The CBCL/4-18 and TRF were used in an epidemiological study of 3,344 6- to 16-year-olds in Shandong Province, China (Liu et al., 2000). The 90th percentile on the distribution of Total Problems scores was used as a clinical cutpoint. Compared to children who attained nocturnal urinary control before age 4, significantly more children who attained urinary control later scored above the clinical cutpoint on all CBCL/4-18 and TRF problem scales.
Furthermore, children with current enuresis were more than twice as likely than nonenuretic children to score above the clinical cutpoint on all CBCL/4-18 and TRF problem scales, after the effects of age, gender, and socioeconomic status were partialed out. Although the prevalence of enuresis was lower than in western countries, its associations with other problems appeared to be stronger. Liu et al. speculated that Chinese children who are enuretic after age 4 may have underlying physiological abnormalities and/or may experience stress as a result of enuresis that, in turn, increases the risk for behavioral and emotional problems.
Reference: Liu, X., Sun, Z., Uchiyama, M., Li, Y., & Okawa, M. (2000). Attaining nocturnal urinary control, nocturnal enuresis, and behavioral problems in Chinese children aged 6 through 16 years. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1557-1564.