Self-esteem, sense of coherence and attention deficit hyperactivity disorder : a longitudinal study from childhood to adulthood

Abstract

Background: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common behavioural disorders in school-aged children. The prognosis in adulthood can sometimes be problematic in different aspects related to education, employment, socialization, and overall mental health. The functional impairment of ADHD has been related to the development of a low self-esteem. However, there are reports describing children and adolescents with severe ADHD symptoms that do not report problems such as low self-esteem or problems in school or social competencies.

Aim: Self-esteem and sense of coherence (SOC) are both seen as important factors for health and therefore, the overall aim of this thesis was to examine the longitudinal and concurrent relationship between low self-esteem, SOC and ADHD from childhood to young adulthood.

Method: The data used in all four papers came from the longitudinal Twin study of Child and Adolescent Development (TCHAD). The twins and/or their parents have been contacted in four different waves. Wave 1 was in 1994 (twins were 8-9 years old) and wave 2 was in 1999 (twins were 13-14 years old). In 2001, a clinical study with a sub sample including the twin pairs living in the Stockholm county area (twins were 15-17 years of age) and finally Wave 4 was in 2006 (twins were 20-21 years old). I used DSM III based ADHD criteria in order to study ADHD symptoms in Paper I and II and DSM IV based criteria for ADHD symptoms in Paper III and IV. We used the "I think I am" questionnaire in Paper I, II and III for the purpose to study self-esteem and the SOC scale in Paper IV.

Results: There was a long-term relationship between ADHD-symptoms in childhood and a low self-esteem in adolescence. However, the patterns of findings in ADHD discordant MZ and DZ twins could indicate the association is not causal but instead problems caused by a common factor for example personality traits due to a genetic factor. A low self esteem in adolescence was associated with a high score of ADHD symptoms in early adulthood, especially with the development of the inattentive subtype of ADHD compared with the hyperactive/impulsive subtype. Children with high scores of ADHD symptoms often seem to have profiles of self-esteem characterized by low scores in the domains skills and talents and psychological well-being.

However, more than a few children with high score ADHD had profiles characterized of good self-esteem. In addition, children with the most persistent high scores of ADHD symptoms had relatively good self-esteem profiles. SOC could be a protective factor for the development and the maintenance of mental and physical health. This hypothesis was supported by the findings of a statistically significant interaction between SOC and ADHD at 16 on the outcome, i.e. ADHD at 21 years. The young persons with high (SOC) at age 16 had a low score of ADHD symptoms at age 21 even if they had a high ADHD score at age 16.

Conclusions: There was a longitudinal relationship between low self-esteem and high scores of ADHD symptoms from childhood to early adulthood. A high SOC seems to be a good predictor for a reduction of ADHD symptoms from adolescence to early adulthood.