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

by Gabor Maté

The good news is that major changes in the circuits of the brain can occur in the child and even in the adult if the conditions necessary for positive development are created.

Medicine tells us as much about the meaningful performance of healing, suffering, and dying as chemical analysis tells us about the aesthetic value of pottery. —IVAN ILLICH, Limits to Medicine

I felt I had discovered what it was that had always kept me from attaining psychological integrity: wholeness, the reconciliation and joining together of the disharmonious fragments of my mind.

The shock of self-recognition many adults experience on learning about ADD is both exhilarating and painful. It gives coherence, for the first time, to humiliations and failures, to plans unfulfilled and promises unkept, to gusts of manic enthusiasm that consume themselves in their own mad dance, leaving emotional debris in their wake, to the seemingly limitless disorganization of activities, of brain, car, desk, room.

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.

“my life is just so much soup and garbage can.” What those words mean exactly, I could not say. Like poetry, they convey their meaning through the feelings and word associations they evoke.

There is an almost active not noticing, as if a person purposefully went out of her way to be oblivious of what is around her.

You may be able to visualize what a tidy and organized room would look like, but the mind-set to do the job is missing.

a profound reluctance to discard anything—who

little ability to conceptualize in three dimensions or to divine the spatial relationships of things, no matter how well they are explained.

to some activities a child may be able to devote, if anything, compulsive, hyperconcentrated attention. But hyperfocusing that excludes awareness of the environment also denotes poor attention regulation.

Active attention, the mind fully engaged and the brain performing work, is mustered only in special circumstances of high motivation. Active attention is a capacity the ADD brain lacks whenever organized work must be done, or when attention needs to be directed toward something of low interest.

What can be immobilizingly difficult is to arouse the brain’s motivational apparatus in the absence of personal interest.

impulsiveness of word or deed, with poorly controlled emotional reactivity.

The impulsiveness may express itself as the purchase of unneeded items on a whim, without regard for cost or consequence.

“If I had the money I would impulse buy the whole world.”

It’s as if such a child is saying, I’m cut off from people, so anxious that if I don’t work overtime to establish contact with them, I will be left alone. I only know to do this through my words. I know no other way.

rarely had a moment’s relaxation without the immediate and troubling feeling that I ought to be doing something else instead.

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.

On the other hand, when there is something one wants, neither patience nor procrastination exist. One has to do it, get it, have it, experience it, immediately.

In my early twenties, I had gradually scaled down my academic ambitions

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.

I was semioblivious to the fact that my frenetic, catch-as-catch-can working style meant that others had to make adjustments and accommodations to their work that I had never formally negotiated with them.

couples choose each other with an unerring instinct for finding the very person who will exactly match their own level of unconscious anxieties and mirror their own dysfunctions, and who will trigger for them all their unresolved emotional pain.

In virtually every one of the families I have seen where one child or another has ADD, I found stories that, while different in detail, spoke similarly of tension and stress.

The fact is, we in this society are often quite removed from our own emotional reality.

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.

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.

With ADD we witness a delayed or permanently arrested maturation of the balanced time sense most people achieve by adulthood. In attention deficit disorder, the circuitry of time intelligence is underdeveloped.

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.

What conditions are needed for human physiological and psychological maturation? What conditions would inhibit or interfere with that growth process? Instead of asking why a disorder or illness develops, we ask why a fully self-motivated and self-regulated human personality does not.

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.

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.

“Whether these features become talents or problems depends, in short, on how the child’s nature is nurtured,” he writes.5 The critical difference is the environments in which children are reared.

Of all environments, the one that most profoundly shapes the human personality is the invisible one: the emotional atmosphere in which the child lives during the critical early years of brain development.

It may be said that no two children have exactly the same parents, in that the parenting they each receive may vary in highly significant ways.

Whatever the hopes, wishes or intentions of the parent, the child does not experience the parent directly: the child experiences the parenting.

Was it the bee sting that sent the first victim into physiological crisis? Not directly. It was his own physiological responses that brought him close to death. More accurately, it was the combination of stimulus and reaction.

People with ADD are hypersensitive. That is not a fault or a weakness of theirs, it is how they were born. It is their inborn temperament. That, primarily, is what is hereditary about ADD. Genetic inheritance by itself cannot account for the presence of ADD features in people, but heredity can make it far more likely that these features will emerge in a given individual, depending on circumstances. It is sensitivity, not a disorder, that is transmitted through heredity. In most cases, ADD is caused by the impact of the environment on particularly sensitive infants.

people with ADD have emotional allergies.

there is no dissimulation in their behavior around pain or discomfort, only, in a phrase of Friedrich Nietzsche’s, “a refined susceptibility to pain.” Sensitivity is affected by emotional states. People’s pain tolerance is lower when they feel anxious or depressed, partly because of changes in stress hormone levels and in the levels of endorphins, the body’s innate painkillers.