1. In the professional literature Stephen P. Hinshaw, associate professor of psychology at the University of California, Berkeley, has been a distinctive voice, suggesting the possiblity of complex biological, social, and psychological interactions together forming the roots of ADD: “Notions of complex causal pathways in which psychobiologic risk factors, problematic family functioning, and wider system influences might combine to shape problems in attention regulation, activity level modulation, and response inhibition have been slow to gain acceptance.” (Hinshaw, Attention Deficits and Hyperactivity in Children, ix.)
1. Canadian statistics regarding Ritalin use: The Vancouver Province, April 3, 1998.
2. Regarding our still rudimentary knowledge about the microfunctioning of the brain, “We are still far away from explaining even one aspect or piece of an integrated act by a neural circuit, neural assembly, or neural code,” writes the brain researcher Patricia S. Goldman-Rakic. (Dawson and Fischer, Human Behaviour and the Developing Brain, xi.)
1. Singer and Revenson, A Piaget Primer, 95.
2. Goleman, Emotional Intelligence, 34.
3. University of Alberta study: Janzen, Troy et al., “Differences in Baseline Measures for ADD and Normally Achieving Preadolescent Males,” in Biofeedback and Self-Regulation, Vol. 20, No. 1 (1995): 65.
4. “The cortex’s job is to prevent the inappropriate response rather than to produce the appropriate one,” writes neuroscientist Joseph LeDoux. (LeDoux, The Emotional Brains, 165.)
5. Greenspan, The Growth of the Mind, 143.
1. The paucity of evidence for the genetic basis of personality traits is not limited to ADD. Robert Plomin, an internationally known behavioral geneticist at the University of Colorado, Boulder, touched on this issue in his book Development, Genetics and Psychology. The study of hereditary effects on the development of personality, he pointed out, would require the identification of single genes that code for specific characteristics. “Unfortunately,” he concluded, “there is no example of a single gene that accounts for a detectable amount of variance in any psychological characteristic such as cognitive ability, personality, or psychopathology.” (Plomin, Development, Genetics, and Psychology, 4.)
2. “Because parents share family environment as well as heredity with their offspring, parent-offspring resemblance does not prove the existence of genetic influence.” (Plomin, 9.)
3. There is one more argument regarding identical twins made on behalf of the genetic view: that since identical twins adopted out have a higher concordance rate than fraternal twins, the difference again must be due to genetics. To some degree this is true, of course. Whatever genetic susceptibility one identical twin inherits will also affect his/her sibling. However, there is an important environmental factor at play here, too. The world is much more likely to respond in similar ways to identical twins—same sex, same inherited tendencies, identical physical features—than to fraternal twins who may be of different sex and have very different looks and reactivity patterns. In other words, for identical twins the environmental factors are still more likely to be similar, even after adoption into different families.
4. Wender, Attention-Deficit Hyperactivity Disorder in Adults, 98.
5. Greenspan, The Growth of the Mind, 143.
6. “The influence of birth order, like that of gender, can be traced throughout history with clear and dramatic consequences … The psychological consequences of birth order provide compelling evidence for the role of the family environment,” says Frank J. Sulloway of the Department of Brain and Cognitive Science at the Massachusetts Institute of Technology, in his recent book, Born to Rebel: Birth Order, Family Dynamics, and Creative Lives, xiv.
7. Mahler, The Psychological Birth of the Human Infant, 3
1. Vagal stimulation study: Dawson and Fischer, 349.
1. “The number of synaptic contacts in human cerebral cortex is staggeringly high,” writes Peter Huttenlocher, a neuroscientist at the University of Chicago. “It is clear that this large number cannot be determined by a genetic program, in which each synapse has an exact assigned location. More likely, only the general outlines of basic connectivity are genetically determined.” (Dawson and Fischer, 138.)
2. Damasio, Descartes’ Error, 260.
3. Regarding the vulnerability of the infant brain to environmental influences: “At any point in this process you have all these potentials for either good or bad stimulation to get in there and set the microstructure of the brain,” Dr. Robert Post, chief of the U.S. National Institute of Mental Health’s biological psychiatry branch said in an interview with Chicago Tribune science writer Ronald Kotulak. (Kotulak, Inside the Brain, 8.)
4. Neural Darwinism: “Both neurons and neural connections compete to survive and grow,” write two researchers, Kurt W. Fischer and Samuel P. Rose: “Neurons that receive little input and so are not active are pruned away; those that are active are sustained. Similarly, synapses connecting neurons compete with each other, and those that receive ample input thrive, while those that receive minimal input become weaker or are pruned away. This competition is an important part of development and apparently accounts for many of the effects of specific experience. Experience causes some neurons and synapses (and not others) to survive and grow.” (Dawson and Fischer, 9.)
5. “All the evidence indicates,” writes the anthropologist Ashley Montagu, “that while the duration of the gestation period in man differs by only a week or two from that of the great apes, a large number of factors, all combining to lead to the much more prolonged development of the human infant, causes him to be born before his gestation has been completed.” (Montagu, The Human Revolution, 86.)
1. Scientific American article quoted in Schore, Affect Regulation and the Origin of the Self, 73.
2. Seattle EEG infant study: Dawson and Fischer, 367.
3. British studies on postpartum depression: Murray and Cooper, Postpartum Depression and Child Development, 97.
4. Daniel J. Siegel, Cognitive Neuroscience Encounters Psychotherapy, notes for a plenary address to the 1996 Annual Meeting of the American Association of Directors of Psychiatric Residency Training.
5. The intricate processes of attunement are described in the following manner by Daniel Stern, professor of Psychiatry and chief, Laboratory of Developmental Processes, Cornell University Medical Center: “First, the parent must be able to read the infant’s feeling state from the infant’s overt behavior. Second, the parent must perform some behavior that is not a strict imitation but nonetheless corresponds in some way to the infant’s overt behavior. Third, the infant must be able to read this corresponding parental response as having to do with the infant’s original feeling experience and not just imitating the infant’s behaviour.” (Stern, The Interpersonal World of the Infant, 139.)
In other words, the mother (or mothering figure) has to be exquisitely aware of the minute and rapidly changeable gradations of the infant’s emotions. She (or he) then has to be able to communicate to the infant by means of facial expression, tone of voice and body language, that she understands those emotions and is with the child in experiencing them. These messages are processed and encoded in the front part of the infant’s right hemisphere, the right prefrontal cortex.
6. Bowlby, A Secure Base, 7.
7. Attachment was explained by John Bowlby, the pioneer of attachment theory: “To say of a child that he is attached to, or has an attachment to, someone means that he is strongly disposed to seek proximity to and contact with a specific figure and to do so in certain situations, notably when he is frightened, tired or ill …” (Attachment, 371.)
8. Greenspan, The Growth of the Mind, 53.
1. The research data and the psychological observations pointing to the central role of the OFC in self-regulation, motivation, emotional processing and attention are detailed masterfully in Affect Regulation and the Origin of the Self by Allan N. Schore, destined to become a classic in the literature of brain development.
2. Schore, 195.
3. “There are many subtle ways in which disruptions in electrical and chemical functions can adversely affect a brain region, with lesions being just an extreme example of this,” the psychologist and neuroscientist Joseph LeDoux points out. (LeDoux, 250.)
4. Daniasio, 78.
5. Dubovsky, Mind ↔ Body Deceptions, 193.
6. Study on anxiety and natural benzodiazepines in rats: Christian Caldji, Beth Tannenbaum et al., “Maternal care during infancy regulates the development of neural systems mediating the expression of fearfulness in the rat,” in Neurobiology, Vol. 95, No. 9 (April 28, 1998): 5335–40.
1. The quotations on this page–this page are from Barkley, Attention Deficity Hyperactivity Disorder, 147–48 and 157.
2. 1994 study: van der Kolk, Traumatic Stress, 31.
3. Barkley, Attention Deficit Hyperactivity Disorder, 149.
4. Barkley, Attention Deficit Hyperactivity Disorder, 148
5. Bowlby, Separation, 266.
1. Hallowell and Ratey, Driven to Distraction, 191.
2. Bowlby, Attachment, 46.
3. Hollowell and Ratey, Driven to Distraction, 191.
1. “In its broadest terms,” writes the psychologist Etzel Cardena, “dissociation simply means that two or more mental processes or contents are not associated or integrated.” (Lynn and Rhue, Dissociation, 15.)
The value of dissociation is explained in the following manner by Dr. Bessel van der Kolk, associate professor of psychiatry at Harvard Medical School and director of the Trauma Centre at Human Resources Institute Hospital, in Brookline, Massachusetts: “During a traumatic experience, dissociation allows a person to observe the event as a spectator, to experience no, or only limited pain or distress; and to be protected from awareness of the full impact of what has happened. (van der Kolk, 192.)
2. Freyd, Betrayal Trauma, 68.
3. Fischer and Rose, writing in Dawson and Fischer, 33.
4. LeDoux, 287.
5. Greenspan, The Growth of the Mind, 45.
6. When the maternal face expresses positive internal emotional states, infants are more likely to seek the mother’s gaze. Toward the end of the first year, as babies begin walking, checking the mother’s face becomes an important guide to exploring the world. A happy, supportive look from mother encourages interest in the environment. It takes but a moment—on the average 1.33 seconds—for the infant to read in mother’s facial expression the signals allowing continued exploration and interest, or the signs of discouragement. (Data from Schore.)
7. Schacter, Searching for Memory, 154.
1. The scanning behavior described on this page, as well as other automatic behaviors observable in ADD children and adults, strikingly resembles the descriptions given in John Bowlby’s work on the demeanor of infants after a period of separation from their mothers: “For hours on end sometimes the infant would crane his neck, scanning his surroundings without apparently focusing on any particular feature and letting his eyes sweep over all objects without attending to any particular one.” (Bowlby, Separation, 54.)
Older children who are able to move around exhibit a form of mobile hyperactivity that may alternate with dejected inactivity. These are also the pendulum swings that characterize ADD behavior. Another study quoted by Bowlby observed: “This increased activity frequently took the form of anxious searching or agitated movement. There was occasionally a quite opposite kind of reaction to the stress of being alone: a kind of frozen immobility … Also, it occasionally happened that a child who was upset over separation would alternate between unfocused running activity and immobility.” (Separation, 50.)
Data from animal experiments is revealing. At Pennsylvania State University, it was found that rats deliberately lesioned—damaged—in the orbitofrontal area of the cortex became hyperactive. Similar observations were made at the University of Colorado Medical Center when young monkeys were separated from their mothers. Together, these findings suggest that interference with the mother-infant attachment has consequences similar to those resulting from physical damage to the orbitofrontal cortex. The difference is that the manmade lesion cannot be reversed, but the attachment disruption can be.
2. Kaufman, Shame, 13.
3. All research observations in this chapter, unless otherwise specified, are quoted from Schore’s Affect Regulation and the Origin of the Self, 199–230.
1. All three quotations on this page are from Diamond, Enriching Heredity, 150, 157 and 164 respectively.
2. Plasticity of the brain in infancy: Dawson and Fischer, 147.
3. Benes, writing in Dawson and Fischer, 198.
4. Damasio, 112.
5. Greenspan, The Growth of the Mind, 151.
6. Rogers, On Becoming a Person, 283.
7. Diamond, 163.
8. Rogers, 283. Rogers was summing up the qualities of a good therapist in relation to her/his clients. Substitute parent for therapist and child for client, and we see an eloquent description of what is needed in a parent-child relationship.
1. Kerr and Bowen, Family Evaluation, 203.
2. Freeman, Family Therapy with Couples, 8.
1. Deci, Why We Do What We Do, 28.
1. Greenspan, The Growth of the Mind, 68.
2. Magic marker study: M. R. Lepper, et al, “Undermining Children’s Intrinsic Interest With Extrinsic Rewards,” Journal of Personality and Social Psychology, 28, 1973, 129–37: 237: Deci, 18 and 25.
1. Rathvon, The Unmotivated Child, 25.
2. Deci, 30, 42.
3. Greenspan, The Challenging Child, 50.
4. Greenspan, The Challenging Child, 44.
5. Rathvon, 119.
1. Allyson Golding’s article, “The Incoherent Brain,” appeared in Harper’s Magazine, May 1998.
2. The New York Times, April 7, 1998.
1. Miller, The Drama of the Gifted Child, 33.
2. Damasio, 240.
1. Herman, Trauma and Recovery, 235.
2. Schacter, 161.
3. LeDoux, 198.
4. Schacter, 233
5. LeDoux, 204.
6. Greenspan, The Growth of the Mind, 56.
1. Epstein, Thoughts without a Thinker, 165.
2. LeDoux, 203.
3. On the interaction of the orbitofrontal cortex and the amygdala: “The orbital cortex provides a link through which emotional processing by the amygdala might be related in working memory to information being processed in sensory and other regions of the neocortex,” writes Dr. LeDoux (The Emotional Brain, 278). In short, the OFC collects data about incoming information, especially the emotional content of stimuli, interprets them in the light of the implicit memory imprinted in its circuits from our earliest months and years and connects all this input with the emotional messages flooding toward it from the lower regions of the brain.
4. Bowlby, Separation, 12.
5. Kerr and Bowen, 165.
6. Greenspan, The Growth of the Mind, 248.
7. Hendrix, Getting the Love You Want, 35.
1. Ginzberg, The Legends of the Jews, 294.
2. Storr, Solitude, 22.
3. Damasio, 255.
1. Storr, 25.
2. Epstein, no.
3. Weil, 7.
1. Kearney, Within the Wall of Denial, 62.
2. The role of natural opiates in infant attachment: “Opiates play a unique role in socioemotional, imprinting, and attachment developmental processes. In face-to-face affective interactions, the emotionally expressive face of the imprinting object, the mother, induces alterations in opioid peptides in the child’s developing brain.” (Schore, 145.)
3. Schore, 438.
4. Hallowell and Ratey, Driven to Distraction, 368.
1. The Globe and Mail, May 27, 1998.
2. Armstrong, The Myth of the A.D.D. Child, 48.
3. Greenspan, The Growth of the Mind, 204.
4. Sherwin Nuland in an article in The New York Times, May 10, 1998.
1. Greenspan, The Challenging Child, 46.