A United Kingdom population-based study of intellectual capacities in children with and without soiling, daytime wetting, and bed-wetting

Parental perception of nocturnal enuresis in a local region of Saudi Arabia

Nocturnal enuresis (NE) has been associated with neurodevelopmental disorders such as autism spectrum disorder, attention deficit or hyperactivity disorder, and intellectual disability. This study aimed to assess parents' perception of NE in children in the eastern region of Saudi Arabia. We conducted a cross-sectional study from May to August 2023, including parents aged ≥18 years living in the area. We administered an online questionnaire to assess parents' knowledge and attitudes toward NE and its treatment. A total of 616 parents completed the questionnaire, 71.4% of which were women, 35% were aged between 25 and 35 years, 75% were married, 65% had a university degree, and 49% had three or more children. In total, 70% demonstrated a good overall knowledge about NE and its treatment, and nearly 60% had a positive attitude toward the condition. Univariate and multivariate ordinal logistic regression analyses revealed that female sex, a higher level of education, and having more than one child were associated with a higher score regarding attitude toward treatment. The level of education and the number of children were predictors of knowledge and a positive attitude toward NE in children.

Exploring a causal role of DNA methylation in the relationship between maternal vitamin B12 during pregnancy and child's IQ at age 8, cognitive performance and educational attainment: a two-step Mendelian randomization study

An adequate intake of vitamin B₁₂ during pregnancy plays an important role in offspring neurodevelopment, potentially via epigenetic processes. We used a two-step Mendelian randomization approach to assess whether DNA methylation plays a mediating and causal role in associations between maternal vitamin B₁₂ status and offspring’s cognition. Firstly, we estimated the causal effect of maternal vitamin B₁₂ levels on cord blood DNA methylation using the maternal FUT2 genotypes rs492602:A > G and rs1047781:A > T as proxies for circulating vitamin B₁₂ levels in the Avon Longitudinal Study of Parents and Children (ALSPAC) and we tested the observed associations in a replication cohort. Secondly, we estimated the causal effect of DNA methylation on IQ using the offspring genotype at sites close to the methylated CpG site as a proxy for DNA methylation in ALSPAC and in a replication sample. The first step Mendelian randomization estimated that maternal vitamin B₁₂ had a small causal effect on DNA methylation in offspring at three CpG sites, which was replicated for one of the sites. The second step Mendelian randomization found weak evidence of a causal effect of DNA methylation at two of these sites on childhood performance IQ which was replicated for one of the sites. The findings support a causal effect of maternal vitamin B₁₂ levels on cord blood DNA methylation, and a causal effect of vitamin B₁₂-responsive DNA methylation changes on children’s cognition. Some limitations were identified and future studies using a similar approach should aim to overcome such issues.

Maternal dietary patterns during pregnancy and intelligence quotients in the offspring at 8 years of age: Findings from the ALSPAC cohort

Dietary intake during pregnancy may influence child neurodevelopment and cognitive function. This study aims to investigate the associations between dietary patterns obtained in pregnancy and intelligence quotients (IQ) among offspring at 8 years of age. Pregnant women enrolled in the Avon Longitudinal Study of Parents and Children completed a food frequency questionnaire at 32 weeks' gestation (n = 12,195). Dietary patterns were obtained by cluster analysis. Three clusters best described women's diets during pregnancy: “fruit and vegetables,” “meat and potatoes,” and “white bread and coffee.” The offspring's IQ at 8 years of age was assessed using the Wechsler Intelligence Scale for Children. Models, using variables correlated to IQ data, were performed to impute missing values. Linear regression models were employed to investigate associations between the maternal clusters and IQ in childhood. Children of women who were classified in the meat and potatoes cluster and white bread and coffee cluster during pregnancy had lower average verbal (β = −1.74; p < .001 and β = −3.05; p < .001), performance (β = −1.26; p = .011 and β = −1.75; p < .001), and full‐scale IQ (β = −1.74; p < .001 and β = −2.79; p < .001) at 8 years of age when compared to children of mothers in the fruit and vegetables cluster in imputed models of IQ and all confounders, after adjustment for a wide range of known confounders including maternal education. The pregnant women who were classified in the fruit and vegetables cluster had offspring with higher average IQ compared with offspring of mothers in the meat and potatoes cluster and white bread and coffee cluster.

Primary nocturnal enuresis is associated with lower intelligence quotient scores in boys from poorer socioeconomic status families

OBJECTIVES

To explore intelligence quotient in boys with primary nocturnal enuresis compared with normal boys considering their socioeconomic status.

METHODS

A total of 152 school-aged boys (including 55 boys with primary nocturnal enuresis and 97 matched normal controls) were assessed. Boys with a history of any neurological or urological disease were excluded. Two different districts of Tehran: Khani-Abad (a poor district) and Pirouzi (a middle class district) districts were enrolled according to socioeconomic status data reported by the World Health Organization. Intelligence tests were carried out using a validated Iranian translation of the Wechsler Intelligence Scale for Children Revised. Total, as well as performance intelligence quotient and verbal intelligence quotient scores and verbal-performance discrepancy (the difference between verbal and performance intelligence quotient scores for each individual) were compared using a t-test between boys with primary nocturnal enuresis in each district and their matched controls.

RESULTS

Considering each district separately, the total intelligence quotient score was lower in primary nocturnal enuresis cases than controls only in the lower income district (90.7 ± 23.3 vs 104.8 ± 14.7, P = 0.002). Similarly, boys with primary nocturnal enuresis ranked lower in verbal intelligence quotient (P = 0.002) and performance intelligence quotient (P = 0.004) compared with their matched normal controls only in lower income district, whereas in the higher income district, boys with primary nocturnal enuresis ranked similar in total intelligence quotient to their matched controls.

CONCLUSIONS

Boys with primary nocturnal enuresis had a lower intelligence quotient compared with the control participants only in low-income district. It seems important to adjust the results of the intelligence quotient assessment in these children according to their socioeconomic status.

Bladder and bowel continence in bilateral cerebral palsy: A population study

INTRODUCTION

The attainment of continence is an important milestone in all children, including those with disability.

OBJECTIVE

To describe the age of bladder and bowel continence in children with bilateral cerebral palsy (BCP), and the association with intellectual impairment (II) and severity of motor disability.

PATIENTS AND METHODS

The parents of 346 children with BCP were interviewed as part of a population-based prospective study of the children at 3, 7, and 17 years of age. The age of bladder and bowel continence by day and night was ascertained and compared with controls from the Avon Longitudinal Study of Parents and Children (ALSPAC).

RESULTS

The median age for daytime bladder and bowel continence in BCP children was 5.4 years compared with 2.4 years in the controls. At 13.8 years of age, 59.4% of BCP children and 99% of controls were continent by day. In BCP children, there was no difference between the attainment of daytime bladder and bowel control. Night-time bladder and bowel control was slower and less completely attained, with 50% of BCP children continent by the age of 11.8 years compared with 3 years in control children. At 13.8 years of age, 51.9% of BCP children compared with 99.4% of controls were continent for bowel and bladder at night. Gross Motor Functional Classification Score (GMFCS) and intellectual ability (IA) (II) were strongly associated with continence attainment (P < 0.0001), but gender was not.

DISCUSSION

Delayed and less complete continence attainment was noted in other clinic series of children with cerebral palsy (including hemiplegics) and children with II. Severity of motor disability (GMFCS), and II impacted on other aspects of toilet training, such as: motivation, understanding, communication, and independence skills. The presence of neurogenic bladder and bowel dysfunction can occur in all levels of GMFCS. Thus, there are many reasons that can prevent continence attainment.

CONCLUSIONS

Children with BCP achieved day and night-time bladder and bowel continence more slowly and less completely than controls, with 60.8% being continent by day and 54.6% by night at the age of 17 years. The majority of BCP children who were continent by day had achieved this by the age of 5.5 years (86%). At least 88% of BCP children with GMFCS I/II and normal, specific or mild learning impairment were continent for bladder and bowel by day and night. Expectations should be shared with parents, and failure to attain expected continence should be actively investigated.

Enuresis and Hyperactivity-Inattention in Early Adolescence: Findings from a Population-Based Survey in Tokyo (Tokyo Early Adolescence Survey)

BACKGROUND

Enuresis (9% at age 9.5) negatively affects children's psychosocial status. Clinically-diagnosed enuresis (2% at the age) is associated with hyperactivity-inattention, and common neural bases have been postulated to underlie this association. It is, however, unclear whether this association is applicable to enuresis overall among the general population of early adolescents when considered comorbid behavioral problems. We aimed to examine whether enuresis correlates with hyperactivity-inattention after controlling for the effects of other behavioral problems.

METHODS

Participants were 4,478 children (mean age 10.2 ± 0.3 years old) and their parents from the Tokyo Early Adolescence Survey (T-EAS), a population-representative cross-sectional study conducted in Tokyo, Japan conducted from 2012 to 2015. Children's enuresis and behavioral problems, including hyperactivity-inattention (as measured by the Strength and Difficulties Questionnaire), were examined using parent-reporting questionnaires. Multivariate linear regression was used to explore whether enuresis predicts hyperactivity-inattention.

RESULTS

The hyperactivity-inattention score was significantly higher in the enuretic group than the non-enuretic group (enuretic: M (SD) = 3.8 (2.3), non-enuretic: M (SD) = 3.0 (2.1), Hedge's g = 0.39, p < .001). This association remained significant even after controlling for other behavioral problems and including sex, age, intelligence quotient (IQ), low birth weight and parents' education (β = .054 [95% CI: .028-.080], p < .001).

CONCLUSIONS

Enuresis was independently associated with hyperactivity-inattention in early adolescents among general population even when other behavioral problems were considered. These results suggest that, as with clinically-diagnosed cases, enuresis may predict need for screening and psychosocial support for hyperactivity-inattention.

Moderate alcohol drinking in pregnancy increases risk for children's persistent conduct problems: causal effects in a Mendelian randomisation study

BACKGROUND

Heavy alcohol use during pregnancy can cause considerable developmental problems for children, but effects of light-moderate drinking are uncertain. This study examined possible effects of moderate drinking in pregnancy on children's conduct problems using a Mendelian randomisation design to improve causal inference.

METHODS

A prospective cohort study (ALSPAC) followed children from their mother's pregnancy to age 13 years. Analyses were based on 3,544 children whose mothers self-reported either not drinking alcohol during pregnancy or drinking up to six units per week without binge drinking. Children's conduct problem trajectories were classified as low risk, childhood-limited, adolescence-onset or early-onset-persistent, using six repeated measures of the Strengths and Difficulties Questionnaire between ages 4-13 years. Variants of alcohol-metabolising genes in children were used to create an instrumental variable for Mendelian randomisation analysis.

RESULTS

Children's genotype scores were associated with early-onset-persistent conduct problems (OR = 1.29, 95% CI = 1.04-1.60, p = .020) if mothers drank moderately in pregnancy, but not if mothers abstained from drinking (OR = 0.94, CI = 0.72-1.25, p = .688). Children's genotype scores did not predict childhood-limited or adolescence-onset conduct problems.

CONCLUSIONS

This quasi-experimental study suggests that moderate alcohol drinking in pregnancy contributes to increased risk for children's early-onset-persistent conduct problems, but not childhood-limited or adolescence-onset conduct problems.

Stressful Life Events in Children With Functional Defecation Disorders

OBJECTIVES

The aim of the study was to determine the prevalence of stressful life events including (sexual) abuse in children with functional defecation disorders by performing a systematic review.

METHODS

We searched MEDLINE, EMBASE, and PsycINFO for cohort, case-control and cross-sectional studies investigating the prevalence of stressful life events, including (sexual) abuse in children with functional defecation disorders.

RESULTS

The search yielded 946 articles, of which 8 were included with data from 654 children with functional constipation and 1931 children with (constipation-associated) fecal incontinence (FI). Overall, children with functional defecation disorders had been significantly more exposed to stressful life events than healthy children, with prevalence rates ranging from 1.6% to 90.9%. Being bullied, being a relational victim, interruption of toilet training, punishment by parents during toilet training, and hospitalization were significantly related to FI, whereas separation from the best friend, failure in an examination, severe illness in a close family member, loss of job by a parent, frequent punishment, and living in a war-affected area were significantly related to constipation. Only 1 study measured the prevalence of child abuse, which reported a significantly higher prevalence of child (sexual) abuse in children with FI compared with controls.

CONCLUSIONS

The prevalence of stressful life events, including (sexual) abuse is significantly higher in children with functional defecation disorders compared with healthy children. To gain more insight into the true prevalence of child (sexual) abuse in children with functional defecation disorders, more studies are clearly needed.

Nocturnal enuresis: A topic review and institution experience

The objective is to provide a review of nocturnal enuresis (NE), including its epidemiology, etiology, pathophysiology, evaluation, and current management. We also set to provide further insight on the treatment of this condition from the experience derived from patients cared for at our tertiary-care institution. NE affects approximately 15% of all children at 5-year-old, affecting boys more frequently than girls. At our large university tertiary pediatric urology center, NE and incontinence, in general, is one the most common chief complaints prompting urologic care. In this review, we examine the condition in detail, highlighting specific goals of the initial evaluation and treatment. We contrast the commonly implemented treatment recommendations, available from the literature with strategies we have found valuable from our extensive experience in treating patients with this disorder. Using current urologic reference textbooks, book chapters, Medline, journal articles and reviews describing the many aspects of NE were reviewed in order to describe NE and the current practices at our institution. Although, this is not a systematic literature review, it includes relevant available research, institutional experience and urological expert opinion and current practices at a tertiary state health facility. The treatment of NE remains a challenge for many pediatricians and pediatric urologists. This likely stems from the multiple possible etiologies of the disorder. We have established a treatment algorithm at our institution, which we have found successful in the majority of our patients. This consists of starting patients on urotherapy, then offering both the enuresis alarm device and medication therapy as first line treatments, and finally adding anticholingerics for combination therapy. Our hope is with further research the treatment of NE will continue to improve.

Maternal iron levels early in pregnancy are not associated with offspring IQ score at age 8, findings from a Mendelian randomization study

Background/Objectives:

Iron is fundamental to many basic biological functions, and animal studies suggest that iron deficiency early in life can have a lasting impact on the developing brain.

Subjects/Methods:

We used a population-based cohort of mothers and their children to assess the effect of iron status among pregnant women on the cognitive ability of their offspring. But to avoid the inherent confounding that occurs within observational epidemiology studies we examined the association of maternal genotype at single-nucleotide polymorphisms in the genes HFE (rs1799945) and (rs1800562), TF (rs3811647) and TMPRSS6 (rs1800562), which are related to iron, haemoglobin or transferrin levels, on their child's cognitive test scores at age 8.

Results:

We found strong associations between HFE and TMPRSS6 genotypes and mother's haemoglobin levels early in pregnancy (P-values are all ⩽4.1 × 10⁻⁵) and a genetic score comprised of alleles at these loci was even more strongly associated with haemoglobin levels (P=3.0 × 10⁻¹⁸), suggesting that this was a good instrument to use to look at the effect of prenatal iron levels on offspring cognition. However, mother's genotype at the above loci was not associated with offspring IQ at age 8.

Conclusions:

We therefore concluded that there is no evidence of an effect of exposure to low levels of iron (within the normal range) in pregnancy on offspring cognition at age 8. However, pregnant women in the UK with low haemoglobin levels are prescribed iron supplements and so we were unable to look at the effect of iron deficiency in our study.

Vitamin B-12 status during pregnancy and child's IQ at age 8: a Mendelian randomization study in the Avon longitudinal study of parents and children

Vitamin B-12 is essential for the development and maintenance of a healthy nervous system. Brain development occurs primarily in utero and early infancy, but the role of maternal vitamin B-12 status during pregnancy on offspring cognitive function is unclear. In this study we assessed the effect of vitamin B-12 status in well-nourished pregnant women on the cognitive ability of their offspring in a UK birth cohort (ALSPAC). We then examined the association of SNPs in maternal genes FUT2 (rs492602) and TCN2 (rs1801198, rs9606756) that are related to plasma vitamin B-12, with offspring IQ. Observationally, there was a positive association between maternal vitamin B-12 intake and child’s IQ that was markedly attenuated after adjustment for potential confounders (mean difference in offspring IQ score per doubling of maternal B-12 intake, before adjustment: 2.0 (95% CI 1.3, 2.8); after adjustment: 0.7 (95% CI −0.04, 1.4)). Maternal FUT2 was weakly associated with offspring IQ: mean difference in IQ per allele was 0.9 (95% CI 0.1, 1.6). The expected effect of maternal vitamin B-12 on offspring IQ, given the relationships between SNPs and vitamin B-12, and SNPs and IQ was consistent with the observational result. Our findings suggest that maternal vitamin B-12 may not have an important effect on offspring cognitive ability. However, further examination of this issue is warranted.

Fetal alcohol exposure and IQ at age 8: evidence from a population-based birth-cohort study

Background

Observational studies have generated conflicting evidence on the effects of moderate maternal alcohol consumption during pregnancy on offspring cognition mainly reflecting problems of confounding. Among mothers who drink during pregnancy fetal alcohol exposure is influenced not only by mother’s intake but also by genetic variants carried by both the mother and the fetus. Associations between children’s cognitive function and both maternal and child genotype at these loci can shed light on the effects of maternal alcohol consumption on offspring cognitive development.

Methods

We used a large population based study of women recruited during pregnancy to determine whether genetic variants in alcohol metabolising genes in this cohort of women and their children were related to the child’s cognitive score (measured by the Weschler Intelligence Scale) at age 8.

Findings

We found that four genetic variants in alcohol metabolising genes in 4167 children were strongly related to lower IQ at age 8, as was a risk allele score based on these 4 variants. This effect was only seen amongst the offspring of mothers who were moderate drinkers (1–6 units alcohol per week during pregnancy (per allele effect estimates were −1.80 (95% CI = −2.63 to −0.97) p = 0.00002, with no effect among children whose mothers abstained during pregnancy (0.16 (95%CI = −1.05 to 1.36) p = 0.80), p-value for interaction  = 0.009). A further genetic variant associated with alcohol metabolism in mothers was associated with their child’s IQ, but again only among mothers who drank during pregnancy.

Maternal and offspring fasting glucose and type 2 diabetes-associated genetic variants and cognitive function at age 8: a Mendelian randomization study in the Avon Longitudinal Study of Parents and Children

Background

In observational epidemiological studies type 2 diabetes (T2D) and both low and high plasma concentrations of fasting glucose have been found to be associated with lower cognitive performance. These associations could be explained by confounding.

Methods

In this study we looked at the association between genetic variants, known to be robustly associated with fasting glucose and T2D risk, in the mother and her offspring to determine whether there is likely to be a causal link between early life exposure to glucose and child’s intelligence quotient (IQ) scores in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. We generated a fasting glucose (FGGRS) and a T2D (T2DGRS) genetic risk score and used them in a Mendelian randomization approach.

Results

We found a strong correlation between the FGGRS and fasting glucose plasma measurements that were available for a subset of children, but no association of either the maternal or the offspring FGGRS with child’s IQ was observed. In contrast, the maternal T2DGRS was positively associated with offspring IQ.

Conclusions

Maternal and offspring genetic variants which are associated with glucose levels are not associated with offspring IQ, suggesting that there is unlikely to be a causal link between glucose exposure in utero and IQ in childhood. Further exploration in even larger cohorts is required to exclude the possibility that our null findings were due to a lack of statistical power.

40,000 memories in young teenagers: psychometric properties of the Autobiographical Memory Test in a UK cohort study

Although the Autobiographical Memory Test (AMT) is widely used its psychometric properties have rarely been investigated. This paper utilises data gathered from a 10-item written version of the AMT, completed by 5792 adolescents participating in the Avon Longitudinal Study of Parents and Children, to examine the psychometric properties of the measure. The results show that the scale derived from responses to the AMT operates well over a wide range of scores, consistent with the aim of deriving a continuous measure of over-general memory. There was strong evidence of group differences in terms of gender, low negative mood, and IQ, and these were in agreement when comparing an item response theory (IRT) approach with that based on a sum score. One advantage of the IRT model is the ability to assess and consequently allow for differential item functioning. This additional analysis showed evidence of response bias for both gender and mood, resulting in attenuation in the mean differences in AMT across these groups. Implications of the findings for the use of the AMT measure in different samples are discussed.

The ATXN1 and TRIM31 genes are related to intelligence in an ADHD background: evidence from a large collaborative study totaling 4,963 subjects

Intelligence is a highly heritable trait for which it has proven difficult to identify the actual genes. In the past decade, five whole-genome linkage scans have suggested genomic regions important to human intelligence; however, so far none of the responsible genes or variants in those regions have been identified. Apart from these regions, a handful of candidate genes have been identified, although most of these are in need of replication. The recent growth in publicly available data sets that contain both whole genome association data and a wealth of phenotypic data, serves as an excellent resource for fine mapping and candidate gene replication. We used the publicly available data of 947 families participating in the International Multi-Centre ADHD Genetics (IMAGE) study to conduct an in silico fine mapping study of previously associated genomic locations, and to attempt replication of previously reported candidate genes for intelligence. Although this sample was ascertained for attention deficit/hyperactivity disorder (ADHD), intelligence quotient (IQ) scores were distributed normally. We tested 667 single nucleotide polymorphisms (SNPs) within 15 previously reported candidate genes for intelligence and 29451 SNPs in five genomic loci previously identified through whole genome linkage and association analyses. Significant SNPs were tested in four independent samples (4,357 subjects), one ascertained for ADHD, and three population-based samples. Associations between intelligence and SNPs in the ATXN1 and TRIM31 genes and in three genomic locations showed replicated association, but only in the samples ascertained for ADHD, suggesting that these genetic variants become particularly relevant to IQ on the background of a psychiatric disorder.

Age- and puberty-dependent association between IQ score in early childhood and depressive symptoms in adolescence

BACKGROUND

Lower cognitive functioning in early childhood has been proposed as a risk factor for depression in later life but its association with depressive symptoms during adolescence has rarely been investigated. Our study examines the relationship between total intelligence quotient (IQ) score at age 8 years, and depressive symptoms at 11, 13, 14 and 17 years.

METHOD

Study participants were 5250 children and adolescents from the Avon Longitudinal Study of Parents and their Children (ALSPAC), UK, for whom longitudinal data on depressive symptoms were available. IQ was assessed with the Wechsler Intelligence Scale for Children III, and self-reported depressive symptoms were measured with the Short Mood and Feelings Questionnaire (SMFQ).

RESULTS

Multi-level analysis on continuous SMFQ scores showed that IQ at age 8 years was inversely associated with depressive symptoms at age 11 years, but the association changed direction by age 13 and 14 years (age-IQ interaction, p<0.0001; age squared-IQ interaction, p<0.0001) when a higher IQ score was associated with a higher risk of depressive symptoms. This change in IQ effect was also found in relation to pubertal stage (pubertal stage-IQ interaction, 0.00049<p=0.038). At age 17 years, however, sex-specific differences emerged (sex-age squared-IQ interaction, p=0.0075). Whilst the risk effect of higher childhood IQ scores for depressive symptoms declined in females, and some analyses even supported an inverse association by age 17 years, it persisted in males.

CONCLUSIONS

Our results suggest that the association between cognitive ability in childhood and depressive symptoms in adolescence varies according to age and/or pubertal stage.

Assessment of toileting difficulties in adults with intellectual disabilities: an examination using the profile of toileting issues (POTI)

A lack of toileting skills is one of many impairments that individuals with intellectual and developmental disabilities experience. Unfortunately, little research has focused on problems in this area including assessment, function, and treatment. A newly developed checklist, the Profile of Toileting Issues (POTI), is being considered for use to screen for toileting issues in this population, and to identify potential functions to target in treatment. The purpose of the current study was to examine the reliability of the POTI. Internal consistency was sound (α = .83) and interrater reliability was significant. The implications of these findings are included.

Functional gene group analysis reveals a role of synaptic heterotrimeric G proteins in cognitive ability

Although cognitive ability is a highly heritable complex trait, only a few genes have been identified, explaining relatively low proportions of the observed trait variation. This implies that hundreds of genes of small effect may be of importance for cognitive ability. We applied an innovative method in which we tested for the effect of groups of genes defined according to cellular function (functional gene group analysis). Using an initial sample of 627 subjects, this functional gene group analysis detected that synaptic heterotrimeric guanine nucleotide binding proteins (G proteins) play an important role in cognitive ability (P_EMP = 1.9 × 10⁻⁴). The association with heterotrimeric G proteins was validated in an independent population sample of 1507 subjects. Heterotrimeric G proteins are central relay factors between the activation of plasma membrane receptors by extracellular ligands and the cellular responses that these induce, and they can be considered a point of convergence, or a “signaling bottleneck.” Although alterations in synaptic signaling processes may not be the exclusive explanation for the association of heterotrimeric G proteins with cognitive ability, such alterations may prominently affect the properties of neuronal networks in the brain in such a manner that impaired cognitive ability and lower intelligence are observed. The reported association of synaptic heterotrimeric G proteins with cognitive ability clearly points to a new direction in the study of the genetic basis of cognitive ability.

Urinary incontinence in the CKiD cohort and health related quality of life

PURPOSE

Many children with chronic kidney disease have urinary incontinence due to urological disorders and/or a urine concentrating defect. We determined the prevalence and impact of incontinence on health related quality of life in children with chronic kidney disease.

MATERIALS AND METHODS

The Chronic Kidney Disease in Children study is a prospective, observational cohort of children recruited from 47 sites in the United States and Canada. Eligibility requirements are age 1 to 16 years and an estimated glomerular filtration rate of 30 to 90 ml per minute per 1.73 m(2). Demographics, continence status, glomerular filtration rate and physical examination were assessed at study entry. Health related quality of life was measured using the parent and child versions of PedsQL. PedsQL scores in participants 5 years old or older were compared among children who were toilet trained and not bed-wetting, bed-wetting or not toilet trained using multivariate linear regression.

RESULTS

Overall median age of the 329 participants was 12.5 years, 61.4% were male, 70% were white and 55.5% had a urological disorder. Of participants 71.4% were toilet trained at study enrollment, 23.1% had bed-wetting and 5.5% were not toilet trained. Children who were not yet toilet trained had an average total score that was 13.5 points lower (95% CI -25.2, -1.8) on the PedsQL child report than in those who were toilet trained (p = 0.02). Physical functioning (-15.0, 95% CI -28.2, -1.9) and school functioning (-15.3, 95% CI -29.8, -0.8) were also lower in this group (p = 0.03 and 0.04, respectively). On the PedsQL parent proxy report physical functioning (-14.2, 95% CI -26.7, -1.6) was similarly affected by child incontinence (p = 0.03).

CONCLUSIONS

Urinary incontinence is common in pediatric patients with chronic kidney disease and associated with lower health related quality of life on the PedsQL child and parent proxy reports. Early recognition of and treatment for urinary incontinence may improve health related quality of life in this population.

Encopresis, soiling and constipation in children and adults with developmental disability

Children and adults with developmental disabilities are more likely to evince encopresis, soiling and constipation than the general population. This set of related behaviors can produce a great deal of stress and can be a major restriction in independent living. This paper provides a review of the current state of knowledge on the prevalence, etiology, assessment and treatment of this co-occurring set of disorders. These problems are more common in persons with developmental disabilities then the general population. Furthermore, classical and operant treatment methods appear to be the best supported interventions for most cases. Strengths and weaknesses of the current research base are discussed along with potential avenues for future research.

Diagnosis and management of nocturnal enuresis

PURPOSE OF REVIEW

To highlight recent advances in enuresis research.

RECENT FINDINGS

Many discoveries have distanced us from the time when bedwetting was considered a psychiatric disorder. Instead, it is now agreed that nocturnal polyuria, detrusor overactivity, and high arousal thresholds are, in various combinations, central to enuresis pathogenesis. All three mechanisms have been further elucidated during the last year. It has been found that solute diuresis, and not just free-water diuresis due to vasopressin deficiency, may be causative. Sonographical bladder wall measurements have been shown to have prognostic value in detrusor-dependent enuresis, and fascinating proof for the interplay between the bladder and the sleeping brain has been put forward. And, ironically, sleep research has caused psychiatry to make a slight comeback, as studies have indicated that enuretic children may suffer from cognitive problems due to suboptimal sleep. Less has been achieved regarding treatment, but some evidence has finally supported the experience that anticholinergics may be effective in therapy-resistant enuresis.

SUMMARY

During the last years, increased insight has been gained into the multifaceted pathogenesis of enuresis, but there is still an irritating lack of proven effective therapies.