Neuropsychological functioning related to specific characteristics of nocturnal enuresis

• Published in: Journal of pediatric urology 2015-08, Vol.11 (4), p.208.e1-208.e6
• Main Authors: Van Herzeele, C, Dhondt, K, Roels, S.P, Raes, A, Groen, L.-A, Hoebeke, P, Walle, J. Vande
• Format: Article
• Language: English
• Subjects: Adolescent; Attention Deficit Disorder with Hyperactivity - complications; Attention Deficit Disorder with Hyperactivity - diagnosis; Attention Deficit Disorder with Hyperactivity - psychology; Child; Child psychology; Circadian Rhythm - physiology; Enuresis; Female; Humans; Male; Neuropsychological Tests; Nocturnal Enuresis - complications; Nocturnal Enuresis - physiopathology; Nocturnal Enuresis - psychology; Pediatrics; Polyuria; Quality of Life; Surveys and Questionnaires; Urination - physiology; Urology
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2015.04.033

Summary Introduction/Background There is a high comorbidity demonstrated in the literature between nocturnal enuresis and several neuropsychological dysfunctions, with special emphasis on attention deficit hyperactivity disorder (ADHD). However, the majority of the psychological studies did not include full non-invasive screening and failed to differentiate between monosymptomatic nocturnal enuresis (MNE) and non-MNE patients. Objective The present study primarily aimed to investigate the association between nocturnal enuresis and (neuro)psychological functioning in a selective homogeneous patient group, namely: children with MNE and associated nocturnal polyuria (NP). Secondly, the study investigated the association between specific characteristics of nocturnal enuresis (maximum voided volume, number of wet nights and number of nights with NP) and ADHD-inattentive symptoms, executive functioning and quality of life. Study design The psychological measurements were multi-informant (parents, children and teachers) and multi-method (questionnaires, clinical interviews and neuropsychological testing). Results Thirty children aged 6–16 years (mean 10.43 years, SD 3.08) were included. Of them, 80% had at least one psychological, motor or neurological difficulty. The comorbid diagnosis of ADHD, especially the predominantly inattentive presentation, was most common. According to the teachers, a low maximum voided volume (corrected for age) was associated with more attention problems, and a high number of nights with NP was associated with more behaviour-regulation problems. No significant correlations were found between specific characteristics of enuresis and quality of life. Details are demonstrated in Table. Discussion The children were recruited from a tertiary referral centre, which resulted in selection bias. Moreover, NP was defined as a urine output exceeding 100% of the expected bladder capacity for age (EBC), and not according to the expert-opinion-based International Children's Continence Society norm of 130% of EBC. The definition for NP of a urine output exceeding 100% of the EBC is more in line with the recent findings of the Aarhus group. Conclusions For children with MNE and associated NP, a high comorbidity with the predominantly inattentive presentation of ADHD was demonstrated. Children experienced problems with daytime functioning in relation to their wetting problem at night. According to the teachers, a low maximum voided volume was associat