Neuromotor Skills in Children With Incontinence Before and During Treatment

AIMS: Nocturnal enuresis (NE) and daytime urinary incontinence (DUI) are often associated with neurodevelopmental disorders (NDs). Among NDs, children with incontinence have a higher rate of developmental coordination disorder (DCD). It is not known if the associated deficits of neuromotor skills persist over time or if they are associated with treatment outcome. Therefore, the aim of the study was to examine the neuromotor skills in children with incontinence prospectively before and during treatment. METHODS: 59 children with NE or DUI aged 5 to 14 years (mean age 8, 3 years; 38 boys; 21 girls) as well as 58 matched continent controls aged 5 to 15 years (mean age 9, 3 years; 36 boys; 22 girls) were examined. Before treatment (T1) and after 4 months of treatment (T2) the neuromotor skills were assessed with the MABC-2 (Movement Assessment Battery for Children 2). Furthermore, a parental questionnaire regarding incontinence, a physical examination and an intelligence test were performed. Child psychiatric comorbidities were assessed by a structured psychiatric interview (Kinder-DIPS). At T1 and T2, child behavioral symptoms were assessed by the CBCL parental questionnaire. RESULTS: Children with incontinence had significantly poorer neuromotor skills than continent controls, especially regarding the "balance" and the "aiming and catching" scales on the MABC-2. Children with DUI did not differ regarding neuromotor skills from those with NE. At follow-up, neuromotor balance skills of incontinent children improved significantly, and in particular those with NE. Improvement of neuromotor skills did not differ regarding treatment success or the presence of a comorbid psychiatric disorder. Overall, children with incontinence had more psychiatric disorders and psychological symptoms according to the CBCL than controls, which also improved with treatment. DISCUSSIONS: The study results show that children with incontinence have poorer neuromotor skills than continent controls, especially regarding balance, which can improve during treatment. Treatment success has no influence on the course of neuromotor skills. CONCLUSION: In conclusion, DCD is another ND that clinicians needs to address in the assessment of children with incontinence. However, neuromotor skills can improve through incontinence treatment alone. In severe cases, specific treatment is needed.