P3.M248: Comparison of Pediatric Patients with Bladder Bowel Dysfunction (BBD) and Pediatric Patients With BBD and Comorbid Attention Deficit Hyperactivity Disorder (ADHD)

Background: Children with ADHD are 4.5x more likely to have incontinence than their peers. The impact of ADHD management with medications on patient response to urotherapy for BBD is ill defined; however, successful management of ADHD is thought to improve BBD management and symptoms. The objective of this study is to compare the rate of improvement following BBD management in patients with ADHD who are taking and not taking ADHD medications to a control population.

Methods: A retrospective review of patients 5-18 years old evaluated for BBD with and without a diagnosis of ADHD from 1/1/2015-12/30/2022. Inclusion required urology visit and completion of the Iowa Pediatric Bladder and Bowel Dysfunction questionnaire. Degree of BBD was defined by questionnaire score. A linear mixed model was used to compare the trend of BBD scores between groups.

Results: Groups included children with BBD and ADHD (n=122) and controls with BBD and no ADHD (n=300). Children with BBD and ADHD had significantly higher baseline BBD scores, 28.29 compared to 18.36 children with BBD only (p < 0.001). Those with ADHD on or off ADHD medications had average baseline BBD scores without medication, significantly higher than the BBD control group (8.18 (p < 0.001) and 10.38 points higher (p < 0.001), respectively). There was no significant difference in BBD score change between initial and first follow-up visit between groups. However, at the final visit, ADHD patients still had significantly higher scores, at 23.46, than controls at 18.16 (p < 0.001).

Conclusion: In previous literature, children not on ADHD medication were excluded from studies. This study indicates children with BBD and ADHD, regardless of ADHD medical therapy status, have significantly more severe BBD compared to controls as demonstrated by higher BBD scores at both initial and final visits. Nonetheless, children with BBD and ADHD respond to BBD therapy with a similar initial rate of improvement to the controls.