Self-esteem in special education children with ADHD: Relationship to disorder characteristics and medication use

Objectives: To describe the level of self-esteem among the study population, to examine how self-esteem ratings may vary by disorder characteristics and medication use, and to identify predictors of low self-esteem while adjusting for sociodemographic factors. Method: In a school district-wide sample of children in special education programs, the authors assessed self-esteem with the Piers-Harris Self-Concept Scale among 143 students at high risk for attention-deficit/hyperactivity disorder (ADHD) in the school year 1995, with an interview participation rate of 73%. Disorder characteristics and medication use were assessed using multiple informants and standardized measures. Results: Self-esteem scores, on average, were in the normal range. However, across ADHD comorbidity profiles, children with ADHD and internalizing symptoms had significantly lower self-esteem scores, especially in the areas of anxiety and popularity, than children with ADHD alone or those with comorbid disruptive behavior disorders. Independent predictors of lower self-esteem were being white, high functional impairment, and comorbid internalizing conditions, but not medication use. Conclusions: Findings suggest that interventions for ADHD should be culturally sensitive as well as aimed at improving a child's functional level and associated internalizing symptoms. Medication use among this younger patient group was not related to self-esteem scores.