14781-koppen

15 General introduction and outline of the thesis FIGURE 1. Bristol Stool Form Scale. Reprinted by permission from Macmillan Publishers Ltd: Saad RJ, Rao SS, Koch KL, Kuo B, Parkman HP, McCallum RW, et al. Do stool form and frequency correlate with whole-gut and colonic transit? Results from a multicenter study in constipated individuals and healthy controls. Am J Gastroenterol 2010;105:403-1. Adapted from Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 1997;32:920-4. Psychological evaluation Between 30-50%of childrenwith fecal incontinence have been reported to have a comorbid emotional or behavioral disorder. 38 Because of this high psychologic comorbidity rate, clinicians are encouraged to observe, explore and enquire about emotional and behavioral problems and to refer children for psychological evaluation if necessary. 39 Children with fecal incontinence have been reported to display significantly increased rates of separation anxiety, specific phobias, generalized anxiety, attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorders. 40,41 In chapter 4 , the association between ADHD and functional defecation disorders is evaluated.