Being good at something makes people happy. I have learned many truths over the years of practicing psychiatry, and that’s one of them. If you’re great at doing your job, get straight A’s, play a sport exceptionally, are an accomplished dancer, musician, gardener or artist, you have something to feel good about.


It’s not enough, however, to be competent. A second requirement, although it may seem related to ego or pride, is essential. You must also be recognized for your competence. Praise, accolades, kudos, 5 out of 5 on a job performance review – whatever form it may take – being recognized for your competence is a type of reality testing which confirms your suspicions that you are, in fact, good at what you think you’re good at.


This recognition need not be in the form of verbal confirmation from others. It may be simply the letter grade, points scored, increased number of clients resulting from positive word of mouth, or even applause. Different types of competence are recognized in different ways that are sometimes obvious, but can be subtle. Stand up comedians know if their audience finds them funny by the volume of laughter. A “not guilty” verdict is confirmation for the defense attorney of a job well done. Removal of an appendix, resulting in alleviation of pain and lack of infection lets the surgeon know she is competent at prolonging life and health.


Most of us strive for excellence in what we do, consciously or not. We might not start our day by thinking “I will improve on my skills and do my very best today,” but we do just that anyway. Problems arise when we try our hardest and the results are less than optimal. A student who studies for several hours and then gets a “C” on the test starts to doubt the connection between effort and outcome. The writer who gets his work rejected by one publisher after another might start to think his abilities are less than adequate.


When a person puts in what they feel is a very strong effort and the feedback is not good, competence and the ability to achieve it may be called into question. One might take such negative feedback as constructive criticism and adjust the approach taken, but only for a limited period of time. Rejection or invalidation of earnest work is sustainable by the persistent individual for varying lengths of time, and depends on the support of close friends and family, the person’s inner conviction that their ability has not yet been recognized but will be in the future, and the belief that they have a “calling” which must be pursued, regardless of recognition by others.


People with ADHD are constantly confronted by the disconnect between their innate ability and what they are able to manifest in reality. Although they have great ideas and can visualize in their mind’s eye the completed product, they are often unable to see their vision through to fruition. This results in frustration, discouragement and eventually doubt regarding their true capabilities. Ultimately, low self esteem and depression can result, leading to the cessation of attempts to demonstrate competence

This is why the recognition of and treatment for ADHD is essential. Children are especially vulnerable to negative feedback in the face of solid effort. Adults, having endured years of rejection and failure, become slowly traumatized by their experiences and often choose “safe” occupations which do not challenge them, but offer the solace of competence in the absence of self nullifying criticism and defeat.


We all start out in life with an innocent, if perhaps naïve belief that if we try hard enough, we can accomplish anything we set our minds to. Nurturing this belief is the job of parents, teachers and coaches entrusted with fragile emotions and limitless potential. With just enough encouragement and praise, persistence and confidence is solidified, leading to competence and recognition thereof. Every person deserves no less, but sadly, not everyone receives these minimal prerequisites.


If we all try to create conditions in which our own sense of competence includes mentoring and instilling this feeling in others, we can “pay it forward,” ensuring the continuance of confidence.