Why Bedwetting Is More Common In Kids With ADHD — & What Parents Can Do

When you become a parent, you don’t necessarily realize how much of your child’s life will involve pee in places it doesn’t belong. My son is 5 and has been potty trained for two years, but recently he came inside soaked with his Spider-Man rubber boots full of pee — the accidents don’t just magically stop or go away completely for a long, long time. That includes nighttime enuresis, aka wetting the bed. And if you do much Googling about the issue, you might notice that bedwetting and ADHD come up a lot in the same articles. So, what’s the connection there?

Most children can’t control their bladder at night until around age 6. Between 4% and 9% of children continue having nighttime enuresis beyond that, but in kids with ADHD, that rate is more like 16%, according to Dr. Leslie Treece, board-certified pediatrician at Cookeville Pediatric Associates in Cookeville, Tennessee.

“Studies also show that the kids with daytime incontinence have more than four times-higher odds of also having ADHD symptoms. So there’s some biological link there,” Treece says.

What do we know about the connection between bedwetting and ADHD?

According to the American Academy of Pediatrics, ADHD affects the brain’s ability to interpret signals from the bladder when it’s full and needs to go.

“Research indicates that many of the brain pathways that we have when we have ADHD are the similar brain pathways that are responsible for being able to regulate using the washroom and preventing bedwetting — things like our attention, our arousal — so being able to notice some of those body cues, those are those same areas impacted. Kids with ADHD may just naturally struggle to be able to be aware of their body signs, and so then this would impact them being aware of bathroom signals,” says Christal Castagnozzi, a clinical and school psychologist in Ontario who specializes in neurodivergence.

The average child is diagnosed with ADHD between 6 and 12, Castagnozzi says, though for some — particularly girls and women — it can come much later. So, bedwetting beyond age 6 could be one of the first signs for some families, or an additional red flag if they were already thinking about the possibility their child has ADHD. Bedwetting does not automatically mean a child has ADHD and not all kids with ADHD wet the bed, Castagnozzi notes, but it’s worth exploring the possibility “in older children that maybe have prolonged bedwetting.”

Aside from the brain-based connection between ADHD and bedwetting, kids with ADHD also tend to struggle with impulse control, making it difficult to stop what they’re doing (probably something way more fun) to go to the bathroom (boring) and stay on the toilet long enough to fully empty their bladder, Castagnozzi explains.

How To Support Your Child If They Are Dealing With Bedwetting & ADHD

There are so many options and things you can try to help your child have fewer accidents during the day and at night, these experts say.

• Make sure your child isn’t constipated. Treece and the AAP say constipation is common among kids with ADHD and can make it harder for the bladder to expand enough to hold in urine.
• Establish a consistent bathroom routine. Have your kid visit the restroom every two hours, Treece recommends. Ideally, you would also have your child go to the bathroom before a preferred task, like playing or watching TV, Castagnozzi adds.
• Practice double voiding. That means go pee, relax for a minute, then try to pee again. “A lot of kids who are impulsive want to just jump up off the toilet and go. They’ll go real quick, and then they’ll get up and leave. And if you have them do that double voiding with relaxation, then a lot of times they finish emptying their bladder and their risk of wetting on themselves after that is lower,” she explains.
• Talk about your own body’s bathroom cues. What does it feel like when you need to pee? “Especially for younger kids, it may be very abstract, and so sometimes we have to anchor them and give them that language,” Castagnozzi says. “As we’re approaching that time where we go into the washroom, talk a little bit about the signs that we feel in our body so that they can have the language, and then remind them that’s what they should look for.”
• Make the bathroom more interesting so it feels positive (or at least neutral) to go there. “If we are negatively associating it with fear or boredom, then that can make it even trickier, because with ADHD, we struggle when we have to engage in tasks that do feel mentally daunting,” Castagnozzi says. “Making it more of a neutral environment that could look like bringing in fidget toys or bringing in some kind of music, or bubbles, or whatever it may be so that we can encourage it to be associated in a different way.”
• Include your child in finding a solution. Understanding that you don’t blame them and you’re all on the same team can go a long way. “Include them in the conversation and let them understand that this is not something that they can help, that there are things that we can do to make it better, and that they’re not being bad,” Treece says.
• Try an enuresis alarm. Kids with ADHD tend to sleep through their body’s signals to wake up and pee, Treece says, but an alarm might help. “It’s something that can detect the moisture and then it alarms and wakes the child up. I would think that that enuresis alarm should make a big difference,” she says.
• Don’t have a big conversation about bedwetting when your child has just had an accident. Emotions can be running high, everyone’s groggy, and it’s just not the time, Castagnozzi says. “It should be done at times where they're able to have a conversation about what we are doing to support, how we are reflecting on any strengths or progress that they have made, and trying to show up positive.”
• Don’t shame your kid or yourself. Share with them that a lot of kids deal with this issue, so they’re not alone. Avoid big reactions when they do have accidents, and apologize if you get overwhelmed and have them anyway. Ask relatives not to bring up the subject with or in front of your child when you’re at family gatherings — it shouldn’t be a topic of idle conversation, Castagnozzi advises.

Some phases of our kids' lives are challenging and just kind of suck for everyone involved. But bedwetting is a self-limiting issue, Treece says. Even if you’ve tried everything and nothing helped, it will eventually go away on its own. The most important thing is helping your child manage all aspects of their ADHD shame-free.

“I don’t think I’ve ever seen anybody past about 10 or 12 that was still having these troubles. They do outgrow it, and medications can be very helpful, especially if the child’s going to sleepovers or things like that,” she says. “The biggest thing is to remember that — and this is a big cultural misconception — a lot of people don’t recognize that ADHD is rooted in biology and that it’s a brain issue. There’s a cultural stigma attached to treating ADHD, whereas if your child had a problem with their heart or their lungs or their kidneys, those organs don’t have the same stigma attached. You’re not copping out if you’re treating the child. You’re actually helping them to be more confident.”

Castagnozzi agrees. “Be mindful that if a child is struggling this way, it is not misbehavior. It’s not something that is within their capacity at this point to be able to control,” she says, adding, “Parents are juggling a lot on their plates. It does feel challenging to be able to manage some of these difficulties, and we’re doing our best. If you feel overwhelmed and you’re not sure which way to go, access support from a therapist, psychologist, or someone in the community so that, together, we can improve some of the challenges.”