In a typical American classroom, there are nearly as many diagnosable cases of ADHD as there are of the common cold. In 2008, researchers from the Slone Epidemiology Center at Boston University found that almost 10 percent of children use cold remedies at any given time. The latest statistics out of the Centers for Disease Control and Prevention estimate that the same proportion has ADHD.
The rising number of ADHD cases over the past four decades is staggering. In the 1970s, a mere one percent of kids were considered ADHD. By the 1980s, three to five percent was the presumed rate, with steady increases into the 1990s. One eye-opening study showed that ADHD medications were being administered to as many as 17 percent of males in two school districts in southeastern Virginia in 1995.
With numbers like these, we have to wonder if aspects of the disorder parallel childhood itself. Many people recognize the symptoms associated with ADHD: problems listening, forgetfulness, distractibility, prematurely ending effortful tasks, excessive talking, fidgetiness, difficulties waiting one’s turn, and being action-oriented. Many also may note that these symptoms encapsulate behaviors and tendencies that most kids seem to find challenging. So what leads parents to dismiss a hunch that their child may be having difficulty acquiring effective social skills or may be slower to mature emotionally than most other kids and instead accept a diagnosis of ADHD?
The answer may lie, at least in part, with the common procedures and clinical atmosphere in which ADHD is assessed. Conducting a sensitive and sophisticated review of a kid’s life situation can be time-consuming. Most parents consult with a pediatrician about their child’s problem behaviors, and yet the average length of a pediatric visit is quite short. With the clock ticking and a line of patients in the waiting room, most efficient pediatricians will be inclined to curtail and simplify the discussion about a child’s behavior. That’s one piece of the puzzle. Additionally, today’s parents are well versed in ADHD terminology. They can easily be pressured into bypassing richer descriptions of their kid’s problems and are often primed to cut to the chase, narrowly listing behaviors along the lines of the following:
Yes, Amanda is very distractible.
To say that Billy is hyperactive is an understatement.
Frank is impulsive beyond belief.
All too often, forces conspire in the doctor’s office to ensure that any discussion about a child’s predicament is brief, compact, and symptom-focused instead of long, explorative, and developmentally focused, as it should be. The compactness of the discussion in the doctor’s office may even be reassuring to parents who are baffled and exasperated by their kid’s behavior. It is easy to understand why parents may favor a sure and swift approach, with a discussion converging on checking off lists of symptoms, floating a diagnosis of ADHD, and reviewing options for medication.
In my experience, the lack of a clear understanding of normal childhood narcissism makes it difficult for parents and health-care professionals to tease apart which behaviors point to maturational delays as opposed to ADHD.
What is normal childhood narcissism? It can be boiled down to four tendencies: Overconfident self-appraisals; craving recognition from others; expressions of personal entitlement; and underdeveloped empathy.
Let’s start with overconfident self-appraisals. The veteran developmental psychologist David Bjorklund says the following of young children:
Basically, young children are the Pollyannas of the world when it comes to estimating their own abilities. As the parent of any preschool child can tell you, they have an overly optimistic perspective of their own physical and mental abilities and are only minimally influenced by experiences of “failure.” Preschoolers seem to truly believe that they are able to drive racing cars, use power tools, and find their way to Grandma’s house all by themselves; it is only their stubborn and restricting parents who prevent them from displaying these impressive skills. These children have not fully learned the distinction between knowing about something and actually being able to do it.
It is normal for preschoolers to think big and engage in magical thinking about their abilities, relatively divorced from the nature of their actual abilities. Even first graders, according to research by psychologist Deborah Stipek of the University of California at Los Angeles, believe they are “one of the smartest in the class,” whether this self-assessment is valid or not. The play of young children is full of references to them being all-powerful, unbeatable, and all-knowing. As most parents intuit, this overestimation of their abilities enables young children to take the necessary risks to explore and pursue activities without the shattering awareness of the feebleness of their actual abilities. For maturation to occur, kids need to get better at aligning their self-beliefs about personal accomplishments with their actual abilities. They also need to get better at realizing how a desired outcome is fundamentally connected to how much effort and commitment they put into a task. The ways in which caregivers deal with kids’ successful and not-so-successful demonstrations of supposed talents have a bearing on how well kids form accurate beliefs about their true abilities. This brings us to the next ingredient of normal childhood narcissism—recognition craving.
The eminent psychoanalyst Dr. Heinz Kohut had much to say about kids’ showiness and its role in the acquisition of self-esteem. He was the one who brought the concept of narcissism into the spotlight during the 1980s. He proposed that adequate handling of a kid’s “grandiose-exhibitionistic needs” is one pathway toward establishing a kid’s basic sense of self-worth. Consider, for example, a toddler who discovers for the first time that she can run across the living room unassisted. She brims with pride and is delighted by her masterful display. Her mood is expansive. She turns to caregivers for expressions and gestures that mirror back her sense of brilliance. Appreciation and joy shown by caregivers during these moments of exhibitionistic pride are absorbed like a sponge and become part of the child’s self-experience. Such praise becomes the emotional glue that she needs to hold together a basic sense of aliveness and self-worth.
Disappointment, of course, always lurks around the corner. Kids cannot always flawlessly swing across the monkey bars or execute a perfect cartwheel. Parents are not always able to pay undivided and sensitive attention to their kids’ efforts. And parents cannot, and should not, be constant sources of unqualified praise. They only need to be good enough in their recognizing efforts. It is also important that parents do not emotionally rescue their kid when his or her pride gets injured. Gushy statements aimed at putting Humpty Dumpty back together again should be avoided. When a narcissistically needy seven-year-old loses in a footrace with Joey, a neighbor, it’s better to avoid saying, “You are a great runner. Your dad and I even think you’ll be a wide receiver one day. Come on now. Wipe off those tears.” What his emerging sense of self needs is something more like this: “Honey, I’m so sorry you lost. ... I know how bad you must feel. ... It feels so great to win. ... But you know Joey is on the all-star soccer team and has been practicing his running for months. It’s gonna be tough to race against him anytime soon. You can always jog with your dad on Saturday mornings. That will surely make your legs stronger, and who knows what might happen?” This sort of measured response ensures that kids will develop realistic self-appraisals. It also aids with the sort of self-talk that kids need to acquire to help them restore their self-esteem in the face of failures and setbacks, without crumbling in shame or lashing out at others because their pride has been injured.