Contextualizing cognition: Socio-environmental factors shape how momentary stress predicts memory.

Pediatric patients with bladder bowel dysfunction (BBD) may experience urinary incontinence, urgency, frequency, incomplete bladder emptying, constipation, encopresis, and delays in toilet training. The International Children’s Continence Society defines BBD as a “…comprehensive term of a combined bladder and bowel disturbance that does not explain pathogenesis…an umbrella term that can be subcategorized into LUT dysfunction and bowel dysfunction.” [] A previous study showed that lower urinary tract dysfunction and psychiatric disorders coexist at a rate of 29.4%, with attention-deficit/hyperactivity disorder (ADHD) being the most common []. As of 2022, 11.4% of children had been diagnosed with ADHD [] and 20–25% of children with ADHD have urinary incontinence. Children with ADHD are 4.5 times more likely to have urinary incontinence and 2.5x more likely to have nocturnal enuresis than their non-ADHD matched control []. In one study, only 68% of patients with ADHD became continent, compared to 91% of control patients []. Prior studies analyzing urinary continence outcomes only evaluated children taking ADHD medication [–]. Our hypothesis is pediatric urology patients with comorbid ADHD, whether taking ADHD medication or not, have more severe BBD than their peers with BBD alone. Furthermore, we hypothesize that children with comorbid ADHD taking ADHD medication would show faster improvements of their BBD symptoms with any BBD treatment than patients with comorbid ADHD not taking ADHD medication. Patients between 5 and 18 years of age with BBD defined as a chief complaint (pain in the genitalia, feeling of incomplete bladder emptying, dysuria, urinary urgency, urinary frequency, pelvic floor dysfunction, hematuria, constipation, encopresis, urinary incontinence, nocturnal enuresis, dysfunctional voiding, infrequent urination, or recurrent urinary tract infection) and ADHD (predominantly inattentive, predominantly hyperactivity, combined, other, unspecified, types) seen in pediatric urology clinic between January 1, 2015, and December 30, 2022, were identified and yielded 249 patients. Demographic data (age, gender, race and ethnicity) was captured.