Scattered Minds: A New Look at the Origins and Healing of Attention Deficit Disorder

by Gabor Maté

prefrontal cortex may be seen as that policeman. One of its major tasks is inhibition. It evaluates the myriad impressions, thoughts, sensations and impulses reaching it from the environment, from the body and from the lower brain centers. It must select what is essential and helpful and inhibit input and impulses that are not useful

Our initial response to a stimulus, whether anxiety producing or pleasurable, is unconscious. It comes not from the cortex but from lower brain centers where emotions originate. The cortex has a split second to decide whether to give permission to the impulse or to cancel it.

Hence the efficacy of stimulant medications: they arouse the inhibitory function.

Instead of asking why a disorder or illness develops, we ask why a fully self-motivated and self-regulated human personality does not.

westernmost shores of Canada, on Vancouver Island, one sees scruffy and twisted little conifers, stunted relatives of the magnificent fir trees that dominate the landscape just a short distance inland. We would be wrong to see these hardy little survivors as having some sort of

plant disease; they have developed to the maximum that the relatively harsh conditions of climate and soil allow. If we wish to understand why they differ so dramatically from their inland relatives, we need to know under what conditions majestically tall, stout and ramrod-straight fir trees are able to thrive.

neurological and psychological maturation can take place at any time during the life cycle, even in late adulthood.

ADD is also found more commonly in people whose first-degree relatives are alcoholics or suffer from depression, anxiety, addiction, obsessive-compulsive disorder or Tourette’s syndrome.

family atmosphere in which the child spends the early formative years has a major impact on brain development.

brain/mind problems such as ADD are far more likely to develop in families where the parents are struggling with dysfunction or psychological problems of their own.

long-term positive changes are indeed possible, based on changing the environments of children, and even of adults.

siblings growing up in the same home almost never share the same environment.

Of all environments, the one that most profoundly shapes the human personality is the invisible one: the emotional atmosphere in which the child lives during the critical early years of brain development.

Of the various Oxford Dictionary definitions of sensitive, it will be useful to keep three in mind.

1. Very open to or acutely affected by external stimuli or mental impressions. 2. Easily offended, or emotionally hurt. 3. (As of an instrument) responsive to or

recording small ...

People with ADD are hypersensitive.

It is sensitivity, not a disorder, that is transmitted through heredity. In most cases, ADD is caused by the impact of the environment on particularly sensitive infants.

“a refined susceptibility to pain.”

Even though fully half of the roughly hundred thousand genes in the human organism are dedicated to the central nervous system, the genetic code simply cannot carry enough information to predetermine the infinite number of potential brain circuits. For this reason alone, biological heredity could not by itself account for the densely intertwined psychology and neurophysiology of attention deficit disorder.

times in the first year of life, new synapses are being established at a rate of three billion a second. In large part, each infant’s individual experiences in the early years determine which brain structures will develop and how well,

Attention deficit disorder results from the miswiring of brain circuits, in susceptible infants, during this crucial period of growth.

brain mass of humans will have tripled by age four. By adulthood, the size of our brain will have quadrupled, meaning that fully three-quarters of our brain growth takes place outside the womb following birth, with most of this increase occurring in the early years.

The three conditions without which healthy growth does not take place

nutrition, a physically secure environment and the unbroken relationship with a safe, ever-present maternal organism.

The third prime requirement, a secure, safe and not overly stressed emotional atmosphere, is the one most likely to be disrupted in Western societies.

Even more than breast-feeding, healthy brain development requires emotional security and warmth in the infant’s environment.

more than the love and best possible intentions of the parents. It depends also on a less controllable variable: their freedom from stresses that can undermine their psychological equilibrium.

AREAS OF THE CORTEX responsible for attention and self-regulation develop in response to the emotional interaction with the person whom we may call the mothering figure.

Because the formation of the child’s brain circuits is influenced by the mother’s emotional states, I believe that ADD originates in stresses that affect the mothering parent’s emotional interactions with the infant.

Anything that threatens the mother’s emotional security may disrupt the developing electrical wiring and chemical supplies of the

infant brain’s emotion-regulating and attention-allocating systems.

All that was lacking in the instant video replay, during which infants saw their mother’s face unresponsive to the messages they, the infants, were sending out. This sharing of emotional spaces is called attunement.5 Emotional stress on the mother interferes with infant brain development because it tends to interfere with the attunement contact.

In the attunement interaction, not only does the mother follow the child, but she also permits the child to temporarily interrupt contact. When the interaction reaches a certain stage of intensity for the infant, he will look away to avoid an uncomfortably high level of arousal. Another interaction will then begin. A mother who is anxious may react with alarm when the infant breaks off contact, may try to stimulate him, to draw him back into the interaction. Then the infant’s nervous system is not allowed to “cool down,” and the attunement relationship is hampered.

Infants whose caregivers were too stressed, for whatever reason, to give them the necessary attunement contact will grow up with a chronic tendency to feel alone with their emotions, to have a sense—rightly or wrongly—that no one can share how they feel, that no one can “understand.”

We may also attempt to satisfy the lack of the human contact we crave by various other means, such as addictions,

the orbitofrontal cortex.1 It is part of the prefrontal cortex, that area of the gray matter most involved in social intelligence, impulse

control and attention.

also important in short-term wor...

OFC plays a role in visual-spatial orientation,

When visual-spatial orientation is impaired, a person tends to bump his head a lot or run into people unseeingly and have difficulty following physical directions—all features of ADD

It carries out a constant and instantaneous computation of the emotional significance of situations. It is deeply concerned with the assessment of relationships between the self and others.

“dominant for the processing, expression, and regulation of emotional information.”

OFC also functions in impulse control, helping to inhibit the lower centres in the brain where urgent emotional drives originate.

Finally, the OFC records and stores the emotional effects of experiences, first and foremost the infant’s interactions with his or her primary caregivers during the early months and years.

when “happy” events are experienced by the infant, endorphins—“reward chemicals,” the brain’s natural opioids—are released. Endorphins encourage the growth of nerve cells and of connections between them.

chronically high levels of stress hormones such as cortisol have been shown to cause important brain centers to shrink.

Ritalin or other psychostimulants are thought to increase the availability of dopamine in the brain’s prefrontal areas. This is believed to increase motivation and attention by improving the functioning of areas in the prefrontal cortex. Although they carry some truth, such biochemical explanations of complex mental states are dangerous oversimplifications—as

early interactions with the mother shaped the adult rat’s neurophysiological capacity to respond to stress.

The letters ADD may equally well stand for Attunement Deficit Disorder.