PEDIATRICS Vol. 83 No. 2 February 1989, pp. 211-217
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Self-Esteem in Children Medically Managed for Attention Deficit Disorder

Patrick C. Kelly DO1, Melvin L. Cohen MD2, William O. Walker MD3, Owen L. Caskey EdD4, and A. W. Atkinson MD, PhD5

1 The 97th General Hospital, Frankfurt, West Germany
2 Developmental Pediatrics, San Antonio, Texas
3 Exceptional Family Member Department, Second General Hospital, Landstuhl, West Germany
4 the El Paso Independent School District, El Paso, Texas
5 William Beaumont Army Medical Center, El Paso, Texas

Self-esteem was measured initially in a group of 21 eight- to 12-year-old children with newly diagnosed attention deficit disorder/hyperactivity and remeasured after 1-month courses of treatment with methylphenidate and placebo given in double-blind cross-over fashion. Multimodal management of all patients included diagnosis, demystification, medication, close follow-up with supportive counseling, and referral as indicated for psychosocial and educational assistance. Long-term follow-up of 12 children who continued to receive methylphenidate was done for an average of 16 months. Initial total self-esteem was low in 30% of all subjects, intermediate in 55%, and high in 15%. No statistically significant changes occurred in self-esteem during the short-term phase of the study despite clinically significant behavioral responses to medication as assessed by serial questionnaires. At long-term follow-up, total, general, and academic self-esteem scores were improved significantly, however. These findings indicate that many preadolescents with attention deficit disorder/hyperactivity exhibit low self-esteem. Despite clinical response to medication, short-term improvement in self-esteem may not occur; however, long-term, multimodal management that includes medication does appear to improve self-esteem.

Key Words: self-esteem • methylphenidate • attention deficit disorder • hyperactivity

Submitted on November 3, 1987
Accepted on March 16, 1988




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