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NewsNotes
Monthly NewsNote
February 2006
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ADD, Self-Esteem, And Treatment
After I have seen a child in an ADD evaluation, the parents often ask what it
is that makes me recommend medication as a treatment. Often, and without hesitation
my answer is “poor self-esteem.” I believe this is a major problem
for most children with ADD and will discuss the subject in this NewsNote.
Poor self-esteem can come about in several ways. It can be due to the comments
of other children. Or it can be the child’s awareness that he is falling
short of the expectations of peers or teachers. Of course hurtful comments made
by parents out of anger or frustration have a negative impact. This is not a
complete list, but what we need for our discussion.
Remember that the usual ADD symptoms aren't silent; they're easily noticed
by others -- peers, teachers, parents -- and lead to those around the child
developing a negative image of his behavior. These behaviors include hyper or
restless activity, inattention, failure to complete work in class, disruptive
behavior, poor test results and, later in the day, trouble with homework. As
a result, the student is open to teasing by other children, critical comments
from teachers, and frustration and anger from parents. I think most of us have
seen the ad in which the parent is yelling at the child who says “Face
it, I’m not going to college.”
Often the child feels dumb or stupid because of the ADD difficulties. Part
of the problem is that he is criticized by most of the people around him with
very few offering unqualified support. The child lives with the feelings of
inadequacy that get worse as the grades get higher.
Ronald is a case in point. He struggled in class and had trouble with homework.
Every night he asked his mother if he was stupid. These questions tore Mom up
because of his obvious unhappiness. She didn’t know what to say except
“You’re very smart.” But what went on around him made him
feel stupid despite what his Mom said.
Ted was not much different. He was teased because he blurted out answers, often
lost his homework, and was told by his teacher to “pay attention.”
And he sat in the front of the room, which singled him out and made him feel
different.
As you can see, in many cases the symptoms of ADD and the behavior it causes
leads directly to poor self-esteem. This, as I noted earlier, is a major problem
in the feelings a child has about himself and I believe it needs to be acted
on.
Certainly treatment, including cognitive behavioral therapy, can be helpful.
But in these situations I think medication is essential. In my experience, the
most effective way to improve self-esteem is to reduce or remove the symptoms
we have discussed.
Medication does this best and allows the child to see himself in a different
light, to improve school and social areas and to make therapy more successful.
Therefore, for me self-esteem is a key in my evaluation and a reason for treatment
with medication. When I explain this to the parents, they understand.
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