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

by Gabor Maté

Asked the appropriate questions, concerned parents, almost without exception, confirm the history of stress in the family.

Such unequal division of emotional labour is, I believe, one of the main reasons why more women than men become depressed.

families of ADD children are three times more likely to experience separation and/or divorce of the biological parents than are families of normal children.…

recurrent themes blighting the childhoods of adults I have seen with severe cases of ADD are family strife and divorce; adoption, depression—especially in the mother; violence— especially from the father; alcoholism; and sexual abuse.

the psychological atmosphere that later will make abuse possible is already present in infancy.

Stressed or depressed mothers are found to be more short-tempered, more controlling and more angry with their children.

The greater prevalence of ADD in North America is rooted in something more prosaic and more disturbing than genes from adventuresome forebears: the gradual destruction of the family by economic and social pressures in the past several decades.

Each species has what Bowlby calls its “environment of adaptedness,” the circumstances to which its anatomy, physiology and psychological capacities are best suited.2 In any other environment, the organism or species cannot be expected to do so well, and may even exhibit behavior “that is at best unusual and at worst positively unfavourable to survival.”

attuned parenting is becoming alarmingly difficult. The result in successive generations of children is seen in alienation, drug use and violence—what Robert Bly has astutely described as “the rage of the unparented.”

In the language of psychology, mental absence, tuning out, is an example of a mind state known as dissociation.

Dissociation, including the tuning-out of ADD, originates in a defensive need—it is a form of psychological defense. Gloucester’s motive to be “distract,” in the fourth act of King Lear, is very close to the source of the “distractness” of ADD. It is a way of coping with emotional hurt.

pain itself serves a crucial function in survival.

Physical pain warns us of physical danger, such as the heat of a fire or the cutting edge of a blade. Emotional pain warns us that a situation threatens our psychic well-being.

Since tuning out can be perilous even as it protects, only under certain dire conditions will nature allow us to use it as defense.

severe distress.

helples...

For a person with ADD, tuning out is an automatic brain activity that originated during the period of rapid brain development in infancy when there was emotional hurt combined with helplessness.

Episodic experiences of a distressing nature do not induce dissociation, but chronic distress does—the

Because tuning out is based on deeply entrenched neurological responses, their later activation requires very little stimulus. Once a circuit is established, signals will travel along it much more easily than along alternative routes,

Attention is complex, the result of complex brain activity with multiple components. The deficit of attention in ADD is not just a matter of some sluggish brain mechanism to be set in action by admonishments or rewards, or simply to be lubricated by this or that pharmaceutical product. The brain’s level of arousal is a major factor in determining our capacity to give attention,

Because of insufficient self-regulation, children with ADD are often underaroused or overaroused. In the first state, they cannot get going on a task; in the second, they cannot focus on it.

it’s hard to turn it off—this is the nature of anxiety).”4 Arousal levels reflect such obvious factors as rest or fatigue, but are also deeply affected by the emotional context. Many people with ADD have noticed that a strange drowsiness may come over them in the midst of some emotionally charged situations,

What is really happening is that the right prefrontal cortex is over-inhibiting a network of neurons in the brain stem, known as the reticular formation—an important part of the circuitry of arousal—because the emotions are too threatening. The reticular formation sends axons (nerve cables) to the cortex, where chemicals are released that make the cortical cells more alert, more responsive to incoming information. The cortex, in turn, projects axons to the reticular formation and can inhibit its arousal function, as in the case of our drowsy individual or the tired child.

Another reaction to fear or anxiety can be overarousal, due to the activity of the brain center where those emotions are generated, the amygdala. Once the amygdala is activated, it magnifies arousal and floods the cells in the cortex with messages of danger. The cortex now becomes hyperfocused on the perceived source of the anxiety, initiating a cycle: anxiety—arousal—more anxiety—more arousal,

in the midst of which all other information is blocked out. A person in this state cannot concentrate on much else, as anyone who has ever been anxious can verify.

Arousal is only one aspect of attention. Other factors such as interest, motivation and the child’s emotional priorities contribute.

The nagging hunger for emotional contact explains the oft-observed “paradox” that many children with ADD are capable of focused work in the presence of an adult who is keeping them company and paying attention to them. This is no paradox at all, if we see the opposing roles of anxiety and attachment in influencing attention:

The notoriously poor short-term recall is in large part due to the tuned-out, semidissociated, internally preoccupied state of ADD.

In attention deficit disorder, stages becomes states: the individual’s psychological development remains static.

Hyperactivity and its counterpart, the lethargy of many children and adults with ADD, are both exaggerations of body states first experienced during toddlerhood,

each represent the activity of the autonomic nervous system, which, in ADD, is poorly controlled.

The autonomic nervous system (ANS) is autonomous from, independent of, our conscious will, as its name implies.

It governs body states such as the release of

hormones, blood flow to internal organs and to the skin and the contraction of the muscles in the intestines. Autonomic nerves also set the baseline tension level of voluntary muscles, as well as skin temperature and the erection or relaxation of hair follicles.

The body’s physiological states are directly influenced by emotions because the part of the cortex that processes emotions also oversees the ANS.

The ANS has two opposing divisions: the sympathetic, which expends energy, and the parasympathetic, which conserves energy. When we are in a sympathetically aroused state, our muscles tense, our heart rate increases, blood flow goes to our limbs and adrenaline is pumped through our bodies.

When parasympathetic nerves dominate, the body slumps, the head hangs down, the arms go limp, the eyes are averted, the facial muscles go slack.

The low-arousal state is experienced in the common feeling of shame. In a chronic form, it is a characteristic of depression.

Just as inattention diminishes in the presence of a warmly supportive adult, so does the hyperactivity.

In response to the words, vocal tone and body language of disapproval, the toddler goes into the physiological shame state: from activity to inactivity,

During the phase of decreased arousal, new circuits will develop so that the cortex can inhibit the other part of the autonomic nervous system, its parasympathetic division. As before, the environment has to be right for the pathways of inhibition to mature.

Shame becomes excessive if the parent’s signaling of disapproval is overly strong, or if the parent does not move to reestablish warm emotional contact with the child immediately—what

What strikes me immediately when I meet new ADD patients is how often they apologize.

These expressions of remorse, where no offense was committed, communicate a deep sense of shame.

at any age studied, we have shown anatomical effects due to enrichment or impoverishment.”

Early in life, plasticity, the responsiveness of the human brain to changing conditions, is so great that infants who suffer damage to one side of their brain about the time of birth, even if they lose an entire hemisphere, may compensate for the deficit.

With age, plasticity declines, but it is never completely lost.

Integration of cognition with emotion—the melding of what we know with what we feel—is the very integration the healing process in ADD requires. Lack of it underlies the fragmentation of the ADD mind.

Restoring relationships on a healthy basis promotes mental organization. New ways of processing emotions need new neural circuits, and the wiring of new circuits requires new experiences in a favorable emotional milieu.

In his book On Becoming a Person, Carl Rogers described a warm, caring attitude, for which he adopted the phrase unconditional positive regard