Children with enuresis were reported by their parents to have greater social problems and higher total problem scores than control children (P = 0.019, P = 0.048, respectively). However, there were no differences in the percentages of children falling beyond pre-selected clinical thresholds between the groups., Conclusions: Children with enuresis had higher mean scores for total and social behavioural problems than controls; however, clinically relevant behavioural problems did not show differences between the groups. Given the inconsistent research findings across studies, longitudinal research and outcome studies could help determine whether there is a causal relationship between psychopathology and enuresis.

Background: There are cross-cultural variations in sleep habits among children. No previous study has assessed the prevalence of cosleeping in school-aged children in Middle Eastern countries., Purpose: To assess the prevalence of, and the factors associated with, cosleeping in Saudi school-aged children., Methods: Questionnaires were distributed according to a specified sampling procedure, and parents were asked to rate each item that described their child's behavior within the previous 6 months. Cosleeping was defined as all-night sharing of a bed or room with a parent., Results: Data were analyzed for 977 children (50.5% boys) with a mean age of 9.5 +/- 1.9 years and a range from 5 to 12 years. Cosleeping with parents was reported by 26% (95% CI: 23.2-28.7%) of the sample. According to a multivariate logistic regression model, a child's school level, enuresis, and nightmares were the only predictors of cosleeping., Conclusion: This study demonstrated that cosleeping is more common among Saudi school-aged children than has been reported for other countries. When assessing children's sleep, the practitioner should give special consideration to the child's needs, and his/her family's cultural background.

Objective: To review both the scientific literature and lay literature on toilet training, covering parents' expectations, the methods available for achieving bladder and bowel control and associated morbidities., Sources: Articles published between 1960 and 2007, identified via the MEDLINE, Cochrane Collaboration, ERIC, Web of Science, LILACS and SciELO databases plus queries on the Google search engine; a search of related articles, references of articles, by author and of pediatrics societies. A total of 473 articles were examined and 85 of these were selected for this review., Summary of the Findings: Parents have unrealistic expectations about the age at which diapers can be withdrawn, not taking child development into account. Toilet training strategies have not changed over recent decades, and in the majority of countries the age at which children are trained has been postponed. Training methods are rarely used. Starting toilet training prematurely and stressful events during this period can extend the training process. Children who have not been trained correctly present with enuresis, urinary infection, voiding dysfunction, constipation, encopresis and refusal to go to the toilet more frequently. Literature intended for lay parents is both abundant and adequate, available in book form and on the Internet, but it is not widely available to the Brazilian population. Just three international pediatrics societies have published guidelines on toilet training., Conclusions: Toilet training is occurring later in the majority of countries. The training methods that exist are the same from decades ago and are rarely used by mothers and valued little by pediatricians; incorrect training can be a causative factor for bladder and bowel disorders, which in turn cause problems for children and their families.

Purpose: The current study focuses on the construction and validation of the Short Screening Instrument for Psychological Problems in Enuresis, for emotional problems and symptoms of attention deficit hyperactivity disorder, in a population of children with enuresis., Materials and Methods: In phase I factor analyses were performed on 31 items of the Internalizing scale of the Child Behavior Checklist and on 18 items of the Attention Deficit Disorder scale of the Disruptive Behavior Disorders Rating Scale to select the most discriminating items. The question format and cutoff score for referral were determined by maximization of correctly classified patients, with the full Child Behavior Checklist and Disruptive Behavior Disorders Rating Scale as standards. In phase II 109 children with enuresis (76 males and 33 females, mean age 8.5 years, SD 2.4) admitted to a tertiary care university hospital entered the validation study. The parents completed the Short Screening Instrument for Psychological Problems in Enuresis and the original questionnaires, ie Child Behavior Checklist and Disruptive Behavior Disorders Rating Scale., Results: Seven items (factor loading greater than 0.65) were selected for "emotional problems," 3 (greater than 0.80) for "attention problems" and 3 (greater than 0.75) for "hyperactivity/impulsivity problems." Full screening was indicated when at least 2 problem behaviors occurred at least "sometimes" for Child Behavior Checklist items or "frequently" for Disruptive Behavior Disorders Rating Scale items. Validation of the Short Screening Instrument for Psychological Problems in Enuresis revealed good accuracy for all subscales (approximately 88%), excellent specificity (0.91 to 0.99) and low to fair sensitivity (0.29 to 0.75)., Conclusions: The Short Screening Instrument for Psychological Problems in Enuresis meets its goal because it leads to time efficient and early detection of problems of emotion, attention and hyperactivity/impulsivity. The implementation of this short questionnaire can contribute to better followup of medical treatment.

Objective: The objective of this study was to examine differences in intellectual capacities between children with and without soiling, daytime wetting, and bed-wetting., Methods: This study was based on a population of >6000 children (age range: 7 years 6 months to 9 years 3 months; median: 7 years 6 months) from the United Kingdom-based Avon Longitudinal Study of Parents and Children. Data on wetting and soiling were obtained from a questionnaire completed by parents. The Wechsler Intelligence Scale for Children-Third Edition was administered at a research clinic., Results: Bed-wetting was associated with lower Wechsler Intelligence Scale for Children-Third Edition IQ scores compared with control subjects, particularly performance IQ. This difference remained after exclusion of children with an IQ of <70 and adjustment for gender, stressful life events, and sociodemographic background. There were fewer differences in IQ scores between children with and without soiling or daytime wetting. Co-occurring wetting and soiling were associated with lower IQ scores than isolated soiling, daytime wetting, or bed-wetting, but this was mostly attributable to an overrepresentation of children with an IQ of <70 in the co-occurrence group., Conclusions: It is hypothesized that the differences in intellectual capacities between children with and without bed-wetting are associated with maturational deficits of the central nervous system. There was less evidence for differences in intellectual capacities between children with and without soiling and daytime wetting. The central nervous system is involved to a lesser extent in soiling and daytime wetting, because peripheral influences from the bladder and gut play a greater role.

Background: Anorectal malformations (ARMs) often result in lifelong problems with defecation. There have been no studies performed to develop scoring systems in children with fecal incontinence following repair of ARM. This study was designed to develop and validate a tool (Baylor Continence Scale [BCS]) to measure social continence in children after surgical correction of ARMs., Methods: The BCS is a 23-question survey, was administered to children who have had repair of an ARM, children with enuresis, and normal children., Results: Children in the ARM group had an average BCS score of 28.0, which was statistically different from an enuresis control group (16.5) and normal controls (11.5) (P < .05). A significantly greater proportion of children in the ARM group had higher Impact on Family Scores (>30) than either the enuresis or normal control group (P < .05)., Conclusions: The BCS tool should be useful in prospective studies of interventions to improve incontinence after repair of an ARM. An important secondary result of this study was to demonstrate the effect on families of caring for a child with imperforate anus, even years after the repair.

Aim: To examine the association between enuresis and psychopathology in urban Ethiopian children., Methods: A two-stage mental health survey of 5000 urban children found enuresis to be by far the most common disorder. Logistic regression modelling was carried out to determine the independent associations of a number of socio-demographic and psychopathological characteristics with enuresis., Results: Male sex, younger age and lower achieved educational grade of the child were all independently associated with childhood enuresis. The odds of having enuresis were significantly higher for children in families with significant financial worries and in children from homes where parents were separated. Children with DSMIII-R anxiety disorders, especially simple phobia, or disruptive behaviour disorders were found to have significantly higher odds of having enuresis., Conclusion: Psychopathology, both anxiety and behavioural disorders, as well as family stressors in urban Ethiopian children were found to be risk factors for enuresis. Although a cause-effect relationship could not be ascertained, the findings of higher association of psychopathology with enuresis in this and other studies indicate that there is a need for evaluating children with enuresis for the presence of concurrent psychopathology, especially in traditional societies where undetected psychopathology may be more common.

Objective: The aim of the study was to examine antecedent childhood psychiatric disorders in adult patients with bipolar disorder., Method: Using structured diagnostic interviews, childhood psychiatric diagnoses of 83 referred patients with diagnosed DSM-IV bipolar disorder were compared to those of 308 adults without mood disorders., Results: Patients with bipolar disorder had significantly higher rates of childhood disruptive behavior disorders (ADHD, oppositional-defiant disorder, and conduct disorder), childhood anxiety disorders (separation anxiety and overanxious disorder), and enuresis, compared to patients without mood disorders. The presence of these childhood disorders was associated with an earlier age of onset of bipolar illness., Limitations: The retrospective nature of the study may have affected both the rates of disorders recalled, as well as the ages of onset of disorders. Different referral sources for bipolar and comparison participants may have also impacted findings., Conclusions: Bipolar disorder in adults is frequently preceded by childhood disruptive behavior and anxiety disorders. These childhood disorders may be important markers of risk for adult bipolar disorder.