الفهرس 
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Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is a chronic pervasive childhood disorder characterized by developmentally inappropriate activity level, low frustration tolerance, impulsivity, poor organization of behavior, distractibility, and inability to sustain attention and concentration. It is one of the most common childhood disorders, occurring in 3% to 7% of school-age children and representing one third to one half of referrals to child mental health services. The core symptoms of ADHD are associated with impairments in several domains of functioning, including academic achievement at school, interactions with parents and siblings, and peer relationships. Children diagnosed with ADHD also have a higher likelihood of coexisting psychiatric disorders and usually continue to have problems attributable to ADHD as adults that require treatment.
The core symptoms of ADHD, the associated functional deficits and comorbid disorders, and the risk for ongoing problems as adults underscore the seriousness of ADHD as a childhood condition and the importance of appropriate diagnosis and effective treatments. Public interest in the disorder has increased, including debate in the public media concerning the diagnostic process and treatment choices.
Researches regarding the social and psychosocial factors associated with ADHD and how these factors may affect the self-worth or self-perception of children with this disorder have yielded conflicting results. It is known, however, that children with ADHD often receive negative attention because of their behavior. Research has shown that these children exhibit difficulties in social situations. The cumulative effect of years of negativity and social rejection can lead to low self-esteem and a negative self-perception.
Nocturnal enuresis, according to DSM-IV, is defined as an involuntary (or voluntary) voiding of urine into the bed, with a severity of at least twice a week, in children over 5 years of age, when not provoked by congenital or acquired defects of the central nervous system (CNS) or by the direct physiological effect of a substance (such as a diuretic).
Nocturnal enuresis has been described as the most prevalent and chronic of all childhood problems. The experience, particularly for the older child, can be extremely distressing and limiting. It is now thought that psychological distress (emotional, behavioural, and self-esteem) arises as a consequence of bedwetting.
Lack of medical attention to enuresis may also be a cause for concern because the persistence of enuresis past the age of 7 years is frequently associated with low self-esteem in children. In addition to reducing enuresis symptoms, successful treatment of enuresis is also associated with improvement in self-esteem.
Attention-deficit/hyperactivity disorder (ADHD) and enuresis co-occur at a higher rate than expected; Incontinence, urgency, abnormal voiding frequency and pattern are more common in children with ADHD than normal controls.
On the other hand the prevalence of attention deficit disorder or ADHD in nocturnal enuresis is significantly increased, especially in older children .Previous studies of children with enuresis mentioned comorbidity rates up to 30%, more over the inattention problems were predominant in the enuretic group.
The self-esteem of children is an important psychological variable that is supposed to be associated with mental health. Low self-esteem is seen in different psychiatric disorders as depression, eating disorders and identity problems. Harter (1982) suggests that the self-concept of children has important implications on the experience of their competencies on different dimensions. The impaired self-esteem is the consequence of their physical as well as psychological experience of their body.
Self esteem &self perception are very important in the physiological &psychological development of the child, and by understanding the causes that may lead to low self esteem, and by knowing how to deal with these causes we can reach our goal in elevating self esteem for better psychological &physiological development of the child in order to develop healthy mature persons taking their role in the community.
In this study we tried to investigate The prevalence of nocturnal enuresis in children with ADHD, the frequency of distribution of NE with clinical subtypes of. ADHD and the impact of comorbidity of nocturnal enuresis with ADHD on self esteem
Seventy three patients were recruited from the psychiatric out patient clinic at Childhood institute, Ain shams university; thirty six were diagnosed as ADHD. After excluding some of them according to the exclusion criteria 13 were included in our study. All of the included cases were subjected to Psychiatric assessment:
• Psychiatric interview and examination
• ADHD assessment by ADHD Rating Scale-IV Checklists.
• IQ assessment by Stnford Binet.
The 13 cases were investigated for nocturnal enuresis and subjected to self esteem assessment by the self esteem inventory by Coopersmith.
We found that 30% of the cases included were enuretic but no statistical significance was found regarding the impact of the comorbidity of nocturnal enuresis and ADHD on self esteem.
Enuresis is a common condition among children with ADHD. They co-occur at a higher rate than expected.