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How Does an ADHD Diagnosis Affect Self-Esteem?

 ADHD Weekly, August 8, 2019


For most adults and many older teens, learning that ADHD is the root of their struggles is a relief. That’s what psychologist and author Sharon Saline, PsyD, says, following her 30 years of working with children and adults who have ADHD. For children, their reaction is something else—they don’t want to be different in some way from their friends. The concept of an executive function disorder is often too big for them to understand.

“I think a lot of adults do feel a self of relief when they get an ADHD diagnosis,” Dr. Saline says. “It puts a category into these diverse experiences they’ve been having. It formulates it into a reason. They’re not actually crazy, lazy, stupid, or ineffectual. They have something that’s different about their neurobiology that contributes to the difficulties they’ve had in living effective and rewarding lives.”

Children, though, are still developing the experiences that they will draw on as adults, she says, and that makes their concept of what it means to have ADHD different from an adult’s viewpoint.

“Kids who don’t have the ability yet to look at themselves,” she said. “They are in the middle of those struggles and actively comparing themselves to their peers. They see their peers having an easier time. Kids want to be like other kids. And when there’s a diagnosis or label they feel there is something wrong with them.”

ADHD and a person’s self-esteem

The struggles that can come from growing up with ADHD can harm a person’s self-esteem, making it harder for her to take appropriate risks in friendships and relationships, education, careers, and the workplace. Without taking those risks there might be limited or no forward movement.

“When you have healthy self-esteem, you feel good about yourself and see yourself as deserving the respect of others,” according to the experts at Mayo Clinic. “When you have low self-esteem, you put little value on your opinions and ideas. You might constantly worry that you aren’t good enough.”

Dr. Saline helps her young patients build their self-esteem by focusing on developing skills to be successful with their symptoms, rather than looking at ADHD as a personal flaw. She usually avoids using the term “ADHD” with her youngest patients, leaving the decision to their parents. Instead, she asks them to come up with a name for the type of brain they have.

“They come up with a name for their brain related to how they experience ADHD,” she says. “In my office I refer it as attention-wandering or fast brain. We might say, ‘You have a super creative brain. You have many thoughts at the same time. We’re going to call it a ‘many thoughts brain.’”

Dr. Saline says often teens will feel some relief but will still be worried that ADHD will set them apart from their friends or prevent them from achieving their goals. She helps them to identify role models, such as Simone Biles or Michael Phelps, and others who have ADHD.

“The goal is how can you accept the brain that you have and work with it,” she says.

Building up self-esteem

Children need to hear three positive or supportive comments for every negative or hurtful comment. Dr. Saline has done her own informal poll of how many negative comments a child or teen receives, compared to positive ones. Her estimate: For every 15 negative comments a child with ADHD receives, there is only one positive comment.

“If you’re a kid and you get the message that you’re missing the mark over and over again, you internalize that voice,” she says. “You can imagine what that does to someone’s confidence.”

Parents can do a lot to counteract that loss of self-esteem, says Dr Saline. She calls her approach the 5Cs of parenting:

  • Self-Control: Learn to manage your own feelings first so you can act effectively and teach your child to do the same.
  • Compassion: Meet your child where they are, not where you expect them to be.
  • Collaboration: Work together with your child and co-parent (if one exists) to find solutions to daily challenges instead of imposing your rules on them.
  • Consistency: Do what you say you will do—over and over and over again.
  • Celebration: Acknowledge what’s working and doing more of it, day after day after day.

From 5Cs of ADHD Parenting Bonus Handout

“Celebration is actually noticing,” Dr. Saline says. “It’s acknowledging and validating positive steps that you see. When you acknowledge and valid both their successes and efforts you are improving their self-esteem. You are nurturing their resilience and self-confidence.”

When a diagnosis of ADHD is finally made, Dr. Saline says it should offer the opportunity to better understand the past and then to put in place the academic and behavioral support that will make a difference going forward. Creating opportunities for success can help to rebuild and strengthen a child or teen’s sense of self-esteem.

“One of the most important things after an ADHD diagnosis is the dance of learning how to do this and skills and the emotions of dealing with it,” she says.

Self-esteem is a process

A diagnosis is only the beginning of the process to help strengthen self-esteem by knowing why there are difficulties and what can be done to meet those challenges.

“Adults have to process years of shame and grief, even self-loathing, that they have internalized,” Dr. Saline says. “With kids, we can help them to avoid some of that. I would want people to really get a sense of what they like about themselves. Increase that and live in that as much as they can.”

Dr. Saline says she hopes people with ADHD will experience their talents and strengths along with their ADHD symptoms as part of a bigger picture—and with a little bit of humor.

“I’d like it if they could say, ‘“Yep, that is who I am. I am really good at this, but I’m not so good at that. And that’s why I have systems set up and people who help me,’” she says.

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