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American Academy of Pediatrics
Article

Association of Constipation and Fecal Incontinence With Attention-Deficit/Hyperactivity Disorder

Connor McKeown, Elizabeth Hisle-Gorman, Matilda Eide, Gregory H. Gorman and Cade M. Nylund
Pediatrics November 2013, 132 (5) e1210-e1215; DOI: https://doi.org/10.1542/peds.2013-1580
Connor McKeown
Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Elizabeth Hisle-Gorman
Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Matilda Eide
Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Gregory H. Gorman
Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Cade M. Nylund
Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Abstract

OBJECTIVE: Functional constipation and fecal incontinence are common childhood gastrointestinal conditions. Both conditions may be associated with behavioral problems. Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral disorder of childhood, characterized by shortened attention span and hyperactivity. We hypothesize that a diagnosis of ADHD increases the risk for functional constipation and fecal incontinence.

METHODS: A retrospective cohort study of children was performed by using the military health system database. Children of active-duty military personnel, aged 4 to 12 years, from October 2005 to September 2007, were included. ADHD, constipation, and fecal incontinence were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Relative risks and adjusted incidence rate ratios (IRRs) were calculated. A subgroup analysis of subjects receiving medical therapy was performed.

RESULTS: There were 742 939 children identified in the study, 32 773 (4.4%) of whom had ADHD. Children with ADHD had an increased prevalence of constipation (4.1% of children with ADHD vs 1.5% children without ADHD; P < .001) and fecal incontinence (0.9% of children with ADHD vs 0.15% of children without ADHD; P < .0001). Children with ADHD had more visits than those without ADHD for both constipation (IRR 3.39; 95% confidence interval 2.59–4.43) and fecal incontinence (IRR 7.74; 95% confidence interval 5.01–11.98). Children with ADHD receiving medicinal therapy did not differ significantly from children with ADHD not receiving medicinal therapy on rates of constipation visits (P = .57) or fecal incontinence visits (P = .32).

CONCLUSIONS: Children with ADHD are significantly more likely to have constipation and fecal incontinence. Medical therapy for ADHD does not impact visit rates for defecation disorders.

  • ADHD
  • constipation
  • encopresis
  • fecal incontinence
  • Accepted August 22, 2013.
  • Copyright © 2013 by the American Academy of Pediatrics

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Pediatrics
Vol. 132, Issue 5
1 Nov 2013
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Association of Constipation and Fecal Incontinence With Attention-Deficit/Hyperactivity Disorder
Connor McKeown, Elizabeth Hisle-Gorman, Matilda Eide, Gregory H. Gorman, Cade M. Nylund
Pediatrics Nov 2013, 132 (5) e1210-e1215; DOI: 10.1542/peds.2013-1580

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Association of Constipation and Fecal Incontinence With Attention-Deficit/Hyperactivity Disorder
Connor McKeown, Elizabeth Hisle-Gorman, Matilda Eide, Gregory H. Gorman, Cade M. Nylund
Pediatrics Nov 2013, 132 (5) e1210-e1215; DOI: 10.1542/peds.2013-1580
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