Despite the limited number of Rorschach studies on children with ADHD, and the inconsistent use of Rorschach variables across these studies, the present researcher has discerned an emerging profile of the personality functioning of ADHD children. Adopting the psychoanalytic framework of personality proposed by Pine (1990) described in Section 3.1.2 above, this inchoate profile can be articulated in terms of three core domains of psychic functioning, namely ego functioning, object relations, and sense of self. These domains can in turn be divided into constituent aspects of personality functioning, assessable by variables contained within the CS for the RIM.
Thus, ego functioning, as measured by the CS (Exner, 1991, 1993, 2003; Exner & Weiner, 1995) for the RIM, refers to the effectiveness of internal adaptive resources (ideational and expressive), the capacity for stress tolerance, the ability to tolerate and
modulate emotion, the capacity to attend to experience, and ability to perceive reality accurately. Object relations, as identified by the CS, refers to interpersonal perception and behaviour, namely, the capacity for social engagement, interaction and empathy, and the ability to identify with and internalise whole, real relationships with people. sense of self, assessed by the CS, refers to self-concept, its quality and nature, and the level of self-esteem (Weiner, 1998).
3.4.1 Ego functioning of children with ADHD
In terms of the ego functioning of children with ADHD, they have been found to lack adequate internal coping resources, which render them vulnerable to emotional overload, behavioural disorganisation, and interpersonal problems (Bartell & Solanto, 1995; Meehan et al., 2008). More specifically, these children have been found lacking in their capacity to delay the enactment of their impulses and to mentally represent and reflect on their thoughts and ideas (Bartell & Solanto; Gordon & Oshman, 1981; Jain et al., 2005; Meehan et al.). This ego deficit has been considered to be associated with compromised executive functioning arising from a core feature of ADHD, namely disinhibition or impulsivity (Fonagy et al., 2002; Gilmore, 2000, 2002; Rothstein, 1998, 2002; Rothstein & Glenn, 1999; Schmidt Neven et al., 2002).
Regarding the capacity of children with ADHD to tolerate and regulate affects, it has emerged that these children have difficulties mentally representing their affects in thoughts and language (Bartell & Solanto, 1995; Cotugno, 1995), a precondition for the development of affective and behavioural control (Barkley, 2006; Fonagy et al.,
2002; Gilmore, 2000, 2002; Rothstein, 1998, 2002; Rothstein & Glenn, 1999; Schmidt Neven et al., 2002). There has also been evidence of these children avoiding affective stimuli and narrowing their attention in an attempt to gain control over their affects (Cotugno, 1995). Meehan et al. did not confirm this latter finding, and proffered as an explanation that these children might have a “bi-modal” relationship with affect, whereby they fluctuate between the strategies of avoidance and constriction, and attempts at representation, with the latter making them vulnerable to affective over-arousal.
In contrast, however, Jain et al. (2005) found that children with ADHD were more comfortable processing affect, and were more able to mentally represent and regulate affect, than children in the control group. Clearly, these findings ran counter to the body of evidence gathered by others. The authors were not concerned to interpret these findings in terms of personality functioning, and did not attempt to explain why their findings differed from those of previous studies. A possible explanation may be in the fact of Jain et al.’s sample being culturally different (Indian) from that of the other studies, or in the use of the Beck (1961; Beck & Molish, 1967) coding system.
Thus, while there was not direct evidence of excessive emotionality in children with ADHD, the aforementioned deficits in their ego functioning indicated that they were vulnerable to an exacerbation of unregulated behaviour when their limited internal resources become taxed by strong affects.
The reality testing of children with ADHD, a key aspect of ego functioning, has been found to be impaired (Bartell & Solanto, 1995; Cotugno, 1995). It has also appeared
likely that these children are less prone to highlight less conventional aspects of reality (Cotugno; Jani et al., 2005). Such impairments of ego functions are consistent with the adjustment difficulties of these children, as inaccurate perception and disregard for conventional aspects of social reality contribute to faulty reasoning and decision-making, and in turn inappropriate social behaviour (Weiner, 1998).
3.4.2 Object relations of children with ADHD
In terms of the object relations of children with ADHD, they have been found to demonstrate a generally impoverished capacity for adaptive representations of object relations (Meehan et al., 2008; Gordon & Oshman, 1981; Bartell & Solanto, 1995; Cotugno, 1995). These studies demonstrated that children with ADHD have difficulties understanding and feeling empathy for people, as well as engaging in age- appropriate social interaction and relationships. Where these children had a co- morbid diagnosis of ODD, there was evidence of lessened capacity for empathy compared to those children without ODD (Bartell & Solanto). Using the terminology of Fonagy et al. (2002), children with ADHD appear to be inadequately developed in their capacity for mentalization, the ability to reflect on affective states and the interpersonal behaviour of other people, as well as oneself.
Of further interest in the domain of object relations was the finding that children with ADHD do not anticipate their social interactions to be rewarding and reciprocal (Cotugno, 1995). However, contrary to prediction, these children were not found to be more prone to representing object relations in hostile or aggressive interactions than normal or other clinical subjects (as measured by the frequency and comparison
of Rorschach responses depicting aggressive interactions or themes). Similarly, ADHD children with co-morbid ODD were no more prone to Aggressive Movement (AG) responses in their protocols than non-ODD ADHD subjects. These counter- intuitive findings highlighted the possibility of a compromised ability in children diagnosed with ADHD to mentally represent interpersonal aggression. This is not surprising, given their tendency to discharge rather than represent, contain and internally process affect generally.
3.4.3 Sense of self of children with ADHD
Difficulties in personality functioning concerning the domain sense of self have been identified in children with ADHD. Regarding their subjective experience, they have been found to have poor self-esteem, and appear prone to depressive symptoms (Cotugno, 1995). The latter may tend to strain their limited internal resources, including their capacity to tolerate stress and to regulate affects, making behavioural control even harder. Barkley’s (2006) review of the literature on co-morbid depression in children with ADHD was entirely consistent with this apparent trend. Furthermore, these children have evidenced impaired capacity for identification with people as whole objects (Gordon and Oshman, 1981; Bartell & Solanto, 1995; Cotugno, 1995), a process undermining adequate identity formation.