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TITLE:
Voiding dysfunction and the presence of adverse childhood experiences and neuropsychiatric disorders.
DEFINITIONS:
Adverse childhood experiences (ACEs): abuse, adoption, divorce, multiple family moves, incarcerated family member, death of family member, and other experiences identified as significant family stressors
Neuropsychiatric disorders (NPDs): ADD/ADHD, autism, Asperger’s, mental retardation, learning disability, developmental delay, anxiety, depression, bipolar disorder.
Psychosocial factors: any of the above.
BACKGROUND:
In pediatric urologic clinical work, a relationship between dysfunctional voiding and psycho-social factors is widely recognized. Research has demonstrated the effect of adverse childhood experiences (ACEs) on later physiologic function and illness development (Felitti, Anda, Nordenberg, et al., 1998). In urologic literature, the relationship between neuro-psychiatric disorders (NPDs) and bladder dysfunction is well-documented (Franco, 2011, Joinson, et al., 2008). Observations in pediatric clinical practice suggest that a blend of these two areas of research can inform care of patients with voiding dysfunction. The research question asked in this study was: Among children with symptoms of voiding dysfunction who are treated with a bowel and bladder retraining program, is there a difference in progress toward resolution of symptoms between children who have ACEs and/or NPDs and children who do not?
METHODS:
Retrospective review of 216 patients seen in a single pediatric urology clinic by a single provider over a 24 month period. A descriptive, correlational study design was used to assess the extent to which ACEs and NPDs affected resolution of symptoms when patients were treated with a bowel and bladder retraining program. Patients were selected using diagnostic codes related to voiding dysfunction and a chart audit using and electronic medical record was conducted. Patients with neurogenic bladder were excluded from this study.
RESULTS:
A majority of patients who were seen for voiding dysfunction (60%) had at least one psychosocial factor. There is a greater prevalence of ACEs (51%) than NPDs (25%). Children with psychosocial factors dropped out of treatment at a higher rate than did those with no factors. When factors were looked at separately, NPDs were more likely to impede progress than ACEs. Findings were not shown to be statistically significant but are clinically significant.
CONCLUSIONS:
ACEs and NPDs affect patients’ ability to make progress with bowel and bladder retraining and to stay in treatment. Efforts specifically aimed at maintaining therapeutic relationships with patients who have ACEs are needed to fully treat this group that typically has a high dropout rate but high rate of resolution if they are able to stay involved in treatment. Recognition by pediatric urology nurses, nurse practitioners, and physicians of the role that ACEs and NPDs play increases the ability to provide supportive treatment strategies.