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Lead Applicant:  Dr Carol Joinson, Associate Professor (Reader) in Developmental Psychology, Bristol Medical School, University of Bristol

Funding: Medical Research Council

Continence problems are among the most common chronic conditions in children and many are still affected in adolescence. This study used data on continence problems and a wide range of potential risk factors and outcomes from The Avon Longitudinal Study of Parents and Children (ALSPAC: http://www.bristol.ac.uk/alspac/).

The study also collected new in-depth qualitative data from young people aged 11-20 to explore their experiences of living with a continence problem.

The study provided evidence about the factors that distinguish between children who attain bladder and bowel control as expected and those who continue to suffer from continence problems into later childhood and adolescence. Important risk factors for persistent continence problems included the presence of emotional and behaviour problems in early childhood; exposure to stressful life events; later initiation of toilet training; mothers’ history of bedwetting, and maternal depression.

Persistence of continence problems into adolescence leads to considerable distress for young people and their families. This study highlights the need for better support from health professionals and teachers. 

Findings from this project were used in the 2019 Paediatric Continence Commissioning Guide: A handbook for the commissioning and running of paediatric continence services (http://www.paediatriccontinenceforum.org/wp-content/uploads/2019/10/PCF-Childrens-Continence-Commissioning-Guide-Sep-2019.pdf).

Key papers:

A prospective cohort study of biopsychosocial factors associated with childhood urinary incontinence.

Joinson C, Grzeda MT, von Gontard A, Heron J.

Eur Child Adolesc Psychiatry. 2019 Jan;28(1):123-130. doi: 10.1007/s00787-018-1193-1


Psychosocial risks for constipation and soiling in primary school children.

Joinson C, Grzeda MT, von Gontard A, Heron J.

Eur Child Adolesc Psychiatry. 2019 Feb;28(2):203-210. doi: 10.1007/s00787-018-1162-8


Early childhood risk factors for constipation and soiling at school age: an observational cohort study.

Heron J, Grzeda M, Tappin D, von Gontard A, Joinson C.

BMJ Paediatr Open. 2018 Feb 21;2(1):e000230. doi: 10.1136/bmjpo-2017-000230. eCollection 2018.


Left behind and left out: The impact of the school environment on young people with continence problems.

Whale K, Cramer H, Joinson C.

Br J Health Psychol. 2018 May;23(2):253-277. doi: 10.1111/bjhp.12284.


Examining the effectiveness of parental strategies to overcome bedwetting: an observational cohort study.

Grzeda MT, Heron J, Tilling K, Wright A, Joinson C.

BMJ Open. 2017 Jul 13;7(7):e016749. doi: 10.1136/bmjopen-2017-016749.


'What does that mean?': a qualitative exploration of the primary and secondary clinical care experiences of young people with continence problems in the UK.

Whale K, Cramer H, Wright A, Sanders C, Joinson C.

BMJ Open. 2017 Oct 16;7(10):e015544. doi: 10.1136/bmjopen-2016-015544.


Effects of urinary incontinence on psychosocial outcomes in adolescence.

Grzeda MT, Heron J, von Gontard A, Joinson C.

Eur Child Adolesc Psychiatry. 2017 Jun;26(6):649-658. doi: 10.1007/s00787-016-0928-0.


Early childhood psychological factors and risk for bedwetting at school age in a UK cohort.

Joinson C, Sullivan S, von Gontard A, Heron J.

Eur Child Adolesc Psychiatry. 2016 May;25(5):519-28. doi: 10.1007/s00787-015-0756-7.


Stressful Events in Early Childhood and Developmental Trajectories of Bedwetting at School Age.

Joinson C, Sullivan S, von Gontard A, Heron J.

J Pediatr Psychol. 2016 Oct;41(9):1002-10. doi: 10.1093/jpepsy/jsw025.