ADHD and Bed-Wetting: Are They Related to each Other?

Children are really great to be with and even greater to teach. They have to be taught certain things and some things they pick up themselves. Potty training and bedtime training are somethings that they have to be taught and most children do pick up the training well with time. But the task is slightly different in children who suffer from ADHD or Attention Deficit Hyperactivity Disorder. The prevailing belief is that children with ADHD have an increased tendency to bed-wetting that persists for several years beyond normal and this condition can ultimately find its way into the classroom. But is this belief actually true? If yes, then what are the sources for that information? If no, then what caused the misconception? Let’s find out!

Attention Deficit Hyperactivity Disorder among children is very common. According to the latest statistics by researchers, ADHD is one of the most common disorders affecting children with over 3%-5% of children being afflicted. (Source- Nair J, Ehimare U, Beitman BD, Nair SS, Lavin A (2006). "Clinical review: evidence-based diagnosis and treatment of ADHD in children". Mo Med 103 (6): 617–21. PMID 17256270).

To observers, the symptoms of ADHD are very simple but the disorder can persist and worsen as time passes. Affected children are easily distracted and frequently keep skipping from one activity to another. They cannot focus on one idea or job at a time and they are easily distracted from the task present at hand. Fidgeting and trouble sitting still for even a short period of time are very common in ADHD patients.

Children with ADHD will also say inappropriate comments and are extremely impatient even interrupting adult conversations and activities. One of the most common symptoms of ADHD is supposed to be bed-wetting. The common belief is that children with ADHD are simply too impatient to heed the warnings of a full bladder resulting in bed-wetting or enuresis. But there is still no research to back that claim. There are three main subtypes of ADHD called "predominantly hyperactive-impulsive, predominantly inattentive and combined hyperactive-impulsive and inattentive." Each of these have slightly differing symptoms, but none of them list bed-wetting as a symptom.

Treatments are possible to control and focus the child’s attention, but there is no permanent cure. Before any treatment can be started, the child will have to undergo extensive mental, and physical and medical testing to rule out medical conditions, to identify his disorder and get a definitive diagnosis.

Enuresis is fairly common in children and the condition is more frequent in boys rather than girls. Most children are able to achieve full bladder control by 5 or 6 years of life. But causes like hormonal treatments, urinary tract infections, abnormalities in the urinary tract and spinal cord, genetic factors, stress and small bladders may compound the problem. There is also a common school of thought that states a strong connection between bed-wetting and ADHD in children but there is no research to prove it. At present there is no particular form of treatment for bed-wetting as most children do outgrow it with age. You can try simple tricks like reducing water intake, bladder training, and positive reinforcements to induce your child to reduce bed-wetting.

Bed-wetting and ADHD have long been considered strong bedfellows. According to research articles published in the Southern Medical Journal, 1997, strong connections have been established between children with ADHD and bed-wetters. There was a 2.7 times higher incidence of night time enuresis as well as a 4.5 times higher incidence of daytime bed-wetting in the same patients. Parents can sometimes exacerbate the problem. in an effort to control the bed-wetting, they wake the child and get up themselves repeatedly in the night to go to the bathroom.

However, this may not prevent the child who may still pass urine in bed in-between toilet trips. The entire process stresses parents and children too. The sleepy child may then seem to be attention deficit in class with an inability to focus on class work ( Source- AD/HD and Enuresis (Bed-wetting), Carol Watkins, MD, Northern County Psychiatric Associates). Punishments for bed-wetting will also increase stress and anxiety increasing the bed-wetting and also causing the child to seem inactive and uninterested in class due to poor self esteem issues.

Enuresis and ADHD may seem to run together in children but there is no actual proof to support it. According to the following study: Clinical correlates of enuresis in ADHD and non-ADHD children by Biederman J, Santangelo SL, Faraone SV, Kiely K, Guite J, Mick E, Reed ED, Kraus I, Jellinek M, Perrin J. carried by the Pediatric Psychopharmacology Unit (ACC 725), Massachusetts General Hospital, Boston 02114, USA, the following conclusions were drawn:

1. Bed-wetting did not increase the risk of psychopathology in children. The risk for developing bed-wetting was equal in ADHD children and normal children

2. Bed-wetting did not cause any psychosocial hardship or developmental problems

3. Bed-wetting was associated with an increased risk of developing learning disabilities, weakened intellectual functioning, as well as a lesser school achievement record in normal children but not in children with ADHD; and

4. The identical model of results was derived after comparing bed-wetting children of primary versus secondary and of nocturnal versus diurnal variants. The results suggested that the clinical results of bed-wetting differed in ADHD and non-ADHD children