Childhood ADHD and Poor Self-Esteem
When every day is a terrible, horrible, no good, very bad day.
Posted Oct 16, 2017
Attention-deficit/hyperactivity disorder (ADHD) isn't just about symptoms you can see. Sure, a child with ADHD can be fidgety, or overly talkative, or unable to focus. Hiding underneath that, though, may be intense anxiety, too. Maybe their lack of impulse control goes so deep they can't even control their own thoughts. Then, after years of being punished more often than their siblings, or removed from classrooms day after day, they become angry and depressed. If your child is like mine, they start saying they're worthless or a "bad" kid. Every day becomes a terrible, horrible, no good, very bad day.
Anxiety, Impulse Control, and Poor Self-Esteem
My son has what's called "combined type" ADHD (both inattentive and hyperactive/impulsive). When researching why he constantly puts himself down, and how to make it stop, I learned that this behavior is common for kids like him. Castagna, Calamia, and Davis (2017) reported that these children are especially sensitive to personal failure. Hence the constant refrains of "I'll never be able to do this" or "I'm too stupid." At points, my son even gets to "I don't deserve to live."
If a child is anxious, this gets even worse. Anxiety disorders are extremely common in children with ADHD with up to 40 to 50 percent of them experiencing it (Castagna, et al., 2017). When an anxious child hears people pointing out how he does things wrong or doesn't operate well in a classroom, it makes sense that he becomes anxious about his behaviors and avoids situations where they might be repeated. His own negative talk reflects what others have said, and that turns into negative thoughts.
Negative thoughts might then spin out of control. Children with ADHD lack impulse control in general, and if they can't manage outward behavior, it's possible they can't control what happens inside, either. All of us have intrusive thoughts at times, and we just push them away. According to Castagna, et al. (2017), some children with ADHD might not be able to do that. They are bombarded by constant negative thoughts about their abilities, or their hopes, or what their parents or others might think of them. Their brain says they're going to fail, and they can't simply push those thoughts away.
So What Does a Parent Do?
I am no expert in this arena, but there are a couple of things we've done that have helped our son.
1. Medication. My son's ADHD, anxiety, and mood disorder are better-controlled thanks to a combination of medications. Now that he can manage the outbursts, lack of focus, and other typical ADHD symptoms, he succeeds more. He's no longer failing at what everyone else insists should be "normal", and we can now focus on more than just keeping him safe.
2. Special Education. It was a tough decision, but removing my son from mainstream classes was an amazing decision for him. His EBD (emotional/behavior disorder) classroom has only ten kids, which means he's not overstimulated. Three adults manage the classroom, meaning he gets more one-on-one attention. Teaching is divided into 20-minute installments so that attention deficits aren't an issue. As a result, my son always finishes his work. He does his homework every night without fighting because he knows he can do that work. The new classroom allows him to prove he's not stupid or incapable. He had fought the decision initially, but now he loves his class and doesn't want to change it.
3. Cognitive Behavioral Therapy. For kids with ADHD, we tend to focus only on behaviors, setting up token economies and the like. Often, the "cognitive" part of things gets forgotten, and so kids like mine with intense anxiety are crippled by negative self-thoughts. My son's in-home therapist has now been trying to identify not only how to de-escalate destructive behaviors but what triggers them. This includes identifying the negative self-thoughts and problem-solving how to battle them.
It's always a struggle when things get hard but remember, too, that our children need our validation. No matter how negative it gets, they need to hear the positive, too. If you have to dig far to find that positivity, I get it. Some days, I feel like I can't find it, either. Do the digging, though. It's worth it.
Castagna, P.J., Calamia, M., & Davis, T.E. (2017). Childhood ADHD and Negative Self-Statements: Important Differences Associated with Subtype and Anxiety Symptoms. Behavior Therapy, article in press.