The Connection Between Bedwetting and ADHD
"I have always known my son was different: three handfuls, not just one," says Sylvia, an Oberlin, Pa., mom of a 10-year-old boy. He was diagnosed with attention deficit hyperactivity disorder (ADHD) at 6 and has experienced bedwetting ever since he was in diapers.
Sylvia is not alone in facing these two challenges together. Parents, clinicians and researchers have all noticed a tendency for ADHD and bedwetting to occur in the same children. A research study published in the Southern Medical Journal in 1997 found that at age 6, ADHD children were nearly three times more likely than other children to have nighttime bedwetting and almost five times more likely to have daytime wetting episodes.
What's the Connection?
Despite the clear tendency of ADHD and bedwetting to occur together, doctors and medical researchers have not been able to find a definitive link between the two, says Dr. Joseph Biederman, a pediatric psychopharmacologist at Harvard University. The big question is: Does ADHD cause bedwetting, does bedwetting cause ADHD, or does something else cause both?
"It is possible that enuresis (bedwetting) is more common in children with ADHD, because children with ADHD are distractible and do not pay attention to the signals of the need to void," says Dr. Lane Robson, a specialist in pediatric urology at the University of Oklahoma. "If this were true, then ADHD might be considered a potential cause of enuresis." In other words, bedwetting is just one of the things that can happen as a result of ADHD behaviors.
Alternatively, Dr. Robson says that there might be something else – such as a genetic predisposition or an environmental link – that causes both.
Perhaps because of the lack of understanding of exactly how ADHD and bedwetting might be related, clinicians often recommend treating the two separately.
Dr. Jerry Rushton, a pediatrician and researcher at the University of Michigan, offers this advice for parents: "The best approach is to realize the association and relation of these conditions and to understand that ADHD can cause sleep problems and children to be less attentive to their needs to void, to remember not to drink too much at bedtime and to resist some parent requests at times. However, treating them separately with the most effective approaches for the individual conditions would be my recommendation instead of trying to handle both with a single treatment."
While traditional medicine tends to treat ADHD and bedwetting symptoms separately, there are non-traditional treatments available. These alternative therapies tend to be based on a belief that ADHD and bedwetting are often both symptoms of another underlying cause.
Some people believe that food allergies or chemicals in food can cause both ADHD-like symptoms and bedwetting. By shifting a child to a diet that eliminates the foods to which he or she is sensitive, supporters of this approach claim that ADHD symptoms and bedwetting are often much improved or eliminated. For parents interested in exploring this type of treatment, a good place to start is the Feingold Association, which advocates a dietary approach developed by the chief of allergy medicine at Kaiser-Permanente Medical Center in San Francisco, Calif. in the 1960s.
Another alternative therapy addresses a deep sleep disorder as the root cause of ADHD-like symptoms and bedwetting in many people. "The inherited deep sleep disorder that causes bedwetting also causes people to spend most, if not all of their nights in stage 4 of sleep," says Shelly Morris, director of the Enuresis Treatment Center. "Stage 4 is the deepest stage in the sleep cycle. It is the stage where the whole body slows down and rests. It is when the cells rejuvenate, the pulse slows down and the oxygen levels are low. When one spends the whole night not getting enough oxygen, the symptoms are going to be identical to ADD/ADHD ... lack of focus, staring out in space, easily distracted, etc."
Treatment therapies of this type focus on conditioning and biofeedback approaches to correct sleep patterns. Successful treatment will eliminate bedwetting issues and eliminate or reduce ADHD symptoms. According to Morris, even children who have both the sleep disorder and ADHD tend to see substantial improvement in their ADHD symptoms.
While you are working on bedwetting, it may be helpful to use disposable absorbent underpants. They help your child wake up feeling dry, which generates positive self-esteem – and means less laundry for you.
Tips From a Parent
In the face of all these treatment options and not many clear-cut answers, perhaps the hard-won advice of a mom in the trenches is the most useful to parents in this situation. Sylvia offers this advice for parents:
- Find out if there is an underlying problem, such as stress or a bladder infection. Rule these out.
- Try cutting out drinks one hour before bedtime. (She points out, however, that this did not work for her family because of their schedule.)
- If you know your child is wetting the bed, try waking him to go to the bathroom before you go to bed, but try to keep it at the same time every night. "If I waited until 10:30 p.m., it was too late," she says. "10 p.m. seemed to work for us."
- "I always made him shower off before changing clothing. Sometimes this was a hassle, but then I didn't have to deal with it in the morning," she says. "Our mornings were nutty anyway."
- Don't yell. It is something the child has to learn to feel. Be patient. It should be over by puberty.
For many children with ADHD and bedwetting challenges, there will be no silver bullet, just the patience of a parent willing to try and try again.
There is Hope
Take heart from Sylvia's story – in the end, it seems to be working. By 8 1/2, her son was only having accidents about once a week. Now at 10, he has made it nearly six months accident free.