MHM Magazine

At Goldilocks and The Bear Foundation, our dedicated team and volunteers take great care when making referrals after our screenings and assessments. We aim to ensure every child gets the help and support they need, not only for Attention-Deficit/Hyperactivity Disorder (ADHD) and other mental health concerns, but also for a wide range of additional challenges that are noted by our professionals. Often, children are referred to general practitioners for medical evaluations that extend beyond mental health concerns alone. As a result, a recurring pattern has been observed where many children referred for ADHD assessments, were also referred to doctors for bladder-related problems, especially enuresis (wetting the bed). Firstly, it’s important to clarify that bladder and bowel control issues are not part of the official diagnostic criteria for ADHD in either the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) or the International Classification of Diseases (ICD-10). However, this is not a newly noted occurrence and the association between ADHD and elimination disorders (meaning children having difficulty with bladder or bowel control) has been recognised for several decades, dating back to studies in the early 1990s. Neurodevelopmental disorders, like ADHD, are also referred to as incapacitating disorders, meaning they can impair an individual’s physical or mental ability to carry out daily tasks or perform essential functions. These disorders have also been associated with an increased occurrences of nighttime and daytime wetting, soiling, and constipation among children and adolescents Although incontinence (involuntary loss of bladder control) during childhood isn’t uncommon, a recent case-control study found that 13.6% of their participants diagnosed with ADHD (ages 7 to 23) also experienced enuresis, compared to just 0.9% in the control group. Their findings support what many in the field have suspected for years: enuresis is more common in individuals with ADHD than in those without it, specifically among children and adolescents. In fact, estimates based on various studies suggest that between 20% and 30% of children diagnosed with ADHD also experience nocturnal enuresis. Why does this happen? There isn’t a single or straightforward explanation for why ADHD and elimination disorders often co-occur amongst children. In truth, this phenomenon is not fully understood yet, but research has explored several contributing factors: Genetics Technology Some studies have found evidence that there is a tendency for ADHD and enuresis to be familial, indicating that there may be a genetic component playing a role. Interestingly, certain genes have already been identified that increase the likelihood of a child developing either one of these conditions, or both together. Neuroanatomical abnormalities By using functional Magnetic Resonance Imaging (fMRI), studies have also revealed that there are discrepancies in children’s brain structures and their functioning, where children who have been diagnosed with both ADHD and enuresis have been compared to the brains of children who have only been diagnosed with ADHD. These differences were noted to appear in areas of the brain involved in bladder control, arousal, and alertness. Sleep disruptions It’s well known that ADHD can impact the sleep of children. It has therefore also been suggested that this can disrupt a child’s sleep and wake patterns, causing more frequent bladder contractions at night, leading to nighttime bedwetting. Executive dysfunction Children who have ADHD can sometimes really struggle with their executive functioning. This means that they struggle more with things like planning ahead, keeping neat and organised, and suppressing or controlling their impulses. As such it has also been discussed that, due to this, it might be more difficult for them to learn and develop good bladder control. Treatment challenges and outcomes When ADHD and enuresis occur together, it can complicate treatment. Research indicates that By Reauliza Meyer Goldilocks and the Bear Foundation UNDERSTANDING THE CONNECTION BETWEEN ADHD AND ENURESIS IN CHILDREN MHM | 2025 | Volume 12 | Issue 3 | Understanding the Connection Between ADHD and Enuresis in Children MHM 22 | MENTAL HEALTH MATTERS | 2025 | I sue 3 H