Taking care of a child with ADHD can present various challenges. And one of those challenges could be related to bathroom trips.
A recent study found that children with ADHD (attention deficit hyperactivity disorder) were more likely than other children to have problems with constipation or bowel incontinence.
Constipation occurs when a person is unable to easily empty their bowels. Incontinence means a person cannot easily control their bladder or bowels, leading to possible accidents.
This study showed that both of these medical concerns occurred at higher rates among children with ADHD than without.
The researchers provided a variety of possible reasons for the connection between the conditions.
The study, led by Connor McKeown, MD, of the Department of Pediatrics at F. Edward Hebert School of Medicine in Bethesda, Maryland, looked at whether kids with ADHD were more likely to have constipation or incontinence.
The researchers examined the records of 742,939 children, aged 4 to 12, who were all children of military personnel (because it provided a health system database).
Of these children, 4.4 percent (32,773 children) had ADHD.
The researchers found that more of the children with ADHD had constipation or incontinence than the children without ADHD.
While 4.1 percent of the children with ADHD had constipation issues, only 1.5 percent of children without ADHD had constipation problems.
Meanwhile, 0.9 percent of children with ADHD had problems with bowel incontinence, compared to only 0.15 percent among children without ADHD.
Overall, children with ADHD visited the doctor for constipation 3.4 times more often than children without ADHD.
Kids with ADHD also saw the doctor for bowel incontinence almost eight times more often than children without ADHD did.
There was no difference between constipation or bowel incontinence problems among children with ADHD who were or were not taking medications.
The researchers explored several different possible reasons for why children with ADHD might have more problems with constipation or incontinence.
One reason might be related to neurological (brain) differences in the children. Perhaps the brain is not communicating properly with the rest of the body in some children with ADHD.
The connection may also have to do with emotional issues that affect those with ADHD and might influence control of their bowels.
Or, the researchers suggested, children who have ADHD develop bowel difficulties as a result of behavioral issues.
"Children with ADHD may not respond as promptly to physical cues of either defecation or urination, and have difficulty interrupting current more desirable tasks," the researchers wrote. "Children with ADHD may be unable to focus on defecatory urges [need to go to the bathroom] long enough to carry out normal evacuation [defecating]."
The researchers also suggested that children with ADHD may be less motivated in toilet training when younger.
Another possibility for the link between the conditions might relate to nutritional concerns among children with ADHD.
Regardless of the reasons, the researchers noted the importance of ensuring that parents and care providers are aware of the association between ADHD and bowel difficulties.
Likewise, "in patients who repeatedly present or require specialist referral for medical management for constipation and fecal incontinence, screening for ADHD may be helpful," the researchers wrote.
Glen Elliott, MD, PhD, a clinical professor at the Stanford University Department of Psychiatry and Behavioral Sciences, said that parents of children with ADHD are unlikely to be surprised by these findings.
"Although far from universal, many children with this diagnosis have unusual eating habits with restricted diets and a lower awareness of or attention to internal signals, resulting in more frequent difficulties with urinary and bowel control," Dr. Elliott said.
"These authors have nicely shown the extent of the problem and hypothesized several reasons for the increased risk of difficulties with bowel control," he said.
"They also, importantly, found no correlation in either direction with medication treatment for ADHD," he said. "What remains to be determined is a better understanding of the underlying causes of and best approaches to treating this additional condition in patients with ADHD who present with such symptoms."
This study was published October 21 in the journal Pediatrics. The research did not use external funding, and the authors reported no conflicts of interest.