Alternative Thoughts About Attention Deficit Disorder

Dr. Gabor Mate, who is a family practice physician in Canada has ADD himself. He is the author of the book "Scattered," which offers a new perspective on ADD and a new approach to helping children and parents living with the problems ADD presents.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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Conference Transcript

David: Good evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. I'm glad you had the opportunity to join us and I hope your day went well. Our topic tonight is "Alternative Thoughts About Attention Deficit Disorder." Our guest is Dr. Gabor Mate M.D., who is a family practice physician in Canada. He too has ADD himself. He is also the author of the book "Scattered," which offers a new perspective on ADD and a new approach to helping children and parents living with the problems ADD presents.

Good evening, Dr. Mate and welcome to HealthyPlace.com. We appreciate you being our guest tonight. You believe that ADD is not an inherited illness, but a reversible impairment (not a genetic disorder), a developmental delay. Could you elaborate on that please?

Dr. Mate: Hi, thanks for having invited me. I have been diagnosed with ADD, as have my three children, but as you point out, I do not believe it is an inherited disorder.

I believe ADD originates from the effects of stressful social and psychological circumstances on the developing brain of highly sensitive infants. In other words, there is a genetic predisposition, but not a genetic pre-determination.

What modern brain science has clearly established is that the development of the human brain does not depend upon heredity alone, but is heavily influenced by the environment. This includes the circuits and biochemistry of the part of the brain where the problems with ADD are located.

David: When you say, "stressful social and psychological circumstances," what are you referring to exactly?

Dr. Mate: In ADD the part of the brain most affected is a piece of the gray matter, or cortex, in the prefrontal area, near the right eye. This part of the cortex has the job of regulating attention and emotional self-control. Now, like all circuits, this part of the brain requires the right conditions for its development.

In this, it is like all other parts of the brain. For example, vision: an infant may have perfectly good eyes and genes at birth, but if you put him in a dark room for five years, he will be blind. This is because the visual circuits of the brain need the stimulation of light waves for their development. Without light, they would die.

In the same way, the attention regulation and emotional regulation centers of the brain need the right conditions for their development. These right conditions are, chief and foremost, a calm, non-stressed relationship with an emotionally consistently available, non-stressed, non-depressed, non -distracted primary caregiver.

In all cases of ADD I have seen, including that of my own children, there were emotional stresses in the environment that interfered with those conditions.

David: So are you saying that parents are, in large part, responsible for these hostile life experiences that create, or foster, ADHD in their children?

Dr. Mate: I am certainly not suggesting that parents do not love their kids, or that they do not try their best. I certainly love my kids, and always have, however, conditions in present day society have put terrific stress on the parenting environment. Many of us lead very stressed lives, and the supports of extended family, village, and neighborhood that used to be there for parents are largely gone. Hence, we are seeing so much more ADD. So I am not talking about bad parenting, but I am talking about how parenting under stressed conditions does affect the development of brain circuits.

David: Dr. Mate also has ADD himself. He is also author of the book "Scattered," which offers a new perspective on ADD and a new approach to helping children and parents living with the problems ADD presents. You can purchase his book by clicking on this link.

How do you promote the healing process in the ADD child then, Dr. Mate? Would it be to relieve the stressful environment that the child is in?

Dr. Mate: The brain research evidence very strongly suggests that the human brain, particularly the emotional self-regulating circuits, can develop not only in infancy, but also later on, even in the adult.

So the question is not simply how to treat symptoms, and all the behaviors of the ADD child are only symptoms. The question is, how to promote development. And for any living creature, the question of development has to do with the conditions in which that creature (plant, animal, human) must live. So the issue is, how do we best promote the development of our children, not just how we control their behaviors. Very often the things we do to change behaviors actually undermine development. So, my whole book is aimed at discussing and describing the conditions under which children and adults can experience new development.

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David: We have a few audience comments, Dr. Mate, that I'd like you to address, then we'll proceed on with how to help your child with these development issues.

motheroftacha: Most of us with ADHD children have spent years absolving ourselves of guilt, so we can help our children. This is hard to take, honestly. Secondly, many of us have been much more stressed as a result of living with ADHD. Life was a piece of cake before. Thirdly, it could also be speculated that ADHD adults, being more impulsive, produce more kids than non-ADHD adults (impulsivity), thereby "contributing" more children into this world.

Dr. Mate: I understand that parental guilt is a very negative quality. I am not trying to promote guilt, which I have felt myself, only understanding. The more we understand, the more active we can become in reversing the problems.

The point of view that ADD is some sort of genetic illness may help some people feel less guilty, perhaps, but it is essential pessimistic. After all, if something is genetic, we are kind of stuck with it, aren't we?

So, I am saying that it is not a question of an inherited diseases, but one of development. We can actually promote positive development in our children, if we understand what they are all about instead of just trying to change their behaviors. Furthermore, it's true that living with ADD children adds terrific stress to any parent's life (I have experienced that myself). However, we can reduce that stress if we really learn about what makes the child tick.

Finally, it is true that ADD runs in families, but from the scientific point of view the evidence for a genetic causation is extremely weak. The point its, that if a parent has ADD, as I do. then he/she can create the conditions in which his/her children's development will follow along similar lines.

David: I think it might be helpful, Dr. Mate, if you could list a few positive things that parents could do to encourage the kind of development you are talking about.

Dr. Mate: First, one has to put the long term ahead of the short term. For example: these children are all, by nature, I think this is genetic, highly sensitive. This means they are affected by the environment, physical and emotional, more than other kids. This includes most particularly how the parent relates to them.

These kids, being emotionally hypersensitive, are also very vulnerable. If say, I react to their behavior with anger and with some punishing technique like "time out," I am just reinforcing his insecurity, which is already deep. So, we have to be most loving and most understanding precisely when the child is acting out, because that is precisely when she/he is most hurt, defensive, and vulnerable. Yet most advice parents get is that they should become more controlling, more punitive at such times.

David: How would you suggest dealing with such things as inattention, and then hyperactivity?

Dr. Mate: It is well known that the inattention of ADD kids is highly "situational." In other words, it varies from one situation to another. It is also well known, that many of these children calm right down and can pay attention in the present of an emotionally calm, loving, and attentive adult. The point is that attention increases with emotional security.

In animal studies, it has also been shown that new brain circuits and new brain blood supply develop in animals given the appropriate emotional stimulation, even in adults. So the very first condition of long term development of attention and emotional self-regulation, is absolute emotional security. It is very hard to provide that, but if we work on it, and if we work on ourselves, we can do a lot. The results are quite amazing.

ericsmom: Does Dr. Mate believe in medication?

Dr. Mate: I take medication myself; it helps me. However, there are potential problems with medications, and I don't just mean side effects that can usually be managed. The chief problem is that 80% of the time a child is diagnosed with ADD, all he/she gets is a prescription. Medications can be helpful, but they don't by themselves promote development. So the danger is that if we medicate a child and she functions better, we think we have solved the problem, however we haven't.

David: One of the things you mention in your book is that ADD is being diagnosed a lot, but it's being diagnosed by the wrong people which, in itself, causes problems. What kind of professional should be diagnosing ADD?

Dr. Mate: Physicians-family doctors, pediatricians, psychiatrists, who understand ADD. Many don't, just as I knew very little about it until about six years ago. Also, well trained psychologists can diagnose, if they know about ADD, however, many do not.

HPC-Phyllis: Should a child with ADHD be in therapy?

Dr. Mate: It depends very much on the child. In most cases I feel it's not the child, but the parents who need counseling and advice. I spend much more time with the parents, than with the child. However, it does depend on the individual case. Some kids are quite ready for therapy. For example, if not talking therapy, then play, or art therapy.

nanabear: I have a daughter with ADD, now age sixteen, who is now a year behind in school. Specifically, how can I promote her development in our day to day lives? Can you give some examples?

Dr. Mate: I would have to know much more about the individual case. I have a whole chapter on teenagers in the book. In general, we have to let go of trying to control these kids at this age. You have to allow them to make their own decisions, and yes, their own mistakes. Above all, it is important that whatever we do, we don't exacerbate the resentment and oppositionality of the ADD teenager, and that we understand why they feel the way they do.

David: If you are looking for a lot of ADD information, here's the link to the HealthyPlace.com ADD/ADHD Community. 

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Carolina Girl: So how do we eliminate "stresses" from school, work, and even play in this busy world?

Dr. Mate: We can't eliminate all stresses. What we can try to do is that within the family, we begin with an understanding, open-minded, and compassionate attitude. Now, for example, being an ADD adult, I used to be quite a workaholic doctor. I still have those tendencies. However, I realize, given the sensitive nature of my children (we still have a twelve-year-old at home) that if I am to reduce the stress in her life, I have to say "no" to things and reduce the stress in mine. That's just one example.

DaveUSNret: My stepson was originally diagnosed with ADD. We later found that he had, in fact, a high IQ and was bored with school. Once he had an intellectual challenge, the problem resolved itself. How many kids get this wrong diagnoses?

Dr. Mate: I think many do. We tend to forget that kids have other reasons, besides ADD, why they may not be paying attention (i.e. rigid and boring school routines). They could also be too interested in their peers to pay attention to what adults want. It's not all ADD.

Krissy1870: I have such a difficult time with my own ADHD, that it makes having patience with my child, who also has ADHD, almost impossible sometimes.

Dr. Mate: I have a chapter called "Like Fish In The Sea." This means, as a psychologist once told me, that "kids swim in their parents unconscious like fish in the sea." ADD kids are highly sensitive to their parents' emotional states. There is no way to help them unless we first develop an attitude of compassionately seeking help for ourselves.

munsondj: Dr. Mate, how do you feel about using natural approaches to ADD as opposed to traditional medicines?

Dr. Mate: Truth to tell, I do not know much about them. I have had some parents tell me they have had success with various herbal remedies, etc., but for the most part, I have not been impressed. However, I have nothing against them, so long as they are not harmful, and most are not. Again, for me, the major issue is not what substances, medications, or otherwise, we wish to use, but how do we create the right conditions for our children to develop.

David: Some audience members would also like to know if you think there's a relationship between ADD and diet?

Dr. Mate: As I mentioned, these children are highly sensitive. I think that is what is genetic here. They certainly tend to have, on the average, more allergies, eczema, asthma, frequent ear infections, etc. This means they also are more sensitive to whatever they happen to ingest. Certainly, they tolerate low or high levels of blood sugar very poorly. However, I don't think diet by itself can either cause or cure, ADD.

ahowey: This doesn't seem to be helping at all. My child is now sixteen and was diagnosed at seven. No one has any answers for us that work. Schools and teachers are only supportive for so long, and then it is the same thing. They say he is lazy and won't do the work. How can I talk to schools that only seem to talk and think like the left-brained people?

Dr. Mate: Well, it's difficult for me to comment on individual cases, without knowing a lot of the particular details. Dealing with schools is extremely frustrating (that's another chapter in my book). Furthermore, I used to be a school teacher myself, so I know what schools are like, they want to assume that everyone has the same kind of brain, when the truth is that we don't. The best thing is for the parents to completely understand and accept their child, and this will fortify him to deal with the rest of the world. Some teachers are open and can be talked with, others are quite rigid and closed. I don't have an easy answer to your important question.

David: In our ADD community, click on "The Parent Advocate" site. There's a lot of good info there.

munsondj: Dr. Mate, how do you suggest we handle the behavior of these children?

KDG: How do you punish, you can't just ignore behavior that is hurtful to other children.

Dr. Mate: Punishments simply do not work. They do not teach anything, except they make the child feel more embittered. A child who is hurting other children needs to be removed from that environment, but not in a punitive fashion. If we emotionally connect with these kids, and they are desperately hungry for that, their anger and their hostility abates. The main thing is is to recognize that aggression, hostility are only symptoms of emotional insecurity and a sense of frustration and rejection: the behaviors are only the symptoms, not the underlying problem. We have to understand the emotional dynamics behind the "bad" behaviors and not be focused on changing the behaviors themselves. As the child heals emotionally, the "bad" behaviors automatically stop. They are only symptoms.

David: Just to clarify, you are saying most children with ADD act out, as do "normal" children, because the lack something, emotionally. Furthermore, you are suggesting it's important for the parent to give that child what it needs on an emotional basis?

Dr. Mate: Exactly. Look at that phrase "act out." What does it mean? It means precisely that the child cannot directly express his emotions in word, so he acts them out. If he is angry, instead of saying so, he will act it out in the form of hostile behavior. So, we need to respond not to the behavior, but to the emotionally hurting child who is sending us a message but acting out his emotions in ways he himself does not understand. It's our job to understand him. That's what I emphasize throughout "Scattered."

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David: So then, under your theory, what separates the ADD from the non-ADD child? I mean, both can be emotionally traumatized in life, and it is these traumatic life experiences creates identical behaviors.

Dr. Mate: Yes, many people are traumatized who don't have ADD, in fact, some are traumatized much more than the average ADD child. However, we do have to recognize that ADD children do suffer from emotional pain, that this pain happened to them not because they weren't loved, but because, perhaps, parents were themselves overstressed and didn't quite know how to relate to the child's extremely sensitive nature. If this stress occurred during the first few crucial years of brain development, it would have affected how the child's brain circuits, connections and chemistry,-developed. So now the question is, as I keep stressing, is how to promote healthy development.

Keatherwood: My son has ADHD, Tourettes, ODD and OCD. We've found that when they treated one thing, the medications make something else worse. He has been in therapy most of his life, but finally turned to drugs. Are these kids more prone to drug use. The treatment center he's in says that many of their kids are ADHD?

Dr. Mate: ADD individuals are more prone than average to engage in addictive behaviors. I have a chapter on that, in which, I discuss my own addictive tendencies. They are also more prone to become substance addicted, particularly to caffeine, nicotine, cannabis, and cocaine.

DaveUSNret: I can back up Keatherwood's comment, many of my own Drug/Alcohol clients were diagnosed as ADD.

KDG: There is still guilt even if ADHD is genetic. After all, I have clearly passed it along to my son.

motheroftacha: For what it is worth, I do not cop-out. I read and try to understand her. What touches me about Dr. Mate, is that what he says about how it feels to live like this, is frequently in my mind about her with love and caring. I get it that she doesn't have control over much of what she does, and we work to help that.

missypns: A more positive approach is simply looking at how the child is able to understand the information, rather than insisting that they take what is given just because it is the way it is done, it makes life a lot simpler for everyone involved.

kellie1961_ca: I find out the medications work very well. My son is doing great in school a year ago he was getting C's and D's in school, now he gets A's and B's.

Krissy1870: I am halfway through your book and it has already helped, but it is still hard dealing with both her ADHD and mine.

hrtfelt33: My child will not tell me when something is wrong and he does not act out, how can you get a child to talk to you when they won't?

Dr. Mate: The first question we have to ask is "why doesn't our child talk to us." After all, all infants are very vocal about letting us know when they are unhappy and uncomfortable. If a child then closes down as he/she gets older, it's because somehow, completely inadvertently, we have given the message that we have difficulty accepting what they are telling us, their anger, their unhappiness, etc.

So what we have to do is to rebuild that trusting relationship which existed when he/she screamed as an infant when they were uncomfortable, knowing that we would take care of them. We don't do that through words and promises. We do it by daily demonstrating to them that we fully accept them, regardless of what is happening. I can't say much more about that in this short space, but that's the idea. Unconditional love.

David: ADD children tend to be unmotivated. You say much of what parents are told about motivating children is self-defeating. What would you suggest as the best ways to motivate your child to improve him/herself in different aspects of their lives?

Dr. Mate: I have a chapter on motivation. Motivation cannot come from the outside, which is why rewards and punishments always backfire in the end. Motivation has to come from within, and human beings who feel good about themselves are naturally and intrinsically motivated. So the thing is, to build the child's self-love through how we love them. Then they will develop motivation on their own.

solo: My daughter is eighteen, and has only recently been diagnosed with ADD. Her school said she was lazy and they only tested her for her IQ (which was l46). The test did show that she had a learning disability. She is constantly frustrated and never follows-thru. She feels that I am the source of her problems, because I do keep on her constantly. How, or what, can I do to help her understand her disability?

Dr. Mate: It's very difficult to help an eighteen-year-old who basically, just wants us to leave her/him alone. My first advice to parents in such a situation is to back off, to take a deep breath, and not to inflict our anxiety on our nearly-adult child. I know it may sound self-serving, but I believe there is a lot in my book that would help you understand your daughter and help you to take a more constructive approach. Certainly, our judgments and unasked for advice only increases the resistance and oppositionality. 

ryansdad: Dr. Mate, my son is ADHD and bipolar and so far none of the medications have worked that good. I have an appointment to check with a new doctor, who does brain mapping. She say's that is 98% accurate. What do you know about this procedure?

Dr. Mate: It can be quite helpful, in pointing towards the right medication.

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missypns: What happens to our children that become adults with ADHD?

Dr. Mate: Well, they may become doctors and writers, like me. What can I say, it depends very much on many factors:

• the child's intelligence
• family support
• social and educational background
• the degree of ADD
• the kind of professional help available

However, we should never give in to pessimism. I treat many ADD adults, and yes they struggle, but then life is a struggle and suffering for many. Most people can cope and overcome problems, although they may have to go through difficulties. I think we all, speaker, moderators, guests, have likely experienced that one way or another.

motheroftacha: Yet, if there is an emotional "hypersensitivity" and often times our kids miss the societal feedback for behavior and academic performances. How can we nurture self-confidence? My child is loved by so many people, yet she rather misses that when she "chooses to." If the problem is not enough love and acceptance, then it is an error in interpretation. How do you help that?

Dr. Mate: These kids have often overdeveloped emotional defenses and our love sometimes just doesn't get through. When it does, it can work miracles. But it's very difficult. I think the issue is that the love has to get across precisely when it's most difficult for us. When our child is acting out and challenging us, we feel anxious and helpless. That's what we have to work on. I hope that answers your question, at least in part.

hrtfelt33: I am confused about what causes depression in ADHD children. Knowing that the social drawbacks are certainly part of it most likely, I would like to know if ADD medications, like Ritalin, themselves can cause depression?

Dr. Mate: Yes, it depends on the individual. When I took Ritalin, it certainly made me feel depressed, although it does not have that effect on everybody. Depression in the ADD child is a product of social rejection, but most fundamentally from a sense, unconscious usually, of being cut off from the parents. Again, the solution is to work on really connecting with the child. Sometimes antidepressant medications may be helpful, not as a long term solution, but as a temporary help.

David: So everyone knows we have a Conference Transcript homepage that includes various transcripts.

Thank you, Dr. Mate, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com.

Thank you again, Dr. Mate.

Dr. Mate: Thank you David, and to all participants. 

David: Good night, everyone.

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Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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