The relationship between aggressive behaviors in children and adolescents with attention deficit hyperactivity disorder and narcissistic traits and self-esteem

This study aims to investigate self-esteem, narcissistic traits, aggressive behaviors, and related factors in children and adolescents with Attention Deficit Hyperactivity Disorder. To this end, the study included male patients aged 9-14 with a diagnosis of ADHD who were followed up at the Child and Adolescent Psychiatry Clinic of Akdeniz University Faculty of Medicine Hospital, and a control group of healthy volunteers matched by gender and age, with no psychiatric diagnosis and no prior psychiatric consultations. A sociodemographic data form was used to determine the sociodemographic characteristics of the children and adolescents. To identify possible psychopathologies, the Schedule for Affective Disorders and Schizophrenia for School Age Children–Present and Lifetime Version (K-SADS-PL) was administered. Parents completed the Strengths and Difficulties Questionnaire (Parent Form), the Aggression Scale for Children (Mother-Father Form), the Narcissistic Personality Inventory, and the Turgay ADHD Symptom Screening Scale. For the children and adolescents, the Rosenberg Self-Esteem Scale and the Childhood Narcissism Scale were used. There were no significant differences between the patient and control groups in terms of sociodemographic data. When comparing self-esteem between the patient and control groups, the control group had significantly higher self-esteem. Narcissistic traits were found to be significantly higher in the patient group compared to the control group. The total difficulty score of the parent-reported Strengths and Difficulties Questionnaire was significantly higher in the patient group than in the control group. Aggressive behaviors, except for weapon use, were found to be significantly higher in all subscales in the patient group compared to the control group. A moderately significant negative correlation was found between the total scores of the parent-reported Strengths and Difficulties Questionnaire and the Rosenberg self-esteem scores for children in the patient group. A moderately significant positive correlation was observed between the Rosenberg self-esteem scores and the Childhood Narcissism Scale scores in the patient group. In conclusion, children and adolescents with an ADHD diagnosis may be more likely to have lower self-esteem, more narcissistic traits, and higher aggressive behaviors compared to those without a psychiatric diagnosis. Children with ADHD may face more difficulties emotionally, behaviorally, in peer relationships, and in social life. Given the risk of narcissistic traits causing issues in personal and relational domains, the functionality of children and adolescents with ADHD may be further negatively impacted by the behavioral and emotional regulation problems resulting from both the diagnosis and comorbidities. Identifying narcissistic traits in children and adolescents with ADHD may help in reducing aggressive behaviors.