Are kids with ADHD harder to treat?

Kovacevic, Wolfe-Christensen, Rizwan, Lu, and Lakshmanan (2018) wanted to identify the severity of bedwetting in children with attention deficit hyperactivity disorder (ADHD). It’s known that there is an association between ADHD and bedwetting.  They compared children with bedwetting with ADHD and without ADHD.  They found that kids with ADHD had more severe daytime voiding symptoms, constipation and nocturnal enuresis.
They also found that children with ADHD responded better to medication than behavioral therapy. Their urinary symptoms could be related to the inability to recognize their bladder signals.  Also, their overactivity makes it difficult for them to respond appropriately to the signals they do recognize.  Surprisingly, there was no difference in treatment rates for kids with ADHD on psychotropic medication versus not on psychotropic medication.
My opinion: Children with ADHD tend to have more significant symptoms and need a multidimensional approach.  I encourage timed voiding (especially at school with their teachers) and constipation management with miralax (constipation is underdiagnosed in this group of children, yet it is often a known side effect of their ADHD medications). I offer desmopressin, if the child will be compliant with fluid restriction an hour before taking the medication and no fluids overnight. If their symptoms persist, our next step is to add a bladder medicine such as ditropan, so they can hold more overnight.  It’s very important to wean down on medication every 3 months that they are dry to get off of medications as soon as possible.
Kovacevic, L., Wolfe-Christensen, C., Rizwan, A., Lu, H., & Lakshmanan, Y. (2018). Children with nocturnal enuresis and attention deficit hyperactivity disorder: A separate entity? Journal of Pediatric Urology, 14(1). doi:10.1016/j.jpurol.2017.07.002
Disclaimer: This does not replace treatment by a medical provider. Patient needs to be seen by a Pediatric Urologist to follow this pathway.

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