The level of self-esteem was measured, using the Piers-Harris Self-Concept Scale, in 143 special education students at high risk for ADHD in the school year 1995, at a school district in Northern Florida. Overall, self-esteem scores were in the normal range. Children with ADHD and internalizing symptoms (anxiety or depressive disorders, diagnosed in 29%, according to child self-report questionnaires) had significantly lower self-esteem scores, compared to children with ADHD alone or ADHD with comorbid disruptive behaviors. Those with higher levels of functional impairment were also at greater risk for low self-esteem. Children from minority backgrounds, primarily African-American, had higher self-esteem scores than white children. Medication use was not an independent predictor of low self-esteem. 
COMMENT. Comorbid internalizing (anxiety or depression) symptoms and severe learning or emotional dysfunction can predict low self-esteem in ADHD children. Minority background and use of stimulant medication do not increase risk of low self-esteem. In fact, African-American children with ADHD have a relatively higher level of self-esteem than their white counterparts.