Comparing bladder bowel dysfunction (BBD) in children with attention deficit hyperactivity disorder (ADHD) with or without ADHD medical therapy and their initial response to BBD treatment.

Introduction: 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.

Objective: Comparing response to BBD treatment between patients with ADHD taking and not taking ADHD medications.

Study design: 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.

Results: 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.

Discussion: 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.

Conclusion: 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.