Scattered Minds: The Origins and Healing of Attention Deficit Disorder

by Gabor Maté

Family strife and parental depression contribute to the child’s ADD problems not just because of their negative influence on attunement during brain development. Stressed or depressed mothers are found to be more short-tempered, more controlling and more angry with their children.

Given their automatic tuning out, ADD children forever find themselves being told to “pay attention”—a demand that completely misunderstands both the nature of the child and the nature of attention.

An example in the classroom may be a young pupil with ADD in whom the gruff commands of a perhaps well-meaning but authoritarian teacher trigger anxiety. The child will become overaroused and will not “pay attention,” which raises the teacher’s ire. His disapproval, in turn, will further lock the child into his anxious state. “Marty would do much better if he would only learn to concentrate,” the teacher will write in his report card.

So does the body’s internal environment, as a highly sensitive child may be distracted by physical sensations. Unbalanced chemical states, such as blood sugar levels at either the high or low ends of the normal range, are notoriously powerful negative influences on the ADD child’s ability to concentrate or to remain emotionally balanced.

A woman in her thirties whose ADD was never noticed because she was not hyperactive, only a day-dreamer, told me that she spent entire school days staring out the window, lost in fanciful adventures with imaginary friends. From the outside, one might have described her as “distracted.”

Anyone with ADD has experienced, numerous times a day, going into another room or running up- or downstairs only to stand there puzzled, wondering what she came to look for in the first place, or of returning with something quite useless that she had absentmindedly picked up.

There is another component to hyperactivity: throughout life, it continues to be a human response during times of high anxiety.

The Vancouver psychologist Gordon Neufeld calls anxiety “an attachment alarm.” Its role in the survival of the human infant and child is to signal when our attachment relationships, which we are absolutely dependent on, are threatened. It is useful, unless it becomes a chronic state.

What strikes me immediately when I meet new ADD patients is how often they apologize. They apologize when I ask them to speak louder, when they cannot easily answer a question, when I interrupt their flow of speech to ask for more information, when I tell them that we will wind up the session in a few minutes as time is running out. People ask forgiveness for being in my office in the first place.

In a cerebrovascular accident, or stroke, brain tissue is destroyed, usually because of bleeding. Although nerve cells that have died will not come back to life, often the patient will, in weeks or months, be able to use again a limb that was paralyzed by the stroke.

We see this in attention deficit disorder when the same child is able to attend to a subject in one type of environment but is unable to concentrate on the same topic in another. This situationality of ADD reflects the input of emotions, which play a powerful role in attention.

The understandable desire of parents is for point-by-point advice: What do I do in this situation? How do I handle that? Important as such questions are, they are secondary. The answers to them depend on how one interprets the child’s behaviors and on what the long-term objectives are. What we want to promote is not a mere change of behavior but a transformation of inner experience leading to the development of self-regulation.

The unfortunate “time-out” technique of disciplining is an archetypical example of how opting for the short-term goal can harm attachment and therefore be ruinous to the long-term objective.

The ADD child is not capable of understanding what triggered her father’s outburst, at least not at that moment. She has poor self-insight to begin with, owing to her age and owing, as well, to the developmental delay that prevents such children from being able to view the world from another person’s perspective. Her

Children with ADD may be highly susceptible to the negative aspects of their environment, but the other side of the coin is that they are equally responsive to positive changes. The very sensitivity that makes them vulnerable is also an asset that gives them tremendous potential for development.

ADD children, without exception, harbor a deep insecurity about themselves. It is essential to demonstrate to such a child that his very existence is appreciated. The parent may put out this message verbally, but if she does not live the message by a commitment of time and energy, the child will receive mixed signals at best.

The ADD child is mired in shame. She will express it in many ways. There may be self-abusive statements such as “I’m stupid.” There may also be their opposite: a complete denial of the child’s own negative contributions to her interactions with others: “So-and-so is mean. She is always starting fights.”

Shame does not arise in the left hemisphere of the brain; it will not be dislodged by left-brain logical and verbal means. One weakens shame by not feeding it, by not doing anything to make the child feel isolated or deficient.

They seem opposite, but the underlying message is the same: the parent puts a high value not on who the child is, but on what he does. This is why many ADD children, no matter how much they crave and court attention, are uncomfortable with praise.

To try to teach a child any useful lessons when cold anger seizes hold is self-defeating. In the biochemical soup of stress and shame, no learning can take place.

People with ADD, especially children, are like cold-blooded animals, in this sense. Their internal balance is too easily upset by even relatively slight external variations. They are too often reacting automatically instead of acting purposefully.

Many find transitions stressful because they are not flexible enough to adjust emotionally to even small changes. Others with ADD thrive on constant turmoil and change. This also is a failure of internal regulation expressed in the need to take up new activities, new relationships or new situations constantly because the interest and energy level cannot be sustained from within, without highly charged external stimuli. When circumstances make that impossible, there is chaos or emptiness. An

Parents who put the attention on their own psychological functioning soon notice this highly interdependent relationship between their moods and the level of the ADD child’s reactivity. Much of what the parent interprets as problematic or disturbed behavior represents the child’s automatic right-brain responses to the parent’s emotional messages. Only superficially are dysfunctional responses the results of her “disorder.”

When their son was born, the mother naturally had to direct much of her nurturing energy toward the baby. Her own needs for emotional bonding were also satisfied, in part, by the close contact with the infant. She could feel intense joy, for example, when she was breast-feeding. For the father, it was a different story. Without knowing it, he began to exhibit behavior that betrayed mounting anxiety.

I observe similar patterns almost universally in the families I see for ADD assessment. One of, and often both, the parents may work long hours. Morning is rush, rush, rush, and the evening is no different. The parent comes home depleted and must put full energy into meeting the physical and emotional needs of a child who, for a whole day, may have been deprived of parental contact.

The parents of a child with ADD will often find themselves angry and upset. The parent tells the child to hurry: the child drags her feet and may even say something insolent. The parent flies into a rage, and he imagines that his rage has been caused by the child’s behavior. The child is chastised not for what she has done but for the unpleasant feelings experienced by the parent. In reality, the child cannot cause the parent’s rage.

The parent who learns to observe herself carefully will soon recognize that greatly complicating many situations is not what the child is doing as such but the degree of anxiety that the child’s actions set off in the parent.

When the child “misbehaves,” the parent could react with curiosity and attempt to understand exactly what is being acted out, which would make for a much more effective parental response.

An exasperated couple related that their twelve-year-old son rejected with outrage and indignation their demand that he contribute to the housework—for example, by emptying the dishwasher. “I always have to do everything,” he complained. The reality, of course, was that when it came to household duties, the parents found it easier to wring water from a stone than any cooperation from their son.

A skilled negotiator, he was able to approach any situation from new angles and unique perspectives that could break a logjam when everyone else was stuck. “I do things nobody else would dream of doing, but I feel I could be doing a lot more,” he said. At times he would impulsively take on problems and responsibilities beyond his experience or control. This propensity for risk taking had brought him and his company near the precipice of disaster more than once.

Me

Quitting music was not an act of will, it was an expression of what the Vancouver developmental psychologist Gordon Neufeld calls counterwill.fn1 Distinguishing will from counterwill is important for any successful parenting. Understanding counterwill is particularly crucial for the parenting of the ADD child and for the self-understanding of the ADD adult.

ADD children can hardly be said to have a will at all, if by that is meant a capacity that enables a person to know what he wants and to hold to that goal regardless of setbacks, difficulties or distractions.

Most obviously, it is expressed in verbal resistance—“I don’t have to,” “You can’t make me,” the constant arguing and countering whatever the parent proposes, the ubiquitous “You are not the boss of me.” Like a psychological immune system, counterwill functions to keep out anything that does not originate within the child herself.

In a manner characteristic of infants and toddlers, children with attention deficit disorder are unable to hold simultaneously in their minds two different images of themselves or of others. For the preverbal child, the “me” is either happy or miserably upset. Mommy is either good or bad.

For ADD children (and for ADD adults), it’s all or nothing. When anger arises, all feelings of attachment and love are banished. Since counterwill grows as attachment weakens, the child who is upset and angry may, in that moment, resist the parent with the emotional fury one would feel toward a despised enemy.

Many parents find out to their chagrin that there is no better way to kill a child’s interest in music than to force him to practice, even if by methods much milder than the brutality Steven’s father employed. All one ends up with is the child’s resistance.

A lack of inner-directed purpose also typifies a large number of ADD adults.

Notme

THERE IS A built–in contradiction in North American education that particularly affects students with attention deficit disorder: the tendency to teach everyone as if their brains all worked the same way, when the reality is that they do not.

My teaching style was influenced by my ADD traits: I was a gifted improvisational artist but did virtually nothing to plan lessons, units, course outlines. The results reflected my methods.

Ditto

Many teenagers are wary of the diagnosis of attention deficit disorder. They do not want to be different, or to be regarded as if something was mentally wrong with them. They sense very strongly that the parents see the attention deficit disorder as the root of all the conflicts and clashes that erupt each day.

While features of many other chronic and troubled psychological states, such as depression, for example, low self-esteem and merciless self-criticism are so much part of the ADD personality that it would be difficult to know where ADD ends and low self-esteem begins.

ADD adults don’t have low self-esteem because they are poor achievers, but it is due to their low self-esteem that they judge themselves and their achievements harshly. It is also, in part, due to low self-esteem that people do not reach their full potential, do not strive to locate within themselves fonts of creativity and self-expression, do not venture to embark on activities and projects where success is in doubt.

The need to be needed at all costs comes from one’s earliest experiences. If the child does not feel accepted unconditionally, he learns to work for acceptance and attention.

experiences and feelings I have heard from many others with ADD: a painful hyperconsciousness of injustice, accompanied by ineffective rage or by shamed silence.

features of attention deficit disorder can be understood when interpreted in the light of implicit memory, notably the trouble with authority figures reported by most ADD adults. This trouble can present itself in three ways: fear, rebelliousness or a combination of both. There is always at least an inner rejection of authority, a perhaps unspoken sense that people with power are unseeing, unknowing and unfair.

There are memories, the psychiatrist Mark Epstein explains, “that are not so much about something terrible happening, but, in the words of D. W. Winnicott [the great British children’s psychoanalyst] about ‘nothing happening when something might profitably have happened.’

Dog not barking

able to recall of his later childhood years.) The emotion a sensitive infant would experience when he feels cut off from his primary caregivers would be a deep anxiety of being abandoned, which is precisely what Trevor experiences at the slightest intimation that a woman whose attention he wants is withdrawing from him, if only on the telephone.

Trevor’s anxiety is not over the ending of the relationship—he is serially ending relationships—but over being the one who is left by the other.

When mother and infant are rapturously gazing into each other’s eyes, the infant at some point will look away, to avoid being overstimulated. He has no anxiety over doing so. Should the mother be the one to break eye contact, however, the infant is morti...

The fear of rejection is not unique to the ADD personality—no single psychological feature of attention deficit disorder is unique. Its importance in attention deficit disorder comes from the hyperreactivity of temperament everyone with ADD was born with.