The Connection Between Bedwetting and ADHD
Taken from an article by Ahuva Rosenwasser in the magazine "Yom l'Yom (Day to Day)", Health section, October 2008
Attention Deficit and Hyperactivity Disorder (ADHD) is a common phenomenon among children (3%-5%) in the western world. The disorder is characterized by impulsiveness, hyperactivity, and distractibility. The symptoms begin at six years old and appear both at home and at school.
It is known that bedwetting influences the child both physiologically and socially, and almost all research studies on the topic identify a worsening in behavioral problems in bedwetting children in general, and in those suffering additionally from ADHD in particular in comparison to their non-bedwetting, non-ADHD peers.
The formal medical definition of bedwetting is a loss of urine unwillingly while sleeping, at least two times a week, by a child above five years of age. In Israel, more than 110,000 children suffer from bedwetting. About 20% of five year olds, 12% of eight year olds, and 4% of 11 year olds suffer from the problem. In addition, 2% of the population are expected to cope with bedwetting all of their lives.
Among children who are diagnosed with ADHD, the extent of the problem of bedwetting is estimated at 25% more. This problem increases the difficulty in functioning for the child, as the quality of sleep is negatively affected, so is the problem of distractibility during the day.
In a research study that was conducted at "Shaarei Tzedek" with children suffering from ADHD and bedwetting, the doctors suggest a hormonal treatment with a medicine called Minirin, which is preferred in favor of anti-depressive medication.
According to Dr. Chartin, a specialist in child urology and director of the Bedwetting Clinic at Shaarei Tzedek Hospital in Jerusalem, and the one initiated and directed the research study - "until now there hasn't been placed an emphasis on weaning these children from bedwetting, since the common treatment until now in groups of these children was with Primonil, an anti-depressive drug, which occasionally worsened the situation during the day and at night. The reason to connect between bedwetting and ADHD is since the area of the brain which is responsible for distractibility and the area responsible for bedwetting are in close proximity."
Fifty-four children, aged 6-11, participated in the research study, which lasted 12 months (2006-2007). The participants were divided into two groups corresponding identically in age, sex, and type of disorder. One group of 27 children was treated with Primonil, an anti-depressive medication, and the second group of 27 children received a treatment combining two medications: one medication (from the anticholinergic group) which causes relaxation and improved nervous system functioning and the second medication, Minirin, the only drug treatment currently available for bedwetting, which helps in cases of increased release during the night. The Minirin decreases the problem at night in a way similar to that of the natural body hormone, ADH.
The research project was presented in the international magazine "The Urology Journal" and was not released in Israel.
The children of the two groups were instructed how to behave during the day and received directions concerning appropriate food. The results of the study, as presented by Dr. Chartin, show that by the children in the second group that was treated with the combined treatment the goals of decreased bedwetting and improved bladder functioning were reached. There was a significant decrease in bedwetting during the night and in frequency during the day. In both groups, there was a significant improvement as far as behavior; however, in the second group there was a significant decrease in number of bedwetting incidents at night. In summary, the study suggests use with the designated treatment for bedwetting and improved bladder functioning in the group of these children.