ADHD and Lacking Empathy: Was I Raising a Narcissist?

ADHD narcissist

What do the words ADHD, low empathy, and narcissist have in common? Potentially, more than many people realize.

When we consider the negative chatter around “drugging children” for ADHD, what gets lost? Compassion—for these children and their families.

Many children with ADHD suffer cognitive impairments far beyond the classroom. Some of these impairments distort any reasonable person’s idea of a “happy childhood.”  I’m referring to impairments that, in fact, also threaten to negatively shape the course of their entire lives, especially their relationships. These include deficits in empathy, reciprocity, reflection, and remorse.

What’s more, in the wrong mental health professional’s hands, a child lacking empathy and having sense of entitlement can invite a dire diagnosis: narcissistic personality disorder—or even psychopath.  (When Your Child Is a Psychopath, an extremely hidebound and punishing look at the phenomenon.)

If that child also has ADHD, there is a good chance that the first-line medication for ADHD, the neurostimulants, can enhance empathy—along with all the other “higher-order” brain functions.  This is not hard to understand. But it is not common knowledge. ADHD treatment can often help the narcissistic child have more reliable access to these brain functions.

Of course, narcissistic parents might have ADHD or any of a  number of frontal-lobe issues. I can only imagine what that is like for their children. But I suspect it feels worse when therapists or pop culture tells those adult children that their parents’ narcissistic actions stemmed from control and power. Maybe they did. Maybe they didn’t.  Unless the therapists have a clue about these brain issues, those grown children might never know.

ADHD, Empathy, and Raising a Narcissist

In this post, Taylor J, the host of the “You, Me, and ADHD Book Club,” shares this story of her eldest child’s recent ADHD diagnosis and treatment.

Taylor had despaired that her daughter would grow up to resemble her own parents: narcissistic and lacking empathy. Generally speaking, empathy deficits form the foundation for narcissism.

Taylor and her husband tried to teach empathy to the girl, but the lessons never took hold. Or, so they thought.

P.S. You Read About This Here First

Please note: An earlier version of this post appeared is Jan 27,. 2016. (I started this blog in 2008.) This points to my being among the very first ADHD experts online to write on ADHD and empathy — or lack therof. Probably the first. Since then, many have copied, including those who publicly criticized my earlier writings for “saying mean things about ADHD.”  My guess? They saw the high Google search rankings for this post, now that everyone can analyze any websites’ analytics.

Unlike most ADHD and health sites, I’ve never accepted pharmaceutical-industry support. This makes me self-funded—unusually so. I do this work as a public service.  I appreciate your support in visiting, reading, and sharing this post.

—Gina Pera

ADHD consequences

By Taylor J.

The Number One most profound thing I’ve learned about ADHD is this: It can create trouble connecting “cause” with “effect.” And that can create a world of trouble.

For example, a student will not see his poor study habits as the reason for his poor grades. Instead, he’ll blame a “mean” teacher. A wife will not see that her cutting, sarcastic words caused her husband to withdraw emotionally. Instead, she’ll call him “cold.” A young man will not see that his reckless driving and speeding caused a car accident. Instead, he’ll blame barely there weather conditions.

It doesn’t take a genius to see that continually failing to connect actions with consequences will wreak havoc on a person’s life. Worse, it can kill the potential for relationships.

I saw this play out starkly in my 10-year-old daughter. Let’s call her  The Firecracker.

is your parent a narcissist? Does your parent have ADHD?

I Vowed To Be Unlike My Narcissistic Parents

First, let me give you some background.

My parents are horribly mentally ill, and they refuse treatment. Instead, they blamed everyone else for their troubles—and drowned their sorrows in alcohol, drugs, and pity parties. Even when I was in the hospital—sick or with a new baby—my parents could only talk about themselves. I found their utter lack of empathy horrifying.

When I married and started a family of my own, I vowed to be different. Yet, in raising my first-born child, the oldest of four girls, I watched helplessly as every lesson about empathy I tried to impart seemed to bounce cleanly off her soul.

What do I mean by that? Well, she would exploit others. She would set up games where everyone had to treat her like a queen visiting from another planet—or convince friends to “share” their favorite toys and clothes. Forever.

I even caught her in an elaborate kindergarten “protection racket” at one point: taking her sister’s money to keep monsters away. (She’d already made 6 dollars!)

She would take—but never give. Her friends would give her presents, invitations, or compliments. Yet she never saw any need to return the favor.

In fact, she would complain if a compliment missed a detail, or if the gift didn’t fit just right. She would even go to a friend’s house and critique their clothes or décor for them! “You really shouldn’t have that dollhouse—it’s for babies. You should get a Barbie dollhouse.” Seriously? Where did you learn this?

I was asking the wrong question. As I came to learn much later, hers wasn’t learned behavior. It was innate.

No “Cause and Effect”—Only “Mean Parents”

My husband and I explained, repeatedly, that her words hurt other people. We’d ask,  “How would you feel if Ginny came to your house and said your dollhouse was for babies?”

The confused-looking Firecracker would reply, “But my dollhouse is not for babies, so she would never say that!” We would punish her for saying cruel words—and she never understood why she was being punished. We were just “mean parents.” The type she might be complaining in the future to a therapist—who won’t have the full picture.

There was more. She would explode over the tiniest frustration. Itchy seams on her socks. Bedcovers not being straight. Her oatmeal being the slightest bit “too watery.” Her low frustration tolerance would set her off on an explosive tantrum—and others were always to blame.

I remember when she was only one year old, screaming at the shape-sorter because she couldn’t make the block go in the way she wanted it to.

Sporadic Bursts of Caring—and Low Frustration Tolerance

We did see sporadic bursts of caring from her. We could just never predict when they would happen.

Her first words upon meeting her sister: “I’m going to watch out for her, and make sure she doesn’t run out into the street without me!” At age 3, she started punching a preschool classmate who came up and shook her baby sister’s car seat carrier (while I was talking to a teacher). She was afraid he would hurt the baby’s “soft spot.”

When I was violently ill with another pregnancy, she proclaimed to her sister, “Don’t worry. When Mom throws up, I’ll make you a sandwich.”

Words, however,  rarely met actions.

The Firecracker screamed at her sister for adjusting her stuffed-animal display. My second daughter would dissolve into tears, and ask, “Why doesn’t she love me?” The Firecracker’s response?  Her sister’s sobs were disturbing her reading time.

Without the larger context, you might take this as typical sibling rivalry. But it was much more troubling.

I had started to wonder if I was raising a narcissist.


ADHD empathy narcissismA Shocking Change:

My husband and I both have ADHD. We both take medication. I know full well the dramatic changes in cognition and behavior the medication provides.

But when The Firecracker was finally diagnosed with ADHD this past July and began medication treatment, even I was not prepared for the change that followed.

I gave her the first dose of Ritalin. Two hours later, as we were returning from the grocery store, she said, “Mom, you can’t carry all that. Let me help you!” She grabbed two grocery bags and the diaper bag. “You need to ask for help when you need it, mom!”

Then, when the baby started crying: “Oh, honey, come here and let me hug you! Don’t worry, mom, I’ve got her—I know you’re making lunch.”

When I had to change plans that she’d been looking forward to: “Aw, that stinks, but I know you didn’t try to make it hard for me. We can go tomorrow.”

To be clear: My daughter had not become some creepy “good child” automaton.  She was still herself.  But a better emotionally regulated version of herself. A more content version of herself.

This much was obvious: She was as relieved as we were with the changes.

hyperactive child empathy
Our Firecracker, constantly in motion. With her little sister


“It’s Going to Be Okay”

Five hours later, the medication had worn off. The Firecracker came to me, tears streaming down her face, screaming, “Mom! This is awful!!! The baby won’t stop crying! [The baby had cried for one minute.] Is this what it felt like all the time when I wasn’t on medication?”

I took her by the shoulders, looked her in the eye, lowered my voice, and said, “Don’t worry. It’s going to be okay. Yes, this is what it was like all the time. Take your next dose, then sit here and watch something on TV while I set a timer. When the timer goes off, your next dose will have kicked in.” I wiped her tears and turned on something funny.

Half an hour went by. When she felt better, she looked up at me, and said, “Mom, maybe you should get me a puzzle book to work on when I’m angry. Then I can calm down without yelling at anyone.”

I watched the rest of the night as she spoke lovingly to her sisters and forgave them when they committed the grave sin of touching her stuff.

ADHD child narcissist

Relief At Connections Made

As she was reading her favorite book before bed, she looked up and said, “Mom, now I understand why Eragon sighed so deeply when he saw his brother: He was afraid his brother would become a rider, too!” Even the stories were becoming more clear.

Remember, this is just the first day of ADHD treatment.

I asked my husband to tuck the girls into bed that night. Then I turned on the shower and broke down into sobs as the water washed over my face. With immense gratitude and relief, I finally realized that my daughter had ADHD but was not a narcissist. She actually did take in the lessons about compassion and empathy that we were teaching her. She simply couldn’t access them when she needed to.

My daughter had been suffering from a treatable brain condition, not an incurable evil that was lurking behind her smile.

Maybe my parents can be helped to change their narcissistic behaviors, too. I can only hope that they’ll reach a point where they’re willing to try treatment.

So, the next time you hear someone gasp at the thought of putting a child on medication for ADHD, please remember my Firecracker. Please know that it is beyond the control of many people with ADHD, including children, to make certain cause-effect connections.

Please know that, since beginning to take stimulant medication, my girl is happier and healthier than she has ever been. (More about that in a future post from Gina.)

ADHD empathy


The Firecracker’s Comic: Overcoming a Struggle

I’ll close with this amazing comic that The Firecracker drew for school. I had nothing to do with this. My daughter loves graphic novels, including authors such as Raina Telegmar, and has created dozens of comics in that style.

Recently, her class read a story called The Dot, about overcoming a difficult struggle. In response, they were to write about a struggle that they overcame. This is my girl’s story.

The Research: ADHD and Narcissistic Traits

From Gina:

This phenomenon is more common than the mental-health profession seems to realize. That is, the association among ADHD, lacking empathy, and narcissistic behavior.

This post (ADHD and Empathy: A Study, Book Excerpt, and Empathy Defined) tackles the topic from several angles:

1. Defining empathy (it’s not what most people think).

2. Excerpting a passage on empathy and relationships from Is It You, Me, or Adult A.D.D.?

3. Sharing details from yet another study pointing to a connection between dopamine and cognitive empathy.

A sneak preview of the study:  It confirms my observation that stimulant medication often enhances empathy in people with ADHD.

But wait. This happens not because the medication “creates empathy.” Rather, the medication enhances dopamine transmission. That, in turn, allows some people with  ADHD to focus on and access this “higher-order” brain function. In fact, it is one they have always possessed but haven’t been able to reliably access.

Empathy sounds simple. But it’s really a complex phenomenon. In fact, some people with ADHD have trouble reining in their empathy; medication often helps them, too. As with many ADHD-related challenges, it’s all about the self-regulation.

For another angle on this topic:  Empathy and Mirror Neurons: Or, Monkey See, Monkey Yawn

Gina Pera's online course

How about you? Have you noticed a difference in your child’s

expressions of empathy or mood-regulation post-treatment for ADHD?

I welcome your perspectives.

—Gina Pera

69 thoughts on “ADHD and Lacking Empathy: Was I Raising a Narcissist?”

  1. I am so thankful for this blog. I am starting to realize that maybe, just maybe, my low level of empathy isn’t because I am horrible person, but because I have a condition.

    I am 45 years old and went to school in 80’s and early 90’s, and back then unless you were hyper, ADHD wasn’t diagnosed. I was the forgotten about child who couldn’t focus, had no motivation, and got poor grades. Also to top it all off, I was frequently bullied, teased, and abused, both at home and at school. I also didn’t have a lot of friends. Even before my dad died when I was 13, my parents had no regard for my mental wellbeing, and that didn’t change. I was left to fail, and left to be bullied. Even without having ADHD-PI that would make it hard for anyone to learn empathy.

    I sought help for ADHD a couple of years ago after the realizing I might have it. Concerta did nothing but my GP was reluctant to try other things. He referred me to a psychiatrist who confirmed the diagnosis but he wasn’t very knowledgeable about ADHD. I begged for a Strattera prescription after I read it could help. I have been on it for about 3 weeks now and will up the dose soon. I will be seeing (at my request) a psychiatrist who specializes in ADHD who has agreed to find the right medication and dosage for me. Maybe I will try Vyvanse or Adderall in addition to the Strattera, if the 80mg doesn’t work for me. I am hoping that once I get the right meds and dose, that it helps with my lack empathy.

    I rarely ever raise my voice or get mad at anyone. I also do not wish anyone pain or unhappiness. However, I am very un-self-aware other people’s pain, even if I am the cause. People to me are only like background characters in this game of life, I am trying to fight my way through. I am glad I am not alone. thank you for this blog and your website.

    1. Dear Mark,

      I am so grateful for your comment, letting me know my work has meaning for you.

      You make a profound point. Even for a child who doesn’t have challenges with “higher-order brain processes”, rarely (if ever) receiving empathic caring provides no foundation for seeing how empathy works in practice.

      Many people confuse ADHD-related symptoms that mean not noticing facial expressions, not remembering what one did in the past that would bring such a big reaction now seemingly “out of nowhere,” etc. with poor empathy. It’s complicated!

      It’s hard to form strong attachments or have empathy for others when it’s hard to focus, organize yourself, watch out for the next invisible banana peel that will trip you up, and “fight your way through” the day.

      A couple of points:

      1. It’s all down to genes, as to which stimulant class will work best for an individual. So, if you gave MPH (methylphenidate) in the form of Concerta a good try without positive effect, that’s useful data.

      2. Did you try brand, though, and not one of the slew of inferior generics?

      3. Strattera doesn’t work as well as the stimulants for most people, research shows. But it does work well for about 1/4 of people with ADHD (as I recall, last I researched this).

      4. It’s a very different mechanism of action targeting different molecules.

      5. Many people with ADHD do well on a lower dose of Strattera (25 mg to 40 mg) and a stimulant.

      6. Strattera can have more urinary/prostate/sexual side effects. So, if that should happen, know that it’s probably the Strattera. You could try a much-lower dose or, at that point, move to Vyvanse.

      I’m not an MD. I just help people who have been ravaged by reckless MDs…by conveying the evidence-based knowledge.

      I wish you all the best. Stay tuned for the “soft launch” of my online training. I think you will find it very useful.


    2. Thanks for the reply Gina. It was definitely was brand name Concerta I tried, and tried many doses from 18-27-36. I am trying strattera to see if I’m one of the ones it works for, and because it’s also easier to get a Doc to prescribe that than an amphetamine. The new doc I will be seeing has no issues with it though. I know about the side effects with strattera and don’t care. Living with adhd-pi is pure agony and will gladly take the sides if it helps with it.

      This was all just initially for the adhd. Now that I know that it could help with empathy as well, I am even more optimistic. Thanks again.

  2. Wow, this is deep. I’ve just left a man because he gave off pretty bad NPD vibes. My mum I suspect is covert NPD. My youngest has adhd and I have always struggled with him showing empathy when one of his siblings got hurt by him. He has only just started on ritalin and I have noticed a big difference in his executive functioning but not yet his emotion regulation…I will keep an eye on him now.

    1. Dear Anna,

      Yes, I am for deep. Because that’s where the critical information is. The kind that can enormously effect the trajectory of a life.

      There are a lot of factors that determine how a person, especially a child, responds to medication. It might be that Ritalin is not the best choice for him, or that he needs better sleep or diet.

      But also, the example you mention is a complex one. Showing empathy when he’s hurt one of his siblings.

      It’s possible that he did not mean to hurt the sibling so he feels that since the intention wasn’t there, he’s not responsible for the aftermath?

      Poorly managed ADHD means that symptoms can get the better of a person.

      make sense?


    2. Wow, I never realized other kids went thru the same thing growing up. Thank you for this.

      I’m 16 and I remember being very bossy most of the time when playing with other kids. I’ve also never had any inclination to help others out with chores, or buy gifts for even my parents on their birthdays ‍♀️ (I started doing chores by “surprising” my mom @ 12yo by doing the dishes one time, and since then she’s expected me to keep it up).

      Then when confronted about it, I wouldn’t feel bad at all. I’d just pretend like I did.

      I’m currently waiting to see a psychiatrist because my family doctor thinks I have inattentive ADHD (formerly known as ADD) and even though I relate to so many things ADHD, I still doubt.

      My parents are convinced it’s just bad habits.. I don’t blame them because many people dismiss mental health issues and expect you to fix everything on your own.

      I took an empathy test and got 9 out of 80. Scary. Anyway, hoping by this time next year I’ll figure out what this is. Thanks again for your article! 🙂

    3. Dear Issy,

      Thanks for reading — and writing.

      How clever you must be, to not only find this post but to be so reflective about the contents as it might apply to you.

      I suspect that “being bossy” is a way for some children with unrecognized ADHD to “stay engaged” in whatever play that’s happening. Much harder to follow someone else’s directions and rules.

      It’s interesting that neither you nor your parents are prone to seeing that you might have it. But your family doctor does….

      If you do have ADHD, that is a very important thing to know how. It could affect the entire trajectory of your life.

      If I were you, I would not be passive about the evaluation. And it doesn’t sound like you are.

      I encourage you to write down snippets such as this….how the ADHD diagnosis might resonate for you.

      If you provide your writings to the professional, I recommend concise bullet points. More likely to be read!

      Good luck and know there is a TON of great information on my blog — the first and oldest on adult ADHD. 2008


  3. Wow – I would love to connect with you to talk about this more.

    I have been diagnosed with ADHD at the age of 29 and being treated. Safe to say, my life has changed. This entire article and firecracker resignate with me strongly. Thank you for sharing

  4. Such an interesting article – I’m glad to hear that Firecracker is doing so well.

    I believe that my parent in their 60s suffers from undiagnosed ADHD (the parent themselves believes so, as do others in the immediate family).

    I grew up with so much fear and anxiety around their erratic, angry outbursts. They are incredibly defensive about even the smallest things. They were either disinterested, or mean and critical. I wonder if ADHD is largely to blame, or if there may be other issues at play as well.

    I don’t know if they would be willing to see anyone or try medication, but is there any hope of change at this later stage in life?

    1. Hi Sam,

      It’s hard to fathom how many people have gone to therapy after growing up with such parents as you describe.

      It’s entirely possible that ADHD plus a lifetime of poor coping responses can credited with the behaviors.

      There is no “cookie cutter” anything about ADHD. Definitely, with impaired higher-order brain functions, some very hurtful, emotionally dysregulated, and narcissistic behaviors are possible.

      Yes, it depends on your parents’ attitude, but definitely: People in their 60s and older have found benefit from treatment.

      The trick will be finding a physician to treat ADHD in the 65+ set, especially if there is a physical condition (hypertension, etc.). Stimulant medications are not necessarily contraindicated for those conditions but many physicians will feel uncomfortable, given poor knowledge of ADHD treatment.

      I hope this helps.

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