Here’s an interesting theory – what if ADHD doesn’t really exist? What if it exists in a small number of cases, yet for the rest of those kids who are distracted, hyperactive and impulsive – they are actually just narcissistic?
Furthermore, what are the implications for the hundreds of thousands of children being treated for ADHD if they are being unnecessarily treated with drugs they actually don’t need?
The theory has been raised by Dr. Enrico Gnaulati is his book titled ‘Back to Normal: Why ordinary childhood behavior is mistaken for ADHD, bipolar disorder, and autism spectrum disorders’, where he goes through most of the core symptoms of ADHD and shows how closely they resemble aspects of childhood narcissism.
He writes for The Atlantic, “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 behaviours point to maturational delays as opposed to ADHD.”
He says part of the problem is our familiarity with the symptoms of ADHD. More than any other disorder he says, it’s the one that comes to mind when kids are acting out or having trouble concentrating in school.
Normal childhood narcissism is defined by four tendencies:
- Overconfident self-appraisals.
- Craving recognition from others.
- Expressions of personal entitlement.
- Underdeveloped empathy.
But these four traits are remarkably similar to many of the "signals" of ADHD we commonly understand.
Writing for Psychiatric Annals, Karen Kernbery Bardenstein, Ph.D. says that, "The narcissistic child believes she possesses exceptional talents or intellect, she is haughty toward others and does not view others as important. The absence of reciprocity, as in taking turns, supports her inflated self-love. Others’ needs don’t matter to her. Her needs always prove more pressing."
The narcissistic child also cannot admit when they are wrong, refusing to take responsibility for their actions and showing no remorse when they hurts someone’s feelings. They will insists on going first in games and bend the rules to suit their needs. They will also outright lie to get out of trouble refusing to admit their mistakes.
Sounds like a lot of pre-schooler and primary school students doesn’t it? Sounds, also like a lot of ADHD diagnoses. Interestingly, pre-school and primary school is the age that ADHD is diagnosed, with some clinicians diagnosing children as young at four with ADHD.
In Australia, 11% of children and adolescents are said to have ADHD. But what if it is really a lot lower?
Dr Gnaulati says that in his practise many parents descriptions of their child’s supposed “ADHD-like behaviour” is actually an all too similarly description of normal and not-so-normal levels of childhood narcissism.
Jumping to conclusions about a child's symptoms he says is dangerous because many behaviours we associate with ADHD could also indicate anxiety, a learning disorder, or even, as Dr. Gnaulati points out, a lack of maturity.
"Does Ernesto have impulse-control problems or are his emotional boundaries underdeveloped?" he asks. "A poor evaluation from a harried paediatrician won't investigate the other possibilities."
The thing is that it's important narcissism is recognised and treated too.
The danger with a narcissistic child is that their lack of empathy and need to be the centre of attention can impede on their ability to relate to others, to see another’s point of view or to feel compassion. This inability to sustain healthy social relationships can lead to long term feelings of depression and anxiety.
A study released this year said that parents who "overvalue" their children, teaching them that they are entitled to special treatment, are more likely to produce narcissistic children.
Dr. Gnaulati says that parents cannot, and should not, be constant sources of unqualified praise. “They only need to be good enough in their recognising efforts. It is also important that parents do not emotionally rescue their kid when his or her pride gets injured," he said.
But how do you help a narcissistic child?
Dr. Michele Borba writes that you can help a narcissist through three strategies:
1. Refocus Praise: Temper those oohs and ahhs that focus only on your kid. Watch out for lavish sugar-coated, undeserved praise and giving out a trophy for every little thing.
2. Face-to-Face Interaction: Narcissistic, entitled kids shut down their capacity to understand where other people are coming. Because they only focus on “ME,” it’s hard to put themselves into someone else’s shoes and feel how they feel. So nurture your their empathy.
3. Stress We Not Me: The best way to learn benevolence and selflessness is not lecturing about it but providing kids with real opportunities to do for others.
But how do you truly differentiate between ADHD and other conditions?
According to a study in 2010, there were over one million misdiagnosed cases of ADHD. That's a lot of unnecessarily medicated children. Experts also say that other incorrect diagnoses of ADHD may in fact be just low blood sugar levels, overtired kids or hearing problems.
It's a concern.
In Australia in order to get an ADHD diagnosis, children must display inattention and/or hyperactivity symptoms for at least six months.
The National Health and Medical Research Council clinical practice guidelines say that they must have displayed symptoms since early childhood - before age seven. This must affect their behaviour at school, at home or socially. Also there must also be no better alternative explanation for the symptoms.
In a view at odds with Dr Gnaulati, Dr David Coghill a Scottish based expert who leads the team at the Developmental Research Group at the University of Dundee’s Division of Neuroscience says there is no need to worry yet.
He told Australian Medicine that the diagnosis of ADHD was still a reasonably rare condition that was hardly suggestive of an epidemic of over-diagnosis.
He said that just as important as the diagnosis of ADHD is its treatment saying that while more than three-quarters of children diagnosed with ADHD are being given drugs intensive non-pharmaceutical therapies could be effective as the first line of treatment for those with milder forms of ADHD.
As the debate rages over the condition the experts all advise to seek help early - and make sure it's comprehensive help. Your GP and a specialist are your best source of information.
Do you think ADHD is over diagnosed?