On Gabor Mate’s Scattered: How Attention Deficit Disorder Originates and What You Can Do About It

Photo: Gabor Gastonyi, under Creative Commons license.

Many take it for granted that ADHD is an inborn condition. If we consider the role of environment in childhood brain development, however, the origins of ADHD appear to be much less determinate. Gabor Mate, a Hungarian-Canadian physician renowned for his theories on the link between addiction and trauma as well as on the origins and treatment of ADHD, argues that the condition is often developed early in life. Furthermore, Mate suggests that the set of symptoms associated with ADHD can be improved with therapy. In his tour de force on the disorder, Scattered, Mate presents findings from clinical practice and encourages us to reconsider our perception of brain physiology.

Environment and genes in ADHD aetiology

Often, the deterministic assumption is made that disease is hereditary, and while there is a hereditary component to the aetiology of disease and mental disorder, such as ADHD, there is no specific gene coding for ADHD. Typically, genes do not have a straightforward correspondence to disease, except in the case of specific genetic impairments affecting an essential biomolecule, such as in Lesch-Nyhan Syndrome. After all, genes are code for the building blocks of the body and for their structural interrelations. The only plausible hereditary component of ADHD, Mate suggests, is sensitivity, causing an organism to be particularly responsive to environmental stimuli, which can either increase or decrease its adjustment, depending on the characteristics of an environment. For instance, in the presence of sensitivity, the processing of environmental stressors results in a heightened physiological response, which may account for the development of ADHD in certain individuals but not others within a shared environment.

Neuroconnectivity and the environment in early life

In early childhood brain development, the environment dictates which neural pathways will be developed, as postulated by Gerald Maurice Edelman in his theory of neural Darwinism. “Nerve cells, circuits, networks and systems of networks vie with one another for survival. The neurons and connections most useful to the organism’s survival in its given environment are maintained. Others wither and die.” A particularly grotesque illustration of this process involves a hypothetical child kept in darkness during the brain’s formative period, resulting in atrophied visual nerves, and consequently, blindness. Environmental input can either encourage or discourage the formation of brain structures.

A healthy childhood environment is an important precursor to adult mental health.

Photo: Maria Solomatina

Early childhood environment linked to ADHD

In the first months of life, the human being is totally incapable of ensuring its own survival. During a period of exterogestation, the caregiver provides the newborn with a secure physical and emotional environment, which serves as a reconstruction of the secure conditions of the womb. It is no wonder then, considering the child’s dependent state, that the child is keenly perceptive of the nurturing adult’s emotional state. As the developing human depends on the caretaker for survival, forming an attachment relationship with them becomes the prerequisite for healthy development. An important aspect of the attachment relationship is attunement, the caretaker’s capacity for emotional responsiveness to the child, and vice versa. The attuned parent senses the child’s emotional cues and responds accordingly. As demonstrated by the unsettling double TV experiment, when being shown a video of its smiling mother, the baby responds with emotional distress, due to the perceived unresponsiveness of the mother, impervious to the baby’s typical cues. Parents dealing with stress, depression, or otherwise distracted from parenting, despite best intentions, often lack attunement in the relationship with their child. The resulting style of stressed parenting undermines the child’s sense of emotional security, negatively impacting the development of brain structures associated with attention and emotion regulation.

Neuroconnectivity and the environment in later life

If ADHD is acquired, the question remains, can aspects of the condition ever be reversed? Optimistically, studies show that the brain retains neuroplasticity throughout life, meaning it continues to form new pathways and synaptic connections in response to environmental stimuli. The interaction of an environment with individual patterns of thought emphasizes the point that, without a change of environment, “the brain cannot develop new circuits or the mind new ways of relating to the world and to self.”

Postscript

A sly little consequence of Gabor Mate’s analysis of ADHD is that the proposed relationship between health and socioeconomic forces serves to emphasize that social concerns tend to also become public health concerns. Mate presents stressed parenting as a reaction to the brutal logic of the economic model that insists on prioritizing success rather than the security of young children.