Scattered Minds: The Origins and Healing of Attention Deficit Disorder

“We all have experiences as parents that we are ashamed of and wish we could erase. Such scenes always represent failures of self-regulation and impulse control.”

Maté believes that parents are responsible for reestablishing a safe relationship with their child with ADD. This means that the parent needs to take responsibility for their own contributions to emotional dysregulation in the household. However, Maté softens his criticism by including himself within it; his use of the first-person plural pronoun bolsters his contention that “all” parents make mistakes.

“The deficiencies and imbalances of brain chemicals are as much effect as cause. They are greatly influenced by emotional experiences.”

Maté is convinced that physiology and emotion are interconnected. He believes that our emotional experiences are at least as responsible for brain development as our genetics are in determining our emotions, which contributes to his Skepticism of the Illness Model in ADD Awareness and Treatment.

“But even if the existence of these genes is proven, there is no reason to suppose that they can, on their own, induce the development of ADD or any other disorder. First, not everyone with these genes will have the disorders. Second, not everyone with the disorders will be shown to carry the genes.”

Maté points out that gene expression is far from determinate in brain development. He believes that it is the emotional aspect of development that most informs neurochemical expression.

“Psychological tension in the parents’ lives, during the child’s infancy is, I am convinced, a major universal influence on the subsequent emergence of ADD.”

Maté believes that it is impossible to fully treat the symptoms of ADD without a comprehensive model of infant development. This includes understanding any tension that existed in the parents’ lives during this critical period, which may have interrupted the attunement relationship. By suggesting that this tension is a “universal” factor in cases of ADD, Maté contrasts it with genetic influences that may or may not be present.

“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.”

Maté proposes that hypersensitivity is the fundamental genetic characteristic of ADD. The ADD brain, to Maté, is particularly susceptibility to the experience of abandonment. He reflects throughout the book on how hypersensitivity informs the various ADD symptoms.

“The areas of the cortex responsible for attention and self-regulation develop in response to the emotional interaction with the person whom we may call the mothering figure.”

Attention and self-regulation, Maté says, are the brain functions most affected by ADD. He asserts that this impairment is the result of insufficient nurturing from one’s primary caretaker during infancy. Maté here associates nurturing with the maternal role, although he notes that the person filling it need not be a woman.

“Attunement is necessary for the normal development of the brain pathways and neurochemical apparatus of attention and self-regulation.”

The book’s fundamental claim concerns The Centrality of the Attunement Relationship to the Development and Healing of ADD: Maté claims that this special attachment relationship between parents and their infants is critical for healthy brain development. To Maté, the miswiring of the brain at this critical stage leads to symptoms of ADD.

“She finally understood that she could understand her own childhood only if she recognized the early circumstances that shaped her mother’s life.”

Maté quotes the experience of Marilyn, one of his patients with ADD. Marilyn, like many people with ADD, could only find healing when she began to unravel the unprocessed family feelings that created the context for her emotions. Although Maté largely downplays hereditary factors in ADD, he believes that family history is important, as insecure attachment tends to be self-perpetuating across generations.

“The family as an institution has been put under enormous strain by enormously powerful forces in our society and culture.”

Maté suggests that looking at internal family systems in isolation cannot help one understand ADD. Society is implicated in the pressure it puts on families, which undermines healthy development. Maté’s repetition of “enormous”/“enormously” emphasizes just how influential society is in shaping family environments.

“Blame becomes a meaningless concept if one understands how family history stretches back through the generations.”

Taking responsibility is the goal of personal development for Maté. He believes that the self-perpetuating cycles of generational sensitivity and pain can create more compassion for one’s parents, children, and self.

“Hyperactivity, like other traits associated with ADD, is a normal stage in the maturation of a child.”

Maté believes that many symptoms of ADD represent stages of infant development that have become entrenched states of being. Hyperactivity, he says, correlates with stress derived from sympathetic arousal in the ANS. Although the prolongation of this state is atypical, the fact that hyperactivity itself is normal supports Maté’s skepticism of the illness model.

“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.”

Maté lists these three particular aspects of ADD in connection with the development of different arousal states in the ANS during infancy. Chronic or easy activation of the sympathetic and parasympathetic nervous systems, he believes, corresponds to emotional wounds of abandonment.

“Th[e] situationality of ADD reflects the input of emotions, which play a powerful role in attention.”

Maté pushes back against the notion that people with ADD consciously choose whether or not to pay attention. The ADD brain requires extraordinary stimulation to activate attention. He believes that properly functioning cognition is contingent upon emotional healing.

“Every child with ADD has been wounded by disruption in the relationship between the caregiver and the sensitive infant. All the behaviors and mental patterns of attention deficit disorder are external signs of the wound, or inefficient defenses against feeling the pain of it.”

This is the fundamental premise of Maté’s understanding of ADD. He believes that the disorder represents the underdevelopment of emotional regulation in a child as the result of insufficient active attention. His description of this as a “wound” indicates the sensitivity of certain children to any disruption—not necessarily the magnitude of that disruption.

“Attention of the right kind is the child’s central need, the lack of it her central anxiety. Recognizing that transforms the very nature of Attention Deficit disorder.”

Maté believes that the ADD brain lacked a specific type of attention as an infant. As a result, the person with ADD is anxious for attention. The key, says Maté, is to approach the child with compassionate curiosity.

“We try to make our kids act as truly socially responsible people at the expense of their emotional security and their autonomous sense of self.”

Maté argues that by demanding compliance from children, parents only reinforce the idea that the child’s value is contingent. The child also comes to lack their own self-regulated sense of responsibility since that responsibility has always been external to them.

“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.”

Maté criticizes the standardization of education. He believes that teacher-centered learning models are a problem because they are not flexible enough to compensate for the unique needs of individual students. His critique of the educational system is part of his broader argument about The Physiological Impact of Social Pressures on the Family.

“On the social level, the denial of arts education simply helps foster a culture of consumerism rather than of self-expression.”

Maté is unsatisfied with the North American educational system, which prioritizes job placement over creative expression. Especially for people with ADD, Maté believes that creative outflow is important for emotional growth.

“My experience with ADD teenagers is that they are quite open to looking at themselves more realistically and to reach out for help once they see that their parents are willing to see and accept them for who they are, and to respect their feelings and their autonomy.”

Mate cites his own experience as a physician and father to advocate that parents of teens with ADD adopt an empathy-first approach. The long-term goal of establishing safety in the relationship outweighs the short-term goal of enforcing a particular behavior. Maté believes that parents should accept responsibility for their own role in the interaction to model the behavior they would like to see in their children.

“Absolutely universal in the stories of all adults with ADD is the memory of never being comfortable about expressing their emotions.”

ADD, to Maté, is in part a psychic pain that corresponds to feelings of shame and automatic mistrust of self. The difficulty many ADD patients had in sharing their emotions with their parents is further evidence of Maté’s model of deficient attachment.

“Fear of intimacy is universal among adults with ADD. It coexists with what superficially would seem to be its opposites—a desperate craving for affection and a dread of being rejected.”

It is Maté’s belief that the ADD personality fears intimacy because it never received intimacy at a critical juncture of development. The implicit memory of this period, Maté says, creates an anxiety of abandonment that can lead people with ADD to avoid intimacy altogether. This paradox, which he here highlights, is one of several Maté associates with ADD.

“The deficient neurochemistry of addiction, like the deficient neurochemistry of ADD, can be traced to events in the first year or two of life, as we know, the brain’s most crucial formative period.”

Maté compares addiction, a theme he explores in more depth in his other work, to the neurochemical deficit of ADD. Maté believes that both medical explanations and moralism fail to recognize the true essence of these conditions, which are bound up in social relationships.

“Attention deficit disorder is not primarily a medical problem. Neither its causes nor manifestations are due to illness.”

This passage summarizes Maté’s core hypothesis: that ADD represents a lack of a particular emotional development rather than the emergence of an illness. A strictly medicalized approach to treatment, he believes, can only temporarily disguise the symptoms.