- Email: [email protected]
hyperactivity disorder
Progress in Neuro-Psychopharmacology & Biological Psychiatry 35 (2011) 647
Contents lists available at ScienceDirect
Progress in Neuro-Psychopharmacology & Biological Psychiatry j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / p n p
Letter to the Editor (Case report) The possible effect of methylphenidate on secondary encopresis in children with attention-deficit/hyperactivity disorder Sir Children with encopresis had more emotional/behavioral problems, poorer social competence and family functioning (Hultén et al., 2005). It is unclear whether these disturbances may simply be considered as the result of the encopresis or they play a role in the development of the disorder. In addition, there is no enough evidence that psychiatric treatments have a therapeutic effect in encopretic children. This report presents two children with attention-deficit/hyperactivity disorder (ADHD) and coexisting secondary encopresis who displayed improvement in ADHD symptoms accompanied by complete resolution of encopresis with methylphenidate (MPH) treatment. The first case, an 8 year-old-boy diagnosed with ADHD-combined type and coexisting conduct disorder, secondary encopresis-nonretentive type and secondary diurnal enuresis. The second case, a 13-year-old-boy diagnosed with ADHD-combined type and coexisting oppositional defiant disorder. Their encopretic symptoms have continued for three and seven years without any improvement period. They had previously undergone psychical examination that revealed no pathological findings. Because both children refused to comply with behavioral treatments before and they are reluctant to meet with clinician, no behavioral intervention was undertaken at this stage. In the first case, MPH slow release treatment was started at 18 mg daily, but only a slight improvement was obtained after a period of 4 weeks. The medication dose was then increased to 27 mg daily. All symptoms decreased markedly in the first week of the 27 mg daily dose and encopretic and enuretic behavior completely stopped in the course of the fifth week of the treatment. In the second case, short acting MPH treatment was commenced at 10 mg twice daily, resulted in moderate improvement in hyperactivity and impulsivity symptoms and complete resolution of the encopresis after the first day of the treatment. But, his attention symptoms did not decreased with MPH treatment. After MPH treatment, these two boys revealed no signs of encopresis over the follow-up period of six and two months, respectively. The prevalence of ADHD, psychosocial adversity and aggressive symptoms among children with encopresis is very high compared to the general population (Johnston and Wright, 1993; Foreman and Thambirajah, 1996). Cox et al. (2002) speculated that inattentive/ impulsive children would be less able to recognize and respond to
0278-5846/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.pnpbp.2010.11.036
internal cues to defecate and treatment of their ADHD symptoms would help improve their encopretic behavior. However, there is only one report regarding the effect of MPH for encopresis coexisting ADHD in two children with primary encopresis (Golubchik and Weizman, 2009). In this report, the author suggested that improvement in executive functioning, working memory, and impulse control, may also improve self-organizing skills and leads to alleviation and stable remission in primary encopresis. On the other hand, it is possible that the development of encopresis may be related to the child–parent relationship conflicts and poorer social and school functioning, which frequently occurred in children with ADHD and the treatment benefit with MPH on encopretic behavior may be secondary to the successful treatment of ADHD symptoms. It seems that the MPH treatment is responsible for the disappearance of encopretic behavior in the present cases and MPH also could be effective for secondary encopresis coexisting ADHD. The anti-encopretic effect of the MPH for ADHD patients definitely needs to be validated with prospective studies. References Cox DJ, Morris JB, Borowitz SM, Sutphen JL. Psychological differences between children with and without chronic encopresis. J Pediatr Psychol 2002;27:585–91. Foreman DM, Thambirajah MS. Conduct disorder, enuresis and specific developmental delays in two types of encopresis: a case–note study of 63 boys. Eur Child Adolesc Psychiatry 1996;5:33–7. Golubchik P, Weizman A. Attention-deficit hyperactivity disorder, methylphenidate, and primary encopresis. Psychosomatics 2009;50:178. Johnston BD, Wright JA. Attentional dysfunction in children with encopresis. J Dev Behav Pediatr 1993;14:381–5. Hultén I, Jonsson J, Jonsson CO. Mental and somatic health in a non-clinical sample 10 years after a diagnosis of encopresis. Eur Child Adolesc Psychiatry 2005;14: 438–45.
Ayhan Bilgiç Malatya Government Hospital, Department of Child and Adolescent Psychiatry, 44300, Malatya, Turkey Tel.: +90 422 3261569; fax: +90 422 3264443. E-mail address: [email protected]. 31 October 2010
Contents lists available at ScienceDirect
Progress in Neuro-Psychopharmacology & Biological Psychiatry j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / p n p
Letter to the Editor (Case report) The possible effect of methylphenidate on secondary encopresis in children with attention-deficit/hyperactivity disorder Sir Children with encopresis had more emotional/behavioral problems, poorer social competence and family functioning (Hultén et al., 2005). It is unclear whether these disturbances may simply be considered as the result of the encopresis or they play a role in the development of the disorder. In addition, there is no enough evidence that psychiatric treatments have a therapeutic effect in encopretic children. This report presents two children with attention-deficit/hyperactivity disorder (ADHD) and coexisting secondary encopresis who displayed improvement in ADHD symptoms accompanied by complete resolution of encopresis with methylphenidate (MPH) treatment. The first case, an 8 year-old-boy diagnosed with ADHD-combined type and coexisting conduct disorder, secondary encopresis-nonretentive type and secondary diurnal enuresis. The second case, a 13-year-old-boy diagnosed with ADHD-combined type and coexisting oppositional defiant disorder. Their encopretic symptoms have continued for three and seven years without any improvement period. They had previously undergone psychical examination that revealed no pathological findings. Because both children refused to comply with behavioral treatments before and they are reluctant to meet with clinician, no behavioral intervention was undertaken at this stage. In the first case, MPH slow release treatment was started at 18 mg daily, but only a slight improvement was obtained after a period of 4 weeks. The medication dose was then increased to 27 mg daily. All symptoms decreased markedly in the first week of the 27 mg daily dose and encopretic and enuretic behavior completely stopped in the course of the fifth week of the treatment. In the second case, short acting MPH treatment was commenced at 10 mg twice daily, resulted in moderate improvement in hyperactivity and impulsivity symptoms and complete resolution of the encopresis after the first day of the treatment. But, his attention symptoms did not decreased with MPH treatment. After MPH treatment, these two boys revealed no signs of encopresis over the follow-up period of six and two months, respectively. The prevalence of ADHD, psychosocial adversity and aggressive symptoms among children with encopresis is very high compared to the general population (Johnston and Wright, 1993; Foreman and Thambirajah, 1996). Cox et al. (2002) speculated that inattentive/ impulsive children would be less able to recognize and respond to
0278-5846/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.pnpbp.2010.11.036
internal cues to defecate and treatment of their ADHD symptoms would help improve their encopretic behavior. However, there is only one report regarding the effect of MPH for encopresis coexisting ADHD in two children with primary encopresis (Golubchik and Weizman, 2009). In this report, the author suggested that improvement in executive functioning, working memory, and impulse control, may also improve self-organizing skills and leads to alleviation and stable remission in primary encopresis. On the other hand, it is possible that the development of encopresis may be related to the child–parent relationship conflicts and poorer social and school functioning, which frequently occurred in children with ADHD and the treatment benefit with MPH on encopretic behavior may be secondary to the successful treatment of ADHD symptoms. It seems that the MPH treatment is responsible for the disappearance of encopretic behavior in the present cases and MPH also could be effective for secondary encopresis coexisting ADHD. The anti-encopretic effect of the MPH for ADHD patients definitely needs to be validated with prospective studies. References Cox DJ, Morris JB, Borowitz SM, Sutphen JL. Psychological differences between children with and without chronic encopresis. J Pediatr Psychol 2002;27:585–91. Foreman DM, Thambirajah MS. Conduct disorder, enuresis and specific developmental delays in two types of encopresis: a case–note study of 63 boys. Eur Child Adolesc Psychiatry 1996;5:33–7. Golubchik P, Weizman A. Attention-deficit hyperactivity disorder, methylphenidate, and primary encopresis. Psychosomatics 2009;50:178. Johnston BD, Wright JA. Attentional dysfunction in children with encopresis. J Dev Behav Pediatr 1993;14:381–5. Hultén I, Jonsson J, Jonsson CO. Mental and somatic health in a non-clinical sample 10 years after a diagnosis of encopresis. Eur Child Adolesc Psychiatry 2005;14: 438–45.
Ayhan Bilgiç Malatya Government Hospital, Department of Child and Adolescent Psychiatry, 44300, Malatya, Turkey Tel.: +90 422 3261569; fax: +90 422 3264443. E-mail address: [email protected]. 31 October 2010