Scattered, by Gabor Mate

is subtitled How Attention Deficit Disorder Originates and What You Can Do About It. I have to admit that's an attention-grabber. People have said that its description of early life at home was right on, and left them weeping. Parents of ADD kids say they've felt indicted by the book. I can see why.

Mate's thesis is that ADD is largely due to environment, not heredity. He explains that all the correlations explainable by heredity are also explainable by the parental environment (including some of the twin studies: twins tend not to go to radically different environments from each other). On the assertion that environment is the key, he goes on to slay the dragon.

Some people are exceptionally sensitive. If a very sensitive baby is raised by parents who are extremely stressed, the attunement between parent and child doesn't happen enough, and there is empaired brain development. (The brain is extremely plastic.)

It is not that a disorder develops, but that certain important brain circuits do not develop. Interference with the conditions required for the healthy development of the prefrontal cortex, I believe, accounts for virtually all cases of ADD.

And what does that do for us?

The prefrontal cortex may be seen as that policeman. (traffic cop) One of its major tasks is inhibition. It evaluates the myraid impressions, thoughts, sensations and impulses reaching it from the environment, from the body and from the lower brain centers. It must select what is essential and helpful and inhibit input and impulses that are not useful to the organism in the given situation. Our initial response to a stimulus, whether anxiety producing or pleasurable, is unconscious. It comes not from the cortex but from lower brain centers where emotions originate. The cortex has a split second to decide whether to give permission to the impulse or to cancel it. One way to understand ADD neurologically is as a lack of inhibition, a chronic underactivity of the prefrontal cortex. ... Hence the efficacy of stimulant medications: they arouse the inhibuitory function.

(from the chapter titled Forgetting to Remember the Future).

As a baby grows he learns to remember the future, to shut out certain stimuli in order to focus on something of interest. It seems quite plausible that if you inhibit the development of this skill you will develop something very like ADD.

Mate spends some time describing himself (classic ADD) and his extremely stressful (for his mother) early years (a Jew in Nazi Europe), and various case histories. He asserts that a stressed parent cannot bond ideally with the baby. Children pick up very quickly on emotions, and on indifference or distraction. Children predisposed to extra sensitivity don't develop the comfort/confidence to be able to focus on one thing well.

His solution to ADD issues with young children is to deal with the parents' stresses first, and only then look to medication if still needed. The ADD child needs pro-active love and attention, and unconditional love and accptance. He goes on in detail about suggestions for parents and teachers of ADD. Teachers need to have ways of letting ADD kids exercise and be creative without disrupting the other students: something most schools are not at all well-equipped to handle.

He has suggestions for adults with ADD as well. I think these deserve some detailed description. My interest isn't moot: we have an adult son with ADD.

The ADD adult, like the child, needs more than organizational tools and behavior modification techniques. Although these do have their place, they will not address the fundamental problem, which is not how the person manages this or that duty or self-appointed task but in what relationship he stands vis-a-vis his own self. The issue still remains one of relationship, but this time parent and child are combined in one and the same person.

The steps he lays out for the ADD adult are

• Compassionate curiosity in the search for self-insight. Notice, not judging the behavior and the feelings that drive it, to find out what the underlying feelings actually are.
• Self-acceptance: tolerating guilt and anxiety. Guilt is intrinsically useful, but can be inappropriate. Learn to decide where guilt is real, and what causes it when it isn't.
• You don't punish yourself for where you find yourself.
• Choosing a guide: psychotherapy and counseling. (Can be $$$, but choose your priorities)
• The physical space. Make a conscious choice about how to live; set small, incremental tasks if you must, with strict time limits rather than job completion goals.
• Sleep hygiene. The ADD adult is often a night owl: separation anxiety? But lack of sleep undermines your emotional and mental state. Be proactive about getting sleep.
• Nutrition. Pretty obvious.
• Physical exercise. Pretty obvious.
• Nature. Get outdoors, relax away from the urban--even if it is only lying staring at the grass in a yard.
• Extracurricular duties. Don't overcommit yourself.
• Recreation. This is NOT the same as entertaining diversions. TV is entertaining "but not a process that re-creates."
• Creative expression. "It is unusual for me to meet an ADD adult who does not have some secret longing for artistic expression, and almost as unusual to find one actively doing something about it." Creativity and ADD "originate in the same inborn trait: sensitivity." Maybe you won't be a famous artist, but you'll be your own artist (in whatever art form: music or math).
• Meditation and mindfulness. This includes the obvious: TM-like generic meditation, but also the spiritual exercises of prayer and contemplation. Contemplative solitude, or "any activity, from gardening to martial arts, that promotes mindful concentration will bring benefits."

That many people would feel indicted by the book is no surprise. No parent can honestly claim that they've never been distracted or unstressed and always ready for their child; and the suggestion that this lack could have injured their child is heartbreaking. So pretty much everybody will recognize themselves in the situations, whether or not there is reason to feel guilty. Remember the "refrigerator mother" explanation for autism? This is somewhat kin to it.

Which is not to say that he is wrong. ADD is on the rise at a rate that doesn't seem explainable by superior diagnostic methods. We have a very stressful and child-unfriendly society. I include the TV babysitter among the disasters of our culture. It cuts off real human contact and self-directed play. TV uses shortcuts to attract our attention and focus, and (Mr Rogers being one of the few exceptions) offers frantic changes in topic and scene that can't possibly help develop concentration. How can you develop concentration of your own when the topic changes are not self-directed by determined by the implacable schedule laid down by the director?

I'm not an expert in this field, unless you count trying to raise someone with ADD. But the first rule of medicine is to do no harm, and the suggestions Mate provides can't hurt, and are bound to help make life more pleasant.

I've skimmed a lot. If you have or deal with ADD children, find Scattered and see if you find it useful.