Purpose: We hypothesized in this descriptive investigation that children with daytime wetting demonstrate unique emotional/behavioral patterns, independent of gender and age, compared to children with nocturnal wetting.
Materials and methods: Two groups of children 5 to 17 years old with day wetting and urinary tract infections in the absence of organic etiology were recruited for study. There were 488 children in group 1 and 418 in group 2. Group 1 was given a short set of behavioral questions and group 2 was evaluated for behavioral characteristics with a revised and longer set of questions. Also in group 2 children with nocturnal wetting only were recruited as a comparison group. A subgroup of 58 children was randomly selected from group 2 and administered 2 standardized questionnaires.
Results: Children with day wetting and urinary tract infection had a significantly higher rate of constipation (35%) than those with day wetting and no infection (25%, p <0.02). Parents of group 1 children reported the level of frustration and anger to be similar whether the children had urinary tract infection or not. Parents also reported that only 3.8% of children had significant learning or school problems. Parents of group 2 did not report any differences between nighttime and daytime wetting with respect to positive outlook, organizational skills or willingness to talk. Differences were noted, with daytime wetters perceived as more stubborn (p <0.0001), secretive (p <0.0001), refusing to follow parental requests (p <0.002) and constipation (p <0.0003). Of the subsample group the incidence of verified attention deficit/hyperactivity disorder was highest in children with daytime wetting and no infection (21%), and nighttime wetting (22%) compared to 0% in daytime wetting and infection. The Child Behavioral Checklist results on this sample suggested that 35% of the children with daytime wetting and no infection earned significant T scores of mixed or externalizing symptoms, while the nocturnal enuresis group demonstrated 16% significant T scores, primarily externalizing. All females with the daytime wetting and infection showed significant T scores within the internalizing domain. The Child Behavioral Checklist defines externalizing behaviors as aggressive and acting out behaviors, while internalizing behaviors include withdrawn and anxious/depressed behaviors. Mixed behaviors on this questionnaire include social, attention and thought problems.
Conclusions: These data suggest that a minority of children with daytime wetting and infection tend to show an internalizing style of problems (11%) and constipation, while those with daytime wetting and no infection show a more mixed style of psychological problem (35%). In contrast, the nighttime wetting group tends to show externalizing problems (16%). Based on a subsample of the data children with daytime wetting and no infection, and nighttime wetting showed a significantly incidence of verified attention deficit/hyperactivity disorder compared to the general population. According to parent perceptions, stubbornness and secretiveness seem to describe a style that the children with daytime wetting exhibit that is not present in those with nighttime wetting. There is a possible role of uncontrol and over control psychological styles to the development and treatment of daytime wetting as well as the relationship of these styles to treatment outcome. Further research is needed to clarify the psychological style of children with daytime wetting to customized treatment protocols.