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Contains fulltext : 248384.pdf (Publisher’s version ) (Open Access) Several non-mental diseases seem to be associated with an increased risk of ADHD and ADHD seems to be associated with increased risk for non-mental diseases. The underlying trajectories leading to such brain-body co-occurrences are often unclear - are there direct causal relationships from one disorder to the other, or does the sharing of genetic and/or environmental risk factors lead to their occurring together more frequently or both? Our goal with this narrative review was to provide a conceptual synthesis of the associations between ADHD and non-mental disease across the lifespan. We discuss potential shared pathologic mechanisms, genetic background and treatments in co-occurring diseases. For those co-occurrences for which published studies with sufficient sample sizes exist, meta-analyses have been published by others and we discuss those in detail. We conclude that non-mental diseases are common in ADHD and vice versa and add to the disease burden of the patient across the lifespan. Insufficient attention to such co-occurring conditions may result in missed diagnoses and suboptimal treatment in the affected individuals.

Zusammenfassung. Ausscheidungsstörungen sind häufige Störungen des Kindesalters. Es können drei übergeordnete Gruppen unterschieden werden: die Enuresis nocturna, das Einnässen tagsüber und die Enkopresis oder Stuhlinkontinenz. Inzwischen sind viele Subgruppen identifiziert, die sich exakt diagnostizieren lassen. Das Ziel dieser Übersicht ist es, die Klassifikationsvorschläge der ICD-11 kritisch darzustellen. Die Definitionen der Enuresis nach ICD-11 werden mit den Störungsbildern der Enuresis nocturna und der funktionellen Harninkontinenz tags nach ICCS verglichen. Die Enkopresis nach ICD-11 wird den Rome-IV-Definitionen der funktionellen Obstipation und der nicht-retentiven Stuhlinkontinenz gegenübergestellt. Es wird dabei deutlich, dass die ICD-11 nicht dem aktuellen Forschungsstand entspricht, dass sie für die klinische Praxis keine therapieleitenden Diagnosen liefert und dass sie für die Forschung nicht genau genug ist. Deshalb sind die Klassifikationssysteme der ICCS und der Rome-IV in Klinik und Forschung vorzuziehen.

Background and objectives Obsessive-compulsive disorder (OCD) is a disease that causes personal distress or social dysfunction, especially in childhood. The present study aimed to provide the prevalence, comorbidity, and predictors of OCD among children and adolescents. Methods This was a cross-sectional national project conducted on 29,858 children and adolescents using the multi-stage cluster random sampling in Iran. There were both genders in each cluster and three age groups (6–9, 10–14, and 15–18 years) within each cluster. The tools used in this research included a demographic questionnaire and K-SADS-PL. To analyze the data, logistic regression and cross-tab tests were used. Results According to the results, the prevalence of OCD in children and adolescents was 3.1 in boys and 3.8 in girls. Also, gender, age, place of residence, and history of psychiatric hospitalization of parents could predict OCD. OCD had comorbidity with behavioral disorders (OR = 0.60, 95%CI: 0.39–0.92), elimination disorders (OR = 0.50, 95%CI: 0.30–0.83), mood disorders (OR = 2.92, 95%CI: 1.43–5.94), and smoking and alcohol disorders (OR = 4.33, 95%CI: 1.28-14.63). Conclusion In the development of the obsessive-compulsive disorder, other disorders and symptoms also environmental factors can play a role and are important. Based on our findings, given the prevalence rate of OCD was higher in the age groups of 10–14 and 15–18 years, are one of the most important stages of development for the prevention and treatment of mental disorders, especially OCD, clinical specialists can design appropriate clinical trials or modify existing interventions based on the results of such research.

Evidence-based interventions have continued to show positive effects on both reducing symptoms and helping children with elimination disorders achieve continence and manage troubling psychological distress. Despite this, there is a group of children who do not respond to standard treatments and are classified as having a complex elimination disorder. As a means of addressing the broader clinical challenge and implications of complex elimination disorders, a team of clinicians in Germany developed the Urinary and Faecal Incontinence Training Program for Children and Adolescents. A pilot investigation was undertaken to apply the Urinary and Faecal Incontinence Training Program for Children and Adolescents programme to children aged 6–12 years in an Australian context who met the complex elimination disorder diagnostic criteria, to determine if any subsequent change in the measures of life quality and general well-being was achieved. Findings suggest a reduction in the frequency of the child’s symptoms and improvements in family quality of life measures. Qualitatively, children and parents perceived that their child’s ability to now respond to stimuli and in so doing avert severe accidents was a major outcome of the programme and was able to increase a child’s sense of acceptance of incontinence, improve levels of self-efficacy and increase self-awareness.

PURPOSE: Currently, there is a paucity of studies on the prevalence of Elimination Disorders among Iranian children and adolescents. Due to the ongoing need to monitor the health status of these children and adolescents, the present study aims to investigate the prevalence of Elimination Disorders and comorbid disorders in Iranian children and adolescents. METHODS: In this cross-sectional study, 29,781 children and adolescents age 6 to 18 years old were selected and studied from all the provinces in Iran. The sampling was carried out by employing a multistage cluster sampling method, and several clinical psychologists using semi-structured interviews collected the data. Furthermore, clinical psychologists collected demographic information (including information about gender, age, place of residence, education level, and parental education level). The collected data were analyzed using SPSS version 20. RESULTS: Generally, the prevalence of Elimination Disorders was found to be 5.4 covering both enuresis (p= 5.4, 95 CI = 5.1-5.7) and encopresis (p= 0.13, 95 CI = 0.09-0.2). The total prevalence of comorbid disorders was 38, and among the comorbid disorders, Attention Deficit Hyperactivity Disorder (ADHD) (p= 11, 95 CI = 9.5-12.7) and Separation Anxiety (p= 10.6, 95 CI = 9.1-12.2) were the most prevalent. CONCLUSION: The prevalence of Elimination Disorders in Iranian children and adolescents is moderate compared to similar studies elsewhere. As for comorbid disorders, ADHD and Separation Anxiety were found to be the most prevalent disorders. Since Elimination Disorders coexist with psychiatric disorders in children, further studies of these comorbidities may give better insight into the treatment and prognosis of Elimination Disorders. © 2021 - IOS Press. All rights reserved.

The 3q29 microduplication syndrome is usually associated with an intellectual disability or global developmental delay and mild dysmorphisms. Other comorbid presentations reported in the literature include psychiatric disorders such as behavioral disorders, attention-deficit/hyperactivity disorders, elimination disorders, and autism spectrum disorders. The current case is of an adolescent girl with the 3q29 microduplication syndrome who had a diverse psychiatric presentation. The patient was a 14-year-old girl in institutional care, with a moderate intellectual developmental disorder, major behavioral problems, with auto- and hetero-aggressions and a suspicious trait, who presented with frequent episodes of emotional dysregulation, disorganized speech with derailment, incoherence, perseveration and grossly disorganized behavior. Auditory hallucinations were suspected sometimes but were difficult to evaluate. In our assessment, we were not able to determine a diagnosis because the symptoms do not seem to be defined by any classification. Major pharmacological and non-pharmacological interventions were needed to manage this case.

Elimination disorders (EDs) encompass faecal incontinence or encopresis, daytime urinary incontinence, and nocturnal enuresis. Many different subtypes can be identified. EDs are common disorders in childhood, associated with emotional distress and a higher rate of comorbid psychiatric disorders such as attention-deficit/hyperactivity disorder. These have to be addressed separately. Genetic and environmental factors play a role in the aetiologies of EDs. Medical causes have to be ruled out, but most EDs are functional, that is, non-organic. Assessment is non-invasive and clinically based in most cases. Treatment is symptom-oriented, with the goal of complete continence. The most effective treatment is primarily by urotherapy, cognitive behavioural therapy, and medication. As each subtype of ED requires a specific treatment approach, an exact diagnosis is essential. International guidelines are available to ensure optimal care for children and adolescents with EDs.

Şermin Yalın Sapmaz,1 Bengisu Uzel Tanrıverdi,2 Masum Öztürk,1 Özge Gözaçanlar,1 Gülsüm Yörük Ülker,2 Yekta Özkan1 1Department of Child and Adolescent Psychiatry, 2Department of Psychology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey Purpose: This study assessed early-onset psychiatric disorders and factors related to these disorders in a group of refugee children after immigration due to war.Materials and methods: This study was conducted between January 2016 and June 2016. Clinical interviews were conducted with 89 children and their families, and were performed by native speakers of Arabic and Persian who had been primarily educated in these languages and were living in Turkey. A strengths and difficulties questionnaire (SDQ) that had Arabic and Persian validity and reliability was applied to both children and their families. Independent variables for cases with and without a psychiatric disorder were analyzed using the χ2 test for categorical variables, Student’s t-test for those that were normally distributed, and Mann–Whitney U-test for data that were not normally distributed. Data that showed significant differences between groups who had a psychiatric disorder and on common effects in emerging psychiatric disorders were analyzed through binary logistic regression analysis.Results: A total of 89 children and adolescents were interviewed within the scope of the study. The mean age of cases was 9.96±3.98 years, and 56.2% (n=50) were girls, while 43.8% (n=39) were boys. Among these children, 47 (52.8%) had come from Syria, 27 (30.3%) from Iraq, 14(15.7%) from Afghanistan, and 1 (1.1%) from Iran. A psychiatric disorder was found in 44(49.4%) of the children. A total of 26 children were diagnosed with anxiety disorders, 12 with depressive disorders, 8 with trauma and related disorders, 5 with elimination disorders, 4 with attention deficit/hyperactivity disorder, and 3 with intellectual disabilities. It was determined that seeing a dead or injured person during war/emigration and the father’s unemployment increased the risk of psychopathology. The OR was 7.077 (95% CI1.722–29.087) for having seen a dead or injured individual and 4.51 (95% GA 1.668–12.199) for father’s employment status.Conclusion: Within the context of war and emigration, these children try to cope with the negative circumstances they experience prior to migration, as well as the despair they see their parents experience. Keywords: young refugees, asylum seekers, mental health, risk factors

Enuresis and encopresis can be stressful for children and parents. We investigated the comorbid psychiatric disorders and the emotional and behavioral symptoms associated with elimination disorders. A total of 97 children and adolescents (aged 4-17 years) with an elimination disorder participated in this study. The elimination disorder group consisted of three subgroups: 50 subjects with enuresis nocturna, 26 with encopresis, and 21 subjects with enuresis+encopresis. The control group with no elimination disorder comprised 50 healthy subjects. All children were interviewed by a child and adolescent psychiatrist. Comorbid psychiatric disorders were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL). Parents completed the Strengths and Difficulties Questionnaire. The most common diagnosis was attention-deficit/hyperactivity disorder, followed by oppositional defiant disorder. The highest rate of psychiatric comorbidity was observed in the enuresis+encopresis subgroup, followed by the enuresis nocturna and encopresis subgroups. All the subgroups had higher total difficulties scores than the control group. Screening for psychiatric disorders should be performed for all children with incontinence.

Background: This community-based study aimed to investigate the psychiatric disorders and their comorbidities according to the kind of psychiatric disorders. Frequency of demographic factors and the prevalence of total psychiatric disorders in term of demographic charactheristics were obtained too. Materials and Methods: The present study focused on 1028 children and adolescent aged 6 to 18 years old across the Razavi Khorasan province by random sampling. The subjects included 496 boys and 532 girls from three age groups (6-9 years, 10-14 years and 15-18 years). Eight clinical psychologists trained to complete the Persian version of K-SADS-PL (Kiddie-SADS present and life time version). This scale measures five diagnostic appendixes of psychiatric disorders. Demographic data of participants were collected too. The data were recorded into the SPSS version 16. The relationship between psychiatric disorders and demographic factors deliberate by descriptive analysis and 95% confidence interval. Results: The total rate of psychiatric disorders among children and adolescent was estimated as 20.5%, elimination disorders with a rate of 12.9% was the most prevalent disorder in the subjects. The lowest prevalence belongs to psychotic disorder and bulimia nervosa (0.1%). Of participants with mood disorders about 71.4% have behavioral disorders too. Anxiety disorders also commonly occurred in person with mood disorders. The comparison of ORs and their 95% confidence interval revealed that there is a significant difference for total psychiatric disorder among boys and girls (OR=0.6 for girls; 95% CI: 0.44-0.82). The rate of total psychiatric disorders in rural and urban areas was 14.9% and 21.1% respectively. Conclusion: With attention to the high prevalence of psychiatric disorders among children and adolescents, it’s necessary that healthcare officials pay more attention to reinforcement of mental health care.[GMJ.2020;9:e1714]

Background Elimination disorders in childhood are common and treatable. Approximately 10% of 7-year-olds wet the bed at night, and 6% are affected by incontinence during the daytime. Two main types of disturbance are distinguished: nocturnal enuresis and functional (i.e., non-organic) daytime urinary incontinence. Each type contains a wide variety of subtypes. Effective treatment requires precise identification of the subtype of elimination disorder. Methods This review is based on a selection of current publications, including principally the German S2k-AWMF guideline and the recommendations of the International Children's Continence Society (ICCS). Results Diagnostic assessment focuses on the clinical picture, is non-invasive, and can be carried out in most health care settings. If the child is suffering from multiple types of elimination disorder at once, then fecal incontinence or constipation is treated first, daytime urinary incontinence next, and enuresis last. 20-50% of children with elimination disorders have a comorbid mental disorder that also needs to be treated. With standard urotherapy, 56% of patients with daytime urinary incontinence become dry within a year. This conservative, symptom-oriented approach consists of educating the patient and his or her parents to promote behavior changes with respect to drinking and micturition. Elements of specific urotherapy are provided only if indicated. For enuresis, the treatment of first choice is alarm therapy, with which 50-70% of the affected children become dry. Pharmacotherapy, e.g., with desmopressin, can be a helpful adjunctive treatment. In intractable cases, training techniques have been found useful. Conclusion Childhood elimination disorders can be treated effectively after targeted diagnostic evaluation and the establishment of specific indications for treatment. In view of the emotional distress these disorders cause, the associated physical and mental disturbances, and their potential persistence into adolescence, they should be evaluated and treated in affected children from the age of five years onward.

OBJECTIVE: Enuresis and encopresis, both conditions are very distressful to children and their family members and it is responsible for significant social and psychological consequences in children and adolescents. The present study aims to determine the rate of abusive maternal attitudes towards children and adolescents with elimination disorders (EDs) and to investigate the maternal psychological and socio-cultural factors associated with abusive parenting attitudes. METHOD: N = 180 children with ED were included in the study. Family Assessment Device (FAD), and Symptom Check List (SCL-90-R) were administered to mothers. RESULTS: Our results indicated that prevalence of abusive maternal attitudes in our sample was 73.8%. Children and adolescents with ED who live with low-educated parents (p = 0.008), low socio economic status (p = 0.014), and in cases with living in a large or divorced family (p = 0.014), disorganized or chaotic families can be considered a population at risk (p CONCLUSION: Present study showed high rates of abusive parenting attitudes in cases of EDs in a sample of Turkish children and adolescents. Further research on the etiological and therapeutic importance of the family in the case of ED referred to a psychiatry clinic should be carried out.Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved. Language: en

Childhood anxiety may lead to serious health consequences in later life. The present study provides the prevalence, comorbidity, and predictors of anxiety disorders among children and adolescents. This was a cross-sectional national project that was implemented on 28,698 children and adolescents in Iran. Participants entered the study by multistage cluster sampling with an equal number of each gender and three age groups (6-9, 10-14, and 15-18 years) within each cluster. The tools used in this research were the demographic questionnaire and K-SADS-PL. To analyze the data logistic regression and chi-square tests were used in SPSS (ver. 16). The prevalence of anxiety disorder in children and adolescents was 13.2 in boys and 15.1 in girls. Furthermore, gender, age, place of residence and history of psychiatric hospitalization of parents could predict anxiety disorders. Anxiety disorders had comorbidity with behavioral disorders, neurodevelopmental disorders, mood disorders, psychotic disorders, substance abuse disorders, and elimination disorders. According to our findings in this study, anxiety disorders affect the performance, health and life of children and adolescents, identifying the childhood anxiety, as well as finding diseases that are associated with anxiety disorders, can help in the prevention of the disorder.

Elimination disorders are common childhood concerns that are often distressing for children and parents. These disorders occur at a higher rate in children with neurodevelopmental disorders including autism spectrum disorder (ASD) and can lead to significant functional impairment at home, school, and in the community. Enuresis, or developmentally inappropriate urination behaviors, can occur during the day, at night, or both. Encopresis, or fecal incontinence, is the passage of stool into inappropriate places such as one’s clothing or onto the floor. Biological and psychobehavioral underpinnings of elimination disorders will be addressed in this chapter. Gold standard interdisciplinary treatment of elimination disorders will be discussed and the evidence for this approach reviewed.

Pre-school children placed in local authority care show elevated rates of mental health disorders when compared to the general population. This study investigated risk factors for mental health disorders relating to the period prior to entering care and while in care. A representative sample of 43 children in care aged 0–72 months in an inner London borough underwent comprehensive multidimensional assessments. Presence of emotional, behavioural, attachment and adaptive disorders was ascertained. Exposure to two pre-placement risk factors and six placement risk factors was compared between children with and without a disorder. A total of 26 children (60.5%) had at least one mental health disorder. The two pre-placement risk factors, multiple types of maltreatment and entry into care after the age of 6 months, were both significantly associated with mental health disorders. The three placement risk factors of sudden placement moves, multiple placement moves and child–carer alienation showed a significant association with mental health disorders. There was a strong correlation between the number of risk factors and the number of co-morbid mental health disorders per child ( r = .67, p < .001). In conclusion, this study identified five modifiable risk factors related to the quality of safeguarding and fostering services which showed a significant association with pre-school mental health.

Ausscheidungsstörungen sind häufig in Kindheit und Jugendalter. Enuresis wird traditionell definiert als ein Einnässen ab dem Alter von 5 Jahren und Enkopresis als ein Einkoten ab 4 Jahren – jeweils nach Ausschluss organischer Ursachen. In den letzten Jahrzehnten wurden viele verschiedene Subtypen von Ausscheidungsstörungen identifiziert, die sich nach Symptomatologie, Ätiologie und spezifische Therapiemöglichkeiten unterscheiden. Leider wurden diese neuen Entwicklungen im DSM-5 nicht integriert. Dagegen bieten die Klassifikationssysteme der International Children’s Incontinence Society (ICCS) für Enuresis und Harninkontinenz und der ROME-III Gruppe für Stuhlinkontinenz neue und relevante Zugänge für Klinik und Forschung.

Pediatric elimination disorders are common in childhood, yet psychosocial correlates are generally unclear. Given the physiological concomitants of both enuresis and encopresis, and the fact that many children with elimination disorders are initially brought to their primary care physician for treatment, medical evaluation and management are crucial and may serve as the first-line treatment approach. Scientific investigation on psychological and behavioral interventions has progressed over the past couple of decades, resulting in the identification of effective treatments for enuresis and encopresis. However, the body of literature has inherent challenges, particularly given the multicomponent nature of many of the treatment packages. This review identified 25 intervention studies-18 for nocturnal enuresis and 7 for encopresis-over the past 15 years and classified them according to the guidelines set forth by the Task Force on the Promotion and Dissemination of Psychological Procedures. For nocturnal enuresis, the urine alarm and dry-bed training were identified as well-established treatments, Full Spectrum Home Therapy was probably efficacious, lifting was possibly efficacious, and hypnotherapy and retention control training were classified as treatments of questionable efficacy. For encopresis, only two probably efficacious treatments were identified: biofeedback and enhanced toilet training (ETT). Best practice recommendations and suggestions for future research are provided to address existing limitations, including heterogeneity and the multicomponent nature of many of the interventions for pediatric elimination disorders.

An easy-to-use assessment tool, which contains reversible risk factors, might influence the success of a falls prevention program. A 2-phase study was undertaken to develop and validate a simplified falls assessment tool. Risk factors of confusion, dizziness, altered elimination, and difficulty with mobility were found to be significantly associated with fall status. The simplified falls assessment tool that contains these 4 risk factors yielded a comparable predictive value to Hendrich II Falls Risk Model.

Elimination disorders are very common in children: 10 % of 7-year-olds wet at night (nocturnal enuresis), 2-3 % during daytime (diurnal urinary incontinence) and 1-3 % soil (faecal incontinence). In the past decades, many subtypes of elimination disorders have been identified with different symptoms, aetiologies, comorbid disorders and specific treatment options. The aim of the paper is to present a short overview of the proposed DSM-5, the ICCS and the Rome-III classification systems, of assessment and of treatment. The DSM-5 criteria no longer reflect current research data and a revision is needed. Classification systems of the International Children's Incontinence Society (ICCS) for enuresis and urinary incontinence and the ROME-III criteria for functional gastrointestinal disorders offer new and relevant suggestions for both clinical and research purposes. Assessment of most elimination disorders can be performed in paediatric and child psychiatric primary care settings. The standard assessment consists of a thorough history, frequency/volume charts, specific questionnaires, a full physical examination, sonography and urinalysis. If possible, a child psychiatric assessment is performed. In all other settings, screening with a validated behavioural questionnaire and referral if indicated is recommended. All other investigations are indicated only in complicated cases and if an organic cause is to be ruled out. Treatment is symptom oriented and based on the exact diagnosis of the type of elimination disorder. Counselling is recommended in every case. Most elimination disorders can be treated by specific treatment programmes integrating cognitive-behavioural elements. Nocturnal enuresis is best treated with alarms. Medication can be indicated in nocturnal enuresis (desmopressin), urge incontinence (anticholinergics such as oxybutynin, propiverine, etc.) and faecal incontinence with constipation (polyethylene glycol). Comorbid behavioural and emotional disorders require additional treatment.

Aims Elimination disorders are common in typically developing children. Only few studies have addressed elimination disorders in persons with intellectual disability (ID)—and even fewer studies in those with specific syndromes. The aim of the study was to investigate the rates of elimination disorders and behavioral symptoms in persons with Prader–Willi (PWS) and Fragile-X syndromes (FXS) in a large sample. Methods Three hundred fifty-seven persons with PWS or FXS were recruited through parent self-help groups. A questionnaire regarding elimination symptoms, as well as the child behavior checklist (CBCL)/young adult behavior checklist (YABCL) were filled out by parents or caregivers. Results The sample included 191 persons with PWS (54.5% male) with a mean age of 20.0 years and 166 persons with FXS (92.2% male) with a mean age of 15.4 years. Persons with FXS were significantly more often affected by elimination disorders. 29.3% of persons with PWS and 48.8% of persons with FXS had at least one elimination disorder. Persons with FXS also had more often DUI (29.5% vs. 12.0%) and FI (28.9% vs. 12.6%). Rates of NE were similar in both groups (22.0% in PWS vs. 28.9% in FXS). Young adults with PWS had more behavioral symptoms in the clinical range (70.8% vs. 48.3%). Incontinence and behavioral symptoms were significantly associated in persons with FXS. Conclusions NE, DUI, and FI are very common in persons with FXS and PWS and are associated with other behavioral symptoms in persons with FXS. They persist into adulthood. Early assessment and treatment are recommended. Neurourol. Urodynam. 32: 986–992, 2013. © 2012 Wiley Periodicals, Inc.

Introduction: Elimination disorders consist of enuresis and encopresis. When a child fails to successfully achieve toilet training by the age of five and has repeated voiding of urine on the bed or clothing at least twice per week for at least 3 consecutive months it is called enuresis; while bowel continence if not achieved by age 4 years, is encopresis. This study seeks to determine parental/caregiver concerns and help-seeking behaviors toward elimination disorders. Materials and Methods: This study was cross-sectional and was conducted over a 3-month period from January 2017 to March 2017. Convenience sampling method was adopted, and pretested researchers-administered questionnaires were used. Results: Two hundred individuals were recruited consisting of 104 (52%) males and 96 (48%) females with a male-to-female ratio of 1.1:1. About 194 (97%) of the respondents were aware of elimination disorders, 62 (31.0%) of them reported elimination disorder occurred in their wards, only 24.2% of the caregivers had sought for medical treatment for elimination disorder. Majority of the caregivers did not know the cause of elimination disorder, but 2% of them believed evil spirits were responsible for elimination disorders. Enuresis was the most commonly reported elimination disorder and most occurred at night (80.6%), and none had isolated encopresis. Ethnicity and educational qualification of respondents had no relationship with their help-seeking behavior toward elimination disorder ([Fishers' exact test = 11.337, P = 0.023] and [Fishers' exact test = 8.074, P = 0.089]). Conclusion: Elimination disorders were prevalent; however, few caregivers seek for medical help/treatment, and their help-seeking behavior was not influenced by their ethnicity or educational qualification.

Several studies have documented low rates of agreement between clinician- and researcher-generated diagnoses. However, little is known about whether this lack of agreement has implications for the processes and outcomes of subsequent treatment. To study this possibility, the authors used diagnostic agreement to predict therapy engagement and outcomes for 197 youths treated in 5 community mental health clinics. Diagnostic agreement predicted better therapy engagement, with the agree group having fewer therapy no-shows and cancellations and a decreased likelihood of therapy dropout. Additionally, support for a link between agreement and treatment outcomes was found, as the agree group obtained larger reductions in parent-reported internalizing problems during treatment. These findings suggest that diagnostic accuracy may be an important precursor to successful treatment and highlight the importance of future research to find ways to incorporate standardized diagnostic procedures into clinical care settings.

Authors from Belgium, the Netherlands and Germany tried to clarify the relationship between disordered defecation and non-neuropathic bladder-sphincter dysfunction; they found few arguments for a casual relationship between these conditions. OBJECTIVE To clarify the relationship between disordered defecation and non-neuropathic bladder-sphincter dysfunction (NNBSD) by comparing the prevalence of symptoms of disordered defecation in children with NNBSD before and after treatment for urinary incontinence (UI), and assessing the effect of such symptoms on the cure rate for UI. PATIENTS AND METHODS In the European Bladder Dysfunction Study, a prospective multicentre study comparing treatment plans for children with NNBSD, 202 children completed questionnaires on voiding and on defecation, at entry and after treatment for UI. Four symptoms of disordered defecation were evaluated; low defecation frequency, painful defecation, fecal soiling, and encopresis. RESULTS At entry, 17 of the 179 children with complete data sets had low defecation frequency and/or painful defecation (9%), classified as functional constipation (FC). Of the 179 children, 57 had either isolated fecal soiling or soiling with encopresis (32%), classified as functional fecal incontinence (FFI). After treatment for UI, FFI decreased to 38/179 (21%) (statistically significant, P = 0.035); for FC there were too few children for analysis. After treatment for UI, 19 of the 179 children (11%) reported de novo FFI. Symptoms of disordered defecation did not influence the cure rate of treatment for UI. CONCLUSIONS FFI improved significantly after treatment for UI only, but not in relation to the outcome of such treatment. FFI did not influence the cure rate for UI. There was little to support a causal relation between disordered defecation and NNBDS (‘functional elimination syndrome’).

This study sets to determine the optimal duration of behavioral urotherapy necessary to achieve maximal improvement in the management of pediatric bowel and bladder dysfunction.

It is well-known that more than 50% of attention-deficit hyperactivity disorder (ADHD) cases also have comorbid psychiatric disorders. We evaluated the comorbid psychopathology of Korean children and adolescents with ADHD using a standardized diagnostic instrument. The Korean Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL-K) was administered and completed in 105 patients who had been referred to the outpatient and inpatient clinics at the Samsung Medical Center from March 2004 to May 2005. All of the cases were diagnosed as ADHD according to DSM-IV criteria. We analyzed their clinical characteristics and psychiatric comorbidities, and assessed the correlation of any comorbidity with gender, age and ADHD subtype. Among our 105 participants, 70 (66.7%) subjects were diagnosed with combined-type ADHD, 22 (21.0%) were the predominantly inattentive type, only 1 (1.0%) was determined to have the predominantly hyperactive-impulsive type of ADHD, and 12 (11.4%) were classified as not otherwise specified (NOS) ADHD. Eighty (76.2%) subjects had at least one comorbid disorder such as oppositional defiant disorder (n = 53, 50.5%), anxiety disorders (n = 35, 33.3%) and affective disorders (n = 15, 14.3%). Our patients ranged in age from five to 16 years. Among the factors including gender, age, and ADHD subtype, ADHD subtype was the only one significant to comorbidity in our study. The results of this study suggest that psychiatric comorbidity in Korean children with ADHD is similar to the results of previous studies in western countries. Out of all the ADHD subtypes, the combined-type group had a significantly higher ratio of comorbid disorders and psychopathologies.

Objective. It has been suggested that urinary tract infections (UTIs) early in life predispose to dysfunctional elimination syndrome (DES). This study evaluated the relationship between early UTI, vesicoureteral reflux (VUR), and DES by comparing two cohorts of school-aged children. Methods. The UTI cohort (n = 123) included children previously enrolled in a prospective treatment trial conducted between 1992 and 1997. All were diagnosed with a febrile UTI before 2 years of age. The comparison cohort (n = 125) included children who were evaluated for fever in the emergency department between 1992 and 1997, whose urine culture was negative. Dysfunctional elimination symptoms were compared in the two cohorts by having families complete a revised version of the Dysfunctional Voiding Scoring System. Results. Completed questionnaires were received from 248 children. There were no significant differences in selected demographic or clinical characteristics between the two cohorts. DES was present in 22% and 21% of children with and without a history of early UTI, respectively. Among children with UTIs, 18% of those with VUR and 25% of those without VUR had DES. Conclusions. Dysfunctional elimination is common in a general pediatric population. Neither UTI nor VUR diagnosed before 2 years of age was associated with DES in school-aged children.

We determined the feasibility of a definitive trial comparing the effectiveness of group vs individual urotherapy for children with bladder-bowel dysfunction.Children 6 to 10 years old with bladder-bowel dysfunction were recruited during the course of 1 year. Feasibility data on screening, eligibility, recruitment and protocol compliance rates were collected. Patients with high grade hydronephrosis, vesicoureteral reflux or learning disabilities and those who had previously undergone urotherapy were excluded. Patients were randomized to 1-hour group urotherapy or 15-minute individual urotherapy. Symptoms and quality of life were measured using the Vancouver Nonneurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome Questionnaire and the Pediatric Incontinence Questionnaire at baseline and at 3 to 6 months of followup. Within/between group comparisons were conducted using t-tests.Of 455 screened children 79 were eligible and 60 were recruited to participate. A total of 24 patients randomized to group urotherapy and 25 randomized to individual urotherapy completed the pilot trial (6 undergoing group and 5 undergoing individual urotherapy withdrew from the study). Symptomology scores between group and individual urotherapy were not different at followup (mean ± SD 14.7 ± 7.9 vs 13.4 ± 6.3, p = 0.54, 95% CI -5.4-2.8). Quality of life scores between patients undergoing group and individual urotherapy at baseline differed (mean ± SD 21.1 ± 10.8 vs 31.0 ± 14.3, p0.01, 95% CI 2.7-7.3) but became similar at followup (21.0 ± 14.2 vs 20.1 ± 15.3, p = 0.84, 95% CI -9.4-7.6). Within group analyses demonstrated improvement in symptomology from baseline to followup in patients undergoing group (mean ± SD 3.6 ± 7.6, p = 0.03, 95% CI 0.4-6.8) and individual urotherapy (6.0 ± 5.4, p0.01, 95% CI 3.8-8.3). Within group quality of life analyses revealed improvement in Pediatric Incontinence Questionnaire scores from baseline to followup in patients undergoing individual urotherapy (p0.01, 95% CI 5.0-16.9) only.Urotherapy, regardless of modality, effectively improved bladder-bowel dysfunction symptoms. A definitive randomized controlled trial is feasible, considering that a high recruitment rate (76%) for this population has been established.

Given the highly carnivalized view of the world that informs the narrative structure of Envy (Zavist'. 1927), one should not be terribly surprised to find that Iurii Olesha's controversial novella contains gastronomic and alimentary motifs that function in a highly Rabelaisian way, with food imagery being called upon to celebrate what Mikhail Bakhtin calls the "material bodily principle" ("images of the human body itself, food, drink, defecation, and sexual life") and thus to express a joyful sense of satiety, abundance, and excess.! Indeed, Olesha's story fairly reverberates with images of gluttonous overeating, heavy drinking, and physical corpulence, all of which Bakhtin identifies with the "grotesque body" portrayed in works of carnivalized literature.2 From the tubby "aristocratic" torso of Andrei Babichev, the Soviet salami king, to the flaccid figure of Anechka Prokopovich, the cook for the barbers' artel (who goes about entangled in the entrails of animals), Envy quite deliberately foregrounds the essential corporeality of the human body and emphasizes many of its basic physiological functions: among them, mastication, ingestion, digestion, and elimination. The novella opens, appropriately enough, within the very "bowels" (nedra) of Andrei Babichev's apartment, his bathroom, where the effervescent food commissar can be

This paper addresses pediatric elimination disorders including nocturnal enuresis from the perspectives of terminology (the Whorf hypothesis), the elimination interview, and the guarding reflex.The elimination interview and a modern model of normal voiding function, including the guarding reflex, are explained.The language of voiding dysfunction influences our perception of it. Nocturnal enuresis, and all other voiding dysfunctions, should be evaluated by a careful elimination interview. The guarding reflex may fit into an evolving etiologic paradigm for nocturnal enuresis.(1) Words and phrases of eliminology should aim for simplicity, clarity and accuracy. (2) Urologists need to perfect their eliminology skills vis-à-vis the elimination interview. (3) The role of the guarding reflex in nocturnal enuresis and all other voiding dysfunctions should be critically examined.

Therapy with psychopharmacological agents of particular symptoms and psychiatric disorders in children and adolescents is part of a multi-faceted therapeutic approach including complementary psycho- and socio-therapeutic measures. This applies in particular to the treatment of children and adolescents with attention deficit/hyperactivity disorder (ADHD), tics and Tourette’s syndrome, elimination disorders (enuresis, encopresis), psychoses, personality disorders, obsessions and compulsions, panic attacks, and anxiety disorders, as well as mood disorders (major depressive disorders and bipolar disorders).

The childhood elimination disorders have been written about extensively in the psychological, medical, child developmental, urological, and pediatrics literature. In fact, the Winter 1976 issue of the Journal of Pediatric Psychology was entirely devoted to this topic. Nearly four decades later, there is still abundant ongoing research addressing etiological frameworks as well as risk factors, comorbidities, and treatment strategies.

Murat Yüce,1 Süleyman Salih Zoroglu,2 Mehmet Fatih Ceylan,3 Hasan Kandemir,4 Koray Karabekiroglu5 1Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey; 2Department of Child and Adolescent Psychiatry, Medical Faculty of Istanbul, Istanbul University, Istanbul, Turkey; 3Department of Child and Adolescent Psychiatry, Dr Sami Ulus Children's Hospital, Ankara, Turkey; 4Department of Child and Adolescent Psychiatry, Faculty of Medicine, Harran University, Sanliurfa, Turkey; 5Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey Objective: We aimed to determine distribution and diversities of psychiatric comorbidities in children and adolescents with attention deficit/hyperactivity disorder (ADHD) in terms of age groups, sex, and ADHD subtype. Materials and methods: The sample included 6–18 year old children and adolescents from Turkey (N=108; 83 boys, 25 girls) diagnosed with ADHD. All comorbid diagnoses were determined based on the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version assessment. Results: 96.3% of the cases were found to have at least one psychiatric comorbid diagnosis. The most frequent psychiatric comorbid disorder was oppositional defiant disorder (69.4%) followed by anxiety disorders (49%) and elimination disorders (27.8%). Disruptive behavior disorders were more common in ADHD-combined type. Depression and anxiety disorders were more common in girls. Separation anxiety disorder and elimination disorder were more common in children, whereas depression, bipolar disorder, obsessive–compulsive disorder, and social phobia were more common in the adolescents. Conclusion: According to our results, when a diagnostic tool was used to assess the presence of comorbid psychiatric disorders in children and adolescents diagnosed with ADHD, almost all cases had at least one comorbid diagnosis. Therefore, especially in the clinical sample, ADHD cases should not be solely interpreted with ADHD symptom domains, instead they should be investigated properly in terms of accompanying psychiatric disorders. Keywords: attention deficit/hyperactivity disorder, psychiatric comorbidity, child, adolescent

Investigating child urinary elimination enables one to identify nursing diagnoses and appropriately plan care actions. Regarding the nursing diagnosis (ND) of impaired urinary elimination, as identified by NANDA-I, gaps can be found in its defining characteristics (DC) when infants are involved, due to particularities of how children in this age group show this diagnosis. The present study aimed to identify the clinical manifestations reported in the literature concerning infants with urinary elimination disorders. An integrative literature review was carried out, whose guiding question was: “What clinical manifestations are infants with urinary elimination disorders likely to present?” CINAHL, Cochrane, PubMed, and LILACS databanks were consulted, identifying 621 articles. Taking the inclusion and exclusion criteria into account, the sample consisted of 21 articles, which were read and classified according to their evidence level. Among the defining characteristics identified in the integrative review, and that are contemplated by NANDA-I, urinary retention and dysuria proved to be the most prevalent. Other clinical manifestations were also found in the literature as likely to be observed in infants with urine elimination disorders, such as weak urinary stream, interruption of urination, crying when urinating, hematuria, and malodorous urine. Results suggest that other DCs should be studied in an attempt to include these in NANDA-I taxonomy so as to better illustrate the condition of infants with the nursing diagnosis of urinary elimination disorder.

AIM: To investigate the effect of treating defecation problems on urinary incontinence in children suffering from combined urinary bladder and bowel dysfunction (BBD). METHODS: We established a clinical database from medical records of all children referred to the urinary incontinence and gastroenterology outpatient clinics with BBD. The following variables were extracted: symptoms of constipation, fecal incontinence, urinary incontinence, age at onset of symptoms, treatment, including duration and response. All children went through the same treatment protocol. Fecal disorders were treated primarily and once relieved, the daytime incontinence was managed and followed by intervention for nocturnal enuresis. RESULTS: In total, 73 children were included in the study. The treatment regimen resulted in resolution of the defecation disorder in 96% of the patients. Of the children with daytime urinary incontinence 68% had at least a 50% reduction in number of daytime incontinence episodes by successful relief of bowel dysfunction and 27% became completely continent during daytime. Only 17% of the children suffering from enuresis had a significant reduction in number of wet nights after relief of their fecal problem. CONCLUSIONS: The empirical treatment approach of managing bowel symptoms before intervening for bladder dysfunction in children with BBD is found to be appropriate. ©2013 The Author(s)/Acta Paediatrica ©2013 Foundation Acta Paediatrica.

Introduction. South African children and adolescents face serious challenges. Over the past decades children have been exposed to rapid and stressful changes in their environment, including increased crime and violence. Aim of study. The aim of the study was to determine the profile of stress factors leading to mental disorders in children and adolescents referred to the Child and Adolescent Unit at the Free State Psychiatric Complex, Bloemfontein, from January 2006 to December 2007. Methods. A total of 669 children (0 - 12 years) and adolescents (13 - 18 years) referred to the unit for evaluation and treatment were included in the study. Results. Thirty per cent were diagnosed with attention deficit and disruptive behaviour disorders, followed by major depressive disorders (22.7%), anxiety disorders (18.5%), conduct disorders (16.1%), mild mental retardation (15.7%), adjustment disorders (9.6%), elimination disorders (8.8%), developmental disorders (7.6%) and bereavement (7.0%). Social stressors were identified in 64.1% of participants, and psychological stressors in 19%.Conclusions. Stress plays an important role in the lives of children and adolescents, which could lead to emotional problems if not well managed. The functioning of children and adolescents should be monitored continuously. Schools are in a favourable position to identify stressors affecting children and adolescents. Educators therefore need training and opportunities to consult on mental health matters. Furthermore, religious organisations should be enlisted to identify stressors manifesting as spiritual dysfunction. School health services can play a role in the recognition of biological stressors such as epilepsy, pregnancy, enuresis, illness, speech problems and sensory dysfunction.

A case of a 6-year-old girl with multiple elimination disorders (nocturnal enuresis, functional urinary incontinence and fecal incontinence) and a fragile X-syndrome is described. The late diagnosis of the fragile X-syndrome had implications for treatment as well as for family interaction. With the knowledge of the diagnosis the parents reacted in a more understanding manner regarding the behavioral problems of the child, whereby the elimination problems were reduced. The need for further research on elimination disorders in children with genetic disorders is discussed.

Attention deficit/hyperactivity disorder is a common comorbid disorder in children with nocturnal enuresis, daytime urinary incontinence and fecal incontinence. We assessed the specific association of these conditions in a population based sample. We hypothesized that children with elimination disorders have a higher rate of attention deficit/hyperactivity disorder, and that children with daytime urinary incontinence are more strongly affected than those with nocturnal enuresis.All children in a defined geographic area (Saarpfalz Kreis) were examined at school entry. Mean age was 6.22 years in 734 boys and 6.18 years in 645 girls. A questionnaire regarding elimination problems and the attention problems scale of the Child Behavior Checklist were administered as an interview to parents. Participation rate was 99.1% (1,379 parents).Of the children 71 (5.1%) had attention deficit/hyperactivity disorder problems of clinical relevance (7.1% of boys and 2.9% of girls). A total of 185 children (13.4%) were wet (nocturnal enuresis in 9.1% and daytime urinary incontinence in 4.4%) and 19 (1.4%) had fecal incontinence. Attention deficit/hyperactivity disorder symptoms were more common in children with urinary incontinence than nonwetting children (16.8% vs 3.4%). When controlled for confounding variables, only children with daytime urinary incontinence (but not nocturnal enuresis) had a significantly higher risk of attention deficit/hyperactivity disorder symptoms (OR 4.4).Attention deficit/hyperactivity disorder symptoms were increased in children with urinary incontinence in this population based sample. Children with daytime urinary incontinence were at greater risk for attention deficit/hyperactivity disorder than those with nocturnal enuresis. Screening and referral for specialized treatment of both disorders are recommended.

Elimination disorders are common in childhood and adolescence. Enuresis is defined as wetting from the age of 5 years and encopresis as soiling from 4 years onwards--after excluding organic causes. In the past few decades, many subtypes of elimination disorders have been identified with different symptoms, aetiologies and specific treatment options. The DSM-IV criteria no longer reflect this wealth of research data and a revision is needed. Classification systems of the International Children's Incontinence Society (ICCS) for enuresis and urinary incontinence and the ROME-III criteria for functional gastrointestinal disorders offer new and relevant suggestions for both clinical and research purposes. These are presented and discussed. Integration of these into DSM-5 is highly recommended.

Patients with hypertonic pelvic floor disorders can present with pelvic pain or dysfunction. Each of the various syndromes will be discussed including elimination disorders, bladder pain syndrome/interstitial cystitis (BPS/IC), vulvodynia, vaginismus, and chronic pelvic pain. The symptoms and objective findings on physical examination and various diagnostic studies will be reviewed. Therapeutic options including physical therapy, pharmacologic management, and trigger point injections, as well as botulinum toxin injections will be reviewed in detail.

Non-neurogenic elimination disorders cover a wide spectrum of lower urinary tract and bowel dysfunctions, observed in the absence of a neurological background or lower urinary tract malformation. We reviewed conditions responsible for incontinence during bladder filling with normal voiding patterns (such as overactive bladder, giggle incontinence, post-void dribbling), and dysfunctional voiding syndromes. Dysfunctional elimination syndrome usually includes detrusor–sphincter dyscoordination, small-capacity overactive bladder or decompensated large poorly contractile bladder, and large-volume post-micturition residuals, occasionally associated with bowel dysfunction. At the most severe end of the spectrum lies the non-neurogenic neurogenic bladder syndrome, characterized by the association of a severe impairment of the upper urinary tract with a dysfunctional elimination syndrome. It must be emphasized that if the term ‘non-neurogenic’ relates to the absence of a neurological lesion, it is however conceivable that these conditions actually do have an underlying neurological cause that remains to be identified.

School-age children with dysfunctional elimination syndrome (DES) do not always have school support for their treatment plans, including an every 2-hr voiding schedule. The objective of this study was to increase school support of treatment plans by allowing access to bathrooms, thereby improving continence. An eight-question survey about bathroom access at schools was given to parents at baseline. The author contacted school nurses requesting that treatment plans be incorporated into individual health plans (IHPs) with teacher support of the IHP. Six weeks later, school nurses were contacted and parents completed a postintervention survey to determine whether IHPs were supported by teachers. Voiding diaries were used to document continence. Seventeen parents completed the survey at baseline, and 13 children were enrolled in the intervention. After the intervention, 100% of the children had IHPs and teacher support of treatment plans. Ninety-two percent had increased continence. IHPs improved teacher support of children’s treatment plans and improved their continence.

Lack of privacy, risk of bullying, limited access, lack of essential products for good hygiene, and dirty bathrooms can all contribute to encouraging a child to withhold urine and stool while in school. Withholding behaviors over time can create a condition known as dysfunctional elimination syndrome (DES). DES is any pattern of voiding or stooling that varies from the developmental norm. These abnormal patterns of elimination can eventually lead to complications of urinary tract infection, vesicoureteral reflux, and incontinence of urine and/or stool. School officials (teachers, school nurses, and school administrators) can help in the prevention of learned behaviors that lead to DES in school-age children. School officials need to realize children are individuals and should not be expected to empty their bowels and bladders according to a set, rigid schedule. In addition, school officials should not expect children to use dirty, unsafe bathrooms that they themselves would not tolerate. School nurses can be a powerful force in protecting children’s health by participating in research and developing evidence-based guidelines to improve bathroom access and conditions.

Urinary tract infections can be a significant source of morbidity in the pediatric population. The mainstay of evaluating urinary tract infections in children has been physical examination, urinalysis and culture, and renal and bladder sonography and contrast cystography. However, novel clinical paradigms now consider the importance of various risk factors, such as bacterial virulence and antibiotic-resistance patterns, elimination disorders, and the role of innate immunity and inflammation in determining the likelihood of renal cortical scarring.