Scattered: How Attention Deficit Disorder Originates and What You Can Do About It

by Gabor Maté

There was also what I call the “weekend despair” of the driven personality. On Saturday mornings, there would be a crash. I was enveloped in a kind of enervated lethargy, hiding behind a book or a newspaper or staring morosely out the window. I was not only fatigued from the whirlwind week, but I did not know what to do with myself. Without the weekday adrenaline rush, I felt a lack of focus, purpose, energy. I was depleted and irritable, neither active nor able to rest.

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. Castles can be built or destroyed with the wave of a wand, worlds traversed in seven-league boots, you can get from Oz to Kansas by clicking your heels together. Magic vanquishes time. No infant is born with a sense of time. The gradual acquisition of time sense is a task of development that begins in early childhood. At the outset, the infant has no categories such as time, space or causality, no awareness that one event leads to another. It is not until the age of seven or so, Jean Piaget found, that children begin to have a full understanding of time as a continuous flow. Until then, the child is in what Piaget, the great Swiss cognitive psychologist, called the “preoperational stage,” when everything is observed and interpreted from only one point of view, the child’s. “The preoperational child, in his egocentric manner, believes that he can stop time, speed it up, or slow it down.”1 The networks of nerve cells responsible for the various brain activities do not all develop the same way, at the same time, or, necessarily, to the same degree. With ADD we witness a delayed or permanently arrested maturation of the balanced time sense most people achieve by adulthoo...

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. Like time literacy, self-regulation is also a distinct task of development in human life, achieved gradually from young childhood through adolescence and adulthood. We are born with no capacity whatsoever to self-regulate emotion or action. For self-regulation to be possible, specific brain centers have to develop and grow connections with other important nerve centers, and chemical pathways need to be established. Attention deficit disorder is a prime illustration of how the adult continues to struggle with the unsolved problems of childhood. She is held back precisely where the child did not develop, hampered in those areas where the infant or toddler got stuck during the course of development.

True or not, narrow genetic explanations for ADD and every other condition of the mind do have their attractions. They are easy to grasp, socially conservative and psychologically soothing. They raise no uncomfortable questions about how a society and culture might erode the health of its members, or about how life in a family may have affected a person’s physiology or emotional makeup. As I have personally experienced, feelings of guilt are almost inevitable for the parents of a troubled child. They are all too frequently reinforced by the uninformed judgments of friends, neighbors, teachers or even total strangers on the bus or in the supermarket. Parental guilt, even if misplaced, is a wound for which the genetic hypothesis offers a balm. There is a significant hereditary contribution to ADD—sensitivity, subject of the next chapter—but I do not believe any genetic factor is decisive in the emergence of ADD traits in any child.1 Genes are codes for the synthesis of the proteins that give a particular cell its characteristic structure and function. They are, as it were, alive and dynamic architectural and mechanical plans. Whether the plan becomes realized depends on far more than the gene itself. It is determined, for the most part, by the environment. To put it differently, genes carry potentials inherent in the cells of a given organism. Which of multiple potentials become expressed biologically is a question of life circumstances.

Studies do show that if parents or siblings have ADD, a child in that family will have a greatly increased statistical risk for having ADD as well. 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. It may appear from such facts that this motley collection of related syndromes is largely hereditary—but to assume that would be like believing that if there are three generations of butchers or bakers or candlestick makers in a family, then meat cutting, baking and candle manufacturing must also be genetic. The family atmosphere in which the child spends the early formative years has a major impact on brain development. It is obvious that 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. It would be astonishing if children growing up in such unsettled environments did not develop some of the same problems. No genes need be involved at all for these conditions to run in families.2

The derivation of sensitivity is from the Latin word sensir, “to feel.” Degrees of sensitivity reflect degrees of feeling. Of the various Oxford Dictionary definitions of sensitive, it will be useful to keep three in mind. Each is exquisitely apt as a description of the ADD child: 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 changes. The word has another connotation, that of being empathetic, respectful of other people’s feelings. The two meanings may coexist in the same individual, but not in every case. Some of the most sensitive people in terms of how they react may be the least mindful of the feelings of others. Some human beings are hyperreactive. A relatively negligible stimulus, or what to other people would seem negligible, sets off in them an intense reaction. When this happens in response to physical stimuli, we say the person is allergic. Someone allergic to, say, bee venom may choke, wheeze and gasp for air when stung. The small airways in the lungs may go into spasm, tissues in the throat may swell, the heartbeat may become irregular. His life may be in peril. The nonallergic person, had she been stung by the same bee, would experience no more than a momentary pain, a welt, an irritating itch. Was it the bee sting that sent the first victim into physiological crisis? Not directly. It was his own physiological responses that broug...

In some children, the nervous system is always in a state of hair-trigger alert. Researchers at the University of Washington, Seattle, measured the electrical activity of an important nerve, the vagus nerve, in five-month-old babies.1 (The vagus connects the central nervous system with the heart, the lungs and the stomach.) Infants with a higher baseline “tone” in the vagus nerve were also “more emotionally reactive to both positive and mildly stressful stimuli.” These same infants at fourteen months were more reactive to maternal separation. Like hypersensitive instruments, sensitive children register and record even minute changes in their emotional environment. It is not a matter of choice for them; their nervous systems react. It is as if they had invisible antennae projecting in every direction, picking up and conducting into their bodies and their minds the psychic emanations around them. They may have no conscious knowledge of this, any more than an instrument is consciously aware of what measurements it is registering. Unlike instruments, however, the sensory equipment of human beings is not easily shut off. My wife and I learned to recognize our daughter’s moods and behaviors as real-time, instantaneous computer printouts of the psychological atmosphere in our home. If we wanted to know how we were doing as individuals or as a couple, we needed only check the facial expressions and emotional responses of our daughter. What was recorded there did not always reassur...

The existence of sensitive people is an advantage for humankind because it is this group that best expresses humanity’s creative urges and needs. Through their instinctual responses the world is best interpreted. Under normal circumstances, they are artists or artisans, seekers, inventors, shamans, poets, prophets. There would be valid and powerful evolutionary reasons for the survival of genetic material coding for sensitivity. It is not diseases that are being inherited but a trait of intrinsic survival value to human beings. Sensitivity is transmuted into suffering and disorders only when the world is unable to heed the exquisitely tuned physiological and psychic responses of the sensitive individual. ADD is not a natural state. It is, to adapt a famous phrase of Sigmund Freud’s, one of civilization’s discontents.

The microcircuitry of the brain is formatted by influences during the first few years of life, a period when the human brain undergoes astonishingly rapid growth. Five-sixths of the branching of nerve cells in the brain occurs after birth. At 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, and which nerve centers will be connected with which other nerve centers, and establish the networks controlling behavior.3 The intricately programmed interactions between heredity and environment that make for the development of the human brain are determined by a “fantastic, almost surrealistically complex choreography,” in the apt phrase of Dr. J. S. Grotstein of the department of psychiatry at UCLA. Attention deficit disorder results from the miswiring of brain circuits, in susceptible infants, during this crucial period of growth. Of all mammals, the human animal has the least mature brain at birth. Early in their infancy, other animals perform tasks far beyond the capabilities of humans for many months. A horse can walk on the first day of life; infant apes cling to mother’s fur within a few weeks of birth. Human beings are able to coordinate the visual skills, muscle control, balance and orientation in space required for comparable activities only near the end of the first year. In the period fol...

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. They cause the disrupted electrical and chemical circuitry of ADD. Attachment and attunement, two crucial aspects of the infant-parent relationship, are the determining factors. They are the subject of this chapter. The right hemisphere of the mother’s brain, the side where our unconscious emotions reside, programs the infant’s right hemisphere. In the early months, the most important communications between mother and infant are unconscious ones. Incapable of deciphering the meaning of words, the infant receives messages that are purely emotional. They are conveyed by the mother’s gaze, her tone of voice and her body language, all of which reflect her unconscious internal emotional environment. 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.b Within minutes following birth, the mother’s odors stimulate the branching of millions of nerve cells in the newborn’s brain. A six-day-old infant can already distinguish the scent of his mother from that of other women. Later on, visual inputs associated with emotions gradually take over as the major influences. By two to seven weeks, the infant will orient toward the mothe...

The most heartrending cases are adults in their midlife or beyond who simply have not been able to make much sense of their world or their lives, despite obvious warm qualities, intelligence and creative potential. When you listen to their stories, you find that many of them have suffered abuse of one form or another and may not even be aware of it. Events may be recalled, but the emotions that would naturally arise from those events are suppressed. If the emotions are remembered, their effects on the present state of mind are not understood. Stefan is a thirty-year-old who at his first visit said, “I’m here because I’m not getting anywhere except older and grayer.” He spoke with a sardonic wit, which I felt was a way of distancing himself from some deeply distressing feelings. “There’s a bunch of things I want to do,” he stated, “but I can’t think of them right now. I don’t even start anything any more because I’ll never get finished with anything anyway.” Despite his evidently high intelligence, he had not even completed high school. He had done well in subjects that he could immediately and instinctively grasp, but he proved completely incapable of studying. He was now working in a warehouse. Asked about his childhood, Stefan said it had been “fine and dandy, I guess.” He did say, on being further questioned, that “my mother laid down a lot of the law, and occasionally got out the spoon.” Asked what that meant, he replied in the same offhand, sardonic fashion that “the ...

Almost all the adults minimize the effects of the trauma they had experienced. They have pushed out of conscious awareness the anger and despair of a small child assaulted by the very people he must rely on for support and protection, or they see such experiences as normal life events. One woman answered in the negative when I asked her if there had ever been any violence in her home of origin. It turned out that she used to be whipped by her father, ostensibly as a form of punishment. I asked her what she had meant by her original answer. “I can see it, now that you mention it,” she replied. “But when I thought of the word violence, I thought you meant something much worse.” When people first mention violence they experienced in the family home, it is not unusual for them to do so with a smile. They use dismissive phrases they would never employ if they were describing the same events happening to someone else, particularly to any small child they know. They feel they brought their punishments on themselves. “Just kid stuff,” said a thirty-six-year-old woman whose father used to hit her with a stick. “I was not an easy kid,” said one man, “I warranted discipline.” “I didn’t get what I didn’t deserve,” said another. I ask them whether they would smile or call it “just kid stuff” if they themselves were to witness a child being subjected to such “discipline.” The answer is always a somber no.

We are all part of a multigenerational family system that does not begin or end with our parents. When we consider our childhoods, we are in many ways considering the effect that our grandparents’ attitudes, unconscious processes and behaviors had on our parents during the latter’s formative years. To understand ourselves, we need to understand the concentric “stories within stories,” in Lance Morrow’s phrase, which place us at the central point—and the resting point, until we have children ourselves. Marilyn was right. The seeds of her own troubled childhood were sown long before she was born, in her mother’s troubled childhood, and even long before her mother was born. We bequeath to our children not only what we honor in ourselves and in our parents; each generation also passes much of its own negative experiences on to the next, quite without wishing to do so. We need not be helpless in deciding how the story of our families will continue in the future, but first we have to recognize the themes and events that have shaped our present. Blame becomes a meaningless concept if one understands how family history stretches back through the generations. “Recognition of this quickly dispels any disposition to see the parent as villain,” wrote John Bowlby, the British psychiatrist who showed the decisive importance of attachment in infancy and childhood.5 Who should we end up pointing the accusing finger at? At Adam and Eve, or perhaps at some poor anthropoid ape ancestor diggi...

At one time or another, every infant or young child feels frustration and psychological pain. Episodic experiences of a distressing nature do not induce dissociation, but chronic distress does—the distress of the sensitive infant with unsatisfied attunement needs, for example. The infant has to dissociate chronic emotional pain from consciousness for two reasons. First, it is too overwhelming for his fragile nervous system. He simply cannot exist in what we might call a state of chronic negative arousal, with adrenaline and other stress hormones pumping through his veins all the time. It is physiologically too toxic. He has to block it out. Second, if the parent’s anxiety is the source of the infant’s distress, the infant unconsciously senses that fully expressing his own emotional turmoil will only heighten that anxiety. His distress would then be aggravated—a vicious cycle he can escape by tuning out. The survival value of all psychological defenses is relatively short-lived. Sooner or later dissociation becomes a hindrance, interferes with life and slows psychological growth. The tuned-out individual has difficulty learning from experience and is hampered in making contact with others. The inner retreat from psychological reality means that he may never learn to cope with emotional setbacks in a creative and positive way. We may compare any psychological defense to a heavy fur coat a man in a cold northern climate puts on to keep from freezing. Wearing the fur coat save...

The classroom behavior of ADD children, to give a common example, is frequently said to be disruptive. They seem to have more interest in interacting with their peers than in the material the teacher would have them study—which may simply mean that they are obsessed with trying to get their relationship needs met. If they tend not to do this very successfully, they do it all the more desperately. Their brain’s attentional system cannot switch into “schoolwork mode” when it is consumed by anxieties about the child’s emotional connection with the world. For people deeply hurt, the internal world may offer more meaning than the real one. 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.” The Latin root of distract is “draw away”—drawing her away from the inside was her hiddenmost emotional longing. Her brain unconsciously assigned greater value to a self-created internal universe than to anything or anyone in the classroom. 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:...

I once asked a forty-three-year-old writer with ADD to describe herself as a child. “Pepper pot, flibbertigibbet and high strung,” she shot back. I loved that account, with its spirited, hyperenergetic, all-over-the-place scatter-mindedness. For the record, though, I did ask her what exactly she meant. Unpredictably explosive, intense, unfocused and always trying to engage other children in chatter, she explained. “You see, you were focused,” I countered. “You were focused on what was important to you: your relationships in the world. But nobody understood.”

Toward the end of the first nine months of life, the infant begins an enthusiastic exploration of her universe. No longer having to rely on adults for mobility, she tirelessly examines every nook and cranny of her surroundings, every object. She tests, tastes, plays and discovers, learning the purpose and use of many things. 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. There is another component to hyperactivity: throughout life, it continues to be a human response during times of high anxiety. If you were told that in the next week, at some unpredictable moment, some unnamed disaster would strike you or one close to you, and that you were helpless to do anything to prevent it, your response would quite probably resemble the habitual mental and physical behaviors of the hyperactive child or adult with ADD. You would have difficulty focusing your thoughts, and your mind might feel like a squirrel on a treadmill: racing but not going anywhere. Sitting still would be a chore. A clichéd image of helpless anxiety in an adult is the father pacing nervously outside the delivery room where his wife is giving birth. I believe hyperactivity in ADD is fed by a current of per...

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. A requirement of healing, becoming whole, is circuitry in the brain that can carry different messages and a different, nonhelpless image of the self. There is strong evidence that such circuits can develop at any time in life, as can neural pathways to help the cortex to do its job of inhibition and regulation.

The parent who can tolerate her anxiety does not need to respond to the child with anger, emotional coldness or pleading. The child is not under pressure to change his behavior immediately in order for the parent to feel comfortable. If the parents do not react with their usual anxious manner and their voices do not convey anger or despair, the child himself will not feel further anxiety. If the child knows that the parent is okay even if the child is not okay, he feels safer. Whatever his immediate response may now be, it no longer has the power to escalate the conflict. He can relax a little. When he does not have to put up defenses against parental hostility, the child can more easily get in touch with his deep-seated wish to be part of the family circle or with his sadness at feeling excluded from it. When the child shows even a hint of his vulnerability, in place of his defenses, the parent can immediately move in and establish contact. The child can feel secure with a parent whom he cannot reduce to his own level of functioning. When safety is established, growth takes place.

Children swim in their parents’ unconscious like fish in the sea, in the succinct phrase of the Vancouver psychotherapist Andrew Feldmar. To create safety for their children, parents need to devote energy and commitment to processing their own “unfinished business.” In this way they can do much more to further the development of their child than by any behavioral approaches aimed at motivating the child or at making him more compliant. Self-regulation is intimately connected with a process developmental psychology has called individuation, or differentiation. Individuation—becoming a self-motivating, self-accepting person, a true individual—is the ultimate goal of development. As individuation unfolds, children are able to move more and more independently into the world, impelled by their own interests and needs. Less and less do they require that another person see exactly what they see in order to feel validated, or that another person feel exactly what they feel. They may have needs and desire for closeness, warmth and mutual support with another human being, but they do not need to be emotionally fused with the other person—they can function on their own, if need be. If parents are to foster individuation in their children, they must also work on their own maturation. Try as they might, poorly individuated parents cannot successfully foster individuation in their children. They are likely to have unsatisfactory relationships with their partners, especially after childr...

The demand for attention, like all the child’s demands, is a compensation for an unconscious emotional hunger. The parent may rightly deny some demand of the child’s for attention, or any other demand, such as for the candy bar at the supermarket, but there is no reason that the child should be expected to understand that decision or to like it. The emotionally wounded child is struck by every refusal as by a rejection, even though no such rejection is intended by the parent. If the parent allows his reaction to the child’s reaction to become cold and punishing, the child’s anxiety will have turned into a self-fulfilling prophecy. In many situations it is fit and proper for the parent not to give in to the child’s demands. The main thing is to refuse without blaming or humiliating the child for the attention seeking or for the demanding behavior. If we anticipate the child’s reactions, understand their source and do not shame the child for them, the child will eventually learn to tolerate refusal. When we endure children’s anger or frustration with compassion, they will often move on to the sadness of not having what they wish for, of having to give up what they think they need just then. At such moments, a parent can move in and witness that sadness with an empathy that will make the child feel understood and supported, despite the refusal.

The family therapist David Freeman once concluded a public lecture on intimacy and relationships by saying that if there was any one thing he hoped his audience would remember from his talk, it was the awareness that one does not know his or her spouse, his or her children. We may believe we have a perfect idea of why they act as they do, when in reality our beliefs reflect no more than our own anxieties. Whenever we ascribe a motive to the other person, as in “you are doing this because...,” we discard curiosity and immobilize compassion. The person who knows has nothing to learn, has given up on learning.

Some children rely on manipulation and control more than others. If we can remain curious, we can explore why a child would need to manipulate. To manipulate is to subtly and covertly influence others, by dishonest means if necessary, to achieve goals that would be unachievable if we were being honest. Powerful people may do this, but only when they are in a morally weak position, as when a government hopes to induce a population to support an unjustifiable war. With children, the manipulation occurs only because the child has learned that openly expressing his needs will not necessarily bring an understanding and nurturing response. It occurs also because the emotionally wounded child may no longer be able to articulate his real needs. Lacking a completely secure sense of attachment, he tries to compensate by getting things that the adult world, quite rightly, perhaps, does not want to give—for example, another expensive toy or a candy bar at an inappropriate time. No healing would come if the adult yielded to inappropriate demands or manipulative tactics, but no healing is possible, either, if the adult insists on seeing the child’s behavior as the primary problem. Excessive manipulation, controlling, bossiness are simply the dysfunctional and self-defeating acquired characteristics of a sensitive and anxious child. Just as these qualities developed in interaction with the environment, so they can atrophy when the environment becomes understanding, nurturing and supportive.

Parents need to be aware of the wide range of their emotional responses, from the functional to what may be called the dysfunctional. They are then much less likely to insist that the child take responsibility for how they feel, regardless of what the child may or may not have done. An enormous emotional burden is lifted off the child’s shoulders once the parent learns to acknowledge within himself the sources of his reactions to the child. That other people do not cause our reactions is a difficult concept, so automatically have we come to associate our feelings with what someone else is doing. The confusion is only natural. When we were very small children, other people did, in fact, cause us to feel this way or that, depending on how they treated us. To the extent that this still remains true for someone as an adult, it reflects the failure of self-regulation to develop. A simple example is the way I might react if someone accidentally stepped on my foot, say, on a crowded bus. I might address the offender politely or in a fit of rage or, if I felt intimidated, I might not even say anything. Although the stimulus in each case is the same, the reaction depends not on the stimulus but on my particular state of mind. Even the same person will react differently to the same stimulus from one moment to the next, so the stimulus cannot be said to cause any one particular reaction. We cannot blame the trigger for the shotgun blast. A person can squeeze the trigger all he wants,...

Counterwill is an automatic resistance put up by a human being with an incompletely developed sense of self, a reflexive and unthinking opposition to the will of the other. 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. Although it can remain active throughout life, normally it makes its most dramatic appearance during the toddler phase and again in adolescence. In many people, and in the vast majority of children with ADD, it becomes entrenched as an ever-present force and may remain powerfully active well into adulthood. It immensely complicates personal relationships, school performance and job or career success. Counterwill has many manifestations. The parent of a child with attention deficit disorder will be familiar with them. 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 It is present when the four-year-old puts both hands over his ears to keep out the parent’s voice, or when the older child pins up an angry Keep Out sign on her door. It is visible in the body language of the adolescent and teenager: the sullen look and the shrugged shoulder. Its signs driv...

Like all natural phenomena and all stages in the child’s life, counterwill has a positive purpose. It first appears in the toddler to help in the task of individuating, of beginning to separate from the parent. In essence, the child erects a wall of no’s. Behind this wall, the child can gradually learn her likes and dislikes, aversions or preferences, without being overwhelmed by the far more powerful force generated by the parent’s will. Counterwill may be likened to the small fence one places around a tender young shoot to protect it from being eaten. The vulnerable little plant here is the child’s will. Without that protective fence, it cannot survive. In adolescence, counterwill serves the same goal, helping the young person loosen his psychological dependence on the family. It comes at a time when the sense of self is having to emerge out of the cocoon of the family. It is a defense mechanism to protect this fragile, threatened sense of self. By keeping out the parent’s expectations and demands, counterwill helps to make room for the growth of the child’s own self-generated motivations and preferences. Figuring out what we want has to begin with having the freedom to not want. “Far from being depraved, counterwill is bequeathed by nature, to serve the ultimate purpose of becoming a separate being,” says Dr. Neufeld. “Counterwill, the dynamic, should not be identified with the child’s self. This is really important. It is not the person that we are getting to know when...

Even though you try to put people under some control, it is impossible. You cannot do it. The best way to control people is to encourage them to be mischievous. Then they will be in control in its wider sense. To give your sheep or cow a large, spacious meadow is the way to control him. So it is with people: first let them do what they want, and watch them. This is the best policy. To ignore them is not good; that is the worst policy. The second worst is trying to control them. The best one is to watch them, just to watch them, without trying to control them. —SHUNRYU SUZUKI ROSHI, Zen Mind, Beginner’s Mind

There are, as Edward Deci points out, universal human needs for self-determination, to feel competent and to be genuinely connected with others. These needs and the drive to satisfy them do not have to be instilled in people: they exist, even if in undeveloped form. Allowed to unfold, they will motivate. The problem is not that parents and other important adults, such as teachers, do not know how to motivate children. The problem is that our parenting styles and teaching methods in many cases fail to support the child’s natural drive for discovery and mastery. Encouraging development to unfold is based on the knowledge that nature has its own positive agenda for the child: it has given the child, every child, all the potential and capacities required for full maturation. Attempting to motivate from the outside betrays a lack of faith in the child and in nature. It reflects the anxiety of the parent, not the limitations of the child. It’s unfortunate but true that while we may not be able to transplant genuine motivation into our children, we are altogether too successful when it comes to sowing in them the seeds of our own anxiety. A child who must meet only parental expectations will likely acquire a chronic sense of incompetence as she fails over and over again to live up to them. Or she may function well enough as viewed from the outside but will have to pay a grievous price internally. She will be unable to experience the joy and satisfaction of acting from her own fre...

Artificial consequences devised by parents intensify resistance and reinforce the child’s already negative view of herself. This is especially true for the underproductive and underachieving ADD child. “Although punishment is ineffective in making [the child] try harder,” writes Natalie Rathvon, “it is highly effective in solidifying her view of herself as unlovable and her view of others as unhelpful. If treatment by punishment continues, it is likely to motivate her to act out her image of herself as bad and dumb by misbehaving in school or at home or by performing even more poorly academically.”5 Will is like psychological muscle, says Gordon Neufeld. Parents cannot do anything directly to develop the child’s will, any more than they can make the child’s muscles grow. What they can do is to provide the nurturing, the right conditions and the proper direction. Like muscles, will needs exercise to grow. “Parents can provide lots of exercise,” Dr. Neufeld says. “Exercise is basically making choices—that is how we exercise our will.” Parents may worry that if they support the child’s autonomy, she may grow up to be selfish, unmindful of others. It is a common fear, but unfounded. It is based on the completely erroneous view that children are wild creatures needing to be tamed by any means necessary. The process of becoming connected with other people and learning appropriate human interactions, of developing into a social creature, is called socialization. Children don’t ha...

Sometimes we forget teenagers have their own take on life. They look at things differently. They see many of our attitudes and concerns as irrelevant or, like Holden Caulfield in The Catcher in the Rye, even absurd. Their priorities are not ours. That much was evident in an illuminating conversation I had with Angus, a highly gifted sixteen-year-old in my practice. I have known him all his life, having been the attending physician at his birth. I saw him grow up. I saw his parents’ marriage fail as his father—a very personable and clever man, an accomplished juggler—sank deeper and deeper into alcoholism. Angus has ADD, and until he participated in a very demanding outdoors course this past year, he also had a heavy-duty drug problem. He was expelled from no fewer than five schools in the two years between Grades 9 and 10. I quote him at some length because he articulates very clearly the ambivalence many teenagers have toward the diagnosis of attention deficit disorder. Parents are best to respect that ambivalence, not to try to force the issue. Angus also voices the teenager’s demand to be accepted as he is. “I love history and English,” Angus said, “but in my other subjects the teachers are always saying that ‘Angus doesn’t pay attention. Doesn’t concentrate. Talks too much.’ I don’t take notes.” “Why don’t you want to try medications?” I asked. “It’s just the way I am. It might sound strange, coming from an ex—drug addict, or however you want to phrase it—a clean addic...