Huang Amy A, Cooper Christopher S, Fuller Laura L, Shelton Jude, Pham Hanh T D, Lockwood Gina M, Storm Douglas W, Edwards Angelena B
Department of Urology, University of Iowa, Iowa City, IA, 52242, USA.
Department of Urology, University of Iowa, Iowa City, IA, 52242, USA.
J Pediatr Urol. 2025 Aug 9. doi: 10.1016/j.jpurol.2025.08.005.
Children with attention deficit hyperactivity disorder (ADHD) are 4.5x more likely to have incontinence than their peers. Previous studies on comorbid ADHD and bladder bowel dysfunction (BBD) only included children with ADHD taking stimulant medications.
Comparing response to BBD treatment between patients with ADHD taking and not taking ADHD medications.
We reviewed urology patients 5-18 years of age seen between 1/1/2015 and 12/30/2022. Inclusion criteria included: BBD diagnosis, formal psychological diagnosis of ADHD and completion of our clinic's pediatric BBD questionnaire. BBD treatments included urotherapy behavioral modifications, bowel medications, and anticholinergic medications. An age-matched control cohort with BBD without ADHD served as a baseline reference of BBD. A linear mixed model compared BBD score trends between children with BBD with and without ADHD and between children taking and not taking ADHD medications.
Patients with ADHD and BBD (n = 122) had higher baseline BBD scores on average than controls with BBD (n = 300), 8.86 and 11.68 points for those taking and not taking ADHD medication, respectively (p < 0.001). At the final visit, the ADHD cohort had significantly higher final BBD scores, 23.46, when compared to controls, 18.16 (p < 0.001). In the "urotherapy-only" group, patients not taking ADHD medication had 13.40-point higher baseline BBD score than those taking ADHD medications (p = 0.005). In the "urotherapy & bowel medication" and "urotherapy, bowel, & anticholinergic medication" groups, patients not taking ADHD medication had similar rates of improvement and BBD scores at baseline and the first follow-up visit to patients taking ADHD medication. The rate of improvement between patients taking and not taking ADHD medication was significantly different in the urotherapy-only group.
Children with comorbid ADHD, regardless of ADHD medical therapy, have more severe BBD than their peers with BBD alone. Patients not taking ADHD medications improved with BBD treatment. However, ADHD medical therapy status may affect BBD management in children only performing behavioral modifications such as timed voiding or potty watch utilization.
Children with BBD and ADHD had more severe BBD scores than peers with BBD only. In the ADHD population, the children not taking ADHD medication had more severe baseline BBD than those taking ADHD medication within the group receiving urotherapy alone but demonstrated improvement in their BBD symptoms. Children with ADHD, regardless of ADHD medication status, were similar in their baseline and first follow-up visit BBD scores and rates of improvement when bowel and/or anticholinergic medications were added to urotherapy.
患有注意力缺陷多动障碍（ADHD）的儿童出现大小便失禁的可能性是其同龄人4.5倍。以往关于ADHD与膀胱肠道功能障碍（BBD）共病的研究仅纳入了正在服用兴奋剂药物的ADHD儿童。
比较服用和未服用ADHD药物的患者对BBD治疗的反应。
我们回顾了2015年1月1日至2022年12月30日期间就诊的5至18岁泌尿外科患者。纳入标准包括：BBD诊断、ADHD的正式心理诊断以及完成我们诊所的儿科BBD问卷。BBD治疗包括尿疗法行为矫正、肠道药物和抗胆碱能药物。一个年龄匹配的无ADHD的BBD对照队列作为BBD的基线参考。线性混合模型比较了患有和未患有ADHD的BBD儿童之间以及服用和未服用ADHD药物的儿童之间的BBD评分趋势。
患有ADHD和BBD的患者（n = 122）平均基线BBD评分高于仅患有BBD的对照组（n = 300），服用和未服用ADHD药物的患者分别为8.86分和11.68分（p < 0.001）。在最后一次就诊时，ADHD队列的最终BBD评分显著高于对照组，分别为23.46分和18.16分（p < 0.001）。在“仅尿疗法”组中，未服用ADHD药物的患者基线BBD评分比服用ADHD药物的患者高13.40分（p = 0.005）。在“尿疗法和肠道药物”组以及“尿疗法、肠道和抗胆碱能药物”组中，未服用ADHD药物的患者与服用ADHD药物的患者在基线和首次随访时的改善率和BBD评分相似。仅尿疗法组中服用和未服用ADHD药物的患者之间的改善率有显著差异。
患有ADHD共病的儿童，无论是否接受ADHD药物治疗，其BBD比仅患有BBD的同龄人更严重。未服用ADHD药物的患者通过BBD治疗得到改善。然而，ADHD药物治疗状态可能仅在进行诸如定时排尿或使用便盆观察等行为矫正的儿童中影响BBD的管理。
患有BBD和ADHD的儿童的BBD评分比仅患有BBD的同龄人更严重。在ADHD人群中，未服用ADHD药物的儿童在仅接受尿疗法的组中基线BBD比服用ADHD药物的儿童更严重，但他们的BBD症状有所改善。无论ADHD药物治疗状态如何, 当在尿疗法中添加肠道和/或抗胆碱能药物时，患有ADHD的儿童在基线和首次随访时的BBD评分及改善率相似。
