Scattered Minds: The Origins and Healing of Attention Deficit Disorder

Maté begins by talking about absentmindedness, which he calls a “byproduct of living in a complex society” (118). With ADD, the brain’s inability to discriminate between stimuli is severe enough to affect one’s life. Maté calls this phenomenon “dissociation” and compares it to a psychological anesthetic. Dissociation is functional under the right conditions, but pain can be an important indicator of helplessness or extreme distress. Maté uses the example of a skiing accident in which someone breaks their leg. If the person has someone with them, they may be unable to move because their body knows that moving may threaten their life. The person with the broken leg has to sit still while their friend goes to retrieve help. If the person is alone, however, their body may recognize the desperation of the situation and block out the pain long enough for the person to escape to safety.

For people with ADD, Maté says, dissociation is an automatic brain activity caused by chronic stress. If the parents’ anxiety is the source of this distress, the infant senses that expressing their own emotions will exacerbate this anxiety and tunes out, undermining the infant’s ability to process emotional hurt in a positive way. This can become the default setting of the child, who requires little stimulation to return to this dissociated state. To heal these cycles, Maté says, one must build new pathways in the brain.

Many children with ADD find it very difficult to pay attention as a result of dissociation, Maté says. Arousal is important for attention and emotional problem solving, and children with ADD are often over- or under-aroused because of insufficient self-regulation. Maté quotes Joseph LeDoux to reinforce the idea that arousal locks one in an emotional state. Drowsiness during emotionally volatile situations, for instance, is a common experience for people with ADD. It provides a temporary escape for someone trapped in such a feeling. Maté notes that the connection between the right prefrontal cortex and the reticular formation in the brainstem is responsible for arousal and dissociation.

The amygdala is responsible for flooding the cortex with signals of anxiety or fear, which can lead to overarousal. A person in this state may become overwhelmed. Maté gives the example of a child in a classroom who gets chastised for not paying attention. This locks the child in a state of anxiety that only exacerbates the inattention. This child’s behavior cannot simply be seen as biological, Maté says, but exists in context. Attention is a skill that develops as a byproduct of experience; though often thought of as intellectual, it is the result of the emotional arousal of the brain.

Maté says that it is the warm, attuned interest from the primary caregiver that directs the child’s attention. The joy of these interactions is the motivation for the infant to begin exploring the world. Maté quotes Stanley Greenspan to describe the process of attention development in infants. Without attunement, Maté says, the infant will be hesitant, unregulated, and unfocused.

Mate looks at hypothetical examples of schoolchildren who become preoccupied by trying to get their emotional needs met, which their peers often receive as desperate and reject. The child’s brain can only pay attention when the prefrontal cortex is not preoccupied by anxious attachment. When this need is met, Maté says, ADD symptoms will begin to heal.