ADHD And Bedwetting In Children: How To Cope

Attention-deficit/hyperactivity disorder (ADHD) can be associated with more frequent bedwetting in children. Due to this connection, parents and caregivers of these children may wonder whether there are ways to reduce the impact of this symptom on their child’s mental and physical health. There are several options for treating bedwetting in ADHD, including assistive technology and lifestyle changes. A licensed therapist may be able to offer parents more personalized guidance through in-office or online sessions. 

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Understanding ADHD: DSM-5 criteria 

Attention-deficit/hyperactivity disorder is categorized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a neurodevelopmental disorder. 

However, some people identify with the neurodiversity model of ADHD, believing that ADHD symptoms can be the result of brain differences in processing, cognition, and sensory connections, rather than signs of a “disease.” This model suggests that various difficulties experienced by neurodivergent individuals may arise from living in a world that does not accommodate neurodivergent brains. 

The DSM-5 lists three subtypes of ADHD, including primarily inattentive (ADHD-PI), hyperactive-impulsive (ADHD-HI), and combined type. Symptoms of ADHD-PI often include a lack of focus, difficulty remaining engaged in tasks, forgetting essential items or appointments, and experiencing memory difficulties.

People with ADHD-HI may display impulsive behavior, difficulty sitting still, interrupting others when speaking, and quick switches in attention between activities. People with combined type ADHD may have some symptoms of each of the other subtypes. Studies have found that sensory difficulties tend to be present more often in individuals with ADHD than in those without. However, this symptom is not yet listed as an official criterion for diagnosis.  

Children most commonly receive an ADHD diagnosis before age 12. However, teens and adults can also have ADHD. In the case of bedwetting, children most commonly wet the bed before age 10.

ADHD and bedwetting: The connection 

Bedwetting, or nocturnal enuresis, generally occurs when an individual experiences incontinence during sleep. Enuresis can be common in children with ADHD. When they occur together, ADHD and bedwetting are normally said to be comorbid. 

In a study published in the HHS Public Access Journal, bedwetting in children with ADHD was usually more common in younger children and among Black youth than in other kids without ADHD, although updated evidence may be necessary. The study also found that 64% of children experiencing bedwetting received health services for their symptoms.  

Why does bedwetting during sleep occur in children with ADHD?

The reasons a child may experience bedwetting with ADHD are still unclear. Both enuresis and ADHD can cause distress and be confusing for parents and children. 

Researchers are still examining potential factors in this connection, including the increased rates of epilepsy and abnormal EEG patterns found in the above study. It is possible that this symptom could be due to a developmental delay in the central nervous system, difficulty attending to bodily cues due to inattention, or challenges with realizing one’s bladder is full. 

Potential causes of bedwetting

Bedwetting can occur in children of any age, including those without ADHD. According to the Urology Care Foundation, there can be several potential causes of bedwetting in any child, including but not limited to the following: 

• Family history 
• Limited bladder capacity
• Increased urine production at night 
• Slow development of brain-bladder control 
• Sleep disorders
• Stress
• Trauma
• Constipation 

Strategies to manage bedwetting and support your child  

Bedwetting often ceases by age 10 and is usually considered a temporary condition. However, studies show that bedwetting can be a common cause of isolation and decreased self-esteem, which can cause psychological distress. For this reason, there are a few strategies parents and caregivers can use to support their children, including the following.

Avoid causing shame and embarrassment in children

Because of the risk of low self-esteem in children with enuresis disorder, it can help to broach the subject gently and with compassion. Avoid calling a child “lazy” or suggesting they are intentionally wetting the bed. Yelling at a child for this behavior or making them experience more shame can cause emotional damage.

Talk to your child about bedwetting, bodily cues, how it can occur, and their options to move forward. Remind them that you do not judge them, and they can come to talk to you at any time, including at night. Being an empathetic and safe caregiver can help them know they are safe to speak to you about any symptoms they experience now and in the future. 

Talk to your child’s pediatrician about treatment or medication for ADHD and enuresis

In some cases, bedwetting may indicate a medical condition. If you notice bedwetting, talk to your child’s pediatrician before considering other treatment or support options. If your child is experiencing a mental or physical health condition, a pediatrician can refer you to the proper specialists. Although bedwetting is not usually connected to severe illness, it can be safer to ensure your child is receiving the most comprehensive care.

Change their eating and drinking schedule and empty their bladder before sleep

Ensure your child gets enough water during the day, but limit beverages two hours before sleep. In addition, ensure your child uses the bathroom before they go to bed to empty their bladder. Avoid caffeinated beverages during the day and before bed, as these can further stimulate the bladder. 

Use a bedwetting alarm and mattress protector

Some companies have developed technology that detects moisture on the mattress or clothing. For example, parents can purchase underwear with a wetness sensor. When the sensor goes off, the child can get up and go to the bathroom to start training their brain-bladder system to function effectively. 

Parents can also purchase a mattress pad or disposable bedwetting pads that may be put over the mattress each night in case of an accident. Using child diapers or training pants can also be beneficial. 

Develop a bathroom schedule and positive reinforcement routine

Helping your child develop a routine may improve their bathroom habits. Consider having them go to the bathroom three to four times a day at consistent intervals, even if they don’t have the sense that they need to go (it may be helpful to set alarms as reminders). 

In some cases, children with ADHD may have reduced sensitivity to the sensations in their body and may not notice that their bladder is full. For this reason, prompting and a routine may help them better control their bladder function and reduce the chances of incontinence. 

Positive reinforcement may also encourage children to use the bathroom when necessary. It can be helpful to associate change with positivity to improve a child's self-esteem and reduce risk factors for mental health challenges. For example, you might try a sticker chart to offer rewards when a child is following their schedule and practicing healthy sleep hygiene.

Learn how to best support your child

Talk to a therapist online

Talk to a therapist about ADHD and bedwetting

Parents and caregivers raising a child with ADHD may experience varying emotions due to their child’s experiences. Talking to a therapist can be one way to process your feelings and receive professional advice to support your child effectively. 

If you are busy and don’t know if you can fit therapy into your schedule, you might benefit from an online therapy platform like BetterHelp. With an online platform, you can talk to a therapist from home at a time that works for you, including outside of standard business hours. 

Online therapy can help parents cope with their children’s behavior

Studies show that online therapy can be beneficial and, in some cases, more effective than in-person therapy. Parents may face burnout when supporting their children. Research suggests that online therapy can increase parents’ emotional regulation and psychological flexibility skills. Having these skills may help parents better support and show up for their children.