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Do Children With Primary Nocturnal Enuresis Have Clinically Significant Behavior Problems?
Patrick C. Friman, PhD;
Michael L. Handwerk, PhD;
Susan M. Swearer, PhD;
J. Christopher McGinnis, MA;
William J. Warzak, PhD
Arch Pediatr Adolesc Med. 1998;152:537-539.
Objective To determine if primary nocturnal enuresis (PNE) is accompanied by significant behavioral comorbidity.
Design A survey design using a standardized behavioral rating scale.
Setting Behavioral pediatric clinics in the Midwest.
Participants Subjects with PNE (n=92) were selected from 122 consecutive referrals for enuresis. Criteria included age 5 years or older, PNE status, and wetting frequency of at least once per week. The clinical sample without PNE (n=92) was randomly selected from 429 consecutive referrals to the same pediatric clinics, stratified for age and sex. The nonclinical sample (n=92) was randomly selected by strata from the standardization sample (N=614) of the behavioral checklist used in the study.
Main Outcome Measure The Eyberg Child Behavior Inventory (ECBI), a standardized parent report scale, was used to measure the degree of behavioral comorbidity. The ECBI yields 2 scores, Problem Intensity and Problem Number.
Results Results from 2 separate 3 (group) x 2 (sex) analyses of variance indicated a significant main effect for group on Problem Intensity and Problem Number (P<.001). For Problem Intensity, post hoc comparisons indicated the mean of the PNE sample was significantly higher than the mean of the nonclinical sample (P<.05), but the mean scores of the clinical sample were significantly higher than those of both the PNE and nonclinical samples (P<.05). For Problem Number, post hoc comparisons revealed the means of the PNE and nonclinical samples did not differ from each other (P>.05) but were lower than the mean of the clinical sample (P<.05).
Conclusion Primary nocturnal enuresis does not present with significant behavioral comorbidity in most cases. The results suggest that, with the exception of an extraordinary clinical presentation, pediatricians should treat PNE as a common biobehavioral problem without a psychiatric component.
From Father Flanagan's Boys' Home, Boys Town, Neb (Drs Friman, Handwerk, and Swearer and Mr McGinnis); Creighton University School of Medicine (Dr Friman), and University of Nebraska Medical Center, Omaha (Dr Warzak).
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