Amongst the unfortunate side effects of undiagnosed ADHD are cripplingly low self-esteem, self-harm, eating disorders and risky sexual behaviour. In a world where you feel like you do not fully fit in, where you have no control over the way other people perceive you or how to regulate your emotions and behaviour, being able to control something in your life becomes increasingly important in your teenage years- and your own body is often the only thing that you are able to fully control.
Unfortunately this can often have devastating effects.
Adolescence is difficult for everyone, regardless of neurodevelopmental conditions, and as children grow into teenagers and start to gain freedoms they never possessed before, develop new friendships, discover their sexuality and begin to find their place in the world it can be very challenging. Hormones are raging, the body is changing, acne, braces, voices are dropping, breasts are developing, there are growth spurts, and everyone feels awkward about themselves- whilst also developing attraction to each other.
I do not think anyone would go back to that period of their lives if they were paid.
As a teacher who has been based in the upper Primary -Primary 4-7 (Year/Grades 3-6)- for the last seven years, I have often been dismayed and alarmed by the introduction of social media into the mix for our young people and have dealt with particularly unpleasant incidents of online bullying that have caused me to lie awake at night with distress. As the mother of a 12-year-old son, part of me wishes I could fast forward a few years so that my son does not have to experience these horrors, but equally I realise that this is a great age to enjoy a brilliant young man who, so far, is uninterested in social media and to fast forward would mean losing out on some great memories we could create.
It is a tough life being a teacher and parent these days.
Even tougher still if the adolescent(s) in your life have a neurodevelopmental condition and if that condition is undiagnosed, it can take an incredible toll on both the child and family.
This post is the first of three looking at self-esteem, self-harm, eating disorders, risky sexual behaviours and how we can help children with ADHD to tackle these issues that can blight their lives from childhood, through adolescence and beyond.
**I am not a doctor, I am a teacher and adult with ADHD. It is important to remember that if you suspect someone you know of self-harming or having an eating disorder to be open, listen to them, refrain from judgement and seek appropriate medical advice**
Self-esteem is a measure of how we see ourselves, our personal achievements, our value and our sense of worth and is important because it helps children feel proud of who they are and what they do. Children, adolescents, and adults with ADHD may hear negative or naive comments from classmates, teachers, friends, and family so may have lower self-esteem if they see themselves as “different” to others.
Sometimes the symptoms of ADHD mean that the child needs extra time to take tests or finish tasks, which can draw attention in school and lead to further embarrassment and negative comments.
How is self-esteem affected by ADHD?
Many children with ADHD have problems in school and sometimes have difficulties at home and many find it difficult to make and keep friends.
Children with ADHD report feeling stupid, naughty, bad or a failure and unsurprisingly, their self-esteem takes a battering and they find it hard to think anything positive or good about themselves.
Hyperactive or disruptive behaviour is sometimes observed in children and young people with ADHD and while they can’t help their behaviours, teachers with a lack of adequate training and support often exclude children with ADHD from class as a way of managing the behaviours associated with ADHD.
This can then have social implications as other parents may not want to invite a child with a reputation for bad behaviour to birthday parties or social events- which reinforces the idea that they are ‘naughty’ and unwelcome.
Signs of low self-esteem
The following are signs of low self-esteem that parents or family may recognise in a child or adult:
- Difficulty with praise- the person may interpret everything they hear as criticism.
- Loss of confidence in familiar tasks or hobbies.
- Lacks interest in trying anything new due to fear of failure or criticism.
- Moodiness, anxiety and depression.
- Poor concentration.
- Unable to make decisions.
- Difficulties sleeping.
- Communication difficulties- including difficulties with asserting themselves.
- Neglect of their person- including personal hygiene.
Self-harm is a major public health issue amongst young people worldwide and numerous studies have indicated that ADHD is associated with suicide, suicide attempt and suicide ideation- but ADHD is also associated with other self-harm behaviours.
Self-harm is where a person seeks to relieve their pain or distress by cutting or burning themselves, banging heads or parts of their bodies against walls, hair pulling or biting. Self-harm can also include self-poisoning and overdose. During teenage years, self-harm is four times as prevalent in girls as boys.
The main triggers behind self-harm are severe anxiety, impulsivity, depression and low self-esteem.
Whilst there is no reliable method of predicting which children might seek to self-harm, it appears to be prevalent in children who face a combination of pressure in their school and home life and research has shown that self-harm is more likely amongst children who have strong feelings of guilt, frustration, anger and impulsivity.
These emotional and psychological factors are especially prevalent in children with ADHD, and where the condition is not adequately addressed at home and school.
Self- harm is not a suicide attempt, it is also not attention seeking behaviour as many self-harmers go to great lengths to conceal the damage they cause themselves and it should not be dismissed as a cry for attention but rather as a cry for help or an expression of extreme anxiety, frustration and lack of control. Children and adolescents with ADHD often find social relationships and interactions very challenging and this frustration can manifest itself in self-destructive ways that harm the person while they seek ways to manage their feelings and seek control.
It is estimated that more than 50% of girls with combined type ADHD engage in self-harm and 22% attempt suicide in a 2012 UC Berkeley study, and whilst girls with Inattentive Type ADHD aren’t as likely to harm themselves as girls with Combined Type ADHD, they are still more likely to harm themselves than girls without ADHD.
It is also important to note that the majority of studies into self-harm focus on girls but in recent years it has been found that boys are more likely to self-harm than previously thought, particularly if they have ADHD.
This obviously has massive implications across several sectors- mental health, accident and emergency, sexual health (as I will explain tomorrow) and education being the most obvious. But undiagnosed ADHD and these problems has a wider reach in terms of housing, criminal justice and employability- so an understanding of ADHD in children from an early age and a recognition of the wider implications is necessary in order to help children reach their full potential- educators are crucial in this.
Tomorrow I will continue my posts on this topic by looking at eating disorders and risky sexual behaviour and the links to ADHD.
Please leave constructive feedback and share with anyone you think may benefit from reading this post.
Sources from the series