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Jennika L. Finup, NP1, Shannon Cannon, MD1, Martha J. Walter, PhD1, Ruthie R. Su, MD1, Dana M. Perry, NP1, Sarah Truscott, RN, BSN1, Fardod O'Kelly, MD2, Vinaya P. Bhatia, MD1, Walid Farhat, MD1.
1University of Wisconsin-Madison, Madison, WI, USA, 2Beacon Hospital & University College, Dublin, Ireland.

The comorbid incidence of neuropsychiatric conditions in children with Bowel and Bladder Dysfunction (BBD) is reported to be around 25%. Using retrospective data from a step-wise clinical protocol created for BBD patients, we report the prevalence of patients with diagnosed comorbid neuropsychiatric conditions in addition to patients with abnormal psychiatric screening using a validated screening tool and the association to severity of symptoms.
We performed a retrospective review of children with presumptive BBD who presented between December 2020 and April 2022 at our academic center and who were seen in a standardized fashion that included a pre-clinic telephone visit with a Registered Nurse. Initial diagnoses consisted of lower urinary tract symptoms with or without enuresis or recurrent urinary tract infections. The purpose of this visit was to educate parents on timed voiding, proper hygiene, fluid intake and bowel management, administer questionnaires including Dysfunctional Voiding Symptom Scale (DVSS) and Strengths and Difficulties Questionnaire (SDQ) and provide families voiding diaries to complete. We collected data on pre-existing neuropsychiatric diagnoses, SDQ value reported and DVSS score. We then examined this data for associations between SDQ score and severity of symptoms at initial presentation as characterized by DVSS score. Descriptive statistics were performed to assess frequencies of diagnoses and Pearson's correlations were used to assess potential correlations between SDQ and DVSS scores, with p < 0.05 designated as statistically significant.
A total of 143 patients completed an SDQ available for scoring. Average age was 9.4 years with 104 (73%) of patient's female. One hundred and twenty-two patients (85%) had an abnormal score defined as >13 with 63 (44%) having a very high score >20. In our cohort, 45 (31%) had at least one previously diagnosed neuropsychiatric condition. Of the 98 children without a diagnosis, 51 (52%) had an abnormal score with 28 (29%) having a very high score. The average SDQ score was 23 among children with a previously established neuropsychiatric diagnosis, compared to an SDQ of 17 among children with no known diagnosis. The initial average DVSS score was found to positively correlate with increasing SDQ on Pearson's correlation analysis (r=0.321, P<0.01).
Despite the limited potential for selection bias towards identifying children with severe BBD, our data suggests BBD has a high correlation to comorbid neuropsychiatric dysfunction. Using SDQ as an indicator of neuropsychiatric conditions indicates that more than 85% of youth with BBD could be affected, which is higher than the reported incidence in the literature. We also found that the severity of symptoms using the DVSS score was positively correlated with increasing SDQ. Therefore, increasing SDQ could predict a more severe BBD phenotype and the need for ancillary treatments such as biofeedback. Our findings indicate that routine BBD management should
include screening for neuropsychiatric and behavioral health conditions in treatment algorithms for children with BBD.

DVSS Score
SDQ ScorePre-existing Neuropsychiatric Diagnosis(n=45)No known diagnosis (n=98)
Low (<13)78
Medium (13-19)8.49.6
High (>20)10.411.7

Table 1. Average DVSS score by SDQ

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