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BACKGROUND:
Studies examining rates of psychosocial difficulties in children with dysfunctional voiding and/or enuresis have relied on parent-report of the child’s functioning, although previous research suggests that proxy report of adolescents’ psychosocial difficulties may result in an underreporting of symptoms. The current study investigated the level of self-reported psychosocial difficulties in this population and examined the relationship between patient’s self-report and their parent’s report of their difficulties. Additionally, relationships between self-reported psychosocial problems and the severity of dysfunctional voiding was examined.
METHODS:
Prospective data collection was conducted in the Pediatric Urology department at a single institution, and included children ages 11 to 16 with diagnoses of dysfunctional voiding or non-monosymptomatic nocturnal enuresis. The child completed the Youth Self Report of the Pediatric Symptom Checklist (PSC), while his/her caregiver completed the Parent Report of the PSC, which is a validated screening tool for psychosocial difficulties. The child and parent collaboratively completed the Dysfunctional Voiding Scoring System (DVSS), as an objective measure of severity of the child’s bladder/bowel dysfunction.
RESULTS:
Participants included 62 children (28 males), mean age=12.35+1.54 and their parent. The children’s diagnoses included non-monosymptomatic nocturnal enuresis (n=39, 62.9%) and dysfunctional voiding (n=23, 37.1%). The racial/ethnic breakdown included African American (n=26, 41.9%), Caucasian (n=23, 37.1%), and Other Race (n=13, 21.0%). African American patients rated themselves as having significantly more psychosocial difficulties and more severe bladder/bowel dysfunction than the other patients. A paired t-test revealed no significant differences in the mean total scores between self-report and parent report on the PSC (p=.79), indicating overall agreement between the groups when the PSC is scored on a continuous scale. Next, hierarchical regression was conducted with race as a covariate on Step 1, DVSS score as the predictor on Step 2, and PSC self-report score as the dependent variable. Results revealed that the DVSS score significantly predicted self-reported psychosocial difficulties (t(61)=3.85, p<.001), accounting for 19.4% of the variance in PSC score. Additionally, 15 children (25.5%) rated themselves as having clinically significant psychosocial problems (i.e., met the clinical cut-off for needing mental health follow-up), while the parents of only 7 of these children (46.8%) also rated their child in the clinically significant range. The parents of 7 other children indicated their child had clinically significant psychosocial problems, although their children’s scores were not in the significant range. Finally, higher levels of self-reported psychosocial difficulties were correlated with higher scores on DVSS items #3, 4, 8, 9, and 10.
CONCLUSIONS:
Higher levels of self-reported psychosocial difficulties are related to more severe voiding dysfunction. Additionally, although self-report of psychosocial difficulties is highly correlated with parent-report of the child’s functioning in this population, when the clinical cut-off score is used to identify at-risk children, we found that 1/3 of these patients would be “missed” if only one version of the PSC was utilized. As such, it is recommended that for children over 11 years of age, both the parent and self-report of the PSC be administered to all patients with dysfunctional voiding or non-monosymptomatic nocturnal enuresis.