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. This knowledge should be more widely understood, including in the mental health field, because it could hold the key to a happier life.

In this post, I’ll explain with a short introduction before introducing an important first-person essay. At the end, you’ll find a link to my podcast of this post — and more links to my blog posts on empathy and ADHD.

A “Poor Prognosis” — In the Wrong Hands

These days, the Internet brims with lurid stories about narcissists.

Yes, it’s important that we understand what we’re up against when confronted with narcissistic behavior. But the psychologists in particular who are sensationalizing this topic might be doing more harm than good. They betray ignorance on the many potential factors that can underlie narcissism, some of which might be treatable mental-health conditions. Many also claim that the behaviors are intentional, volitional, displays of power over others. But that is not always true.

For example, 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 refer 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.

When we consider the negative chatter around “drugging children” for ADHD, what gets lost? Compassion—for these children and their families. Not to mention: a basic understanding of brain functions.

When your child is a psychopath article The Atlantic

It’s Open Season On Narcissists—including Kids

What’s more, in the wrong mental health professional’s hands, a child lacking empathy and acting with a sense of entitlement can invite a dire diagnosis: narcissistic personality disorder—or even psychopath.

For example, this article at The Atlantic’s website takes an extremely hidebound and punishing look at the phenomenon:  When Your Child Is a Psychopath. 

These diagnoses stick.  That’s because the mental health profession consider them “poor prognoses.” In other words, there is little hope for change. The behaviors are  viewed as part of personality, immutable.

But wait. 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. Far from it.  In fact, you probably read it for the first time in my first book, Is It You, Me, or Adult A.D.D.? 

To be clear: ADHD treatment can often help the narcissistic child have more reliable access to their innate brain functions, including empathy, conscience, and more.

Of course, narcissistic parents might also have ADHD or any of a  number of frontal-lobe issues. Imagine what that is like for their children, especially if the child also has ADHD.

But I suspect it feels even worse when therapists or pop culture tells those adult children that their adult problems stem from their parents’ narcissistic actions, motivated by control and power. Maybe they did. Maybe they didn’t.  That’s just one of the dangers of holding onto old psychological theories. Let’s face it, it’s name-calling.

ADHD, Empathy, and Raising a Narcissist

In fact, my friend Taylor J. was one of those children. Maybe you’ve read her essays in the “You, Me, and ADHD Book Club.” Here, she shifts from talking about her own and her husband’s ADHD diagnoses. Now she shares this story of her eldest child’s recent ADHD diagnosis and treatment.

This was big. 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 ADHD & Empathy Here First

Please note: An earlier version of this post appeared  Jan 27, 2016.  This points to my being among the very first to write on ADHD and empathy. Probably the first.

It’s only in the last couple of years, that many have followed suit. That includes those who publicly lambasted my 2008 book (Is It You, Me, or Adult A.D.D.?) for “saying mean things about ADHD”. They claimed I wrote: “People with ADHD have no empathy.”  What I wrote was this: “ADHD can sometimes create empathy impairments.”

Moreover, I went on to say that medication treatment can often give the person with ADHD more reliable access to their innate empathy.

Why the latter-day conversion? They saw the high Google search rankings for this post, now that everyone can analyze any websites’ analytics. If that’s what creates enlightenment on this complex topic, so be it.

—Gina Pera

cause and effect

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 married and starting 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, for one thing, 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 narcissism

Shocking: My Child Has ADHD — Isn’t a Narcissist

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. Whatever empathy they have can get lost in impulses and distractibility.

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:

Again, this phenomenon is more common than the mental-health profession realizes. That is, the association among ADHD, lacking empathy, and narcissistic behavior.  You can listen to the podcast of this post:

This other 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 first observed 20 years ago: Stimulant medication often enhances empathy in people with ADHD.

But wait. This happens not because the medication “creates empathy.” Rather, as the study in the linked post above suggests, 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, they have always possessed empathy. But haven’t been able to reliably access it—or act upon it.

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

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

  1. But I feel like I have the opposite. I cry at The Voice which we know is rigged. Sometimes I just cry over missing people etc. Had such trouble growing up with my family saying I was just way too oversensitive about everything

    1. Hi Kat,

      Maybe you missed this at the end?

      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.

      Also, I refer to THIS post, which goes into more details on Adult ADHD and empathy:


  2. Reading this article about empathy and narcissistic traits might just be another major breakthrough for me. At 65-years-old, I’m determined to find out the true causes of the many mistakes, impulsive behavior, etc. I’ve made in my lifetime. Before I go on, I am in no way and never will use these causes to excuse me from all my major blunders in my life. Yes, I’ve hurt many people, sadly, my own family. I’d love to talk with the 38-year-old Goddaughter of the woman who just wrote to you. How I wish all the recent research on ADD was available when I was 38. I didn’t even find out I had the wiring of an ADD brain until I was in my mid-40’s. At 38, she has many years ahead of her to limit or even stop making more mistakes that she’ll just regret when she’s 65.

    1. Dear Linda,

      I hope the Godmother is reading. She’s doing all she can, but the “mental healthcare system” isn’t always so well-equipped to provide the necessary care.

      1994 – the year the Adult ADHD diagnosis was made official. It’s taken years for many to receive the memo— or know what to do about it.

      It’s admirable that you don’t want to make ADHD the scapegoat. Still, you didn’t know. No one around you knew. We go based on appearances unless we get better information.

      take care,

    1. Hi Eimear,

      Thanks for visiting.

      SPD = Sensory Processing Disorder

      Here’s an excerpt from an article on the topic from CHADD (linked below). It touches upon the common problem of “silos” — that is, one specialty has one name for a phenomenon, and another specialty has another name for it! Perhaps the cause, too.

      Max Wiznitzer, MD, is a pediatric neurologist and co-chair of CHADD’s Professional Advisory Board. He says that sensory processing disorder, in his professional opinion, is not a diagnosis but instead a description of behaviors. While some of the techniques used in sensory integration therapy can help co-occurring conditions, such as anxiety, he says sensory integration therapy does not help with ADHD symptoms.

      “While people have made these claims about sensory processing disorder, the science there is limited,” Dr. Wiznitzer says. “Here are my concerns: The clinical features of this so-called disorder are non-specific and include parts of different disorders. The explanation of the biological base for the disorder is very limited. The research conclusions are not always supported by the data. And improvements that occur in the population frequently occur without medical intervention.”

      The data on the effectiveness of therapy for sensory processing disorder is also limited, he says. The American Academy of Pediatrics recommends pediatricians educate interested parents on how to determine if a suggested therapy for SPD is effective for their child.

      “The family, pediatrician, and other clinicians should work together to prioritize treatment on the basis of the effects the sensory problems have on a child’s ability to perform daily functions of childhood,” the academy writes.

      “There’s very limited data on the impact of the therapy that is supposed to manage (sensory processing disorder),” Dr. Wiznitzer says. “Therefore you have to monitor the treatments you decide on, to determine if they are working (in the time estimated to be needed for improvement).”

      Dr. Wiznitzer says he is concerned parents may accept the suggestion of sensory processing disorder and not go further to look for answers to a child’s struggles with his environment. Several disorders and conditions share symptoms with the description of sensory processing disorder and should also be investigated, he says.

      Sensory Processing Disorder & ADHD: What To Know


  3. These traits are also very common when a kid is dealing with both ADHD and ASD. In some countries, the ASD profile of high anxiety leading to the need for high control and attempted social manipulation as one aspect of control is recognized as “Pathological Demand Avoidance” or PDA. I prefer to call it Pervasive Desire for Autonomy”. Lots of useful info here:
    Learning about PDA transformed how I approached my kid and things are MUCH better now.

    1. Hi there,

      Thanks for the info.

      I read just a bit about “PDA”. One source says:

      Pathological demand avoidance (PDA) is a profile that describes those whose main characteristic is to avoid everyday demands and expectations to an extreme extent.

      To me this sounds like ADHD “can ‘t looks like won’t”. Maybe some oppositional defiance thrown in. Yes, “Pervasive Desire for Autonomy” sounds more accurate! But it’s also possible the “avoidance” is due to inability. That can be camouflaged by anger at even being asked to do something they know they can’t do.

      The field of ASD tends to overlook ADHD contributors to behaviors. It’s estimated that about half of people with primary diagnosis of ASD also have ADHD. Moreover, it’s thought that ADHD treatment helps these people to better manage their ADHD symptoms.

      Thanks for your comment.

  4. So timely! Just went through another “hurricane” with my 38 years old goddaughter who has lived with me over 13 years. She is seeing a psychiatrist who works with adult ADHD and is on medication, but the storms have only increased. As I put it, damned if I do and damned if I don’t. At 85, she expects me to jump through her hoops so she will “feel” okay. I’ve known her since she was five years old and she was considered the “wild child.” She has a bio in Carol Kranowitz’ book, “Out of Sync Child Grows up.” What happens when the adolescent doesn’t “grow up” which is now what I am dealing with?! I’ve helped her find an OT who works with adult SPD and helped her find her find the only Psychiatrist in our area who works with adults. I have weathered a number of storms with her but this one is a category 5! Pat Rice

    1. Hi Pat,

      That sounds rough indeed. What a loving, extremely patient person you must be.

      I know it sounds awful that I would suggest you “do more” but you and she might be living with the consequences of potential sub-part medication treatment. It might be that you could help to improve things. You Me ADD (my first book) explains the basic medication treatment protocol (which a tiny minority of prescribers seem to follow).

      Also, SPD is typically a “symptom” of ADHD, not a separate disorder. The OT might not know (or believe) this.

      It’s so hard to find proper therapy for Adult ADHD. That’s one reason I created my course:

      Solving Your Adult ADHD Puzzle

      take care of yourself, Pat!

  5. Nowadays this condition is getting very well known across online platforms. i personally know close friends and family members who are having narcissistic traits and after reading many articles about this condition in people i trully understood that this is a real treat when interacting with these type of people. Even if members of familly are having narcissistic traits, we have to learn how to cope with them and their condition. thank you for writting this article.

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