Scattered Minds: The Origins and Healing of Attention Deficit Disorder

by Gabor Maté MD

Imagine, he said, you’re standing in the middle of a really crowded room. Everyone around you is talking. Suddenly someone asks you, “What did so-and-so just say?” That’s what it’s like inside the ADD brain and how it is for your child.

Never at rest, the mind of the ADD adult flits about like some deranged bird that can light here or there for a while but is perched nowhere long enough to make a home.

Such striking imbalance between intellectual awareness on the one hand and emotional and behavioral self-control on the other is characteristic of people with attention deficit disorder.

What begins as a problem of society and human development has become almost exclusively defined as a medical ailment. Even if in many cases medications do help, the healing ADD calls for is not a process of recovery from some illness. It is a process of becoming whole—which, it so happens, is the original sense of the word healing.

At times I have wished that the “experts” and media pundits who deny the existence of attention deficit disorder could meet only a few of the severely affected adults who have sought my help. These men and women, in their thirties, forties and fifties, have never been able to maintain any sort of a long-term job or profession. They cannot easily enter meaningful, committed relationships, let alone stay in one. Some have never been able to read a book from cover to cover, some cannot even sit through a movie. Their moods fly back and forth from lethargy and dejection to agitation. The creative talents they have been blessed with have not been pursued. They are intensely frustrated at what they perceive as their failures. Their self-esteem is lost in some deep well. Most often they are firm in the conviction that their problems are the result of a basic, incorrigible flaw in their personalities.

Attention deficit disorder is defined by three major features, any two of which suffice for the diagnosis: poor attention skills, deficient impulse control and hyperactivity.

A facility for focusing when one is interested in something does not rule out ADD, but to be able to focus, the person with ADD needs a much higher level of motivation than do other people.

The restlessness coexists with long periods of procrastination. The threat of failure or the promise of reward has to be immediate for the motivation apparatus to be turned on. Without the rousing adrenaline rush of racing against time, inertia prevails.

An adult with ADD looks back on his life to see countless plans never fully realized and intentions unfulfilled. “I am a person of permanent potential,” one patient said. Surges of initial enthusiasm quickly ebb. People report unfinished retainer walls begun over a decade ago, partly constructed boats taking up garage space year after year, courses begun and quit, books half read, business ventures forsaken, stories or poetry unwritten—many, many roads not traveled.

Adults with ADD may be perceived as aloof and arrogant or tiresomely talkative and boorish. Many are recognizable by their compulsive joking, their pressured, rapid-fire speech, by their seemingly random and aimless hopping from one topic to the next and by their inability to express an idea without exhausting the English vocabulary.

At social events, I tend to gravitate to the periphery, conscious of a feeling that somehow I cannot enter into the spirit of things. I observe people talking to each other, people I may know quite well, acutely aware that I have nothing to say to anyone.

“Thank God it’s only ADD,” said one man after I confirmed his diagnosis. “I always used to think I was one crouton short of a Caesar salad.”

As Drs. Hallowell and Ratey point out in Driven to Distraction, ADD is a diagnosis not of category but of dimension. At a certain point on the human continuum, the characteristics associated with ADD become intrusive enough to impair a person’s functioning to one degree or another.

In honoring this overwrought sense of responsibility toward others, I neglected my responsibility toward the only people for whom I really was indispensable. This feeling of duty toward the whole world is not limited to ADD but is typical of it. No one with ADD is without it.

ADD is not a problem of knowing what to do; it is a problem of doing what you know. — RUSSELL A. BARKLEY, PH.D., “Improved Delayed Responding”

The ADD mind is afflicted by a sort of time illiteracy, or what Dr. Russell Barkley has called “time blindness.” One is either hopelessly short of time, dashing about like a deaf bat, or else acts as if blessed with the gift of eternity. It’s as if one’s time sense never developed past a stage other people leave behind in early childhood.

The time sense of the ADD adult or child is warped in other ways. Ask people with ADD how long it will take to perform a particular task, and they will notoriously underestimate. A kind of magical thinking dominates, characteristic of young children: if I will it, it will happen. In magic anything is possible.

The major impairments of ADD—the distractibility, the hyperactivity and the poor impulse control—reflect, each in its particular way, a lack of self-regulation. Self-regulation implies that someone can direct attention where she chooses, can control impulses and can be consciously mindful and in charge of what her body is doing.

One way to understand ADD neurologically is as a lack of inhibition, a chronic underactivity of the prefrontal cortex. The cerebral cortex in the frontal lobe is not able to perform its job of prioritizing, selection and inhibition. The brain, flooded with multiple bits of sensory data, thoughts, feelings