Center of Attention
Newsletter of CHADD of Northern California
Also at: http://www.chaddnorcal.org/newsletter
27 May 2002

CHADD Works to Improve the Lives of People with
Attention-Deficit/Hyperactivity Disorder through Education, Advocacy,
and Support

===== In This Issue =====

About the Newsletter
Calendar of Events
Feature Article: Book Review: "Scattered"
This Week: "Hill Day for Parity" on June 6, 2002
Please Tell Us

===== About the Newsletter =====

The Center of Attention is CHADD of Northern California's bi-weekly
newsletter. The newsletter is designed to keep you up to date with
CHADD of Northern California's activities and updates in the field.
It's a step toward bringing the members closer together.

======== Calendar of Events ==========

Contra Costa - 6/5/2002, Wed. 7-9 pm
Walnut Creek Topical Meeting: Setting Priorities -- Ongoing,
confidential support groups for Adults with ADHD
Kaiser Mental Health, Walnut Creek - Contact: Donna Love: 925-687-4324
============================
Sonoma - 6/5/2002, Wed. 7 - 9 pm
Re-Programming the AD/HD Mind - Mondell Brazell, Psy.D. -- Dr.
Brazell brings years of experience as a school psychologist,
therapist, teacher and lecturer to the subject of coping with life
with AD/HD, learning disabilities, mental illness and trauma. Using
conventional and alternative medicine, neurolinguistic programming,
and even the power of music, this lively and interactive presentation
will send you home with new tools to help yourself and your loved
ones in a loving and compassionate way.
Kaiser Hospital Building, Santa Rosa - Contact: Thora Lares: 707-765-4863
============================
San Francisco - 6/5/2002, Wed. 7:30pm
Women's ADD Support Group -- Please Call Lynn to confirm times and
locations before attending.
CPMC Davies Campus, San Francisco - Contact: Lynn: 415-621-1078
============================
Marin - 6/11/2002, Tues. 7-9pm
Ask the Coach -- Three coaches to describe how coaching helps those with ADHD.
Town Center Corte Madera Community Room, Corte Madera - Contact:
Beverlee: 415-789-9464
============================
Online - 6/12/2002, Wed. 6-8:00 PM PST
Russell Barkley, PhD - Recent Advances in Understanding and Managing ADHD --
CHADD Online Chat, Internet - Contact: Message Line: 510-291-2950
============================
Alameda - 6/12/2002, Wed. 7 - 9 pm
Tri-Valley Parent Support Meeting --
Thomas J. Hart Middle School, Pleasanton - Contact: JoAnn Matone: 925-484-2173
============================
Contra Costa - 6/19/2002, Wed. 7-9 pm
Walnut Creek Adult General Support Meeting -- Ongoing, confidential
support groups for Adults with ADHD
Kaiser Mental Health, Walnut Creek - Contact: Donna Love: 925-687-4324
============================
Santa Clara - 6/19/2002, Wed. Reg: 7pm, Meet 7:30pm
Silicon Valley Adult, Parent and Spouse Support Groups -- Separate
peer-facilitated groups let you share struggles and strategies with
each other. Includes video.
Also: Election for Board of Directors for 2002-2003
Friends Meeting House, Palo Alto - Contact: Silicon Valley Warmline:
650-949-5472
============================
Yolo - 6/20/2002, Thu. Lending Library 7:15 pm; 7:30 pm to 8:30 pm
County Meeting -- Support Group Discussion or Speakers
Davis Branch, Yolo County Library, Davis - Contact: Yolo County
CHADD: 530-750-3929
============================
San Francisco - 6/27/2002, Thu. 7-9pm
Jane Stecher, LCSW will speak. -- She has in the past organized
parenting groups for challenging and oppositional children at UCSF.
CPMC Pacific Campus, San Francisco - Contact: San Francisco Warmline:
415-442-1944

===== Feature Article ======

The following article has been published with kind permission from
Lew Mills, MFT, PhD, a Bay Area psychotherapist working with
Attention Deficit in Adults.

Book Review: "Scattered"

Gabor Maté, MD, 1999

Another book claiming that ADHD is caused by environmental factors?
Sure. And ADHD can be cured in a few weeks with the latest snake-oil
treatment.

Those of us who have been around that loop a few times will be
forgiven for being suspicious of a book that once again seems to
argue against the given wisdom that ADHD is fundamentally a
neurobiological disorder, with a large genetic component.

But Maté's book does not fall simply into either side of the
nature/nurture dichotomy. It does allow that there is a genetically
determined "sensitivity" inherent in ADHD. It also insists that there
are environmental factors which play a large role in how ADHD
eventually plays out in the individual. The value of the book is in
how it elaborates the intricate interplay of "nature" and "nurture"
factors.

To choose just one instance of this argument, Maté describes a
familiar feature of ADHD, which he calls "counterwill." It is
sometimes predictable that if you ask an ADHD person to do something,
they will be vexingly compelled to do the opposite. Their will seems
to run the other way from whatever direction they are being pointed.
This is the basis of the overlap of ADHD with "oppositional-defiant
disorder."

It appears to us that an ADHD person is being "too willful." But in
fact, it reflects an absence of a well integrated self and "will" as
well as an environmental experience of being overrun by someone
else's will.

The elaboration of that argument is more complex, but it assumes that
qualities of the experience of having an ADHD biology can lead to
predictable developmental consequences if certain environmental
factors are present. In the case of counterwill, if the ADHD child's
attention errors are consistently met by controlling behavior from an
adult, the ADHD child will learn to counteract the overriding of
their fragile will by being "strong-willed" in the opposite direction.

The child's goal is not the specific willful behavior that results,
but it is rather the assertion of an independent will. The child may
not even know what they want until they are asked to do one
particular thing. Then it is completely clear to them that they want
to do the opposite. This increases the ADHD child's feeling of
autonomy, (even though it is in reality the most slavish reactivity
to other people). Counterwill is desperately required, in order to
not feel the complete dissolution of their own will.

So this has a clear environmental component, even as it also stems in
part from the difficulty that the ADHD child has in constituting
their own sense of self-direction and self-control. Presumably, if
raised in ideal conditions, ADHD children would not develop
counterwill . Hence, counterwill is not a part of the "biology" of
ADHD. However, given the predictable negative and controlling
reactions of imperfect adults to the frustrations of "cat-herding" an
ADHD child, counterwill is likely to develop in the ADHD child with
some frequency. The overwhelmed adult, by increasingly controlling
the behavior of the ADHD child, unintentionally creates the
oppositional behavior that makes their task so much more difficult.
Biology interacts with a predictable environment to reach an unhappy
but common result.

More broadly, the theme that runs underneath the greater part of the
book is that stress amongst parents (or primary care-givers) is
fundamental to the development of ADHD. This stress leaves the
parents unable to sufficiently pay attention to the emotional needs
of the child, which in turn leads to a disturbed attachment process
that Maté sees as characteristic of ADHD children. Maté asserts that
the genetic predisposition to ADHD is based on an oversensitivity to
these stresses in the parents. Only the combination of stressed,
emotionally unavailable parents and the genetic oversensitivity will
lead to ADHD.

Maté does not argue, as some others might, that ADHD causes the
parenting problems in the first place. He claims that the parenting
problems exacerbate the ADHD issues that the child comes to
physiologically. But it would make sense to extend his argument that
environment and genetics interact continuously. Those of us who have
been there know: not only do parents affect the ADHD child, but the
ADHD child profoundly influences the parent.

Personally, I feel that the "nurture" case is overstated in Maté's
book, even though the general thrust makes sense. The overemphasis on
attachment issues in ADHD neglects that many other independent
disorders include disturbances in attachment. Attachment issues are
probably not the defining characteristic of ADHD.

I also think that Maté underplays the significance of medications in
treatment. Even though he acknowledges the sometimes dramatic
improvements that medication can make, he tends to see the disorder
primarily as psychological. Hence psychological treatments take
precedence over biological ones. The therapeutic effect of
"unconditional positive regard" is considered "first line" treatment,
with medication as an adjunct. In my experience, the medication can
have such a profound effect, that it makes little sense to not try
this first. Of course I also agree that the psychological
consequences of ADHD need to be addressed for substantial improvement
to occur.

Of course, the main danger of describing ADHD psychologically is
that it is interpreted as a problem that should be surmounted purely
psychologically. There are people who will blame themselves forever
for just "not trying hard enough" rather than face a real
physiological difficulty that they can treat physiologically.

Maté does not put it together entirely psychologically, but I remain
nervous about that risk. I do not think that anyone is served well if
we categorically fall back to blaming parents and schools for not
adapting to ADHD children better. We have had to work hard to get
past the "psychologizing" of ADHD as the product of a "too fast
culture" or relaxed parenting standards and so on. The task is not to
throw out the insights of a physiological explanation, but to expand
it by looking at the interplay of the given, genetic nature and the
environmental nurture where it plays out.

======== This Week ==========

Alert: "Hill Day for Parity"

CHADD is participating in the "Hill Day for Parity" on June 6, 2002.
All CHADD members and their families are encouraged to come to
Washington and be part of this exciting event to support the Mental
Health Equitable Treatment Act (MHETA) S. 543 and H.R. 4066. As of
today (5/17) there are 177 Co-Sponsors of the House bill and 66 of
the Senate bill. If you have a CHADD shirt, wear it and bring your
children.

If you can not come to Washington on Thursday, take a few moments on
Thursday to go to our Legislative Action Center and send an e-mail to
your Representative and Senators. (put in URL here.)

Share information about upcoming events, organizing rides, places to
stay, roommates by going to the Members Site and going to the
discussion board.

===== Please Tell Us! =====

We thank members for their responses to the Newsletter. Any comments,
suggestions, or criticisms will be greatly appreciated. Please
continue to help us make this newsletter more beneficial to you all.

We also invite readers to share their experiences with us and other
members. Please feel free to write to us about anything that you
would like to see published.

You can e-mail your comments to us at CHADD_Dimples@....
Simply replying to this e-mail will also send your message to the
right place.