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Bedwetting: another autistic problem?

Posted Apr 21 2010 12:00am
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.
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