from Scattered: How Attention Deficit Disorder Originates And What You Can Do About It by Gabor Mate M.D.
The skill of attention that begins during the initial stages of brain growth and mental development goes through several important phases, but the central buttress of them all is the secure attachment/attunement relationship with the primary caregiver. Without that, the infant will not focus. Without it, the toddler will be hesitant or unregulated about how he explores the environment. Happy interactions between caregiver and infant generate motivation and arousal by triggering the release of the reward brain chemicals, endorphins and dopamine. In a positive interaction with mother lasting only ten seconds, an underaroused toddler is energized, his unfocused attention transformed into focused attention.
Attention and emotional security remain intertwined throughout childhood. What looks like a deficit of attention may be a preoccupation with something that is important to the child but hidden from the observing adult: the child’s emotional anxieties. The classroom behavior of ADD children is said to be disruptive. They seem to have more interest in interacting with their peers than in the material the teacher would have them study—which may simply mean they are obsessed with trying to get their relationship needs met. If they tend not to do this very successfully, they do it all the more desperately. Their brain’s attentional system cannot switch into “schoolwork mode” when it is consumed by anxieties about the child’s emotional connection with the world.
For people deeply hurt, the internal world may offer more meaning than the real one. A woman in her thirties whose ADD as never noticed because she was not hyperactive, only a daydreamer, told me that she spent entire school days staring out the window, lost in fanciful adventures with imaginary friends. From the outside one might have described her as “distracted.” The Latin root of distract is “draw away”—drawing her away from the inside was her hiddenmost emotional longing. Her brain unconsciously assigned greater value to a self-created internal universe than to anything or anyone in the classroom.
The nagging hunger for emotional contact explains the oft-observed “paradox” that many children with ADD are capable of focused work in the presence of an adult who is keeping them company and paying attention to them. This is no paradox at all, if we see the opposing roles of anxiety and attachment in influencing attention: attachment promotes attention, anxiety undermines it. When the childis not concerned with seeking emotional contact, his prefrontal cortex is freed to allocate attention to the task at hand, illustrating that what we call attention deficit disorder is not a fixed, unalterable physiological state; it’ a physiological state, yes, but not fixed and unalterable. The warmth and satisfaction of positive contact with the adult is often just as good as a psychostimulant in supplying the child’s prefrontal cortex with dopamine. Greater security means less anxiety and more focused attention. The unseen factor that remains constant in all situations is the child’s unconscious yearning for attachment, dating back to the first years of life. Where this need is satisfied, ADD problems begin to recede.