Narcissistic personality disorders can be identified in childhood and adolescence using the same diagnostic criteria as for adults. There are, however, additional descriptive characteristics specific to children: in particular, quality of friendships, quality of performance in school, gaze aversion, pathologic play, and separation anxiety. Various developmental pathways may present a special risk for the formation of narcissistic personality disorder: having narcissistic parents, being adopted, being abused, being overindulged, having divorced parents, or losing a parent through death. The diagnosis of narcissistic personality disorder has important implications for treatment. The goals of treatment (in intensive psychoanalytic psychotherapy) are to work on the grandiose self, the pathologic defense mechanisms that interfere with development, and interactions with parents and peers. Concomitant parent counseling or family therapy is strongly recommended to work on the maladaptive narcissistic defenses operating at the family level, which help to maintain the disorder.