February 6th, 2023

 What is it about Attention Deficit and Hyperactivity that we see a disease needing a drug to mitigate the problem versus first looking at the other possible root causes? (Some children do have a genetic or epigenetic condition that is not based on the following discussion.) I asked Dr. Sandy Newmark this question, here is his response: "I read Scattered minds a long time ago and thought it was a fantastic book. I agree with much of what he, and you, say. I do think he has a more of a narrow approach to etiology than I would support.

I have many kids with clear ADHD who come from loving homes with 2 parents and little trauma history. There are genetic, epigenetic, and environmental factors that are also important in etiology, and I would not want those to be overlooked."

Well said!

Gabor Mate's book Scattered Minds (thanks Jen!) looks at ADHD from a different viewpoint. He states, "If hyperactivity expresses anxiety, lethargy and underarousal expresses shame, shame like anxiety, is an attachment emotion. The origin of shame is the feeling of having been cut off from the parent, or having lost the connection, if only momentarily. The toddler's hyperactive explorations are curtailed a few months after they began. A necessary outcome of exploring is the identification of limits, of boundaries." (Mate G. Scattered Minds page 132) These are keys to normal emotional success in society. If a child does not learn boundaries as a toddler and over expresses themselves verbally or differentially physically expresses him or herself in a peer group later on in school, they will often meet emotional reactions that are highly negative. i.e. paying attention to and knowing/learning another person's personal space and social cues is a boundary to be followed or set for relationships to thrive. This is part and parcel to the struggles of children on the autism spectrum and some ADHD children.

If attachment is a key part of developing the emotional self, how are parents to foster this truth? The key according to therapist Duey Freeman and author Gabor Mate is the reestablishment of warm contact rapidly no matter the problem at hand. To isolate the child for a prolonged time is akin to being emotionally lost and to foster shame. Shame then leads to a net negative self image which is a slippery slope to all forms of mental health struggle. Shame is initiated and magnified when the parent’s disapproval is overly strong or when there is no support or uneven support of “personhood” as as opposed to “ disapproval of behavior” in pretty much any and all interactions.” Thus, it is inherently important for parents to remain grounded in their emotional state to keep the child's world safe and consistent. A stressed out parent will lend an emotional roller coaster to the child who cannot deliberate why the parent is off and assume that they are to blame growing shame in self. And shame leads to acting out and/or withdrawal.

Gershen Kaufman calls this "reestablishing the interpersonal bridge". This reconnection is critical to all relationships. Parents are the key to building and maintaining the bridge.

Let's look at modern America. We are a more distracted society than ever at the most important times for a child to gain emotional regulation. Long gone are the days of relatively focused in home parenting for many if not most. Now we have a majority of our population consisting of single parents, working parent/s and occupied life parents. Two parent homes with a dedicated single parent always available to meet the child/ren's needs are more rare now. (these are not judgements on any group or style of life or parenting as many deserve even more praise for the effort that must occur to do the work) Current statistics note 62.3% of married 2 parent homes have 2 working parents. Work is often brought home taking away from the parent child experiences. Single parents have massive responsibilities that can distract from attachment. We also have limited parental work leave at the earliest and most important moments of life. There are many more concerns that I won't belabor. In essence, we as a society are not fostering attachment at the societal level.

What about contact?

First let us define contact: As defined by Duey Freeman: “Contact: A moment of present, attuned meeting of another at our physical, emotional, energetic and/or spiritual boundaries.” (Duey Freeman / Kimberly Rose) The key words here are attuned meeting of two people. We must be attuned to connect.

Eye contact is a critical emotional bridge in infants and young children. To break eye contact repeatedly is to break the bridge or relationship. Usher in smart phones! A whole new monkey wrench in the attachment game. Parents who are on their phone while feeding a baby or purportedly playing with a child are sending a massive message. You are not as important to me as your work, phone play etc.... I often find parents playing candy crush in the office while I am taking history and examining a child. Message sent each and every time. My experiences with many parents in the office are unfortunately slanted towards toward screen distraction. I have to confess that I get really frustrated with myself, when I find the phone in my hand during an interaction with one of my children. We are all at risk here. If Dr. Mate is correct, this is the beginning action that leads to a lack of attachment. This lack of attachment on a repeated or chronic basis leads to an emotional hole in the child that seeks a surrogate to fill the hole.

Duey Freeman has a way of showing this in pictorial form that helps one understand this outcome. The lack of attachment leads downstream to a break in the normal emotional regulation pathway changing course toward addiction, shame and pain. These addiction paths can come in any form; work, sex, drug, food and on and on. But, they will occur until the person fixes the attachment break and hole in their emotional sense of self.

For example, if your parent dealt with severe trauma as a child or adult, they may have been unable to attend to your needs regularly setting up this attachment cycle break in your life unbeknownst to you. Dr. Mate believes that this is a pathway to ADHD and ADD.

I distinctly remember a maternal child dyad in my early career where the mother was severely traumatized as a child. She, therefore, was unable to have her own self control and management emotionally toward him. She offered zero structure and discipline for him leading to a complete lack of boundary and limit setting for her son. He was beyond believability in his reaction towards her and his surroundings. He was violent, verbally aggressive and boundary less leaving the mother and subsequently him exhausted and lost. It was a classic example of the broken connection in persistence. He looked like a child with ADHD and behavioral dysfunction. He was lost to our clinic when they moved away, but I would bet a lot of money that he is now addicted to something severely trying to fill that attachment hole.

As parents ourselves, we have to maintain a constant focus on providing structure, discipline and consequences to help a child develop boundaries and limits while not losing the love connection of relationship for a long enough time to provoke shame. Remember that consequences are far from punishments as the latter breaks the connection. The former is to conspire together to repair the problem. For example, a child that breaks a rule could be placed in time out alone and in the emotional cold or could be sat down and hand held while you read together a passage on learning from a mistake.

This means that we have to do the work of self understanding before having children in order to avoid this possibility from becoming a reality. We have to explore our own hurts and reasons that we are emotionally off in order to not bring those wounds to our parenting reality. In a word, we must be "present". I define present as fully devoted to the needs of your child in the moment of crisis. Carl Rogers described a way to be present and grounded for a child this way: “When the other person is hurting, confused, troubled, anxious, alienated, terrified; or when he or she is doubtful of self-worth, uncertain as to identity, then understanding is called for. The gentle and sensitive companionship of an empathic stance… provides illumination and healing. In such situations, deep understanding is, I believe, the most precious gift one can give to another.” (Rogers C.)

Imagine a world where we all learned how to work on our stuff leading each successive generation to be more and more empathetic and understanding. Wow! what a place that would be.

I recognize that this sounds polyanish on the base level, but the key here is maintaining contact throughout the learning. The parent must contain self anger and frustration to help the child. This is extremely difficult with a child who has ADHD tendencies as they test the electric fence more frequently leaving a parent to dig deep to maintain focus on the emotional stability of the relationship. Alas, if you don't show up for your child with ADHD, who will and how will it be received? The child needs the love of the primary caregiver, less the friend.

Always learning on this journey of life and attaching!


Dr. M


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