Wednesday, April 21, 2010

Bedwetting: another autistic problem?

Last night I was watching the Larry King show and comedienne Sarah Silverman was on plugging her new book which in part deals with her childhood problem of bedwetting.

I have written about a number of problems that my autism has caused me in the past, my twiddling (self-stimulatory behaviors) which get in the way of my being able to accomplish things and are not unlike an insidious drug addiction. My ornithophobia (fear of birds) which inspired a short story that I wrote some years ago. I have also written about my lack of a social life, in particular lack of romantic relationships with women. I have also written, I think, about scholastic problems, social judgment and behavioral problems and my loud voice which repulses people. I have also written about my perceptual motor impairments and fine motor coordination problems which impairs my ability to handwrite and draw. Also, are the funny movements I make which draw attention to myself.

On watching the show with Ms. Silverman, I was reminded of my bedwetting which was a problem in my early childhood. It had been so removed from my past that I had forgotten about it for a while.

Some old memories have been jogged and now for the past half day I have been thinking of the old days when I used to wet the bed chronically from as long as I can remember from my earliest childhood up until about age 10 or 11. Between ages 11 and 13 it declined but I would still wet the bed once in a while. Apparently, at about age 13 or 14, this stopped altogether. Aside from being almost completely nonverbal between ages two and a half to about four years old and then recovering my speech, this was the only autistic problem that was completely resolved by my outgrowing it.

I still remember waking up in a urine-infested puddle during the night, absolutely stinking. Also, the urine would biochemically decompose into ammonia and it would sting like hell. I also recall the fights with my parents when they would restrict my fluids during the day and evening in order to try to solve or mitigate this problem. I knew that it was not normal and I did not know the cause of it. I knew it had something to do with my disability, which I later found out was an autism spectrum disorder.

I still don't know the exact etiology, but I had read that bedwetting often resulted from psychological stress or problems of which I had many both due to my autism itself and the teasing and ridicule I would get from "peers" and from fights with my parents and my sister and some nasty and cruel things my therapist would say at times. Also it could be the result of a weak bladder due to the motor problems I have had ( and still have to this day).

I was curious, so I googled a few things about autism and bedwetting. I found this interesting piece. They talk about bedwetting is in fact common in children diagnosed with autism. They cite lack of toilet training which I did not have a problem with at least from age 6 on. They also talk about hypotonia as being one of the possible etiologies. This might be in line with my motor coordination impairments.

One interesting theory that one mother posited in the article was that bedwetting was due to damage in the areas of the cerebellum and basal ganglia as these are two areas of the brain that she said were known to be damaged in autism.

The reports of problems of the cerebellum in autism have been well known, particularly loss of purkinje cells in various autopsy reports. Also both Courchesne and a Japanese researcher named Hashimoto and possibly others have found problems in the vermis of the cerebellum on MRI scans. However, this has not really been replicated on autopsies which show other parts of the cerebellum damaged and the vermis intact.

I am not sure what research if any has shown basal ganglia damage in autism. I do know that many years ago, Ralph Maurer and Antonio Demasio wrote a journal article suggesting that autism could be a problem with the frontal lobes and basal ganglia as a lot of the problems with autism had similarities between persons who as adults had lesions in these areas; this article predated the autopsies and MRI scans showing cerebellar abnormalities.

Jeanne Brohart, the parent who postulated this theory, points towards the fact that the basal ganglia have motor control as one of their functions. Of course one problem with this interpretation (as well as possibly Maurer and Demasio's old paper) is that both Eric Courchesne and Ralph Adolphs have told me that developmental lesions are different than adult lesions, so inferring functioning from adult brain problems as well as the functions the basal ganglia and other brain nuclei control, cannot necessarily be inferred in early childhood problems such as autism.

Bedwetting was a real pain, as I said before, I had forgotten about it, but had my memory jogged after all these years by the King-Silverman interview. I just hope that someday a cure or legitimate treatment can be found so that bedwetting and other issues won't be a problem for persons with autism, and now we can add another thing that makes autism bad in perhaps a fairly good number of persons who have this condition.

12 comments:

Kent Adams said...

Jonathan, bedwetting doesn't have anything to do with autism. Lots of NT kids are bedwetters. I went to school with one and I woke nearly every morning to the smell of urine in my room. My severely autistic child doesn't wet his bed. That study you cited is bunk from my experience. I know of at least 12 kids with AD that don't wet the bed and are under 10 years old (I asked around because I was concerned that I still had to put a diaper on him and I found out I was giving my son a "crutch" by giving him a diaper at night when he really did not need it as I found out). My cognitively disabled son has no problem getting up in the middle of the night to use the toilet.

JediKnight2 said...

Bedwetting was never a problem for me, but it was for my brother (who's not autistic) until he was around 10 years old.

SM69 said...

In our experience, based on about 400 children, children who present as non-verbal, that is a little over ¼ of them, or speaking at single word level (another ¼ of the sample), are commonly delayed in their toilet training. That means the majority of them wears nappies day and night. This is one area we focus on together with communication skills, but at times, the child or young adult does not have the required development to learn to control his bladder and bowel and to associated the signs with a need to go to the toilet.

Those who have been toilet trained can have accidents, this is very common and does not appear to be necessarily related to the cognitive level or the autism type. I have seen this also with Asperger children and adults. I cannot give you the figure though because I have not scored this in our database. But we have a range of issues that have been found related to relapse. Nb 1 is stress, sometimes, either because of life changes, or new phobia developing; a child becomes very stressed and start wetting his bed. We also have children who experience transient regression, commonly in association with an infection. And we have some physiological imbalances, magnesium is a very important minerals that can help adjusting enuresis. Very commonly, the urine of ASD kids has a very poignant smell, so it is a very fair observation you made Jonathan. There are simple ways to run some basic urine checks at home, looking for infection, protein, sugar and this is something parents can do, it costs next to nothing for 50 urine sticks. Ammonia is important because it relates to liver function, protein metabolism, drug side effect and is known to cause neurological dysfunction and in some individuals epilepsy. Abnormal urine smell should lead to investigation of metabolic and excretion function.

Kent Adams said...

Everything SM69 attributes to autism is well documented as reasons for bedwetting in all children, regardless of autism. Pick up any child rearing book ( I have the Mayo Clinic's definitive guide to raising a child) and you will find bedwetting is quite common amongst all children for the exact same reasons SM69 states for autistic children. Not everything a child does "wrong" is related to autism. Autistic kids are in fact kids too and do a lot of the same thing all kids do and for many of the same exact reasons. They're not "aliens" in all facets of function. My co-worker, Travis, has a child that is 5 years old and still not completely toilet trained and this kid is verbal, social and a pleasure to be around and is extremely precocious in other aspects.

Kent Adams said...

I should add that for most autistic kids that I know of, they do toilet train much later. We have issues at times at 7 years of age but it's rare. I think a lot of kids that are autistic benefit from a different way of teaching these skills. Some kids can benefit from social pressure at later ages, but it's best that parents be firm and ignore protests from their children on this issue. Don't assume they can't. Reward good behavior ( but not to the extent that you are rewarding at a ridiculous level).

Some kids have serious cognitive impairments and if that is the case, be consistent and routine oriented. If this fails, train with glycerine suppositories.

Anonymous said...

My ASD son wet the bed almost nightly until the age of 11 when I started the GFCF diet. Within three days of going dairy free, the bed wetting stopped. Coincident? Think not. His vocabulary changed for the better and less outbursts and mood swings. Nutrition matters to all of us despite what mainstream medicine leads us to believe.

Autism For Life said...

My 6 yr old has ASD and wets the bed nightly. Fluids aren't the problem. Sensory problems are the problem,for him, maybe not others. We use pull-ups as "nightpants". It's better on him, so he doesn't have to cry, from "I stinky". Not willing to have my son hurting emotionally. He's #1 in my life and his emotional well-being, is very important. THANKS for you post. Gonna' follow your page!

Kristiana said...

I am so glad I came across this article. My son has PDD nos and is 11 years old. He has been wetting the bed mostly every night since I can remember. I am not sure what the cause of his bed wetting is but even when he gets up in the night to go, he still has accidents. I am hoping he will grow out of it a bit but considering everything else he has to deal with, this is a small step I guess. I think it just feels better to know that we are not alone out there and others have the same issues. Thanks

jonathan said...

Kristiana, I wet the bed at least intermittently until age 13, then I outgrew it, so good possibility your son will outgrow it also in a couple of years.

Best,

Jonathan

yaron said...

Interesting conversation you have going on here, I am setting up a blog and forum to help people stop bedwetting and what you guys are talking about seem to come under 'bedwetting myths.'

vanessa curran said...

my son has A.S.D an is turning 6 in February an was wondering what else can I do, as I don't no if he knows that he has 2 go at night as this has been a nightly thing the last 2 years, an none of the doctor's will do anything 2 help until he is older right they can do something that put him on medication but not feel comfortable putting him on medication at his age, any pointers will be great, as I don no what 2 do now as iv tried everything an now he has starting wetting during the day time also is this common????? thanks

jonathan said...

I really don't know what you can do. It is possible he will outgrow it at some point as I did by the time I turned 13. Other than that, don't know what to tell you.