Pediatric urinary incontinence (UI) did not appear to substantially affect academic performance but the subgroup of children with co-occurring diagnosed psychiatric disorders had poorer performance, a large matched-cohort study from Denmark showed.

Children with nocturnal enuresis (NE) had statistically lower test scores versus the reference group, but the difference in total score had a range that approached 0. Daytime UI (DUI) had no significant associations with test scores except for language scores among eighth graders. Children with psychiatric disorders and any UI performed significantly worse across the range of ages and grades and was most pronounced for sixth- and eighth-grade math.

Not surprisingly, children with UI and intellectual disabilities had the lowest scores but children with attention deficit-hyperactivity disorder (ADHD) also had lower scores on all tests as compared with the reference group, reported Britt Borg, MD, PhD, of Aarhus University Hospital in Denmark, and co-authors in the Journal of Urology.

“School performance in children with UI was normal,” the authors concluded. “However, because PDs [psychiatric disorders] are more prevalent in UI and children with UI and co-occurring PDs had significantly lower school performance, we recommend assessing for PDs in UI. Children with late treatment onset had lower school performance than children with early treatment onset; further research is needed on the effect of delayed treatment on children with UI.”

The study draws attention to the importance of urinary health on overall development and well-being in pediatric patients, said Chester Koh, MD, of Baylor College of Medicine in Houston, who has worked with Danish institutions as part of a research collaboration that includes Baylor and Texas Children’s Hospital. The study relied on data from Denmark’s extensive national electronic health record system and the Danish National Biobank, which allows Danish researchers to “perform these types of longitudinal studies that are much more difficult to conduct in the U.S.”

“We as pediatric urologists understand the impact that pediatric urology conditions such as urinary incontinence can have on pediatric patients and their families,” Koh told MedPage Today. “However, a study in the U.S. would be needed to determine if the U.S. pediatric population has similar findings. The study does highlight the need for multidisciplinary care for pediatric patients with urinary incontinence and that may include specialists who are familiar with childhood neurologic development.”

The study added to existing evidence on a relationship between psychiatric diagnoses and UI. Though psychiatric conditions generally do not cause UI, both physicians and parents have long suspected an association, particularly with NE, Borg and co-authors noted in their introduction. Moreover, psychiatric conditions are overrepresented in UI populations, particularly ADHD, which is known to affect school performance.

The purpose of the current study was to investigate whether UI in children is associated with lower performance on standardized school tests and whether co-occurring psychiatric disorders and age at onset of incontinence treatment influenced the association. Investigators queried the Danish Civil Registration System to identify children born in Denmark from 1997 to 2008. The analysis included children age 5 years or older and with at least one test result from the Danish National School Test Program (test results ranged from 1 to 100 points).

Information on UI treatment was obtained from the Danish National Prescription Registry, and other national registries provided data to identify children treated as inpatients or outpatients for UI and childhood psychiatric disorders. The analysis included 42,999 children with a UI diagnosis and a reference group of 429,990 children without UI. NE accounted for most (83.5%) of the UI diagnoses, followed by DUI (9.2%), and urge urinary incontinence (UUI, 7.3%)

The results showed that children with NE consistently had lower scores versus the reference group. The magnitude of difference ranged from -0.4 to -2.5 (P<0.005). Among children with DUI, the only significant difference was the native language score for 8th graders (-1.8, 95% CI -2.8 to -0.08, P<0.005).

Children with UI and a psychiatric diagnosis had lower scores on language and math tests across all grades, achieving statistical significance (P<0.005) in math for all psychiatric disorders and in language for all disorders except autism and affective disorder. Aside from students with learning disabilities, those with ADHD and UI had the worst scores versus the reference group, ranging from -5.3 to -11.2 for language and from -3.7 to -12.7 for math.

Analysis of the relationship between treatment onset for UI and school performance, older age at onset of treatment for NE was associated with lower test scores, but the difference from the reference group appeared to diminish after treatment started. Investigators found no significant associations between test scores and onset of treatment for DUI and UUI.

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