Scattered Minds: The Origins and Healing of Attention Deficit Disorder

by Gabor Maté

contains more of the reward chemicals associated with pleasure and joy—dopamine and endorphins—than almost any other area of the cortex.

the right OFC interprets the emotional content of communications—the other person’s body language, eye

movements and tone of voice. 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.

The OFC also functions in impulse control, helping to inhibit the lower centres in

the brain where urgent emotional drives originate.

We experience them later in life when we find to our surprise that some relatively minor stimulus, being cut off in traffic, for example, triggers in us an irrational rage, leaving us scratching our head and wondering, What was that about? It was about the early imprinting of the OFC with the rage and frustration of the infant and toddler, and about the Hebbian principle. Each time we scream at someone in traffic, we are

telling a story from the earliest part of our life.

That is, emotional stress particularly affects the chemistry of the prefrontal cortex, the center for selective attention, motivation and self-regulation. Given the relative complexity of human emotional interactions, the influence of the infant–parent relationship on human neurochemistry is bound to be even stronger.

I am scanning the far horizons of the future, or of the past. It’s all the same. What do our fears or fantasies of the future reflect, if not our past?

During this phase of prolonged excitement, neural pathways are established that enable the

cortex to inhibit the sympathetic nervous system—if the necessary circumstances are present. During stress, these circuits do not develop properly, and hyperactivity persists. The stage, meant to last only a few months, becomes a state that the child remains stuck in.

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—

Each time this happens, shame is evoked in the child, especially as the parent usually believes—and makes the child believe—that whatever his (the parent’s) reaction is, the child is responsible for it.

Like so much else about attention deficit disorder, hyperactivity, lethargy and shame are closely connected with the neurological memories of the distant, stressed or distracted caregiver. There will be a sense of discomfort as soon as the mind becomes aware of itself, because such awareness immediately triggers responses encoded with

the infant’s distress at feeling emotionally alone. The mind then lapses into helpless lethargy, or races away, looking for something to attach to: some idea, some fantasy, some memory, conversation, music, reading—anything. When it cannot do so, there is intense unease—or the aversion to one’s own mind, which we call boredom.

The parent takes active responsibility for the relationship

The parent does not judge the child

The parent does not overpraise the child

One does not parent from anger

The parent takes responsibility for restoring the relationship

Self-regulation is not the absence of anxiety, at least not in the very beginning, but a person’s ability to tolerate her own anxiety.

Myth 1: The child is just looking for attention

Myth 2: The child is deliberately trying to annoy the adult

Myth 3: The child purposefully manipulates the parent

Manipulation and the drive to control are fear responses based on

unconscious anxieties. The truly strong person need not be so afraid that she has to direct and control every aspect of her environment.

Myth 4: The ADD child’s behavior causes the adult’s tension or anger

Myth 5: Children with ADD are lazy

When we consider the word lazy, we realize that it does not explain anything. It is only a negative judgment made about another person who is unwilling to do what we want them to do.

Understanding counterwill is particularly crucial for

the parenting of the ADD child and for the self-understanding of the ADD adult.

It is a natural but immature resistance arising from the fear of being controlled. Counterwill arises in anyone who has not yet developed a mature and conscious will of her own.

Figuring out what we want has to begin with having the freedom to not want.

An emotionally self-confident person does not have to adopt an oppositional stance automatically. She may resist others’ attempts to control her, but she will not do so rigidly and defensively.

1. Keep attachment foremost

2. Do not mistake acquiescence for voluntary “good behavior”

3. Do not take the child’s recalcitrance personally

4. Make room for some resistance in the relationship

5. Engage only in those fights that parents must win

6. Encourage verbal expression

7. Parents recognize that they, too, can be recalcitrant at times

8. Mend fences after the fact

9. Encourage self-discipline instead of controlling the child

1. Do no harm

2. Working with the parents

3. ADD specialists

4. Keep attachment needs in the foreground

5. Allow time for play and creative expression

6. Adjust examination and home assignment expectations