Externalizing disorders as attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are common in children with nocturnal enuresis (NE), daytime urinary incontinence (DUI) and faecal incontinence (FI). We examined the prevalence rates of ADHD, ODD and incontinence in a defined geographical area and analysed the association between externalizing disorders and subtypes of incontinence. 1,676 parents of children who were presented at the mandatory school-entry medical examination completed a questionnaire with all DSM-IV items of ADHD, ODD and six questions regarding incontinence. 50.2% were male and mean age was 5.7 years. 9.1% had at least one subtype of incontinence (8.5% had NE, 1.9% DUI and 0.8% FI). Boys were significantly more affected by incontinence overall, NE, FI and ADHD than girls. 6.4% had ADHD, 6.2% had ODD and 2.6% were affected by ADHD and ODD. 10.3% of the children with incontinence had ADHD and 10.3% ODD. Children with FI were significantly more affected by externalizing disorders (50%) than children with isolated NE (14.5%), children with DUI (9.5%) and continent children (9.5%). Children with incontinence, especially those with FI, are at much higher risk of externalizing disorders. An additional effect of children with both ADHD and ODD having higher rates of incontinence than children with only one disorder could not be found. However, these children represent a high-risk group with lower compliance to treatment and worse outcome. Therefore, screening not only for ADHD but also for ODD should be implemented for all children with incontinence.

The prevalence rates of elimination disorders and anxious/depressed symptoms of a representative sample of young children and their associations were assessed. 2,079 children in a defined geographical area were examined at school-entry. A parental questionnaire with 4 questions referring to symptoms of incontinence and 14 items of the anxious/depressed scale of the Child Behavior Checklist (CBCL) was administered. 9.5 % of 6-year-old children wet at night, 2.7 % wet during day and 1.2 % had faecal incontinence. Significantly more boys wet at night (11.7 %) than girls (7.2 %; OR 0.58, 95 % CI 0.43-0.78). 12.7 % had clinically relevant anxious/depressed symptoms. Children with at least one elimination disorder had significantly higher T values of the 'anxious/depressed' CBCL than continent controls. Children with faecal incontinence had highest T values of the 'anxious/depressed' CBCL syndrome scale, significantly higher than those of children with other elimination disorders and controls. Elimination disorders, as well as anxious/depressed symptoms are common at a young age. Boys are more affected by elimination disorders than girls, but not by anxious/depressed symptoms. Children with faecal incontinence have the highest rate of anxious/depressed symptoms.