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Book Review for Scattered: How Attention Deficit Originates and What You Can Do About It

katherine's picture

For my book review, I read Scattered: How Attention Deficit Disorder Originates and What You Can Do About It by Gabor Maté. Based on his own experience as someone with ADD and his clinical experience with patients, he covers the origins of ADD, how it impacts relationships, and possible ways for people with ADD to deal with the challenges the condition presents in life.
Maté defines ADD as those who exhibit at least two of the following characteristics: poor attention skills, deficient impulse control, and hyperactivity. He explains that the neurological origins of ADD are rooted in missing neural connections and blood vessels in the prefrontal cortex. Dopamine and endorphins are central in generating the creation of new neural connections. These connections increase with an increase in the amount of endorphins and dopamine released which occurs when one has joyful, happy experiences. Those who are deprived of these experiences develop fewer dopamine receptors and blood vessels in the right prefrontal cortex; ADD is the result. Maté argues that this means that those with ADD were deprived of the happy experiences that nurture these attributes and as a result develop ADD.
Maté posits that a person's first few months of life are particularly important in the development of ADD. During this time, infinite amounts of neural pathways are being formed. Stress placed on the child inhibits synapses to form which results in hyperactivity persisting longer than is typical for the child's age. For Maté, parents are central in the child's development of ADD. I agree that it is probably true that certain environments allow ADD to thrive more than others, but what about the child that has two devoted parents in a nurturing environment and is still diagnosed with ADD? If ADD were to be attributed entirely to environmental factors, all children with negative parenting experiences would be ADD. Maté's inclusion of the genetic prerequisite for ADD appears to serve as a safety net for his argument as the rest of the book is focused on the environmental factors, particularly the parent-child relationship. Of course no environment or parent-child relationship is perfect so it is always possible to argue that these factors are responsible for ADD, but to me it seems like biology would play a bigger part in this scenario than Maté leads the reader to believe. Perhaps if he had spent more time developing the biological side of the argument then it would not seem as though this was the case.
One aspect of the book that I found particularly interesting and that I thought connected well with the rest of the class was Maté's description of ADD in respect to society. Something I really enjoyed about our class discussions was that we constantly questioned our own experiences as well as many agreements that society seems to have reached when it comes to conditions such as ADD. Maté's own approach to ADD is very similar. He views ADD as a condition that results from a different organization of the brain than what is considered "normal." The strategies he poses are ways for people to compensate for this different organization in a world that is not forgiving of those who are atypical. Rather than jumping to the conclusion that those with ADD are in need of medication, he explores alternatives to medication and how the person with ADD as well as those around them can aide them in coping with their condition. What is particularly refreshing is that Maté insists that if patterns of behavior are changed, new neural pathways can be formed and the negative aspects of ADD can be mitigated, no matter what the age of the person. For me this course really challenged me to look at the nervous system from many different perspectives and to question my previously held notions of reality. In many respects, Maté asks his readers to do the same through the lens of ADD.
That being said, he also emphasizes the drastic improvement that medication can have on someone who is struggling with ADD. He points out that it is essential for the patient, whether it is a child or adult, to willing take the medication. Additionally, the doctor prescribing the medication must be knowledgeable about ADD and what an appropriate dose of mediation is for the individual. He stresses that although medication can be used as a way for people to keep focus, ADD should not be seen as a disease that needs to be cured. Furthermore, he suggests that medication should not be the only treatment for ADD, but rather one of many lifestyle alterations that aides in combating the challenges faced by those with ADD.
Another part of the book that I found particularly interesting was Maté's correlation between ADD and addiction. He explains that among those with ADD, there is also a high incidence of people with addictions. He notes that the rush that people get from their addictive behavior regardless of whether it is gambling, smoking, or shopping releases neurochemicals which make them "feel good." For people with ADD, it is thought that the addictive behavior can serve as self medication and a source of dopamine and endorphin release.
Although this book is at times an interesting analysis of ADD, I found that Maté relies too heavily on his own personal experience as someone with ADD and his relationship with his wife and children to draw conclusions. For the majority of the book, I felt that I was reading his autobiography as opposed to a book about ADD. Furthermore, I felt that he would go off on tangents in order to explain background information about the brain in general and it was only after several paragraphs that he would make a weak connection to how it related to ADD. This could have been because his book is aimed at a general audience with little background in neurobiology or psychology. However even if this is the case, his personal stories and anecdotes detract from the explanation of ADD and the strategies those with ADD can use to compensate for the differences in the organization of their brain compared with what is considered "normal." Despite the aspects of this book that I found problematic, Maté provides an interesting overview of ADD and how those with ADD can cope in our society.