The prevalence of attention deficit-hyperactivity disorder in children with nonmonosymptomatic nocturnal enuresis: a 4-year followup study.

PURPOSE: The prevalence of attention deficit-hyperactivity disorder was increased in a predominantly nonmonosymptomatic nocturnal enuresis population reported on previously. At 2 years after onset of treatment for enuresis attention deficit-hyperactivity disorder seemed to be a risk factor for continuing enuresis. In the current 4-year followup study we sought to determine whether the original attention deficit-hyperactivity disorder diagnosis could be reconfirmed, thereby reflecting the presence of a psychiatric syndrome rather than a coping behavior to deal with the negative consequences of enuresis. An additional study goal was to investigate the evolution in enuresis status in children with and without attention deficit-hyperactivity disorder.

MATERIALS AND METHODS: A total of 79 children diagnosed with enuresis in the baseline study took part in a 3rd screening for attention deficit-hyperactivity disorder. A diagnostic interview (Diagnostic Interview Schedule for Children-Parent Edition) was administered to the parents, questionnaires (Child Behavior Checklist/Teacher Report Form, Disruptive Behavior Disorder Rating Scale) were completed by the parents and teachers, and medical files were consulted.

RESULTS: Of the baseline attention deficit-hyperactivity disorder diagnoses 64% could be reconfirmed at 4-year followup, compared to 73% at 2-year followup. The prevalence of enuresis also decreased by 23%, to 42%. The distribution of enuresis at 4-year followup did not significantly differ between children with and without a baseline or final diagnosis of attention deficit-hyperactivity disorder. No significant predictors of bedwetting episodes could be found in sociodemographic, attention deficit-hyperactivity disorder or organic characteristics.

CONCLUSIONS: At 4-year followup a substantial number of children still met the criteria for attention deficit-hyperactivity disorder, even after becoming dry. The prevalence rate of enuresis decreased much faster than that of attention deficit-hyperactivity disorder, suggesting the presence of a psychiatric syndrome rather than a coping behavior. Contrary to intermediate findings, current enuresis status could no longer be predicted by attention deficit-hyperactivity disorder symptoms.