Although it is generally assumed that children with ADHD tend to think poorly about themselves, there have actually been relatively few studies in which the self-concepts of children with and without ADHD have been compared, and the results of those studies have been mixed. Thus, some researchers have reported that children with ADHD regard themselves less favorably in a number of different domains than other children, while other researchers have not found these differences.

A related area of research has examined the appraisals that children make of their own performance immediately following their participation in a laboratory task. Thus, in these studies, researchers have examined how the self-appraisals of ADHD children vary in situations where their actual level of performance is objectively known. Regardless of whether the tasks have involved academic or social activities, boys with ADHD tend to report they did better than what was shown to actually be the case. Boys without ADHD, in contrast, evaluate their performance more accurately.

Findings from these laboratory studies have led some researchers to speculate that boys with ADHD (unfortunately, girls with ADHD have not been included in this research) have "positive illusory self-concepts". It has been argued that holding unrealistically positive views about themselves may serve an important protective function for boys with ADHD, by allowing them to cope with repeated failures without adverse psychological consequences. Other psychologists have suggested, however, that this "self-protective" strategy may interfere with the remediation of their problems if it leads them to deny that they have problems at all.

Although these are interesting speculations, it is important to recognize that there has been no previous research in which the self-concept of children with ADHD has been examined in relation to their actual abilities and competencies. The laboratory studies mentioned above deal with children's appraisals of their performance on specific tasks, and findings from these studies may not generalize to the more enduring views children hold of themselves. Thus, the question of whether children with ADHD have inflated self-concepts has not been systematically examined.

Do boys with ADHD actually have "positively illusory self-concepts" as some have suggested? This question was examined in a study published recently in the Journal of Abnormal Psychology (Hoza, B. et al, 2002, 111, 268-278.) Participants in this study were 268 boys between the ages of 7 and 13. The majority of these boys (195) had been diagnosed with ADHD and was participating in an intensive summer treatment program. The remaining 73 boys did not have ADHD and were included as comparison subjects. Unfortunately, as has often been the case in research on ADHD, females were not included as participants.

Participants' self-perceptions were assessed using the Self-Perception Profile for Children (SPPC), a widely used instrument that assesses children's views of themselves in five specific areas: academic performance, social competence, physical appearance, athletic competence, and behavioral conduct. In addition to these domain-specific ratings, the SPPC also includes items designed to assess children's general feelings of self-worth. The idea behind this measure is that children have domain-specific self-perceptions that can vary from one area to another, in addition to more general feelings about themselves that are not domain-specific.

To assess the boys' actual competencies in the different domains assessed by the SPPC, their teachers completed a teacher version of this measure. Teachers' responses to the same sets of items were regarded as providing an "objective" assessment of how the boys were actually doing in each domain, and provided a benchmark against which boys' self-ratings could be compared. When a child's self-ratings were higher than the ratings provided by his teacher in a particular domain, it suggests that the child's self-perceptions in that domain were inflated. Similarly, if a child's self-ratings were lower than those of his teacher, it suggests that the child was being unrealistically negative. When child and teacher ratings corresponded, it was assumed to reflect the fact that the child had an accurate perception of his competence. (Note: The teacher measure did not include items reflecting children's feelings of general self-worth because these reflect a child's views of self that are independent of specific areas of competence, and thus can not be compared to an "objective standard".)

The researchers predicted that, although the self-perceptions of ADHD boys might not differ from those of comparison boys in an absolute sense, they would be inflated relative to the "objective" ratings provided by teachers. In other words, they expected to find that ADHD boys had "positive illusory self-concepts". Furthermore, they expected the greatest inflation would be found in those domains that were most problematic for the boys. Thus, for boys with ADHD who also had significant learning problems, their self-concept in the academic domain was expected to show the greatest inflation. For ADHD boys who were also highly aggressive, the greatest inflation was expected in the behavioral and social domains. For ADHD boys who were depressed, no domain-specific predictions were made. These boys, however, were expected to report the most negative feelings about themselves on the general self-worth scale.

RESULTS

To determine whether boys with ADHD overestimate their competence relative to the comparison boys, the authors first compared the size of the discrepancy between self- and teacher-ratings for children in the two groups. Results indicated that boys without ADHD tended to rate themselves similarly to the way in which their teachers had rated them in all domains. Boys with ADHD rated themselves as more competent than their teachers had rated them in the academic, social, and behavioral domains. The discrepancy between self-ratings and teacher-ratings for ADHD boys was significantly higher than that for comparison boys in every domain. In other words, their ratings of their own competence were inflated relative to how their teachers regarded them.

It is interesting to note that the self-competence ratings for boys in the two groups did not differ in an absolute sense. Thus, the ratings made by boys with ADHD were equivalent to those given by comparison boys, indicating that ADHD boys did not regard themselves as either more or less competent than the other boys. As noted above, however, comparisons to the teacher ratings indicated that, for boys with ADHD, these views of themselves are overly positive and do not reflect the opinions of their teachers that are presumed to be more objective.

The researchers next examined whether ADHD boys who had additional problems with aggressive behavior, academic achievement, or depression tended to overestimate their competence in these specific areas. It was predicted that boys with ADHD would overestimate their competence to the greatest extent in the domains that were most problematic for them.

As predicted, ADHD boys with aggressive-behavior problems overestimated their competence to the greatest extent in the behavioral and social domains. Not only was the discrepancy between self- and teacher-ratings for these boys greater than for non-ADHD comparison boys, it was also greater than the discrepancy for ADHD boys without aggressive-behavior problems. For ADHD boys with co-occurring learning problems, the greatest overestimate was found for ratings of academic competence. Compared to non-ADHD boys and ADHD boys without significant learning difficulties, these boys had significantly larger discrepancies between self- and teacher-ratings.

The situation for ADHD boys who also were depressed was somewhat different. These boys were the only group to underestimate their physical appearance, rating themselves as less attractive than their teachers rated them. Relative to comparison boys, they overestimated their competence in the behavioral domain, but to a lesser extent than ADHD boys without depressive symptoms. In the social and academic domains, their self-ratings were not inflated. On the global self-worth scale, they had significantly lower scores than boys without ADHD and ADHD boys who were not also depressed.

SUMMARY AND IMPLICATIONS

The major findings of this study were: ADHD boys overestimated their self-perceptions more than comparison boys in scholastic, social, and behavioral domains relative to how their teachers regarded them; and, examination of ratings provided by boys in the different subgroups indicated that they overestimated their competence the most in those domains in which they were most impaired. Thus, even though they did not rate themselves more favorably than comparison boys in an absolute sense, boys with ADHD perceived themselves to be far more competent than their teachers did. The primary exception to this was for ADHD boys who were also depressed, as these boys regarded themselves negatively in several areas, including their feelings of global self-worth.

As noted earlier, some researchers have argued that these inflated self-perceptions serve a self-protective role for boys with ADHD, buffering them from the adverse psychological consequences associated with daily struggles and difficulties. This explanation suggests that ADHD boys may not be deliberately overstating their capabilities, but may be "deceiving themselves" in an effort to avoid feelings of inadequacy. Alternatively, the authors suggest these findings may represent either a conscious attempt at impression management (i.e. wanting to present themselves favorably to others), or the fact that they lack the necessary knowledge about what constitutes successful vs. unsuccessful behavior.

What are the implications of these results for treatment? There is a lack of clarity on this issue in the literature. Some have suggested that if ADHD boys overestimate their actual competence, their self-perceptions need to be altered to more accurately reflect the reality of their situation. Proponents of this view argue that, unless boys with ADHD develop an accurate appraisal of their abilities and how others perceive them, they will not be motivated to work on changing their problematic behavior. Others have expressed concerns that such "humility training" could be damaging to boys' self-esteem. Clearly, there is no simple answer to this question, and research that specifically examines the treatment implications of these findings would be important to conduct.

As with any study, it is important to be careful not to generalize the results of this research beyond what is reasonable. First, the findings obtained apply only to boys with ADHD, and whether ADHD girls show the same tendency to overestimate their competence is not known. Second, it should not be assumed that these findings apply to all boys with ADHD. Thus, many boys with ADHD -- even those who are not also depressed -- will regard themselves quite negatively, rather than overestimating their competence as was reported here. This may be especially true as boys with ADHD move into adolescence, and replicating this study with a teenage population would be an important extension of this research.

We also do not know what the implications of these findings are for the immediate or longer-term adjustment of boys with ADHD. Does the tendency to overestimate one's competence create more trouble for these boys because it eliminates the motivation to work on their difficulties? Or, does it protect them from becoming discouraged and despondent? Questions like this can only be answered by following boys over time, and examining their ongoing adjustment in relation to the types of discrepancies between self-perceptions and ratings provided by others that were the focus of this study. This is difficult work, but the results of such a longitudinal study would be extremely interesting and informative.