Scattered Minds: The Origins and Healing of Attention Deficit Disorder

Maté discusses his experience with a child who acted out and felt abandoned by his parents. His parents were confused about what to do about the increasing hostility their child exhibited. Maté told the parents that their child was reverting to the anxiety-ridden state of a toddler and that to help their son learn self-regulation and control, they would have to reestablish a secure environment. The parents focused on the long-term goal of relationship, and the child’s behavior improved. Maté notes that the child’s sensitivity was also a blessing because just as he was attuned to negative changes, he was also highly susceptible to positive ones.

Maté outlines five principles for drawing a child into a secure relationship. First, the parent must take responsibility for the relationship by instigating contact rather than waiting for the child to demand it. Second, the parent must not judge the child and risk reinforcing their shame. Third, the parent must not overpraise the child, as this can inadvertently prioritize external results. Fourth, the parent must not parent from anger, though Maté differentiates between cold anger (unbalanced rage) and warm anger (anger under control), which is not damaging to a secure relationship. Finally, the parent must take responsibility for restoring the relationship by acknowledging the child’s feelings in a non-defensive manner, thereby modeling the importance of long-term development and healing.

Maté believes that individuals can only be understood in context. He uses the metaphor of an ant colony that prioritizes the needs of the group over the needs of the individual. The requirements of a community shape individuals just as human families and societies shape individuals. Children, Maté suggests, do not act as much as react. To understand their children, parents should examine their own responses to the child rather than fixating on their child’s responses. This taking of responsibility is a product of self-regulation, which is both the primary goal of development and the primary impairment of ADD: To control one’s mind means that one’s moods are not controlled or determined by the moods of others.

Maté uses the metaphor of a thermostat to describe the emotional temperature of an environment. People with ADD have an extremely sensitive thermostat that is upset by the slightest variation. Some people with ADD are not emotionally flexible enough to handle change. Others thrive on change, trying to sustain levels of excitement with new external stimuli. Maté says that children cannot develop self-regulation without seeing it in their nurturing adults. Parents of children with ADD often find that their own moods are affected by the children. In these situations, it is not the children’s emotions but the parents’ inability to maintain an emotional tone that disrupts the stable emotional environment.

Maté describes a hypothetical in which a child with ADD becomes reactive at dinnertime. The child may slam doors, hurl insults, or act defiantly. If the parent responds with equal defiance and tries to demand submission, the situation escalates. Many books on ADD offer techniques for avoiding this behavior, but they fail because they focus on the child’s behavior, which has been amplified by the parent’s reaction. Maté says that the tension cannot be resolved without the parent’s own self-regulation. Maté reexamines the situation at the dinner table, clarifying that self-regulation is not the absence of anxiety but the ability to tolerate it. With just a little emotional tolerance, he says, the child won’t feel responsible for the parent’s emotional state and will not feel further anxiety. This will lead to a diminishment of the child’s internal anxieties in the long term.

Self-knowledge, Maté says, is a prerequisite for nurturing a child. If the parent of a child with ADD learns more about themselves, Maté says, there is less risk of them passing unconscious psychological burdens to their children. The hypersensitive child manifests what David Freeman calls the “unfinished business” of the parent. Self-regulation is connected to individuation, or becoming a self-motivated, self-accepting person. Parents must work on their own maturation to foster individuality in children, Maté suggests. If parents are able to look at themselves instead of fixating on treating a disorder in their child, they can decrease the tension of the entire household.

Many people treat children with ADD as if they are consciously choosing their actions. Maté lays out five of the most common myths of ADD. The first is that the child is just looking for attention. Maté says that parents need to offer compassionate curiosity to their children to establish what the child’s behavior attempts to communicate. Enduring a child’s frustration with compassion will allow the child to move through their anger to disappointment. At such moments, the parent can empathize with the child and make the child feel supported.

The second myth is that the child is deliberately trying to annoy the adult. Maté believes this view represents “intentional thinking,” which gets in the way of compassion.

The third myth is that the child purposefully manipulates the parent. The desire to control someone is a fear response to anxiety. If the parent gives in to manipulative tactics, no healing is possible, but it’s also not possible if the parent sees the child’s actions as disordered instead of the learned behavior of an anxious child.

The fourth myth is that the child’s behavior causes the adult’s tension or anger. People who blame others for their reactions have failed to develop self-regulation. Reacting to one’s children with curiosity is a more effective response than attempting to control their behavior from a place of anxiety.

The fifth myth is that children with ADD are lazy. Laziness and procrastination are not inborn traits but manifestations of a relationship with the world. Maté suggests that parents may find that their children are expressing unmet emotional needs for connection and that reconnecting will cause their child to become more compliant.

Maté discusses a patient who was a child prodigy at clarinet and expressed regret at having given up the instrument to spite his father. Maté told him that his defiance was normal and that to continue would have represented a surrender of his soul. The force of the father’s desire for him to play the clarinet had created a counterforce, Maté says—what psychologist Gordon Neufeld calls “counterwill.”

Parents sometimes assume that this willfulness represents some deep-rooted negative trait in their child, but Maté says that oppositionality stems from the fear of being controlled. Counterwill represents a normal phase of human development that facilitates individuation. That doesn’t mean that counterwill is the child’s core self; rather, it is a response to external pressure in the face of an insecure sense of self. As a result of this insecurity, the child with ADD is highly sensitive to parental pressure and tends to provoke negative reactions from their parents; the child’s underdeveloped will is easily threatened by control. The child who expresses counterwill is therefore really expressing a lack of self-confidence. These states reinforce one another, often leading people with ADD to be accused of rudeness. It is important, Maté suggests, to understand counterwill as coupled with hypersensitivity and psychological underdevelopment. The weaker the child’s sense of self, the more automatic their counterwill will become. Counterwill has an inverse relationship to attachment but is neglected in child-rearing literature, Maté says, because of that literature’s focus on behavior. He says that parents should try to foster the long-term goal of fostering a healthy sense of self in the child.

Maté believes that understanding counterwill is critical to a parent’s ability to respond to their child with ADD. He cites developmental psychologist Gordon Neufield, who believes that “counterwill-proofing” the relationship is a way to eliminate the power struggle that often occurs between parents and children with ADD: Chronic counterwill may contribute heavily to the child’s inability to form lasting relationships.

Maté explores nine prerogatives for parents to overcome counterwill in their children. First, he advises parents to prioritize attachment. Maté cites a case study in which a child behaved poorly for a mother but was compliant with the father. Maté suggests that the child’s counterwill reaction came out because of his sense of emotional security with the mother. Second, parents should not make acquiescence for voluntary “good behavior.” Third, it is important not to take the child’s recalcitrance personally. Fourth, parents must allow for resistance. Fifth, parents should avoid engaging in fights except when a particular outcome is absolutely essential. Sixth, parents should encourage verbal expression. Seventh, parents must recognize their own stubbornness. Eighth, parents must work to repair the relationship after conflict. Finally, parents should encourage self-discipline instead of controlling the child.

Maté cites Natalie Rathvon’s description of an unmotivated child, which to him reflects a textbook case of ADD. Maté says many parents come to him looking for a way to motivate their child. The long-term goal of establishing a child’s sense of self is all that can spark their motivational curiosities. Citing Edward Deci, Maté points out that self-determination is a universal need, as is the need to feel connected with a group. Maté says that if allowed to explore, the child will find natural motivation. Without choice, he warns, autonomy is impossible.

Maté discusses several families that he has worked with who were able to foster competence in their child by offering the child age-appropriate choices and by ensuring that the child wasn’t overwhelmed by attachment anxiety. Parenting practice must be child focused, teaching the child to get in touch with themselves. Trying to motivate the child from the outside betrays a lack of faith in the child’s nature, reflecting the parents’ anxieties more than the child’s limitations. If the child’s self-esteem hinges on what they do rather than who they are, no amount of success will save them from ruthless self-criticism. The child with ADD will therefore struggle to develop true motivation without a secure relationship with parental figures.

Maté notes three dangers of motivating a child through praise. First, praise tends to feed the anxiety that it is the action and not the child themselves that the parent loves. Second, if the child senses pressure, it may activate counterwill. Third, the praise itself could become the goal for the child, which could lead to cheating or taking shortcuts.

Autonomy is different from permissiveness, which puts children in a position to make decisions they are not equipped to handle. Maté says that the parent needs to establish clearly articulated rules that make logical sense so that the rules, not just the parent’s will, are seen as authoritative.

Parents often worry that they will encourage or intensify their children’s negative feelings by acknowledging them, but doing so actually helps the child to clearly identify their feelings. This identification, or “symbolization,” of their emotions will prevent a child from relying on the simple, opposing, and limiting categories of “good” and “bad” emotions. To support this autonomy, parents should respect the child’s motives instead of attempting to control outcomes. Maté cites research that suggests that punishments are bound to backfire and may reinforce the child’s negative self-image. Parents cannot directly engage their children’s wills, Maté says, but they can create the relationship from which a healthy will can develop.

The erroneous view that children whose autonomy is nurtured will become selfish is unfounded. Instead, socialization is a natural human process that needs a connected and compassionate space in which to develop. Maté compares development to a pyramid. If socialization is the end result, he says, secure attachment is the base.

Maté begins by critiquing the North American educational systems, which adopt a one-size-fits-all approach to education. Maté believes that this system represents a social crisis in which children with ADD are treated with medication or disciplinary action instead of being taught to take responsibility for their learning. Teaching, Maté says, is too teacher centric, focusing on imposed structure and discipline rather than individuality and expression. Maté cites his own experience teaching high school students with ADD. Maté took the children to a shed and let them play instruments for the entire period to release their restless energy. By offering the students an avenue of creative expression, Maté was able to rouse their interest in education the following class period.

Maté describes seven principles for teaching children with ADD. First, one must practice non-maleficence, or doing no harm—one of the core maxims of bioethics. Second, it is important to work with the children’s parents and an ADD specialist. Fourth, educators, like parents, should prioritize attachment needs. Fifth, students must have time for play and creative expression. Sixth, examination and home assignment expectations will likely require modification. Seventh, educators should trust both the child and themselves. Maté believes that education is about helping a child grow without interference.

Maté recognizes a common dynamic wherein a child becomes more rebellious in adolescence as they begin to rely on their peers, which coincides with the parents having higher expectations for the child. Counterwill typically reasserts itself as the child undergoes a second functional stage of individuation. Many parents, in Maté’s experience, are especially desperate in this period, describing experiences of extreme turmoil. Maté has experience with two sons who have ADD and can understand the alarm of these parents, though he no longer shares it. What it takes to understand the child in this period, Maté argues, is an open mind.

Despite their defiance, adolescent children long to be accepted by their parents. If they receive this acceptance, they will feel more stable than if they must rely on their peers. Maté claims that the child will stay connected to the family if not expected to conform in a way that is contrary to their sense of self. Maté warns that many teenagers are wary of an ADD diagnosis, which they may interpret as confirmation that their parents think there is something wrong with them. Maté cites a mother and daughter who were caught in a cycle of arbitrary punishment and rebellion that prevented the daughter from taking responsibility. Maté suggested that the girl’s parents respect her autonomy when crafting rules, which resulted in an improved relationship. Until children feel heard and legitimized, he says, they cannot craft an authentic sense of self or take responsibility. One doesn’t have to agree to listen to and legitimize a child’s feelings. In Maté’s experience, teens with ADD are willing to self-reflect once they feel accepted for who they are.

Maté recalls speaking bitterly to his teenage children as if they were his peers. He cautions that parents have more power and therefore more responsibility to act calmly and listen. In his interactions with parents, Maté almost always recommends loosening rules and responsibilities. Counterintuitively, this approach can diffuse counterwill by granting more autonomy to the child. Many parents ask why they should grant privileges to their child in the face of irresponsibility, but Maté points out that what is at stake is the child’s autonomy, to which the child has a right. Maté believes that once a child’s boundaries are accepted, they can accept the boundaries of others.

Parents often worry about damage to their child’s self-esteem as a result of their decisions. However, Maté says that the child already has low self-esteem; the only thing that can build it back is a sense of secure attachment and autonomy. All interventions, he says, must respect these two factors above all. Maté concludes with a case study in which a high schooler expressed frustration with ADD but refused to take medication because he worried the medication would only remove the symptoms without removing any of the underlying emotional issues.