Risperidone-induced nocturnal enuresis in a pediatric patient with ADHD and behavioral dysregulation: a case report

Abstract Background To describe in a pediatric patient with ADHD and behavioral dysregulation a clinically significant case of risperidone-induced nocturnal enuresis. Case Presentation Due to ongoing aggression and emotional lability, a 10-year-old boy diagnosed with combined-type ADHD and persistent behavioral dysregulation was treated with long-acting methylphenidate and subsequently risperidone (0.5–1 mg/night). The patient started risperidone and soon after developed frequent nocturnal enuresis. A thorough medical assessment ruled out organic causes. Behavioral interventions were ineffective. After discontinuing risperidone, the enuresis resolved but returned upon rechallenge, suggesting a likely causal relationship. Switching to aripiprazole resulted in clinical improvement free from enuresis recurrence. Conclusions Temporally linked to risperidone initiation, the patient’s nocturnal enuresis resolved upon discontinuation and re-emerged upon rechallenge. Transitioning to aripiprazole provided good behavioral control with a more favorable side effect profile. In children, risperidone can cause nocturnal enuresis, a side effect that is often underreported but can seriously affect quality of life and treatment compliance. During antipsychotic treatment, clinicians should actively monitor for urinary symptoms and, when needed, consider pharmacological alternatives. This case emphasizes the need for tailored, side-effect-conscious strategies in pediatric psychopharmacology.