How to evaluate self-image in children and teens with ADHD
Evaluating your ADHD child’s or teen’s self-image may be one of the most important things you can do to help him or her build self-esteem.
As my mentor and friend Dr. Jack Whitaker often said; “The way you feel about yourself has more to do with how successful you are in life than any amount of education that you could ever attain.”
Our self-image has a lot to do with whether we excel in our studies, our social life, and our endeavors or whether we simply stand by as the world passes us by. If your ADHD child feels he or she is valuable as a person, then he or she will usually have the curiosity, burning desire, motivation and determination to overcome most obstacles and succeed in just about everything wished.
Contrariwise, an ADHD child who thinks poorly of himself or has a bad self-image will rarely risk failure or embarrassment to try to better himself or exceed everyone’s expectations. It’s sort of like this: If you feel yourself a failure from the start, why place yourself in a position or situation where you can fail and prove everyone right?
In this article we’re going to deal with how to spot negative self-image traits, behaviors, attitudes, and tendencies in children and teens with ADHD. So, I’m going to tell you about a 13 year-old girl with ADHD I evaluated a few years ago who successfully overcame the stigma and trauma of a poor self-image.
Janelle was the second of three children in a family filled with tales of success. Her mother was a college professor and her father a construction engineer. Both of her siblings, a younger sister and an older brother were straight A students and excelled in math, science, and sports.
When Janelle’s mother brought her in for evaluation, she was already taking an ADHD drug at a very appropriate dosage. Her grades were so-so in everything but math and science-both of which she was clearly barely passing. Her mother just couldn’t understand what was going on as Janelle “should have inherited the very same genes that allowed her brother and sister to whiz through academics without any glitches.”
Both parents worried that she was just lazy or even possibly had some type of brain damage or learning disability. They were embarrassed, frustrated by her behavior and were in gross denial.
For a 13 year-old, Janelle was too quiet-too withdrawn and too blasé. She just didn’t act like the typical 13 year-old seen in my practice. Let me share the negative aspects of Janelle’s self-image I discovered as our interview progressed:
- Janelle had few friends. In fact she only had one “good friend”, if you could call another 13 year-old who talked with her on the phone three or four times a week a good friend. Her mother felt that she shunned others her age because she was embarrassed about her poor grades. Such was not the case as I discovered by talking with Janelle alone. Janelle could care less about her grades, because “That’s all they worry about. They want me to be somebody I’m not. They really don’t care about anything else, as long as I make those stupid A’s!”
- She dressed poorly- was wearing dirty old jeans with holes in the knees, an old sweat shirt and no jewelry. She also obviously didn’t spend time grooming to improve her appearance, as her hair was in tangles, looked greasy, and her nails were dirty and of different lengths. My grandfather always pointed out that successful, happy people dressed like they were successful and happy. Janelle was neither.
- Her mother told me she had a habit of not caring for her possessions. She often left her best clothing in piles around her room and left her few favorite books out on the back deck in the rain and blistering sun.
- She had no plans for the immediate or distant future. Janelle rarely planned to spend time with her one “good friend” or family members. She hadn’t been to the mall shopping but once in three months-and that was when her mom forced her to go to buy a new pair of jeans. For a thirteen year-old, not going shopping or going to the mall to “hang with her friends” is clearly abnormal.
- Had no social life-she turned down chances to go to parties, to participate in sporting events, to go on church outings, to go to the movies, or go on vacation with other families or friends.
- Had no concept of time or urgency- Nothing was important to Janelle, so she had no reason to be in a rush, to be on-time, or to meet deadlines.
- Acted defeated, downtrodden like she had no value in life- she saw herself as less than valuable-not pretty-not smart-not worth her mom’s or dad’s attention.
- Didn’t take pride in her work around the house or at school-she only did chores, homework, and assignments “because her parents and teachers insisted”. She would just shrug when her mom or dad complimented her for jobs well done.
- Never participated in sports unless forced to do so. She played volleyball one term at school and hated it because “everyone was so fake.”
- Spent a lot of time in her room or in front of the TV-It was easier to deal with mind-numbing TV shows than with her brother, sister, or parents.
- Had no pictures of herself or friends in her room she didn’t consider her relationships with others to be important
- Never looked forward to or planned for summer camp or vacation. (Lack of planning is a key symptom of depression and poor self-image)
By now, you might have noticed that Janelle also showed signs and symptoms of teenage depression. Most ADHD children and teenagers who have a poor self-image also suffer from depression and anxiety. You may have also surmised that kids and teens with a positive self-image have traits, behaviors, attitudes and tendencies that are 180 degrees opposite to those Janelle exhibited. We’ll explore your hypothesis in another article soon.
Poor self-image and depression can cause a child to show symptoms of ADHD when they are not ADHD and lead to the misdiagnosis of ADHD!
So what did we do to help Janelle?
- First, we had to evaluate and treat her depression
- Have her evaluated for strengths and weaknesses and the aspects of her self-image whether good or bad
- Then start counseling to deal with the core elements of her depression and poor self-image
- Work on her parent’s attitude about her as a successful person and their personal desires for academic success causing her so much stress and trauma
- Find things she remotely wished to achieve, conquer and excel in doing (This is very tough to do and takes a lot of insight on behalf of the interviewer or counselor)
- Help her develop a close friendship with someone near her current age
- Teach her siblings and teachers how to treat her as a unique individual-it’s hard to follow in the footsteps of successful siblings
- Help her deal with her middle child syndrome- The middle child often suffers insecurity and feelings of “not fitting into the family as a whole”.
Janelle responded well to therapy with counseling and coaching. Her depression lightened-up within two weeks of started an antidepressant-fluoxetine. At her last visit she was no longer depressed and had made several new friends and was becoming more at ease in most social situations.
While she never made the grades her siblings did, she kept her academics reasonable and eventually made it into college to major in elementary education. She wants to be a school teacher, because as she put it: “By becoming a teacher, I can help shape young minds and keep them from suffering a poor self-image like I.”
In our next article we’ll discuss Brian-a 10 year-old with the self-image of a 17 year old.
Frank Barnhill, MD
Just in case you missed the earlier articles in this series:
How to Build Self Esteem in ADHD Kids Two
Ways to build self-esteem and confidence in all children
How to Build Self Esteem in ADHD Kids Three
Finding a great coach for your child with ADHD