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 a nd medication use, and to identify predictors of low self-esteem while adju sting for sociodemographic factors. Method: In a school district-wide sampl e of children in special education programs, the authors assessed self-este em with the Piers-Harris Self-Concept Scale among 143 students at high risk for attention-deficit/hyperactivity disorder (ADHD) in the school year 199 5, with an interview participation rate of 73%. Disorder characteristics an d medication use were assessed using multiple informants and standardized m easures. Results: Self-esteem scores, on average, were in the normal range. However, across ADHD comorbidity profiles, children with ADHD and internal izing symptoms had significantly lower self-esteem scores, especially in th e areas of anxiety and popularity, than children with ADHD alone or those w ith comorbid disruptive behavior disorders. Independent predictors of lower self-esteem were being white, high functional impairment, and comorbid int ernalizing conditions, but not medication use. Conclusions: Findings sugges t that interventions for ADHD should be culturally sensitive as well as aim ed at improving a child's functional level and associated internalizing sym ptoms. Medication use among this younger patient group was not related to s elf-esteem scores.