The prevalence of ADHD in children with enuresis: Comparison between a tertiary and non-tertiary care sample

Objective: The main aim of the current study was to determine reliable comorbidity rates of ADHD for enuretic children admitted either to non-tertiary care or to a specialized paediatric clinic, i.e. tertiary care, since previous research has failed to incorporate a possible setting effect in this comorbidity; and to use a multi-method multi-informant assessment of ADHD. Material and methods: Eighty children, aged between 6 and 12 y, admitted to non-tertiary care with enuresis and 120 children referred to tertiary care were screened for the presence of ADHD using a multi-method (diagnostic interview, questionnaires) multi-informant (parents, teachers) assessment. Results: Enuretic children from the tertiary care sample have a 3.4 times increased chance of having comorbid ADHD when compared to children with enuresis admitted to non-tertiary care, corresponding to a prevalence rate of 28% and 10%, respectively. Overall, the tertiary care sample was older, showed more daytime incontinence and revealed an increasing prevalence of ADHD with older age when compared with the non-tertiary care group. Conclusion: The prevalence rate of ADHD is increased in an enuretic population compared to community samples (3-5%). Moreover, enuretic children admitted to tertiary care show significantly higher comorbidity than non-tertiary care patients. The ADHD prevalence in the former group increases with older age, suggesting therapy resistance and a negative prognosis for enuresis in the case of comorbidity.