I believe that ADHD can be better understood if we examine people’s lives, not only bits of DNA.
Rather than an inherited disease, Attention Deficit Disorder is a reversible impairment and a developmental delay, with origins in infancy. It is rooted in multigenerational family stress and in disturbed social conditions in a stressed society. In Scattered Minds, Dr. Maté offers a completely new perspective on this disorder, providing hope for adults with ADD, and parents seeking to support their children.
Gabor Maté: The Roots of Healing (Sounds True Podcast, March 2017)
- Physician Gabor Maté Gives His Analysis on ADHD and Anxiety (The Joe Rogan Experience, September, 2022)
Scattered Minds: A New Look at the Origins and Healing of Attention Disorder (published in the U.S. as Scattered) offers a groundbreaking and optimistic perspective on this much-misunderstood condition, seeing it not as a disease but as a problem of brain development in the context of a stressed society.
Q. It seems that no brain scan or blood test can give a bona-fide diagnosis of ADD/ADHD. In lieu of that what are telltale signs that should prompt someone to seek treatment?
A. People usually seek diagnosis after recognizing in themselves a litany of the salient symptoms: frequent, involuntary and frustrating tuning-out or absence of mind; difficulty concentrating unless very interested in something; being bored easily; beginning one thing but going on to another before completing the first; problems keeping order physically in one’s room, on one’s desk, in one’s car; often, difficulty being on time; poor impulse control, manifested in speaking out of turn, interrupting others in conversation, impulse buying, and in a tendency towards addictive behaviors; finally, in many but not all cases—and less in women—physical hyperactivity, difficulties sitting still, and fidgetiness.
Q. What treatment options are available? Which do you recommend?
A. As I point out in the book, there are many options, and they don’t need to be mutually exclusive. Some may find medication helpful, but they should never be the only treatment. In my view, ADD is not an inherited condition, contrary to the commonly held opinion, but originates in early childhood stresses during the first years of crucial brain and personality development. Hence, counseling to unravel family issues and issues with self-esteem is always important. Physical self care, exercise, nutritious diets, good sleep hygiene, outdoor activities are all important. Mindfulness practices, like meditation, are very challenging to the ADD mind, but extremely helpful.
Q. You say that ADD isn’t genetic. Are you saying it’s not biological?
A. Not at all. It’s a common mistake to think that everything that’s biological is genetically caused. Biology is greatly affected by what happens in a person’s life, in her family, in the society around her, and so on. For the most part genes don’t predetermine or “cause” anything that happens – they just lay out a set of potentials that might happen, given the right (or wrong) environmental inputs. Especially in early childhood, our brains are very much affected by social and psychological relationships. And, in fact, for its lifetime the brain is in constant interaction with the environment. So something can absolutely be biological without therefore being written in genetic stone.
Q. My son displays many of the behaviors and difficulties that you describe as being typical of ADD. However, I’m reluctant to get an “official” diagnosis – mainly because I don’t want to saddle him with a label that will dog him throughout school and beyond, and expose him to stigmatization and stereotyping. I don’t want him to go through life thinking he is broken or diseased. What do you suggest?
A. I’d say, forget the label. If you recognize these traits in the child, and if you don’t want him specifically diagnosed and labeled, you can still go ahead and work on the environment so that it’s more conducive to his development. Depending on his age and his particular needs, what that looks like will vary, but generally speaking: look at the (internal and external) stresses in the family, at the quality of the relationships he’s surrounded by, at the amount of structure and security the family environment provides, and so on. ADD kids are, temperamentally, highly sensitive creatures – that’s what predisposed them to developing ADD in the first place – so they’re often the canaries in the coal mine. When something’s even slightly off in the surrounding environment – stresses in the marriage relationship, for instance – it will trip these kids’ emotional alarms much more readily than other kids’. It can take courage to face all of those questions, but if you do, and change what can be changed, and the child will automatically respond for the better.
Q. To be honest, I have looked at the environment, and all the things you list as potential stresses, and I just don’t see it. We seem to me to be a normal, healthy, functioning family, or at least no more stressed than your average modern parents. And yet my child has ADD. Are you saying I’m missing something?
A. First of all, I’d say that if my analysis doesn’t resonate with you, there’s probably no point in looking to my book for help. If, on the other hand, you are interested in pursuing this line of inquiry, there are two things you might want to consider.
One is that like many people, you may simply not be aware of the stresses you’re under. As I explored in When the Body Says No, people are very often much more stressed than they’re consciously aware of because they’re so used to it. As a consequence they don’t distinguish or notice their stress, because it seems normal to them.
The other is that, like I said before, these kids who develop ADD tend to be highly sensitive – sometimes exquisitely so. Just as a sensitive seismometer counter is going to detect smaller seismic disturbances than a less sensitive instrument, so too will sensitive kids pick up on stresses in the environment that may not affect a more stolid or placid child. Consequently it takes less stressful stimulation to cause emotional pain in a sensitive child. And I make the case in the book that ADD traits like tuning out and distractability first develop as emotional defense mechanisms against this kind of distress.
All the more reason, then, to take a careful look at the child’s environment with an eye to uncovering hidden stresses, so that you can address them.
Q. I’m very nervous about medicating my child for ADD – I don’t want want to risk turning her into a zombie just for the sake of improving her school performance. What do you suggest?
A. I deal with the question of medication at some length in the book, so I suggest first of all that you take a look at that – in particular Chaper 31.
The first thing to understand is that the purpose of medication should never be to control behaviour or to improve grades or other external results; the proper aim is always to help the child function in the world and feel better about herself. Improved performance may ensue from that outcome – and if so, great – but the focus needs to be on enhancing the child’s own experience of life. That also means that medication should never be forced on the child, or given in the face of the child’s determined resistance, and would ideally be administered with her consent and participation. And the child should never get the impression that approval or acceptance from the adults in her life is contingent on her taking medication. Any short-term gains would be far outweighed by the disastrous long-term consequences, because healthy development (which is what the ADD child needs in the long run) requires trusting, loving, non-coercive relationship.
Secondly, if you do go the route of medication, there’s no reason to stick with a medication that has unwanted side effects, like the “zombification” you’re worried about. Each medication is different and every brain is different, so individual drugs are going to affect people in different ways. There are also variations in dosage that can be tried to eliminate side effects.
Overall, as concerned as I am about their overuse and misuse, I’m not against medications in treating ADD. I’ve prescribed them – in fact I’ve taken them – and have found that they can be helpful, if they’re prescribed and taken in a judicious, targeted, and insightful way. They are never “The Answer”, but they can certainly provide some help, as long as it’s understood that the long-term goal needs to be healthy development, not just the management of symptoms.
Q. I’m an ADD adult. I’ve read in online forums that some people consider ADD people to be simply gifted and misunderstood. Whether or not that’s true, I’m concerned that treating my condition is going to erase or “flat-line” some of my own traits that I value, like my spontanaeity, creativity, enjoyable flightiness and so on. Are my concerns valid?
A. Not really, I’m happy to tell you.
Look, first of all, it’s called a “disorder” for a reason – and I make clear in the book that I don’t consider it a disease, but rather a disorder – which is simply, it dis-orders things in one’s life, creates a lack of order or workability. So I’d simply ask: does it create disorder in your life? If it doesn’t, and your life and personality are working for you, then there’s no problem and therefore nothing to fix. On the other hand, if you notice that there are aspects that cause consistent and unwelcome consequences in your life, then it’s something you probably want to look at.
Second, so-called “ADD traits” are not the same as the positive traits you’re talking about, and addressing the one won’t inhibit the other. It’s a common misconception, borne of the fact that people who have ADD tend to be highly sensitive – but it’s actually that very (inborn) sensitivity, not the ADD, that’s the source of you being so creative. Sometimes artists with ADD are afraid that they’ll lose their ability to think in a rapid-fire, free-associative way, which they consider vital to their creative process. But that doesn’t go away when you properly address the ADD component. What do go away, or become more manageable, are the more problematic aspects like impulsivity, or impatience, or interrupting people, or forgetfulness, or disorganization, or tuning out. Those aren’t functions of a creative mind but of an immature brain that’s stuck in some early stages of development; if anything they can be impediments to your true creative self-expression. Addressing your ADD traits should get some of that out of your way so that you can be more effective in your life and your creative pursuits. And that’s what it’s all about, after all – not “fixing” your personality, but making life more manageable and enjoyable.