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.

25 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.

Anonymous 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.

Anonymous 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.'

Unknown 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.

Unknown said...

My grandson is 4 also ASD, he has been going to the bathroom for about 2 years, except pooping that is 1 year. The two nights he wet the bed..normally gets up and goes with crying of course. I don't know what's up with wetting the bed.He had 1 accident maybe 6 months ago. I'm just hoping it doesn't continue.Any thoughts?

Unknown said...

Bed wetting is a very embarrassing problem, my son was suffering from it up to the age of eighteen i have given him different medication, but no solution,
then i got herbal medication which i used on him, now he can sleep all night with out bed wetting,any body with such problem can contact him on phillips1211@yahoo.com

Melissa said...

Am so glad and thankful to Dr Zadson for helping me cast a spell that stopped my son from bed wetting after 20 years. I came across a testimony online of how this good man helped cure bed wetting just in a few days and i contacted him via eduduzadsontemple@yahoo.com and its been 2 weeks after result and my son sleeps peacefully without any bed wetting. If you are in need of a permanent solution to bed wetting contact this great Dr via eduduzadsontemple@yahoo.com

Anonymous said...

I've always had incontinence issues since birth. I'm currently in diapers both day and night. I was diagnosed Asperger's Syndrome when I was 24 and prior to that I was diagnosed with ADHD at school. At school I always had a weak bladder and if I needed to go to the toilet had to go quickly or else I would wet, later on the doctors looked into it and said it was urge incontinence and was put in diapers 24/7 to help me cope with it. Quite often now I don't know whether it's because I wear a diaper 24/7 I sometimes look at the diaper and am surprised it's wet because I haven't even felt the urge to go.

Anonymous said...

Adan 20 year old with autism, I use to have bed wetting problem and it's a huge embarrassment that cause me to have self esteem issues. I use to be punished my my mom every time I wet the bed every night, from birth till I was 12 years old and my siblings use to ridicule me for wetting the bed. My bed wetting started declining around 2009 (when I was 12 or 13) and by the time I turned 15, I stopped wetting the bed altogether and now I completely forget about it.

I think my autism or bladder issues cause my bed wetting problem to presist till I was an teenager. Thank you for raising concerns that autism caused people to wet the bed.

Unknown said...

Aren't we all forgetting every autistic Childs symptoms are different? Any two autistic people are never the same!

Anonymous said...

My daughter is 12. I wake her to use the bathroom every night, but sometimes i am not fast enough. She's gone through so many mattresses, despite protective coverings. She has outgrown pull ups and women's diapers are to big. Im at my Witt's end. It is basicly every single night. I have tried everything. Alarms (got to where she slept right through them), waking her up, massage, rewards, nothing is working. I can't stand it, it runs our lives.

Anonymous said...

As an adult with autism, I use to wet the bed all the time, it was so embarrassing that it destroyed my self esteem and it cause me to be clinically depressed at a young age. I use to be punished by my mom for wetting the bed every night, from birth till I was 15, wore diapers till I was 12 and my siblings and peers from school use to ridicule and bullying me for wetting the bed. My bed wetting started declining in 2009 or 2010 and by the time I turned 15, I stop wetting the bed altogether and I never forget that bed wetting caused me in complete despair later in life. Even my 2 younger siblings stopped wetting the bed before me which is embarrassing and depressing. I felt so scared of my mom finds out I pee on the bed, I would get punished. I was scared of going to school camp (thankfully I spent 4 years in a autism school), sleep over at cousins or family friend house because I feared that I would get bullied by my peers and they would remember me peeing on the bed forever.

Autism is the main culprit for my bedwetting problem that persisted through my teenage years, toilet training delayed till I was 7 and had bladder problems. Thank you Jonathon for rasing concern that my autism is the cause of my bed wetting problem.

Unknown said...

No offense but you can’t say that because my brother is fully autistic with ADHD and bedwetting was only a problem when he was very small then after his potty training phase it went away like a normal kid and came back at 12 which clearly shows its linking to Autism because he finds bedwetting almost normal and it’s became frequent. So I believe her study more than yours

Unknown said...

Also every kid with autism doesn’t have the same problems so just Bc uk some who don’t have this problem doesn’t mean anything some Autistic kids have seizures some don’t some have stomach problems some are nonverbal some have eating problems it varies but in general they show a range of problems a kid may not have all but instead one or a few

Unknown said...

This is interesting. We went went GFCF for 10 years and grain free (GAPS diet) for a long season. My sons perseverative speech dramatically improved- but he still wets the bed nearly every night and he's 13.

Anonymous said...

adhd is closely linked to autism and in a recent study of ADHD diagnosed cases, 75% of the inattentive sub type of cases also had nocturnal bedwetting. A study by the jill esher autism charity has pointed the finger at "synthetic progesterone" given to pregnant women as a possible cause of autism and adhd. It is possibly that the neurotoxic hypothesis for autism/adhd based on hydroxyprogesterone caproate is the cause of primary nocturnal enuresis and ADHD/AUTISM. A recent study in Albany shows autistic type symptoms in rats from mothers exposed to "hydroxy progesterone caproate".

Simon

Anonymous said...

I'am a older male was tested late in life and found to have autism +dd and have been incontinent a lot of my life.