Moderate-intensity aerobic exercise training as an adjunct to trauma-focused psychotherapy in traumatized refugees and asylum seekers: study protocol of a randomized controlled trial.

Background: Refugees with exposure to multiple traumatic events are at high risk for developing posttraumatic stress disorder (PTSD) and depression. Narrative exposure therapy (NET) is an effective treatment for the core symptoms of PTSD, but it does not reliably reduce depressive symptoms. Endurance exercise on the other hand was consistently found to be effective in treating depression making it a promising adjunct to NET. Up to date, no studies exist investigating the combination of NET and endurance exercise in a sample of refugees with PTSD and comorbid depression.Objectives: In the proposed randomized controlled trial, we aim to investigate whether a combination of NET and moderate-intensity aerobic exercise training (MAET) enhances treatment outcome for refugees with PTSD and comorbid depressive symptoms. We expect a greater improvement in psychopathology in participants who receive the combined treatment.Methods and analysis: 68 refugees and asylum seekers with PTSD and clinically relevant depressive symptoms will be recruited in the proposed study. Participants will be randomly assigned to receive either NET only (NET-group) or NET plus MAET (NET+-group). All participants will receive 10 NET sessions. Participants in the NET+-group will additionally take part in MAET. Primary (PTSD, depression) and secondary (general mental distress, agoraphobia and somatoform complaints, sleep quality) outcome measures will be assessed before treatment, after treatment, and at six-month follow-up. The hypotheses will be tested with multiple 2 × 3 mixed ANOVA's.Trial registration: German Clinical Trials Register identifier: DRKS00022145.

Refugees are at particularly high risk of developing posttraumatic stress disorder and comorbid depressive symptoms due to exposure to multiple man-made traumatic events.Narrative exposure therapy reliably reduces symptoms of posttraumatic stress disorder, but many patients retain their clinical diagnosis, untreated comorbid depressive symptoms may interfere with treatment response.The randomized controlled trial aims to investigate whether combining narrative exposure therapy with moderate-intensity aerobic exercise training enhances treatment outcomes for refugees with posttraumatic stress disorder and comorbid depressive symptoms, compared to narrative exposure therapy as a stand-alone treatment.

Generation climate crisis, COVID-19, and Russia-Ukraine-War: global crises and mental health in adolescents.

Climate change, COVID-19, and the Russia-Ukraine War are some of the great challenges of our time. These global crises affect young people in a particularly vulnerable phase of their lives. The current study aimed to assess the impact of these crises on mental health (depression, anxiety, and health-related quality of life) in secondary school students in Germany. Furthermore, we assessed known predictors of mental health, such as socio-economic factors, individual life stressors, and resilience factors (self-efficacy, expressive flexibility) as covariates. In our sample of 3998 pupils, pandemic- and climate-related distress were linked to greater depression and anxiety and reduced health-related quality of life. War-related distress was associated with greater anxiety. Critically, these associations remained significant after controlling for all covariates, supporting the incremental predictive value of the crises measures. The study reveals a significant impact of the crises on the mental health of the current generation of adolescents. As such it suggests that mental health policies should include interventions that help youth to cope with the stress caused by the crises.

Convergent and Discriminant Validity of the Test of Passive Aggression in a Psychotherapy Outpatient Sample.

Background: While most clinical aggression questionnaires focus on the assessment of active aggression, the recently developed Test of Passive Aggression (TPA) assesses both self-directed (TPA-SD) and other-directed passive aggression (TPA-OD). Reliability and factorial validity of the TPA have been demonstrated in a clinical sample, while previous evaluations of convergent and discriminant validity were limited to student samples. The current study aimed at addressing this gap by demonstrating convergent and discriminant validity of the TPA in an outpatient sample. Methods: Eighty-two patients admitted to an outpatient psychotherapy unit at Saarland University, Germany, participated in the preregistered study with an assessment of self-reported passive aggression, impulsivity, anger expression, self-compassion, self-esteem, and auto-aggressive mindset. Analyses used regression models with robust maximum likelihood estimations. Results: Self-directed passive aggression showed a significant association with self-compassion, auto-aggressive mindset, self-esteem, and internal anger expression supporting the convergent validity of TPA-SD. Results on discriminant validity of TPA-SD were heterogenous at the first sight, revealing small associations of self-directed passive aggression with anger control but medium associations with impulsivity. However, exploratory analysis showed that the medium association with impulsivity was driven by the non-behavioral impulsivity dimension "inattention" and that both behavioral impulsivity dimensions ("motor-impulsivity" and "unplanned behavior") demonstrated only weak associations with TPA-SD. Validity of TPA-OD was not supported by the current study. Conclusion: Our findings provide evidence for the validity of the TPA-SD to outpatient samples. Future studies will need to analyze construct validity based on a nomological network using larger and more diverse samples.

Psychopathology and Parental Stress in 3-6-Year-Old Children with Incontinence.

Objective: Incontinence and functional gastrointestinal disorders are common in young children and are associated with higher rates of psychological symptoms and mental disorders. This article focuses on the mutual association between incontinence and related toilet refusal syndrome, parental stress, and children's psychopathology especially in young children. Methods: Children's psychological symptoms, mental disorders, and parental stress levels were assessed in 38 parent-child dyads involving children with incontinence and 42 dyads of typically developing (TD) children. Results: Compared to TD children, patients had higher internalizing and externalizing CBCL scores and higher rates of clinically relevant externalizing problems. However, the rates of clinically relevant internalizing problems and mental disorders did not differ. The parents of children with incontinence reported significantly higher stress levels regarding child-related stress factors (PSI-CD) than did parents of TD children. However, there were no clinically relevant parental stress scores on a group level, which remained below the clinical range (T-value < 60). When simultaneously analyzed, children's (comorbid) mental disorders but not incontinence had a major impact on parental stress. Conclusions: Despite moderate stress levels, incontinence symptoms, urinary and fecal incontinence are highly prevalent in young children. However, stress among parents of young children was mainly elicited by any (comorbid) mental disorder.

Development and Psychometric Properties of the Test of Passive Aggression.

Background: To date, most research on aggression in mental disorders focused on active-aggressive behavior and found self-directed and other-directed active aggression to be a symptom and risk-factor of psychopathology. On the other hand, passive-aggressive behavior has been investigated less frequently and only in research on psychodynamic defense mechanisms, personality disorders, and dysfunctional self-control processes. This small number of studies primarily reflects a lack of a reliable and valid clinical assessment of passive-aggressive behavior. To address this gap, we developed the Test of Passive Aggression (TPA), a 24-item self-rating scale for the assessment of self-directed and other-directed passive-aggressive behavior. Method: Study 1 examined the internal consistency and factorial validity of the TPA in an inpatient sample (N = 307). Study 2 investigated the retest-reliability, internal consistency, and construct validity (active aggression, personality traits, impulsivity) of the TPA in a student sample (N = 180). Results: In line with our hypothesis, Exploratory Structural Equation Modeling revealed an acceptable to good fit of a bi-factorial structure of the TPA (Chi-square-df-ratio = 1.98; RMSR = 0.05, fit.off = 0.96). Both TPA scales showed good to excellent internal consistency (α = 0.83-0.90) and 4-week retest-reliability (r tt = 0.86). Correlations with well-established aggression scales, measures of personality, and impulsivity support discriminant and convergent validity of the TPA. Conclusions: The TPA is a reliable and valid instrument for the assessment of self-directed and other-directed passive-aggressive behavior.

Do German Children Differ? A Validation of Conners Early Childhood™.

Objective: The present study aimed to validate the German version of the Conners Early Childhood (EC)™ among German-speaking children. Method: A total of 720 parental and 599 childcare provider ratings of 2- to 6-year-old children were surveyed throughout Germany. Validity was assessed by calculating exploratory factor analyses (EFAs) and confirmatory factor analyses (CFAs), and a series of multivariate analyses of variance (MANOVAs) to analyze associations between Conners EC™ symptom ratings and sociodemographic variables. In addition, parent and childcare provider ratings of Conners EC™ scales were correlated with a number of other well-validated German measures assessing preschoolers' behaviors. Results: Although the EFA yielded different factors than the original scales, CFA revealed acceptable to good model fits. Conclusion: Overall, we confirmed the factor structure of the Conners EC's™ American original within the German validation. The use of the American factor structure is justified and can be recommended to facilitate international research on psychopathology in early childhood.

Do adjuvant interventions improve treatment outcome in adult patients with posttraumatic stress disorder receiving trauma-focused psychotherapy? A systematic review.

Background: According to clinical guidelines, trauma-focused psychotherapies (TF-PT) such as trauma-focused cognitive behavioural therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) are recommended as first-line treatments for posttraumatic stress disorder (PTSD). TF-CBT and EMDR are equally effective and have large effect sizes. However, many patients fail to respond or have comorbid symptoms or disorders that only partially decline with TF-PT. Thus, there is growing interest in augmenting TF-PT through adjuvant interventions. Objective: The current systematic review aims to assess whether adjuvant interventions improve outcome among adult PTSD patients receiving TF-PT. Methods: We searched the databases PubMed, PILOTS, Web of Science and the Cochrane Library for controlled clinical trials examining whether adjuvant interventions lead to more symptom reduction in adult PTSD patients receiving TF-PT. Thirteen randomized controlled trials fitted the inclusion criteria. These were evaluated for internal risk of bias using the Cochrane Handbook for Systematic Review of Interventions. Results: Most studies have a substantial risk for internal bias, mainly due to small sample sizes. Thus, no strong conclusion can be drawn from the current empirical evidence. Preliminary evidence suggests that exercise and cortisol administration may have an adjuvant effect on PTSD symptom reduction. Breathing biofeedback showed a trend for an adjuvant effect and an effect for accelerated symptom reduction. Conclusions: Currently, it is not possible to formulate evidence-based clinical recommendations regarding adjuvants interventions. While several adjuvant interventions hold the potential to boost the effectiveness of TF-PT, the realization of sufficiently powered studies is crucial to separate plausible ideas from interventions proven to work in practice.

Antecedentes: De acuerdo a las guías clínicas, las psicoterapias con foco en el trauma (TF-PT, por su sigla en inglés), así como la terapia cognitivo-conductual con foco en el trauma (TF-CBT, por su sigla en inglés) y la terapia de reprocesamiento y desensibilización por movimientos oculares (EMDR) son recomendadas como tratamientos de primera línea para el Trastorno de Estrés Postraumático (TEPT). TF-CBT y EMDR son igualmente efectivas y tienen grandes tamaños de efecto. Sin embargo, muchos pacientes no responden, tienen síntomas comórbidos u otros trastornos que sólo disminuyen parcialmente con TF-PT. Por lo tanto, hay un creciente interés en aumentar las TF-PT a través de intervenciones auxiliares.Objetivo: La presente revisión sistemática busca evaluar si las intervenciones auxiliares mejoran los resultados entre adultos con TEPT que reciben TF-PT.Métodos: Buscamos en las bases de datos Pubmed, PILOTS, Web of Science y en la Biblioteca Cochrane, estudios clínicos controlados que examinaran si las intervenciones auxiliares llevan a mayor reducción de síntomas en pacientes adultos con TEPT que reciben TF-PT. Trece estudios randomizados controlados cumplieron los criterios de inclusión. En estos se evaluó el riesgo interno de sesgo usando el Manual Cochrane para la Revisión Sistemática de Intervenciones.Resultados: La mayoría de los estudios tuvo un riesgo sustancial de sesgo interno, principalmente debido al pequeño tamaño muestral. Por lo tanrto, no se puede extraer conclusiones fuertes de la evidencia empírica actual. La evidencia preliminar sugiere que el ejercicio y la administración de cortisol puede tener un efecto auxiliar en la reducción de síntomas de TEPT. El biofeedback de la respiración mostró una tendencia hacia un efecto auxiliar y un efecto en la reducción acelerada de los síntomas.Conclusiones: Actualmente, no es posible formular recomendaciones clínicas basadas en la evidencia en relación a intervenciones auxiliares. Mientras varias intervenciones auxiliares mantienen potencial para aumentar la efectividad de las TF-PT, la realización de estudios con suficiente poder es crucial para separar las ideas plausibles de las intervenciones con efectividad probada en la práctica.

Central Nervous System Processing of Emotions in Children with Fecal Incontinence and Constipation.

OBJECTIVE: Fecal incontinence and constipation are common disorders in childhood. The enteric nervous system and the central nervous system are highly interactive along the brain-gut axis. The interaction is mainly afferent. These afferent pathways include centers that are involved in the central nervous processing of emotions as the mid/posterior insula and the anterior cingulate cortex. A previous study revealed altered processing of emotions in children with fecal incontinence. The present study replicates these results. METHODS: In order to analyze the processing of emotions, we compared the event-related potentials of 25 children with fecal incontinence and constipation to those of 15 control children during the presentation of positive, negative, and neutral pictures. RESULTS: Children with fecal incontinence and constipation showed altered processing of emotions, especially in the parietal and central cortical regions. CONCLUSIONS: The main study results of the previous study were replicated, increasing the certainty and validity of the findings.

Psychometric properties of the "parental questionnaire: Enuresis/urinary incontinence" (PQ-EnU).

AIMS: The "Parental Questionnaire: Enuresis/Urinary Incontinence" (PQ-EnU) is widely-used in clinical assessment of nocturnal enuresis (NE) and daytime urinary incontinence (DUI). It includes 18 items regarding daytime (DW) and nighttime wetting (NW), 24 items concerning toilet habits (TH), and 14 items regarding behavioral problems (BP). The aim of the study was to evaluate reliability and validity of the PQ-EnU. METHODS: Parents of 490 children (M = 8.7 years [SD = 2.9], 68.2% male) presented in an outpatient incontinence clinic completed the PQ-EnU and the Child Behavior Checklist (CBCL). Internal consistencies, factorial structure, and convergent validity regarding incontinence diagnoses and psychopathology were examined. RESULTS: 84.1% had NE, 38.8% DUI, and 20.8% fecal incontinence (FI). Internal consistencies were good for TH and BP. A factor analysis of the TH scale revealed three subscales ("Lower urinary tract symptoms (LUTS)," "Bowel symptoms," and "Voiding dysfunctions"). The LUTS and "Bowel symptoms" subscales were significantly correlated to clinical diagnoses of DUI and FI, respectively. A factor analysis of the BP scale revealed also three subscales ("attention/school deficits," "impulsive-aggressive behavior" and "internalizing problems," which were all significantly correlated with the CBCL. The questionnaire discriminated significantly between children with and without DUI or FI, and children with and without a clinical CBCL score. CONCLUSIONS: The PQ-EnU is a valid and reliable parental questionnaire to measure incontinence, bladder/bowel symptoms, and behavioral problems in children. Due to its shortness, the PQ-EnU is an efficient measurement, which can be used in clinical settings and also as a screening tool for psychological symptoms.

EEG Measurement of Emotion Processing in Children with Daytime Urinary Incontinence.

OBJECTIVE: Daytime urinary incontinence (DUI) is common in childhood. The aim of the study was to neurophysiologically analyse the central emotion processing in children with DUI. METHOD: In 20 children with DUI (mean age 8.1 years, 55 % male) and 20 controls (mean age 9.1 years, 75 % male) visual event-related potentials (ERPs) were recorded after presenting emotionally valent (80 neutral, 40 positive, and 40 negative) pictures from the International Affective Picture System (IAPS) as an oddball-paradigm. All children received a full organic and psychiatric assessment. RESULTS: Children with DUI did not differ significantly from controls regarding responses to emotional pictures in the frontal, central, and parietal regions and in the time intervals 250-450 ms, 450-650 ms, and 650-850 ms after stimulus onset. The patient group had more psychological symptoms and psychiatric comorbidities than the control group. CONCLUSIONS: EEG responses to emotional stimuli are not altered in children with DUI. Central emotion processing does not play a major role in DUI. Further research, including a larger sample size, a more homogeneous patient group (regarding subtype of DUI) or brain imaging techniques, could reveal more about the central processing in DUI.

Incontinence and psychological symptoms in individuals with Mowat-Wilson Syndrome.

BACKGROUND: Mowat-Wilson Syndrome (MWS) is caused by deletion/mutation of the ZEB2 gene on chromosome 2q22. MWS is characterized by a distinctive facial appearance, severe intellectual disability and other anomalies, e.g. seizures and/or Hirschsprung disease (HSCR). Most individuals have a sociable demeanor, but one third show psychological problems. AIMS: The aim was to investigate incontinence and psychological problems in MWS. METHODS AND PROCEDURES: 26 children (4-12 years), 13 teens (13-17 years) and 8 adults (>18years) were recruited through a MWS support group. The Parental Questionnaire: Enuresis/Urinary Incontinence, as well as the Developmental Behaviour Checklist (DBC) were completed by parents or care-givers. OUTCOMES AND RESULTS: 97.7% of persons with MWS had incontinence (nocturnal enuresis 74.4%; daytime urinary incontinence 76.2%; fecal incontinence 81.4%). Incontinence remained high over age groups (children 95.8%, teens 100%, adults 100%). 46.2% of children, 25% of teens and 37.5% of adults exceeded the clinical cut-off on the DBC. The ability to use the toilet for micturition improved with age. CONCLUSIONS AND IMPLICATIONS: MWS incontinence rates are very high. All had physical disabilities including anomalies of the genitourinary and gastrointestinal tract. Due to the high prevalence rates, a screening for incontinence and psychological problems in MWS is recommended.

Incontinence in persons with Down Syndrome.

AIMS: To assess the rates of incontinence and associated psychological problems in children, adolescents and adults with Down Syndrome, a genetic syndrome caused by partial or complete triplication (trisomy) of chromosome 21 and characterized by typical facial features, a physical growth delay and mild or moderate intellectual disability. METHODS: Three hundred and seventeen persons with Down Syndrome (4-51 years) were recruited through a German parent support group (59.6% male, mean age 19.2 years). The Parental Questionnaire: Enuresis/Urinary Incontinence, the Incontinence Questionnaire-Pediatric Lower Urinary Tract Symptoms, as well as the Developmental Behavior Checklist (DBC) for parents or for adults were filled out by parents or care-givers. RESULTS: 17.2% of the sample had nocturnal enuresis, 15.9% had daytime urinary incontinence, and 14.2% had fecal incontinence. Incontinence was present in 64.0% of young children (4-12 years), 10.3% of teens (13-17 years), 12.8% of young adults (18-30 years) and in 22.4% of older adults (>30 years). 13.6% of children and 8.4% of adults had a DBC score in the clinical range. 19.5% of children and 27.8% of adults with incontinence had behavioral problems. There was a significant association between nocturnal enuresis, daytime urinary incontinence and clinical DBC scores in adults. CONCLUSIONS: Incontinence in Down Syndrome is mainly present in young children and increases in older adults. Behavioral comorbidity is associated with incontinence only in adults with Down Syndrome. Screening and treatment of incontinence in individuals with Down Syndrome is recommended.

Detailed assessment of incontinence in boys with fragile-X-syndrome in a home setting.

UNLABELLED: Fragile-X-syndrome (FXS) is caused by a mutation on the X chromosome (Xq27.3). Males with a full mutation have typical dysmorphic signs, moderate intellectual disability and psychological disorders. Twenty-five to fifty percent are affected by incontinence. The aim of the study was to assess subtypes of incontinence and psychological problems in children with FXS in their home environments. Twenty-two boys with FXS (mean age 11.0 years) and 22 healthy controls (mean age 11.1 years) were examined with sonography, uroflowmetry, 48-h bladder diary, physical examination, IQ test, parental psychiatric interview and questionnaires regarding incontinence and psychological symptoms in a home setting. Boys with FXS had higher rates of incontinence than controls (59.1 vs. 4.8 %). The most common subtypes in FXS boys were primary non-monosymptomatic nocturnal enuresis, urge incontinence and nonretentive faecal incontinence. 90.9 % boys with FXS had a psychological comorbidity. Incontinence and behavioural symptoms were not associated. CONCLUSION: Boys with FXS have a higher risk for physical disabilities, psychological disorders and incontinence than healthy boys. Constipation is not a major problem in FXS. As effective treatment is available for children with ID, we recommend offering assessment and therapy to all children with FXS and incontinence. WHAT IS KNOWN: • Boys with fragile-X-syndrome (FXS) have higher rates of incontinence, psychological disorders and somatic conditions than typically developing boys. What is New: • Constipation is a rare condition in FXS in contrast to other genetic syndromes. • Although incontinence rates are higher, urological findings (uroflowmetry, sonography) are not more pathological per se in FXS.

Voiding postponement in children-a systematic review.

Voiding postponement (VP) has been defined as a habitual postponement of micturition using holding maneuvers. VP can represent both a symptom, as well as a condition. As divergent definitions are used internationally, the aim was to review the current state of knowledge on VP and provide recommendations for assessment, diagnosis and treatment. A Scopus and a Pubmed search was conducted, entering the terms 'voiding postponement' without any restrictions or specifications. Other publications relevant to the topic were added. VP can represent a symptom in healthy children. As a condition, VP in combination with nocturnal enuresis (NE) is a subtype of non-monosymptomatic NE. Most studies have focused on daytime urinary incontinence (DUI) with VP, or more aptly termed voiding postponement incontinence (VPI). It is a behaviorally defined syndrome, i.e., by the habitual deferral of micturition and DUI. VPI is associated with a low micturition frequency, urgency and behavioral problems. The most common comorbid disorder is oppositional defiant disorder (ODD). VP as a symptom and VPI as a condition should be differentiated. VPI is a common disorder with many associated problems and disorders. Urotherapy and timed voiding are the main treatment approaches. Due to the high rate of comorbid ODD, other forms of treatment, especially cognitive behavioral therapy, are often needed.

Incontinence in children, adolescents and adults with Williams syndrome.

AIMS: Williams Syndrome (WS) is a microdeletion syndrome (chromosome 7q11.23) characterized by typical facial features, cardiovascular disease, behavioural symptoms, and mild intellectual disability (ID). The aim of this study was to assess the rates of incontinence and psychological problems in persons with WS. METHODS: 231 individuals with WS were recruited through the German parent support group (52.0% male, mean age 19.4 years). Faecal incontinence (FI) was diagnosed from the age of 4 years and nocturnal enuresis (NE) and daytime urinary incontinence (DUI) of 5 years onwards. The Parental Questionnaire: Enuresis/Urinary Incontinence, the International-Consultation-on-Incontinence-Questionnaire-Pediatric LUTS (ICIQ-CLUTS), as well as the Developmental Behavior Checklist for parents (DBC-P) or for adults (DBC-A) were filled out by parents or caregivers. RESULTS: 17.8% of the sample had NE, 5.9% DUI and 7.6% FI. NE was present in 44.9% of children (4-12 years), 13.5% of teens (13-17y), 3.3% of young adults (18-30y) and in 3.6% of adults (> 30y). DUI (and FI) decreased from 17.9% (21.4%) in children to 0% in adults. 3.5% of the sample had an ICIQ-CLUTS score in the clinical range. 30.5% of children and 22.1% of adults had a clinical DBC score. Children and teens with clinically relevant DBC-P-scores had significantly higher DUI rates. CONCLUSIONS: Children with WS have high rates of incontinence and LUTS, which decrease with age. Most adults are continent. NE is the most common subtype. Except for DUI in children, incontinence is not associated with behavioural problems. Screening, assessment and treatment of incontinence in individuals with WS is recommended. Neurourol. Urodynam. 35:1000-1005, 2016. © 2015 Wiley Periodicals, Inc.

Incontinence in persons with Noonan Syndrome.

OBJECTIVE: Noonan Syndrome (NS) is an autosomal neurodevelopmental disorder with a high phenotypic variability. Mutations in several genes of the RASMAPK signaling pathways are now known to be responsible for NS. Most of the children with NS are of average intelligence, one-third have a mild intellectual disability (ID) (IQ 50-79). So far, no studies have assessed incontinence in persons with NS. The aim of this study therefore was to investigate the prevalence of incontinence and psychological problems in persons with NS. SUBJECTS AND METHODS: Nineteen children (5-17 years) and 10 adults (18-48 years) with NS were recruited through a German parent support group (58.6% male, mean age 15.26 years). The "Parental Questionnaire: Enuresis/Urinary Incontinence", "Encopresis Questionnaire - Screening Version" and the German version of the International Consultation on Incontinence Questionnaire - Pediatric Lower Urinary Tract Symptom (ICIQ-CLUTS) were completed by parents or caregivers to assess incontinence and lower urinary tract symptoms (LUTS). The Developmental Behavior Checklist for parents (DBC-P) or the Developmental Behavior Checklist for adults (DBC-A) were filled out to assess psychological symptoms. RESULTS: In total, 27.3% of the children (4-12 years) had nocturnal enuresis (NE), 36.4% had daytime urinary incontinence (DUI), and 11.1% had fecal incontinence (FI). Only one adolescent (13-17 years) had NE (14.3%) and one young adult (18-30 years) had FI (11.1%); 36.4% of the children, 33.3% of the adolescents and 12.5% of young adults had a DBC score in the clinical range. No adult (>30 years) had incontinence or a critical DBC score. Children and adolescents with NE had significantly higher scores in the DBC total score as well in the "self-absorbed" and "social relating" subscales than continent children and adolescents, whereas no significant difference was found between children and adolescents with DUI compared with the continent group. CONCLUSIONS: A significant proportion of children with NS are affected by incontinence. Incontinence is a relevant problem in children and adolescents with NS, but does not persist into adulthood. In particular, psychological problems are present in children and adolescents with NE. Screening for both incontinence and psychological symptoms are recommended in children with NS. As most of the children with NS have average intelligence or a mild ID, they can be treated effectively with standard methods.

Obesity, overweight, and eating problems in children with incontinence.

OBJECTIVE: The aim was to analyze the prevalence of eating problems and specific associations between overweight, obesity, and eating behavior in children with incontinence. SUBJECTS AND METHODS: Forty-three consecutively presented children with incontinence, diagnosed to International Children's Continence Society standards, and 44 matched continent controls were examined prospectively. All children received a physical examination, sonography, and a one-dimensional intelligence test. Child psychopathology was measured with the Child Behavior Checklist (CBCL/4-18). Eating problems were assessed with the German version of the Dutch Eating Behaviour Questionnaire for Children (DEBQ-C) and a 40-item-parental questionnaire referring to atypical eating problems. RESULTS: Of the 43 children with incontinence, 23.3% had nocturnal enuresis (NE) only, 37.2% had any form of daytime urinary incontinence (DUI) (isolated or combined with NE) and 39.5% had fecal incontinence (FI) (isolated or combined with NE and/or DUI). Incontinent children showed significantly more CBCL externalizing symptoms (35.7% vs. 6.8%) and total problems (46.3% vs. 6.8%) in the clinical range (>90th percentile), as well as significantly lower mean IQ (105.5 vs. 120.6) than continent controls. Of the children with incontinence, 16.9% were affected by obesity (≥95th body mass index [BMI] percentile) compared with none of the continent controls. Especially in children with FI, the rate of obesity was significantly increased (23.5%). In addition, 46.5% of incontinent children, but none of the controls, had constipation. Again, children with FI (82.4%) had the highest rate of constipation (>DUI: 25% > NE only: 20%). "Food refusal" (FR) and "intense fear of gaining weight" (GW), but not other eating problems, were significantly more common among incontinent children (FR mean score 7.3; GW mean score 1.4) than in controls (FR mean score 5.6; GW mean score 0.7). After controlling for BMI percentiles, FR still was significantly higher in incontinent children. Children with FI had the highest score of FR among all subgroups of incontinence (mean score 9.1). CONCLUSIONS: This study shows that overweight, obesity, behavioral and eating problems are especially associated with disorders of the gastrointestinal tract (FI and constipation), and only to a lesser degree with those of the urinary tract (DUI and NE). These problems should be addressed routinely in the clinical care of children with incontinence.

Abdominal pain symptoms are associated with anxiety and depression in young children.

AIM: Abdominal pain symptoms and incontinence are common in childhood. The aim of this study was to analyse abdominal pain symptoms and their associations with incontinence and symptoms of anxiety and depression in young children. METHODS: We examined 1130 children during the school entry check-up (mean age 6.2 years) and 951 participated in the study. Parents completed a questionnaire contained 11 items regarding Rome-III functional gastrointestinal disorders (FGIDs) and incontinence and 14 items from the anxious/depressed scale of the Child Behavior Checklist (CBCL). RESULTS: Of the 951 children (55.6% boys) we recruited, 30.1% had experienced abdominal pain symptoms in the past two months and 14% had complained of them at least once a week. In addition, 2.6% had irritable bowel syndrome, 11.3% had childhood functional abdominal pain, 2.4% were affected by faecal incontinence, 2.1% were affected by daytime urinary incontinence, and 5.5% were affected by nocturnal enuresis. One in ten (10.6%) had symptoms of anxiety and depression, and these were significantly higher in the children with FGIDs, particularly if they were also incontinent. CONCLUSION: Nearly a third of the children (30.1%) had abdominal pain symptoms, and FGIDs were associated with significantly higher symptoms of anxiety and depression, especially if children were also incontinent.

Incontinence and parent-reported oppositional defiant disorder symptoms in young children--a population-based study.

BACKGROUND: Oppositional defiant disorder (ODD) and incontinence are common disorders of childhood. We have examined associations between ODD symptoms and incontinence in a representative sample of young children. METHODS: A questionnaire with seven questions referring to incontinence, eight DSM-IV items of ODD, 15 items of the Home Situations Questionnaire and six items regarding eating, drinking or toileting refusal was administered to the parents of 718 children at school-entry from a defined geographical area at school-entry. RESULTS: Of the 718 6-year-old children included in the analysis, 8.2% had nocturnal enuresis (NE), 1.5% had daytime urinary incontinence (DUI) and 1.1% had faecal incontinence (FI). Significantly more boys than girls had NE (12 vs. 4.3%). Overall, 6.7% of children had ODD symptoms. Rates of ODD symptoms were significantly higher in incontinent children (19.5%) than in continent children (5.2%), with the highest rate of ODD symptoms in children with DUI (36.4%). Children with incontinence (mean 6.1 episodes) or ODD symptoms (mean 8.4 episodes) showed non-compliant behaviours in more problem situations than continent children (mean 4.5 episodes) or children without ODD symptoms (mean 4.5 episodes). CONCLUSIONS: Incontinence and ODD are common comorbid disorders at school-entry age. Boys are more affected by both disorders. Children with DUI have the highest rate of ODD symptoms. As ODD symptoms affect many daily family situations, ODD needs to be diagnosed and treated in children with incontinence, as it can negatively affect compliance.

Specific behavioral comorbidity in a large sample of children with functional incontinence: Report of 1,001 cases.

AIMS: Psychological comorbidity among children with functional incontinence is high: 20-30% of children with nocturnal enuresis (NE), 20-40% of those with daytime urinary incontinence (DUI) and 30-50% of those with fecal incontinence (FI) have clinically relevant comorbid disorders. The aim of this study was to analyze specific comorbid behavioral symptoms for different subtypes of incontinence in a large group of children. METHODS: All 1,001 consecutive children and adolescents (67.5% boys) with a mean age of 8.5 years presented at a tertiary outpatient department between 2004 and 2011 were examined with a full pediatric and child psychiatric assessment. Prevalence of different subforms of incontinence and associated behavioral symptoms were analyzed. The internalizing, externalizing, and total problem scores of the Child Behavior Checklist (CBCL) were evaluated. RESULTS: Of all children, 70.1% (702 children) had NE, 36.1% (361 children) had DUI, and 36.8% (368 children) were affected by FI. More than 43% of all children had clinically relevant psychological symptoms (CBCL total score, cut-off at 90th percentile). Children with non-retentive FI had highest rates of clinically relevant psychological symptoms (58.8%). Children with combined subtypes of incontinence (any combination of NE, DUI, and FI) were more affected by psychological comorbidities than children with isolated subtypes (NE or DUI or FI). CONCLUSIONS: Children with incontinence have high rates of comorbid behavioral symptoms-three to six times higher than norms. Especially children with FI and combined subtypes of incontinence were affected. As behavioral symptoms and disorders will interfere with incontinence treatment, a general screening is recommended.