Enuresis, or bedwetting, and ADHD are both common conditions that affect children and adolescents. Although no evidence exists that one causes the other, children with ADHD appear to have a higher incidence of enuresis. In early studies, bedwetting, especially at nighttime, was noted in hyperactive children. Stewart et al. in a 1966 study found that as many as 43 percent of hyperactive children had bedwetting problems compared to 28 percent of children in the control group. Also, Hartsough and Lambert in a 1985 study reported that children with ADHD were more likely to have bowel difficulties, a condition known as encompresis.

However, Barkley et al. in a 1990 study were not able to replicate any of these studies that related either enuresis or encompresis to ADHD any more than with controls. According to Barkley, the study and evidence to date are not conclusive that children with ADHD have more problems than other children. However, a 1997 article in the Southern Medical Journal found children with ADHD had a 2.7 times higher incidence of enuresis and a 4.5 times higher incidence of daytime enuresis.

The clinical definition of a bedwetter is one who is 5 years old or older who has had at least one episode of urinating while asleep in bed at night, and there do not have to be repeated episodes. Bedwetting is not supposed to happen at all in 5 year olds. However, with the high correlation there is some reason for concern. Bedwetting is devastating to children because it may hinder social activities such as sleepovers, causing children to feel left out. For most children, the exact cause is never known; however, the following may be present:

- The condition tends to run in families and may be hereditary.

- The development of the neurological system may be delayed.

- The person may have a small bladder or increased production of urine during the night.

- There may be a urinary tract infection.

- The person may have a sleep disorder, having a hard time rousing from a deep sleep, and may not be aware of the full bladder; difficulty waking at night is a difficulty similar to waking in the morning, which is present in 91 percent of those with ADHD, according to Dr. Monroe Gross.

- There may be emotional trauma or high stress situations.

- Physical problems, such as diabetes or congenital deformities of the urinary tract, may be present.

Sometimes bedwetting may be more upsetting for a child with ADHD than for the child without ADHD, who may find it easier to cooperate with behavioral interventions. His inattention and disorganization may make it more difficult to cooperate with efforts to correct the situation. Although most children with enuresis experience remission by age 18, people with adult ADHD, who experience inattention and impulsivity, may have enuresis well into adulthood.

Dr. Gross states there are several treatments for bedwetting. The one approach that does not work is the ''no-no'' treatment. Scolding, punishment, and attempts to shame young people cause pain, embarrassment, and loss of self-esteem. Parents should not be harsh or judgmental. The following are some of the treatments for bedwetting:

- Behavior modification. Reminding the child to urinate before going to bed and eliminating liquid intake at least 2 hours before bedtime. He is taught to wakeup regularly at night to void. Bedwetting alarms are available.

- Hypnosis. Some practitioners have used hypnosis to help children become dry by themselves.

- Psychotherapy. When a child shows anxiety in relating to bedwetting, counseling may help deal with stress and trauma.

- Allergies. Rare allergies may be related to bedwetting. - Medication. Two medications are used for bedwetting. One is desmopressin acetate (DDAVP), a nasal spray similar to the hormone that regulates urine production. Children who do not respond may be given a tricyclic antidepressant such as imipramine (Tofranil).

Bibliography:

1) Barkley, R. A. et al. 1990. The adolescent outcome of hyperactive children diagnosed by research criteria: An 8-year follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry 29:546-57

2) Hartsough, C. S., and N. M. Lambert. 1985. Medical factors in hyperactive and normal children: Prenatal, developmental, and health history findings. American Journal of Orthopsychiatry 55:190-210

3) Stewart, M. A. et al. 1966. The hyperactive child syndrome. American Journal of Orthopsychiatry 36:861- 67

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