Attention-Deficit/Hyperactivity Disorder Symptom Severity and Increased Risk for Impaired Self-Esteem

Objective: Elevations in attention-deficit/hyperactivity disorder symptoms are associated with impaired self-esteem, but it is unknown how symptom levels contribute to self-esteem. Using cross-sectional samples from the general population, this study examined whether academic and peer interaction impairments contribute to the association between attention-deficit/hyperactivity disorder (ADHD) symptom levels and impaired self-esteem and whether child demographic characteristics moderate these patterns. Methods: Parents and teachers rated ADHD symptom levels and impairments in independent samples of children from the general population using the ADHD Rating Scale-5 (n = 2,079 parents; n = 1,070 teachers). Models of indirect associations and potential moderators were analyzed. Results: All models accounted for at least 38% of the variance in impaired self-esteem and models using teacher ratings accounted for more variance than those using parent ratings. Models with inattention as predictor demonstrated significant direct effects with impaired self-esteem and indirect effects of both academic and peer interaction impairment (point estimates ranged from 0.16 to 0.22). Models with hyperactivity-impulsivity as predictor demonstrated significant indirect effects of both academic and peer interaction impairment (point estimates ranged from 0.17 to 0.40), but no direct effects with impaired self-esteem. Conclusion: Elevated inattention was associated with impaired self-esteem directly and indirectly through academic and peer interaction impairment, whereas elevated hyperactivity-impulsivity was associated with impaired self-esteem only through indirect associations. Inattention had a stronger adverse impact on behaviorally manifest self-esteem through academic impairment for adolescents vs younger children, and hyperactivity-impulsivity had a stronger adverse impact on behaviorally manifest self-esteem through academic impairment for White vs Black students. Longitudinal research is needed to examine patterns of mediation.