41
" The use of rewards—what might be called positive coercion—does not work in the long run any better than threat and punishment, or negative coercion. In the reward, the child senses the parent’s desire to control no less than in the punishment. The issue is the child’s sense of being forced, not the manner in which the force is applied. This was well illustrated in a classic study using magic markers.2 A number of children were screened to select some who showed a natural interest and inclination for playing with magic markers. Those who did were then divided into three different groups. For one group, there was no reward involved and no indication what to do with the markers. Another group was given a small reward to use the markers, and the third was promised a substantial reward. When retested sometime later, the group that had been most rewarded showed the least interest in playing with the magic markers, while the children who had been left uninstructed showed by far the greatest motivation to use them. Simple behaviorist principles would suggest it ought to have been the other way around, another illustration that behavioral approaches have no more than short-term efficacy. At work here, of course, was residual counterwill in response to positive coercion. In a similar experiment, the psychologist Edward Deci observed the behaviors of two groups of college students vis-à-vis a puzzle game they had originally all been equally intrigued by. One group was to receive a monetary reward each time a puzzle was solved; the other was given no external incentive. Once the payments stopped, the paid group proved far more likely to abandon the game than their unpaid counterparts. “Rewards may increase the likelihood of behaviors,” Dr. Deci remarks, “but only so long as the rewards keep coming... Stop the pay, stop the play.” We "
― Gabor Maté , Scattered Minds: The Origins and Healing of Attention Deficit Disorder
44
" 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. Usually this is the birth mother, but it may be another person, male or female, depending on circumstances.
The right hemisphere of the mother’s brain, the side where our unconscious emotions reside, programs the infant’s right hemisphere. In the early months, the most important communications between mother and infant are unconscious ones. Incapable of deciphering the meaning of words, the infant receives messages that are purely emotional. They are conveyed by the mother’s gaze, her tone of voice and her body language, all of which reflect her unconscious internal emotional environment.
Anything that threatens the mother’s emotional security may disrupt the developing electrical wiring and chemical supplies of the infant brain’s emotion-regulating and attention-allocating systems. Within minutes following birth, the mother’s odors stimulate the branching of millions of nerve cells in the newborn’s brain. A six-day-old infant can already distinguish the scent of his mother from that of other women.
Later on, visual inputs associated with emotions gradually take over as the major influences. By two to seven weeks, the infant will orient toward the mother’s face in preference to a stranger‘s — and also in preference to the father’s, unless the father is the mothering adult. At seventeen weeks, the infant’s gaze follows the mother’s eyes more closely than her mouth movements, thus fixating on what has been called “the visible portion of the mother’s central nervous system.”
The infant’s right brain reads the mother’s right brain during intense eye-to-eye mutual gaze interactions. As an article in Scientific American expressed it, “Embryologically and anatomically the eye is an extension of the brain; it is almost as if a portion of the brain were in plain sight.” The eyes communicate eloquently the mother’s unconscious emotional states. "
― Gabor Maté , Scattered Minds: The Origins and Healing of Attention Deficit Disorder
45
" Everyone has had the experience of suddenly feeling intense physiological and psychological shifts internally at trading glances with another person; such shifts can be exquisitely pleasurable or unpleasant. How one person gazes at another can alter the other’s electrical brain patterns, as registered by EEGS, and may also cause physiological changes in the body. The newborn is highly susceptible to such influences, with a direct effect on the maturation of brain structures.
The effects of maternal moods on the electrical circuitry of the infant’s brain were demonstrated by a study at the University of Washington, Seattle. Positive emotions are associated with increased electrical activity in the left hemisphere. It is known that depression in adults is associated with decreased electrical activity in the circuitry of the left hemisphere. With this in mind, the Seattle study compared the EEGS of two groups of infants: one group whose mothers had symptoms of postpartum depression, the other whose mothers did not.
“During playful interactions with the mothers designed to elicit positive emotion,” the researchers reported, “infants of non-depressed mothers showed greater left than right frontal brain activation.” The infants of depressed mothers “failed to show differential hemispheric activation,” meaning that the left-side brain activity one would
anticipate from positive, joyful infant-mother exchanges did not occur — despite the mothers’ best efforts.
Significantly, these effects were noted only in the frontal areas of the brain, where the centers for the self-regulation of emotion are located. In addition to EEG changes, infants of depressed mothers exhibit decreased activity levels, gaze aversion, less positive emotion and greater irritability. Maternal depression is associated with diminished infant attention spans. Summarizing a number of British studies, Dale F. Hay, a researcher at the University of Cambridge, suggests “that the experience of the
mother’s depression in the first months of life may disrupt naturally occurring social processes that entrain and regulate the infant’s developing capacities for attention. "
― Gabor Maté , Scattered Minds: The Origins and Healing of Attention Deficit Disorder
46
" Just how important a close moment-to-moment connection between mother and infant can be was illustrated by a cleverly designed study, known as the “double TV experiment,” in which infants and mothers interacted via a closed-circuit television system. In separate rooms, infant and mother observed each other and, on “live feed,” communicated by means of the universal infant-mother language: gestures, sounds, smiles, facial expressions. The infants were happy during this phase of the experiment.
“When the infants were unknowingly replayed the ‘happy responses’ from the mother recorded from the prior minute,” writes the UCLA child psychiatrist Daniel J. Siegel, “they still became as profoundly distressed as infants do in the classic ‘flat face’ experiments in which mothers-in-person gave no facial emotional response to their infant’s bid for attunement.” Why were the infants distressed despite the sight of their mothers’ happy and friendly faces? Because happy and friendly are not enough. What they needed were signals that the mother is aligned with, responsive to and participating in their mental states from moment to moment. All that was lacking in the instant video replay, during which infants saw their mother’s face unresponsive to the messages they, the infants, were sending out. This sharing of emotional spaces is called attunement.
Emotional stress on the mother interferes with infant brain development because it tends to interfere with the attunement contact. Attunement is necessary for the normal development of the brain pathways and neurochemical apparatus of attention and emotional selfregulation. It is a finely calibrated process requiring that the parent remain herself in a relatively nonstressed, non-anxious, nondepressed state of mind. Its clearest expression is the rapturous mutual gaze infant and mother direct at each other, locked in a private and special emotional realm, from which, at that moment, the rest of the world is as completely excluded as from the womb. Attunement does not mean mechanically imitating the infant. It cannot be simulated, even with the best of goodwill.
As we all know, there are differences between a real smile and a staged smile. The muscles of smiling are exactly the same in each case, but the signals that set the smile muscles to work do not come from the same centers in the brain. As a consequence, those muscles respond differently to the signals, depending on their origin. This is why only very good actors can mimic a genuine, heartfelt smile. The attunement process is far too subtle to be maintained by a simple act of will on the part of the parent. Infants, particularly sensitive infants, intuit the difference between a parent’s real psychological states and her attempts to soothe and protect the infant by means of feigned emotional expressions.
A loving parent who is feeling depressed or anxious may try to hide that fact from the infant, but the effort is futile. In fact, it is much easier to fool an adult with forced emotion than a baby. The emotional sensory radar of the infant has not yet been scrambled. It reads feelings clearly. They cannot be hidden from the infant behind a screen of words, or camouflaged by well-meant but forced gestures. It is unfortunate but true that we grow far more stupid than that by the time we reach adulthood. "
― Gabor Maté , Scattered Minds: The Origins and Healing of Attention Deficit Disorder
47
" In attunement, it is the infant who leads and the mother who follows. “Where their roles differ is in the timing of their responses,” writes John Bowlby, one of the century’s great psychiatric researchers. The infant initiates the interaction or withdraws from it according to his own rhythms, Bowlby found, while the “mother regulates her behaviour so that it meshes with his... Thus she lets him call the tune and by a skillful interweaving of her own responses with his creates a dialogue.”
The tense or depressed mothering adult will not be able to accompany the infant into relaxed, happy spaces. He may also not fully pick up signs of the infant’s emotional distress, or may not be able to respond to them as effectively as he would wish. The ADD child’s difficulty reading social cues likely originates from her relationship cues not being read by the nurturing adult, who was distracted by stress. In the attunement interaction, not only does the mother follow the child, but she also permits the child to temporarily interrupt contact.
When the interaction reaches a certain stage of intensity for the infant, he will look away to avoid an uncomfortably high level of arousal. Another interaction will then begin. A mother who is anxious may react with alarm when the infant breaks off contact, may try to stimulate him, to draw him back into the interaction. Then the infant’s nervous system is not allowed to “cool down,” and the attunement relationship is hampered. Infants whose caregivers were too stressed, for whatever reason, to give them the necessary attunement contact will grow up with a chronic tendency to feel alone with their emotions, to have a sense — rightly or wrongly — that no one can share how they feel, that no one can “understand.”
Attunement is the quintessential component of a larger process, called attachment. Attachment is simply our need to be close to somebody. It represents the absolute need of the utterly and helplessly vulnerable human infant for secure closeness with at least one nourishing, protective and constantly available parenting figure. Essential for survival, the drive for attachment is part of the very nature of warm-blooded animals in infancy, especially. of mammals. In human beings, attachment is a driving force of behavior for longer than in any other animal.
For most of us it is present throughout our lives, although we may transfer our attachment need from one person — our parent — to another — say, a spouse or even a child. We may also attempt to satisfy the lack of the human contact we crave by various other means, such as addictions, for example, or perhaps fanatical religiosity or the virtual reality of the Internet.
Much of popular culture, from novels to movies to rock or country music, expresses nothing but the joys or the sorrows flowing from satisfactions or disappointments in our attachment relationships. Most parents extend to their children some mixture of loving and hurtful behavior, of wise parenting and unskillful, clumsy parenting. The proportions vary from family to family, from parent to parent. Those ADD children whose needs for warm parental contact are most frustrated grow up to be adults with the most severe cases of ADD.
Already at only a few months of age, an infant will register by facial expression his dejection at the mother’s unconscious emotional withdrawal, despite the mother’s continued physical presence. “(The infant) takes delight in Mommy’s attention,” writes Stanley Greenspan, “and knows when that source of delight is missing. If Mom becomes preoccupied or distracted while playing with the baby, sadness or dismay settles in on the little face. "
― Gabor Maté , Scattered Minds: The Origins and Healing of Attention Deficit Disorder
51
" Virtually all the authors of popular books on the subject assert that ADD is a heritable genetic disorder. With some notable exceptions, the genetic view also dominates much of the discussion within professional circles, a view I do not agree with. I believe that ADD can be better understood if we examine people’s lives, not only bits of DNA. Heredity does make an important contribution, but far less than usually assumed. At the same time, it would serve no purpose to set up the false opposition of environment to genetic inheritance. No such split exists in nature, or in the mind of any serious scientist.
There are many biological events involving body and brain that are not directly programmed by heredity, and so to say that ADD is not primarily genetic is not in any sense to deny its biological features — either those that are inherited or those that are acquired as a result of experience. The genetic blueprints for the architecture and the workings of the human brain develop in a process of interaction with the environment. ADD does reflect biological malfunctions in certain brain centers, but many of its features — including the underlying biology itself — are also inextricably connected to a person’s physical and emotional experiences in the world.
There is in ADD an inherited predisposition, but that’s very far from saying there is a genetic predetermination. A predetermination dictates that something will inevitably happen. A predisposition only makes it more likely that it may happen, depending on circumstances. The actual outcome is influenced by many other factors. "
― Gabor Maté , Scattered Minds: The Origins and Healing of Attention Deficit Disorder
52
" The major impairments of ADD — the distractibility, the hyperactivity and the poor impulse control — reflect, each in its particular way, a lack of self-regulation. Self-regulation implies that someone can direct attention where she chooses, can control impulses and can be consciously mindful and in charge of what her body is doing. Like time literacy, self-regulation is also a distinct task of development in human life, achieved gradually from young childhood through adolescence and adulthood. We are born with no capacity whatsoever to self-regulate emotion or action.
For self-regulation to be possible, specific brain centers have to develop and grow connections with other important nerve centers, and chemical pathways need to be established. Attention deficit disorder is a prime illustration of how the adult continues to struggle with the unsolved problems of childhood. She is held back precisely where the child did not develop, hampered in those areas where the infant or toddler got stuck during the course of development. "
― Gabor Maté , Scattered Minds: The Origins and Healing of Attention Deficit Disorder
55
" Genes can be activated or turned off by factors in the environment. In the Cree population of northwestern Ontario, for example, diabetes is found at a rate five times the Canadian national average, despite the traditionally low incidence of diabetes among native peoples. The genetic makeup of the Cree people cannot have changed in a few generations. The destruction of the Crees’ traditional physically active ways of life, the substitution of high-calorie diets for their previous low-fat, low-carbohydrate eating patterns and greatly increased stress levels are responsible for the alarming rise in diabetes rates.
Although heredity is involved in diabetes, it cannot possibly account for the pandemic among Canada’s native peoples, or among the rest of the North American population, for that matter. We will see that in similar ways changes in society are causing more and more children to be affected by attention deficit disorder. It is easy to jump to hasty conclusions about genetic information. Some studies have identified certain genes, for example, that are said to be more common among people with attention deficit disorder or with other related conditions, such as depression, alcoholism or addiction. 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. "
― Gabor Maté , Scattered Minds: The Origins and Healing of Attention Deficit Disorder
58
" There are a small number of debilitating conditions with a strong genetic basis, such as muscular dystrophy or Huntington’s disease. These are rare, affecting about one person in ten thousand or even fewer. They do not pose a significant threat to the survival of the species. If, however, we add up the numbers of people plagued by depression or ADD or the other common psychological problems people in this society struggle with, including alcoholism and anxiety, we will have identified no less than a third of the North American population.
Genetic explanations for these conditions assume that after millions of years of evolution, nature would permit a very large number of disordered genes, handicapping a third of humankind, to pass through the screen of natural selection — a highly unlikely proposition. "
― Gabor Maté , Scattered Minds: The Origins and Healing of Attention Deficit Disorder
59
" The human brain is the most complex entity in the universe. It has between fifty and one hundred billion nerve cells, or neurons, each branched to form thousands of possible connections with other nerve cells. It has been estimated that laid end to end, the nerve cables of a single human brain would extend into a line several hundred thousand miles long. The total number of connections, or synapses, is in the trillions. The parallel and simultaneous activity of innumerable brain circuits, and networks of circuits, produces millions of firing patterns each and every second of our lives. The brain has well been described as “a supersystcm of systems.”
Even though fully half of the roughly hundred thousand genes in the human organism are dedicated to the central nervous system, the genetic code simply cannot carry enough information to predetermine the infinite number of potential brain circuits. For this reason alone, biological heredity could not by itself account for the densely intertwined psychology and neurophysiology of attention deficit disorder.
Experience in the world determines the fine wiring of the brain. As the neurologist and neuroscientist Antonio Damasio puts it, “Much of each brain’s circuitry, at any given moment in adult life, is individual and unique, truly reflective of that particular organism’s history and circumstances.” This is no less true of children and infants. Not even in the brains of genetically identical twins will the same patterns be found in the shape of nerve cells or the numbers and configuration of their synapses with other neurons.
The microcircuitry of the brain is formatted by influences during the first few years of life, a period when the human brain undergoes astonishingly rapid growth. Five-sixths of the branching of nerve cells in the brain occurs after birth. At times in the first year of life, new synapses are being established at a rate of three billion a second. In large part, each infant’s individual experiences in the early years determine which brain structures will develop and how well, and which nerve centers will be connected with which other nerve centers, and establish the networks controlling behavior.
The intricately programmed interactions between heredity and environment that make for the development of the human brain are determined by a “fantastic, almost surrealistically complex choreography,” in the apt phrase of Dr. J. S. Grotstein of the department of psychiatry at UCLA. Attention deficit disorder results from the miswiring of brain circuits, in susceptible infants, during this crucial period of growth. "
― Gabor Maté , Scattered Minds: The Origins and Healing of Attention Deficit Disorder
