PDF Summary:Scattered Minds, by Gabor Maté
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1-Page PDF Summary of Scattered Minds
In his 1999 book Scattered Minds, physician Gabor Maté argues that if you have ADHD, it’s because early childhood stress prevented you from developing the emotional-cognitive capacities you need to thrive in our world. Further, since ADHD isn’t just a biological disorder but one with social and psychological roots, he argues that medication isn’t the best or only way to treat your ADHD. Based on this perspective, he prescribes non-pharmaceutical treatments for both adults and children with ADHD and explains how society can prevent ADHD in future generations.
In this guide, you’ll learn about what makes your ADHD brain different and how it got to be that way. You’ll also learn about how to manage your symptoms, how to help your child with ADHD flourish, and how society may be able to prevent ADHD in future generations. We’ll supplement Maté’s ideas with up-to-date research about ADHD, other experts’ advice for parenting children with ADHD, and concrete suggestions for coping with your ADHD-related difficulties.
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Second, consistently healthy parent-child interactions teach you important psychological skills—like how to manage your attention, control your impulses, and regulate stillness. For example, Maté explains that you typically learn how to pay attention by having positive interactions with your parents—you want more of the feel-good endorphins these interactions give you, so you learn to focus on your parents when they’re focused on you.
(Shortform note: In addition to affecting your attention and impulses, parent-child interactions can also affect your ability to handle emotions, starting a cycle of unhealthy parent-child relationships. In Adult Children of Emotionally Immature Parents, psychologist Lindsay C. Gibson explains that when parents restrict their children’s freedom to express their emotions, the children may become self-preoccupied, defensive, and psychologically limited, which in turn has an impact on their ability to nurture their children’s psychological needs. Fortunately, it only takes one person to break the cycle—if you learn how to meet your own psychological needs, you can pass those skills on to your children.)
On the other hand, if interacting with your parents was stressful, you never got the opportunity to learn these skills. For example, Maté believes that your difficulty with attention stems from when your brain automatically dissociated your attention from the discomfort you were experiencing when your parents stressed you out. Dissociation is an automatic survival mechanism: Distress takes a physical toll on your body, so your brain protects you by dissociating from your stress. If you had enough negative interactions with your parents, inattention gradually became your baseline state. As a result, you’re only able to pay attention when it’s emotionally rewarding enough—otherwise, it requires an immense conscious effort.
(Shortform note: Dissociation is not a symptom of ADHD, but people with ADHD may dissociate when they experience trauma and may be more likely to experience trauma. If you struggle with dissociation, grounding techniques that help you connect with your present reality may help. For example, one common grounding technique is to list things you can hear, smell, taste, touch, and see.)
Part 2: You Can Heal Your ADHD
Since ADHD results from the underdevelopment of your brain and psyche, Maté theorizes that you can heal your ADHD by leveraging brain plasticity—your brain’s ongoing reactivity to environmental stimuli—to your advantage. In this section, we’ll discuss the theory behind Maté’s approach to healing ADHD. Then, we’ll present some concrete steps you can take to promote healing in yourself and in your children.
Maté’s Theory of Healing
Maté says that doctors tend to treat ADHD like it’s a purely medical problem by prescribing medication—and nothing else—for it. He believes that this approach is fundamentally unsuitable and calls for a more holistic plan for healing ADHD. Let’s dig more deeply into his theory of healing.
(Shortform note: Medication may have been the primary treatment for ADHD in the ’90s, but now, most experts recommend a combination of behavioral therapy and medication to treat ADHD in everyone over the age of 6.)
Medication Can Help, But It Won’t Heal
Maté argues that while ADHD medication can reduce or help you cope with your symptoms, it won’t heal your ADHD. That’s because the source of your ADHD symptoms isn’t simply a chemical imbalance. ADHD does have a chemical component—your brain doesn’t transmit dopamine (a neurotransmitter associated with the regulation of attention, impulse, and stillness) in the typical way.
But according to Maté, the chemical component of ADHD has deeper roots—you can’t transmit dopamine appropriately because you lack the appropriate neurostructure and positive life experiences that are required for typical dopamine transmission. Since ADHD medication can’t address those root causes, he says, it’s not possible to heal your ADHD with medication alone.
He also notes that ADHD medication isn’t appropriate for everyone—sometimes it doesn’t have the desired effect, or the side effects are insurmountably harmful. It’s important that your autonomy be respected when it comes to medication—if you feel it isn’t helping, you shouldn’t let anyone push you or your child to take it.
Dopamine, ADHD Medication, and Healing
Experts are still divided about the role that dopamine plays in ADHD. Some research has indicated that people with ADHD have significantly lower levels of dopamine because they have a higher concentration of dopamine transporters—proteins that can negate the function of dopamine in your brain—resulting from a genetic mutation. However, other researchers suggest that dopamine doesn’t contribute as much to ADHD symptoms as other brain differences do.
Nevertheless, the most common ADHD medications—stimulants like Ritalin and Adderall—work by increasing the amount of dopamine in your brain. These treatments don’t work for everybody, but many people with ADHD report that taking stimulants radically changed their lives for the better. There are also non-stimulant medications available for ADHD that target other neurotransmitters and parts of the brain. If your ADHD medication isn’t working for you, talk to your doctor. They may change your dosage, try a different medication, or prescribe non-drug treatment for your ADHD.
Experts don’t claim that ADHD medications can heal your ADHD because ADHD is widely considered incurable—no treatment, whether it’s medication, behavioral therapy, or something else, will eradicate your ADHD. But ADHD medications can help you cope with your symptoms more effectively and, ultimately, live a happier life.
Your Brain Is Plastic, So Change Can Heal It
Maté theorizes that it’s best to treat ADHD by using brain plasticity to your advantage. He explains that while your brain is most plastic during childhood, it continues to be affected by environmental stimuli throughout the rest of your life. This means that it’s never too late to learn the psychological skills you missed out on developing as a child—and when you do, it’ll have a positive impact on your physical brain, too. Over time, you can gradually overcome the negative effects of early childhood stress on your brain.
(Shortform note: Experts say that you can proactively improve your brain’s plasticity by putting yourself in novel situations—as you adapt to the change, your brain makes new neuronal connections. Example activities include learning new skills (like speaking a language or playing a musical instrument), having new experiences (by traveling to a foreign country, for example), and playing games that involve creativity or surprise. Getting enough sleep and exercise also promotes neuroplasticity.)
Since Maté believes that the fundamental cause of ADHD is the rupture of the parent-child bond, that’s where he thinks you should focus most of your healing efforts. You can’t go back in time and provide yourself with a consistently positive childhood, but you can re-parent yourself as an adult by taking responsibility for your emotional wellness, learning to fulfill your own needs, and accessing the resources you need to improve. Likewise, if you’re the parent of a child with ADHD, you can help them flourish by making changes that strengthen the bond you share.
(Shortform note: Re-parenting yourself is a commonly prescribed treatment for survivors of childhood trauma. According to the psychologist who invented the concept, self re-parenting works because it helps you disidentify from your parents’ negative concept of you and come into your own, healthier self-concept. For example, if your parents made you feel stupid as a child, you probably feel stupid as an adult—and re-parenting yourself would involve learning to see yourself in a more positive light. Self re-parenting is usually done in conjunction with a therapist, who can help you identify the negative patterns you adopted from your parents and learn how to change them.)
Concrete Steps for Adult Healing
So, what kinds of positive changes can you make to your life to help your adult brain heal? According to Maté, there are two essential components to re-parenting yourself: pursuing psychological growth and physical self-nurturing. Let’s explore some of his suggestions for healing in both of these areas.
Pursuing Psychological Growth
Accept yourself, including your difficult emotions and any behaviors you engage in but don’t necessarily approve of. Many people with ADHD struggle with self-esteem because they feel their condition holds them back from achieving their goals and getting others’ approval. You may even feel like there’s something innately wrong with you, which Maté attributes to the shame you felt every time the bond between you and your parents was ruptured. To gain self-acceptance, remind yourself that you’re doing your best and that healing is a journey—it’s okay if you’re not where you’d like to be yet.
(Shortform note: In Radical Acceptance, Buddhist psychologist Tara Brach explains that most people struggle with self-acceptance because they feel ashamed or guilty of their mistakes. To get past these feelings, she recommends self-forgiveness: the practice of welcoming your own feelings, acknowledging the good parts of yourself, and cultivating self-compassion. Self-forgiveness helps you see yourself in shades of gray, rather than black or white: You’re imperfect, but that’s OK—it doesn’t mean you’re bad.)
Attend therapy. Maté explains that people have a deep-seated psychological need for validation from others, especially when they’re in pain. He says that a family therapist can provide you with that validation, help you understand your emotional pain, and support you in learning new psychological skills that can help you thrive.
(Shortform note: Maté specifically recommends seeing a family therapist because they can help you understand the generational patterns of stress and dysfunction that he says cumulated in your own ADHD. However, other experts typically recommend behavioral therapy to treat ADHD. Behavioral therapy works by teaching you skills that can help you overcome your symptoms and replace dysfunctional behaviors with healthier ones.)
Practice mindfulness. According to Maté, mindfulness improves your neurological capacity to focus; in addition, it may have other psychological benefits, like spiritual fulfillment, that help you heal the emotional pain that underlies your ADHD. He specifically recommends mindfulness meditation but notes that mindfulness can be incorporated into a vast array of activities, like spending time in nature.
(Shortform note: Some people with a history of trauma, anxiety, or depression may find that inward-looking kinds of mindfulness, such as meditation, trigger adverse symptoms instead of bringing them peace. If that’s the case for you, mindfulness practices that focus your attention on something outside of yourself—like gardening, forest bathing, or coloring—may be more helpful.)
Prioritize restorative recreation. Many people with ADHD overwork themselves as an outlet for their hyperactivity, but Maté says that in the long run, this only increases your stress. Instead, you should give yourself time to play, explore, and rest. For example, you might take up a creative hobby like crochet.
(Shorform note: In How to Do Nothing, professor and artist Jenny Odell argues that everyone should prioritize restorative recreation. She explains that although modern society demands your constant attention and productivity, it’s healthy to spend some time doing nothing—that is, nothing traditionally considered productive. She specifically recommends three restorative recreational activities: spending time in nature, learning local history, and getting to know your neighbors.)
Physical Self-Nurturing
If you struggle with addiction to any substance or behavior (as many people with ADHD do), seek treatment. According to Maté, to effectively treat addiction, you have to understand and deal with the root of the problem—the emotional pain you’re trying to cover up by engaging in your addictive behavior.
(Shortform note: Not sure if you’re struggling with addiction? There are four signs that generally indicate you may be addicted to a substance or behavior: inability to stop using the substance or engaging in the behavior, neglecting your relationships and responsibilities because you want the substance or behavior more, taking risks related to the substance or behavior (like sharing needles or having unprotected sex), and having physical withdrawal symptoms when you try to stop using a substance. If you check any of these boxes, it may be time to seek help.)
Keep a neat home. An untidy environment can add to your emotional stress. If you struggle with this, Maté recommends setting a timer for a short period of time and cleaning until it goes off. Over time, you’ll make steady progress toward maintaining your environment.
(Shortform note: Keeping a neat home can be a struggle when you have ADHD because you struggle to stay focused—especially if you find cleaning boring. To overcome your boredom, add some enrichment to your cleaning routine—play music while you do dishes, watch a movie while you fold laundry, or call a friend while you mop.)
Practice good sleep hygiene. Because of your difficulty with stillness, you may have trouble relaxing enough to fall asleep at night, but Maté notes that a lack of good sleep can worsen your stress.
(Shortform note: Some basic sleep hygiene practices include going to sleep and waking up at the same time every day, turning off electronic devices and engaging in a relaxing routine before you go to bed, and limiting caffeine to mornings—or eliminating caffeine completely.)
Get adequate nutrition and exercise. Your sensitive temperament means that you feel the effects of undernourishment and under-exercising more strongly, which Maté says can increase stress and inhibit your progress. But your sensitivity also means that if you do get enough nutrition and exercise, you’ll feel their positive effects—like stress relief, increased focus, and improved mood—more strongly.
(Shortform note: Some studies suggest that exercise has more of an impact on your ADHD symptoms than diet does, but it doesn’t hurt to tackle both. Experts say that eating food that’s good for your brain—like healthy proteins, complex carbohydrates, and omega-3 fatty acids—may reduce your ADHD symptoms. Adequate exercise can have the same effect—experts recommend 30 to 40 minutes of moderately intense activity, four or five times a week.)
Concrete Steps for Childhood Healing
Maté’s advice for helping a child with ADHD heal is largely the same as his advice for adults: Don’t force them to take medicine if it does more harm than good, and do your best to provide the psychological and physical nourishment they need. However, children with ADHD—and their parents—face some unique challenges as well. Let’s explore some of those challenges and Maté’s proposed solutions for them.
Repairing the Parent-Child Bond
Recall that Maté believes the fundamental cause of ADHD is the rupture of the parent-child bond. Since your child is still developing, you have the opportunity to repair that rupture and strengthen the bond between you. According to Maté, the best way to do this is by cultivating and communicating an attitude of perfect acceptance of your child. If you’re perfectly accepting of your child, you feel that you love, respect, and appreciate your child no matter what—and more importantly, you make sure that your child feels secure in that fact.
(Shortform note: Like many parents, you may struggle to accept your child’s ADHD diagnosis—perhaps you feel anxious about their future, blame yourself for their struggles, or are even in denial about their diagnosis. To move toward acceptance, experts recommend that you reflect on your feelings so you can understand them, give yourself time to grieve, and focus on your child’s strengths.)
To show your child that you accept them perfectly, Maté recommends the following steps:
Take a loving interest in your child’s inner world. Try to understand what it’s like to be them without trying to “fix” them. If your child senses that you’re judgmental, anxious, or angry about what’s going on with them, it can make them feel ashamed and want to pull away from you.
(Shortform note: One concrete way to take a loving interest in your child is to focus on the meaning behind their behavior instead of the behavior itself. For example, if your teenager with ADHD has been skipping school, you might ask them why instead of immediately punishing them for it. Perhaps they’re skipping school because they feel anxious about their ability to get good grades—once you know this, you can proactively address that anxiety, which could resolve the misbehavior.)
Initiate quality time with your child. This demonstrates that you value their presence in your life.
(Shortform note: In The 5 Love Languages, Gary Chapman explains that there are two kinds of quality time—a meaningful conversation about what’s going on in your lives and time spent focusing on the same activity. You may not be interested in the same activities your child is, but engaging in those activities with them anyway shows that you care more about spending time with them than your own enjoyment.)
Avoid reactionary parenting. Maté says that your greatest priority as a parent is fulfilling your child’s needs—not acting on your own emotional impulses. For example, this could mean taking time to gather yourself before you launch into a difficult discussion with your child about their school performance. If you can’t regulate your emotions while you’re parenting, your child may feel anxious and alienated from you.
(Shortform note: In No-Drama Discipline, parenting experts Daniel J. Siegel and Tina Payne Bryson recommend three strategies to help you avoid reactionary parenting. First, keep in mind that your child’s developing brain doesn’t support adult-like behavior yet, so you shouldn’t expect them to act like adults or understand your adult point of view. Second, ask yourself about the meaning behind your child’s behavior, what you want them to learn from this experience, and how to best deliver that message. Third, wait to discipline your child until you’re both calm enough to have a productive discussion.)
Dealing With Defiance
Many children with ADHD exhibit defiance—an automatic reflex where the child rejects the parent’s demands, expectations, or instructions—and parents struggle to deal with that defiance without escalating the conflict. Maté explains that defiance is healthy to some extent—by defying you, your child sets herself apart as an individual, which is an important part of her development. Defiance is especially common in teenagers because it’s developmentally important for them to begin feeling more independent.
(Shortform note: If you’re struggling with your child’s defiance, you’re not alone: Psychologists note that more than half of children with ADHD are also diagnosed with Oppositional Defiance Disorder
Maté suggests taking the following steps whenever your child is defiant: First, encourage your child to express their feelings, and validate those feelings even if your child isn’t going to get their way. Second, decide whether it’s worth enforcing your rules in this case—is it something trivial or a matter of their safety or well-being? Third, refuse to engage in a power struggle—it’s not about overpowering or imposing your will on them but getting your child to cooperate with you. Finally—and most importantly—after a disagreement, take the initiative to reconnect with your child as soon as possible. This reaffirms your perfect acceptance of your child: They know that no matter what they do, your relationship can’t be damaged beyond repair.
(Shortform note: In addition to Maté’s tips, other experts recommend using positive reinforcement to decrease defiant behavior. This includes praising your child for good behavior, offering lots of positive attention during daily life, and creating a reward system—for example, if your child completes their chores every day for a week, they could earn extra time on the computer.)
Promoting Achievement
Maté emphasizes that promoting achievement shouldn’t be your first priority—it’s not as important as the parent-child bond, and if you put achievement first, your child will internalize your anxiety/anger about their performance as shame. However, Maté also says that children with ADHD need to feel empowered to achieve whatever they want to achieve.
(Shortform note: One way you can empower your child with ADHD to achieve is by teaching them self-advocacy skills. Self-advocacy in the context of ADHD means knowing how your ADHD impacts you, knowing what you need to overcome your ADHD symptoms, and working to meet those needs (for example, by asking for accommodations). When you teach your child to self-advocate, they learn that they’re capable of independently overcoming barriers to their achievement—and studies show that they’re more likely to succeed. Additionally, some experts argue that developing self-advocacy skills also improves kids’ self-esteem and teamwork skills, which provides benefits outside of academic achievement—like strengthening their bond with you.)
He makes a couple of concrete suggestions to promote your child’s empowerment:
Develop your child’s capacity for intrinsic motivation by giving them the opportunity to make their own choices (within reason) and letting them know that it’s okay if they don’t meet others’ expectations for their achievement. Maté says this is better than relying on extrinsic motivation—like punishments and rewards—to encourage your child to achieve for three reasons: it gives the child anxiety about measuring up to your standards, increases defiance, and incentivizes the child to take the easiest route possible to achieve a desired reward (rather than incentivizing them to become genuinely invested in the task itself).
(Shortform note: Experts note that for people without ADHD, the capacity for intrinsic motivation doesn’t fully mature until your mid-20s—and that comes even later for people with ADHD. So even as you encourage your child to develop intrinsic motivation, you may still have to rely on extrinsic motivators—like rewards for good grades—to help them achieve.)
Maté suggests that when it comes to school-related achievement, you work together with your child’s teachers to ensure that your child’s ADHD-related needs are being accommodated. For example, if your child’s teacher says they have difficulty staying still during class, you can collaborate to incorporate appropriate movement into their day—for example, maybe a fidget spinner. You can also collaborate with your child himself by helping him strategize about how to meet his own educational goals without pushing your own goals onto him.
(Shortform note: If you live in the United States and have evidence that your child’s ADHD interferes with their ability to achieve in school, your child may be legally entitled to receive accommodations at school. Common accommodations for schoolchildren with ADHD include extra time on exams, tailored assignments, extra breaks for physical activity, and the elimination of environmental distractions.)
Part 3: The Future of ADHD
Beyond healing your own ADHD, Maté says you can also play a role in the future of ADHD by preventing ADHD. In this section, we’ll explore the role society plays in the prevalence of ADHD and the changes society can make to diminish it.
Maté says that ADHD is preventable if you provide sensitive children with a healthy, stress-free early childhood. Instead of developing ADHD, their brains will develop typically, and they’ll grow into functional adults whose sensitivity helps them excel in life, rather than hindering their progress. According to Maté, if every parent could provide this for their children, ADHD wouldn’t exist.
(Shortform note: Maté favors preventing ADHD because he believes that ADHD is inherently detrimental—it makes life harder, so it should be eradicated. However, in recent years, activists belonging to the neurodiversity movement have argued just the opposite: ADHD is a brain difference, not a deficit, and it only seems to impair function because the world isn’t set up to accommodate people with brain differences. Neurodiversity advocates don’t believe that ADHD should be eradicated—instead, they believe that society should make room for everybody to succeed.)
However, Maté argues that the responsibility for preventing ADHD shouldn’t be left solely up to parents. No matter how earnestly you try to protect and nourish your children, you and your children are likely to experience stress that’s imposed by society. For example, many low-income parents struggle to provide for their children’s basic material needs through no fault of their own. If they have to work long hours to do so, they might become stressed (and stress their children out, too) because they’re juggling too much and don’t have the time or energy to establish a positive, secure relationship with their children.
(Shortform note: The notion that society is responsible for preventing mental health conditions has become more common recently. For example, in Lost Connections, journalist Johann Hari argues that society is responsible for preventing depression since depression is a natural reaction to the way society is set up—for example, you might be depressed because you have to keep a job you hate for the money. Arguments like these are part of a larger theory that the medicalization of social problems is an ineffective way to treat them—the idea is that medical experts pathologize and medicate dysfunction as a means to control undesirable behavior, when we’d be better off addressing the social issues that contribute to people’s dysfunction.)
Maté argues that society has a responsibility to help parents provide a safe, stable, and loving environment for their children by reducing demands on parents and increasing access to support for parents and children. For example, this could mean providing financial support to parents so they can work less and spend more time with their children.
(Shortform note: Formal family support programs aren’t always easily accessible, but they’re out there—for example, if you’re struggling financially and live in the United States, you may qualify for a program like WIC or SNAP, which helps families afford food. You may also benefit from informal support programs, like support groups for parents of children with ADHD.)
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