Standard therapy for enuresis works in children with neurodevelopmental disorders

Bell and pad alarm therapy should be used as firstline treatment for children with neurodevelopmental disorders (NDDs) and enuresis, according to study findings. Investigators compared retrospective medical record data for almost 3000 children in Australia who were given an enuresis diagnosis with data for typically developing children. Children with an NDD had a clinical diagnosis of attention-deficit/hyperactivity disorder, autism spectrum disorder, or intellectual disability (ID). Treatment success was defined as remaining dry for at least 14 consecutive days and relapse as 1 symptom recurrence per month after treatment was interrupted.

The investigators found that the bell and pad alarm was nearly as effective in children with NDDs as in typically developing children. For children with NDD, the success rate was 62%; for typically developing children the rate was 78%. The latter all were successfully dry after the first treatment. Only 59% of children with ID had success after the first treatment, the lowest percentage of all groups analyzed. The number of treatments received, or relapse rates, did not differ significantly between the 2 groups. The results also indicated that a child with a NDD and enuresis is more likely than their peers to be male, be older, and have current constipation aligned with a secondary enuresis diagnosis.

Thoughts from Dr. Farber

I was taught that using an alarm system required a cognitive age of at least 6 years. Unfortunately, this study does not give cognitive ages; perhaps the failures in children with NDD reflect cognitive ages below this level, but there is enough here to warrant a trial in such children if the family is interested.

Reference

1. Schuster S, Reece J, Florentzou, Apos E. Treating enuresis in children with neurodevelopmental disorders using bell and pad alarm. J Pediatr Urol. Published online July 21, 2021. doi:10.1016/j.jpurol.2021.07.010