ADHD & The Legacy of Shame: Part I

ADHD is a multifaceted condition, and when I work with children hindered by it, I try to help them with as many of its facets as I can. I advocate for ADHD kids, especially at school, and encourage them to be more effective in advocating for themselves. I show them techniques for planning, organizing, structuring their time, and managing their schoolwork. And I coach them to develop coping skills that utilize their self-awareness, sense of humor, and reliance upon their own strengths. More often than not, however, the most important part of my work with ADHD kids will focus on the much more sensitive work of helping them learn to face what, for many, will become the most enduring and distressing outcome of their struggle with attention and self-regulation: a pervasive and painful feeling of shame.

Their shame can have many sources, but the most influential are those too frequent moments when they receive the message that they have once again failed to meet the expectations or gain the approval of others. A study recently cited by reported that by the age of 12, children who do have ADHD will receive 20,000 more of these negative messages than will children who do not. Most will come from parents and teachers, and the majority will concern the ADHD child’s performance in school.

The messages are not simply heard. They are “internalized,” becoming rooted so deeply and completely that the perceived beliefs of others become the children’s own assumptions about themselves. ADHD kids hint at these when they describe themselves with such words as lazy, slow, stupid, defective, disappointing, underachiever, screw-up, reject, dummy, loser, or failure. They may also express their negative self-concepts in more raw and explicit ways by saying such things as I’m not as good as the other kids…I’m not good at all… I’ll never be good enough…I’m useless and worthless…I hate myself. Edward Hallowell, MD, the internationally known expert on ADHD and a victim of the condition, describes the feeling this way: “You imagine harsh judges everywhere, as if the world were swarming with strict fifth grade school teachers…Soon the world becomes like a huge set of judgmental eyes, looming down on you, and your only option is to hide.” When we feel bad about things we have done, what we experience is guilt. Shame is something else. It is what we experience when we feel bad about who we are.

The shame of ADHD kids can have a profound impact on their lives. It can trigger their anger, spark their anxiety, fuel their depression, undermine their social relationships, corrode their motivation, and immobilize them in the face of challenge. At some times it can make them want to act out in angry or self-defeating ways. At others it can make them want to withdraw from people and go unnoticed. Even after they reach adulthood, when their symptoms subside and their strengths prevail, their shame can linger as a bitter after-taste that taints their pride and blocks their success. For many ADHD kids, shame will become the meanest, most intractable, most hurtful legacy of their uphill battle to feel normal. Perhaps that is why mental health professionals who use the word “shame” so often pair it with the word “toxic.”

Because shame can be the most painful of human emotions, ADHD kids (like the rest of us) will seek ways to protect themselves against feeling it, a phenomenon psychologists describe as developing defenses. The following are some of the most common defenses among ADHD kids.

Deny. Their denial tends to occur at two levels. The first is to acknowledge that there is a problem but to disown responsibility for it, instead blaming someone else. This is what may be happening when children say such things as the teacher never said I had to do that assignment…I did turn it in so she must have lost it, or she just doesn’t like me. Many children will take denial to a second, more guarded level, disclaiming responsibility for a problem by maintaining that it does not exist. They may insist that there is no such thing as ADHD. They may claim they don’t have it. They may acknowledge their difficulty in the classroom but attribute it to something else such as too little sleep or too many responsibilities. They may proclaim that they don’t care about school, don’t listen to criticism, don’t worry about grades, and don’t mind if they fall behind. Or they may attempt to avoid shame altogether by hiding their deficiencies behind a facade of competence, acting as though they have an abundance of self-assurance when in reality they have little. The implicit belief behind these means of denial is that they can spare themselves the shame of failure if they disavow the hope for success.

Get Angry. Nature gave us anger to help us defend against threats. In the instinctive context of “fight or flight,” it fuels the impulse to fight, and when the threat is external this is what we may prepare to do. However, we also use anger to defend ourselves against internal threats, including the prospect of experiencing the sense of worthlessness that typifies shame. Psychologists sometimes refer to anger as a secondary emotion, a less painful feeling that protects us from a primary, more painful one. For many ADHD children, anger is secondary to the sadness and self-loathing that are fellow travelers with shame.

Defy. Some ADHD kids will express their anger in the more intense ways that lead to negative behaviors and the other diagnoses so common among ADHD kids. These include Oppositional Defiant Disorder, Conduct Disorder, and a new diagnosis introduced in 2014, Disruptive Mood Dysregulation Disorder. These conditions are characterized by fits of temper or rage; by refusal to comply with adults and their rules; by disrupting the home or school environment; or, in the extreme, by causing harm to people and property. Even though a child may know that these patterns of behavior can create potential obstacles in the future, the risk often seems preferable to the emotional hurt of shame that seems certain in the present.

Be Funny. When I was an ADHD child, this was my preferred defense against shame. Because I could seldom gain approval in the classroom for my academic accomplishments, I tried to get it by making others laugh, often blurting out comments I thought were humorous. If teachers thought the same, I did get a sort of approval. If not, I got disciplined. Through the first five grades, I spent hours and hours serving “time outs” in the hallway or coat closet. I took secret pleasure in knowing that when I was found daydreaming, I would be banished to places where I had the unfettered freedom to daydream some more.

Stop Trying. This is the ultimate defense, the one described by teachers and parents with such words as unmotivated, disinterested, even lazy. It is usually none of these. Rather it is a behavioral response to multiple past failures, a refusal to risk any more in the future, and a shutting down of effort that follows a shutting out of optimism. Children who utilize this defense may stop doing their work. They may stop asking for help. They may appear lost or unresponsive. They may fall asleep in school or begin cutting classes. In doing so, they are using behavior to communicate a decision: For fear of more failure, I have stopped investing in the hope of success.