Hyperactives as young adults: self-esteem and social skills

The role of self-esteem in the development of psychiatric problems: a three-year prospective study in a clinical sample of adolescents

BACKGROUND

Self-esteem is fundamentally linked to mental health, but its' role in trajectories of psychiatric problems is unclear. In particular, few studies have addressed the role of self-esteem in the development of attention problems. Hence, we examined the role of global self-esteem in the development of symptoms of anxiety/depression and attention problems, simultaneously, in a clinical sample of adolescents while accounting for gender, therapy, and medication.

METHODS

Longitudinal data were obtained from a sample of 201 adolescents-aged 13-18-referred to the Department of Child and Adolescent Psychiatry in Trondheim, Norway. In the baseline study, self-esteem, and symptoms of anxiety/depression and attention problems were measured by means of self-report. Participants were reassessed 3 years later, with a participation rate of 77% in the clinical sample.

RESULTS

Analyses showed that high self-esteem at baseline predicted fewer symptoms of both anxiety/depression and attention problems 3 years later after controlling for prior symptom levels, gender, therapy (or not), and medication.

CONCLUSIONS

Results highlight the relevance of global self-esteem in the clinical practice, not only with regard to emotional problems, but also to attention problems. Implications for clinicians, parents, and others are discussed.

Social comprehension of children with hyperactivity

From a social cognitive perspective, the social problems of children with hyperactivity could represent failure to attend to certain social cues. To assess the responses of 17 children with hyperactivity and 17 comparisons, 3 taped stories of social problems were presented.

The AD/HD Skills and Strategies Program : A Program for AD/HD Adults in Postsecondary Education

Attention-deficit/hyperactivity disorder (AD/HD) is beginning to be recognized in postsecondary institutions; however, few institutions offer comprehensive programs that provide training in advocacy and study strategies pertinent to the needs of students with this disorder (Richard, 1995). In an effort to address the gap in the literature regarding the treatment of AD/HD adults in postsecondary education, the AD/HD Skills and Strategies Program was developed. The components of this program were carefidly established in accordance with the research literature on the adult form of AD/HD and in keeping with a model of adult AD/HD, proposed by Brown. A two-pronged approach was used to assess the effectiveness of this program. Results and future recommendations are discussed.

Dysfunctional cognitions and their emotional, behavioral, and functional correlates in adults with attention deficit hyperactivity disorder (ADHD): is the cognitive-behavioral model valid?

OBJECTIVE

To investigate the presence of dysfunctional cognitions in adults with ADHD and to determine whether these cognitions are associated with emotional symptoms, maladaptive coping, and functional impairment, as predicted by the cognitive-behavioral model.

METHOD

A total of 35 adult participants with ADHD, 20 nonclinical controls, and 20 non-ADHD clinical controls were assessed with measures of ADHD symptoms, dysfunctional cognitions, depression and anxiety symptoms, coping strategies, and quality of life.

RESULTS

ADHD group showed elevated scores of dysfunctional cognitions relative to nonclinical control group and comparable with clinical control group. Dysfunctional cognitions were strongly associated with emotional symptoms. ADHD group also showed elevated scores in maladaptive coping strategies of the escape-avoidance type. Life impairment was satisfactorily predicted in data analysis when ADHD symptoms, dysfunctional cognitions, and emotional symptoms were fitted into a regression model.

CONCLUSION

Cognitive-behavioral therapy model appears to be a valid complementary model for understanding emotional and life impairment in adults with ADHD.

Self-esteem evaluation in children and adolescents suffering from ADHD

Background:

Several recent studies investigated the relationship between self-esteem and ADHD, however, the results are still controversial. In the present study we analyze the characteristics of self-esteem in a sample of children and adolescents suffering from ADHD, with a particular focus on the relationship between ADHD symptoms severity and treatment strategies.

Methods:

A total of 85 patients with ADHD (44 drug-free and 41 drug-treated, 23 of which atomoxetine-treated and 18 Methylphenidate-treated) and 26 healthy controls were enrolled in the study in order to evaluate self-esteem using the Self-esteem Multidimensional Test (TMA).

Results:

ADHD subjects revealed lower scores on all self-esteem domains compared to controls. Both ADHD drug-free (47.1%) and ADHD drug-treated (44.1%) groups showed significantly higher rates of subjects in the pathological range as compared to normal control group (8.8%) (p <.001) with a higher percentage of subjects in the pathological range. Among ADHD drug-treated subjects, the methylphenidate group showed higher self-esteem scores as compared to the atomoxetine group.

Conclusion:

A lower self-esteem profile is more common in subjects suffering from ADHD than in healthy controls, suggesting the importance of an early detection of psychological well-being in these children in order to reduce the ADHD symptoms long-term impacts.

Development of an internet-based support and coaching model for adolescents and young adults with ADHD and autism spectrum disorders: a pilot study

The aims of this paper were to develop an internet-based support and coaching model for young people with autism spectrum disorder (ASD) and/or attention-deficit/hyperactivity disorder (ADHD), and to validate the model. A user-centred design was applied to develop a model for internet-based support and coaching, where individuals received 8-week support via internet (chat). The model was validated by 10 individuals, 15-26 years of age, with ASD and/or ADHD. Self-report questionnaires [Sense of Coherence (SOC), the Rosenberg Self Esteem Scale, the Manchester Short Assessment of Quality of Life, Montgomery Åsberg Depression Rating Scale, and the Hospital Anxiety and Depression Scale] were distributed before and after intervention. A structured interview regarding the quality of the model, the Patient perspective of Care and Rehabilitation process (POCR), was used after the intervention. The validation showed significant improvement of SOC, self-esteem and subjective Quality of Life at follow-up and the majority perceived high fulfilment/importance on the POCR. In conclusion, The model can be an important complement to other interventions for young people with ASD and/or ADHD.

Parenting of children with ADHD in South Korea: the role of socio-emotional development of children with ADHD

AIMS AND OBJECTIVES

The aim was to investigate the factors affecting the self-esteem and social competence of children with attention deficit hyperactivity disorder.

BACKGROUND

Many studies have reported parenting variables such as parenting attitude and sense of competence have been suggested as significant determinants of socio-emotional development of children with attention deficit hyperactivity disorder. In South Korean society, the traditional culture of Confucianism is a strong influence on parenting practices and children's behaviour. However, there have been few studies that examined the relative significance of the parenting and other associated factors for self-esteem and social competence in children with attention deficit hyperactivity disorder in Korea living in a strict parenting environment.

DESIGN

This study was designed as a cross-sectional and descriptive survey.

METHOD

The subjects were 124 pairs of mothers and their children with attention deficit hyperactivity disorder, recruited from local paediatric psychiatric clinics in South Korea. Data collection was conducted through the use of questionnaires.

RESULTS

Affectionate parenting attitude and co-morbid condition of the child were the most important predictors of self-esteem. Rejecting parenting attitude was the most important predictor of social competence.

CONCLUSION

Higher levels of affectionate parenting attitude of mothers and non-co-morbid status of children both contributed unique variance to the overall prediction of higher self-esteem of children. Higher levels of rejecting parenting attitude of mothers contributed unique variance to the overall prediction of lower social competence in children with attention deficit hyperactivity disorder.

RELEVANCE TO CLINICAL PRACTICE

Parenting attitude is the most important factor to contribute to the healthy socio-emotional development in children with attention deficit hyperactivity disorder. Health care providers need to develop and apply a parenting skills improvement program to improve positive parenting attitudes, which will benefit self-esteem and social competence in children with attention deficit hyperactivity disorder.

Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life

This review provides an overview as to how the social and emotional impairments involved in Attention-Deficit/Hyperactivity Disorder affect the quality of life of patients and their families. A model of three categories into which the emotional difficulties fall, and how they impair quality of life, is also presented.

Self-esteem in adolescent patients with attention-deficit/hyperactivity disorder during open-label atomoxetine treatment: psychometric evaluation of the Rosenberg Self-Esteem Scale and clinical findings

To report on (1) psychometric properties of the Rosenberg Self-Esteem Scale (SES) studied in adolescents with ADHD, (2) correlations of SES with ADHD scale scores, and (3) change in patient-reported self-esteem with atomoxetine treatment. ADHD patients (12–17 years), treated in an open-label study for 24 weeks. Secondary analyses on ADHD symptoms (assessed with ADHD-RS, CGI, GIPD scales) and self-esteem (SES) were performed. One hundred and fifty-nine patients were treated. A dichotomous structure of the SES could be confirmed. Reliability and internal consistency were moderate to excellent. Highest coefficients were found for the correlation between SES and GIPD scores. Self-esteem significantly increased over time, accompanied by an improvement of ADHD symptoms and related perceived difficulties. The Rosenberg SES was shown to be internally consistent, reliable, and sensitive to treatment-related changes of self-esteem. According to these findings, self-esteem may be an important individual patient outcome beyond the core symptoms of ADHD.

Young adult outcome of hyperactive children: adaptive functioning in major life activities

OBJECTIVE

The authors report the adaptive functioning of hyperactive and control children in southeastern Wisconsin (Milwaukee) followed to young adulthood.

METHOD

Interviews with participants concerning major life activities were collected between 1992 and 1996 and used along with employer ratings and high school records at the young adult follow-up (mean = 20 years, range 19-25) for this large sample of hyperactive (H; n = 149) and community control (CC; n = 72) children initially seen in 1978-1980 and studied for at least 13 years. Age, duration of follow-up, and IQ were statistically controlled as needed.

RESULTS

The H group had significantly lower educational performance and attainment, with 32% failing to complete high school. H group members had been fired from more jobs and manifested greater employer-rated attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms and lower job performance than the CC group. Socially, the H group had fewer close friends, more trouble keeping friends, and more social problems as rated by parents. Far more H than CC group members had become parents (38% versus 4%) and had been treated for sexually transmitted disease (16% versus 4%). Severity of lifetime conduct disorder was predictive of several of the most salient outcomes (failure to graduate, earlier sexual intercourse, early parenthood) whereas attention-deficit/hyperactivity disorder and oppositional defiant disorder at work were predictive of job performance and risk of being fired.

CONCLUSIONS

These findings corroborate prior research and go further in identifying sexual activity and early parenthood as additional problematic domains of adaptive functioning at adulthood.

Risk and protection in the development of problem behaviors in adolescents

The development of problem behaviors among adolescents is affected by complex interactions between risk and protective factors. This study was designed to determine whether selected risk and protective factors described among participants in the National Longitudinal Study of Adolescent Health predicted problem behavior cluster membership. Approximately, 13,000 adolescents from the Add Health study were examined. Three clusters of adolescents (exhibiting normal, problem, and deviant behaviors) and changes in cluster membership over 1 year were examined for relationships to specific risk and protective factors. Findings revealed that factors for current behavior problems differ from those for changes in cluster membership. These results suggest that approaches to preventing problems may differ from those required to help adolescents who are already manifesting problems.

Attention-deficit/hyperactivity disorder: an overview of the etiology and a review of the literature relating to the correlates and lifecourse outcomes for men and women

This paper provides a summary of the current conceptualization of what AD/HD is, and its etiology, and then reviews some of the recent literature on the correlates and lifecourse outcomes for individuals diagnosed with Attention-Deficit/Hyperactivity Disorder (AD/HD). The intention is to synthesize that which is known, and to identify important gaps in the literature and knowledge base, which secondary analysis of prospective large-scale longitudinal cohorts, tracking individuals from birth to adulthood, could help to fill. This review highlights the fact that such datasets are rare and that their analysis offers important opportunities for advancing knowledge, particularly of the adult outcomes of childhood AD/HD.

Differences in heterosocial behavior and outcomes of ADHD-symptomatic subtypes in a college sample

The purpose of this study was to explore heterosocial relational outcomes in a college-aged sample showing symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). Using questionnaires and a behavioral observation task, dating, sexual, and social outcomes were examined in three groups: 24 non-ADHD controls, 27 ADHD-Combined (ADHD/C) Type, and 13 ADHD-Primarily Inattentive (ADHD/IA) Type. The ADHD/IA group showed a consistent pattern of passivity and inexperience and was perceived relatively negatively by female confederates, whereas the ADHD/C group reported increased sexual drive and early dating experience. The effects of externalizing comorbidity differed by DSM-IV ADHD subtype. These findings indicate that ADHD-symptomatic adults differ by DSM-IV subtype in the manifestation of heterosocial deficits. Results suggest specific and divergent types of psychosocial intervention with ADHD/C versus ADHD/IA clients.

Low self-esteem and psychiatric patients: Part II - The relationship between self-esteem and demographic factors and psychosocial stressors in psychiatric patients

BACKGROUND: The objective of the present study was to identify the effects and relative importance of demographic factors and psychosocial stressors on self-esteem of psychiatric patients. METHOD: The present study was carried out on a consecutive sample of 1,190 individuals attending an open-access psychiatric outpatient clinic. Patients were diagnosed according to DSM III-R diagnostic criteria following detailed assessments. At screening, patients and controls completed two self-esteem questionnaires, the Rosenberg self-esteem scale and the Janis and Field Social Adequacy scale. In addition, a large amount of demographic and psychosocial data was collected on all patients. RESULTS: Significantly increased self-esteem was observed with an increase in age, educational achievement and income. Employed patients showed significantly higher self-esteem compared to unemployed patients. Female patients had a significantly lower self-esteem compared to male patients. The self-esteem of psychiatric patients did not vary significantly with their marital status. No relationship was detected between acute stressors and the self-esteem of psychiatric patients, although severe enduring stressors were associated with lower self-esteem in psychiatric patients. CONCLUSION: The results of this large study demonstrate that the self-esteem of adult psychiatric patients is affected by a number of demographic and psychosocial factors including age, sex, educational status, income, employment status, and enduring psychosocial stressors.

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 while, 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.

A study of self-perception in hyperactive children

PURPOSE

This research aimed to describe self-perception among hyperactive children in comparison with a general population of children of the same age.

DESIGN

A descriptive study with 116 children (between 6 and 11 years of age) distributed as follows: 57 hyperactive (20 girls and 37 boys) and 59 control group (25 girls and 34 boys). The hyperactive children were being treated at the outpatient clinic of a child psychiatry hospital. The children in the control group were recruited from a Quebec City elementary school.

METHODS

Children in both groups participated in an interview during which they answered the Self-Perception Profile for Children (r = 0.90) consisting of six well-defined subscales.

DATA ANALYSIS

Univariate analyses were used to describe the sociodemographic characteristics of both hyperactive and control group children. Groups were compared using t and chi-square tests. Univariate statistics were used to describe the characteristics of self-perception for each group overall and for each of the dimensions. Multivariate analysis was used to compare self-perception in hyperactive and control group children.

RESULTS

All dimensions of self-perception were lower among hyperactive children than among children in the control group, except athletic competence, which was higher. Multivariate analysis indicated that the dimensions of scholastic competence, social acceptance, and behavioral conduct were problem areas for hyperactive children.

CLINICAL IMPLICATIONS

Nursing care interventions for children with attention deficit hyperactivity disorder (ADHD) should be developed which assist children in increasing self-perception. This is a first step in developing a comprehensive plan of care.

Psychosocial adjustment and educational outcome in adolescents with a childhood diagnosis of attention deficit disorder

OBJECTIVE

To conduct a retrospective follow-up study of psychosocial adjustment and educational outcome in adolescents with a childhood diagnosis of attention deficit disorder (ADD) and a group of clinical controls.

METHODS

Groups included male and female subjects aged 14 to 18 years at time of follow-up with childhood diagnosis of ADD (cases; n = 48) versus other neurodevelopmental disorders (clinical controls; n = 37). Cases were also subdivided based on the presence of conduct disorder (CD) at follow-up. All groups were compared on measures of academic performance, self-esteem, behavior, alcohol and substance use, and adaptive functioning.

RESULTS

Cases had significantly lower academic performance and poorer social, emotional, and adaptive functioning than clinical controls. Cases with CD had significantly lower academic performance, greater externalizing behaviors and emotional difficulties, and lower adaptive functioning than cases without CD. Cases with CD fared worse than clinical controls on self-report measures of behavior, socialization skills, and alcohol and substance use.

CONCLUSIONS

These academic and psychosocial problems in adolescents with a childhood diagnosis of ADD suggest potential long-term ramifications for vocational and psychological functioning into adulthood. In addition, the presence of CD in some of these cases during adolescence appears to further increase the risk for maladaptive outcome.

Is self-esteem an important outcome in hyperactive children?

Using a prospective design, this study examined (a) whether hyperactive children suffer from low self-esteem as adolescents; (b) whether low self-esteem is associated with poor functioning in adolescence; (c) whether hyperactive children exhibit a positive illusory bias, in which self-esteem is independent of level of functioning; and (d) whether self-esteem in adolescence is associated with poor functioning in adulthood. Subjects were 65 children diagnosed as hyperactive in childhood, and 62 matched controls sampled from a medical clinic. After controlling for current mental disorder, the hyperactive cohort reported lower self-esteem in adolescence, was judged by clinicians to have lower levels of overall adjustment in adolescence, and had lower educational achievement and occupational rank in adulthood, as compared to controls.

Resilience and vulnerability in long term outcome of attention deficit hyperactive disorder

Follow-up studies of children with attention deficit hyperactive disorder show that they continue to have problems with restlessness, over-activity, impulsive behaviour and inattention, often resulting in serious academic, social and emotional problems in adolescence. Outcome in adulthood generally falls into three groups: fairly normal outcome, persistent attentional, social, emotional and impulse problems, and serious psychiatric and/or social pathology. Factors affecting outcome include characteristics related to the child (for example, health, temperament, IQ) and characteristics of the family (for example, socioeconomic status, emotional and psychological aspects of the family, family composition and structure, and the larger social and physical environment.

Hyperactivity in adolescence

The behavioral syndrome called hyperactivity is not outgrown in adolescence. Though excess activity becomes less prominent, emotional immaturity and academic underachievement develop into primary complaints. Antisocial behavior emerges as a serious problem in young adolescents. In late adolescence and early adulthood, many of these individuals apparently improve as they adjust to employment. There is some evidence that older adolescents display no more psychiatric disease or serious delinquency than matched controls. Those adolescents with persistent problems continue to respond favorably to stimulant medication, though often they resist pharmacologic treatment. The clinician is urged to advise patience and supportive tolerance in response to the persisting problems of the adolescent.