Q: Biofeedback

My 5 1/2 yr old daughter has ADHD, ODD, developmental delays (speech, fine and gross motor skills) and nonverbal learning disorders. She has not responded well to stimulants and now seems to be doing better on imiprimine which she has been taking for approximately 2 weeks. My question is how you feel about the controversial neuro- or biofeedback? My daughter's OT suggested it b/c she had done research on it, however, there are obviously others who do not advise it. I don't mind spending my money on something that could be helpful, but on the other hand, I don't want to waste money on something that would be worthless. Thank you for any advise you could give me in this regard.

A: 1. I believe there is reasonable evidence that biofeedbeck can be of benefit, in the context of an overall treatment approach. I wonder, however, how useful it can be in a 5-year-old who may simply lack the understanding and motivation to stick with it. I don't know where you are located, but where I work in Vancouver, British Columbia, there is an internationally-recognized expert in biofeedback, Dr. Paul Swingle, who would, I am sure, be able to answer your question more accurately. His phone number is (604) 608-0444. Dr. Swingle may also be able to tell you who in your area is certified to do biofeedback, or where that infomation may be available.

2. I don't know whether or not you have read my book, Scattered (or, in Canada, Scattered Minds.) If so, the following will be redundant to you, but if not:

I don't see ADD as a disease, but as a lack of optimal development. So the long term question is not simply how to help the child with attention, or moodiness, or how to deal with oppositional behaviors: it's how to help her develop. As development happens, dysfunctional behaviors naturally abate and learning takes place. So I would very much recommend you look at the book, nowhere else will find this approach articulated. Particularly, you may wish to download (at no charge) two of the important chapters on how to understand the child: Chapter 19, on myths regarding the ADD child, and Chapter 20, on the real meaning of oppositionality.

And that's what I mean by "an overall treatment approach." Medications may help, biofeedback may also, but it all has to be based an a deep understanding of what makes these children tick, and what conditons they require for healthy development.

Q: Why Are You Against "Time Outs?"

In many books about ADD they advise that when your child misbehaves, you provide some consequence, including "time outs." In Scattered you say that you feel this is damaging. Our psychiatrist has also advised us to use "time outs." Can you explain why you are so against that technique?


A: ADD children are all, without exception, highly sensitive by temperament. They are particularly sensitized to the feeling of rejection. What they need in order to heal is the feeling that they are absolutely loved and accepted, without any conditions whatsoever. And unconditional acceptance means that how a child behaves must not be allowed to threaten our love for them, that nothing must undermine the child's feeling that they are fully loved, that their relationship with us is solid no matter what they do.

What the "time out" technique does is to use the parent's relationship with the child against the child. It's not what the parent intends, but the message delivered is that "if you displease me, I am going to cut off the relationship with you. I don't want you around unless you behave in ways that I expect from you. If you don't meet my expectations, you are gone." Now, this will work with children young enough to be scared by the message. It will get compliance from them, but at the price of undermining their sense of security and therefore completely interfering with their emotional development.

Again, the real question is not how do we control this or that behavior, but how do we promote long-term development. The basis of emotional/psychological development is absolute security. So achieving behavior control by such means (even if it works in the short term) will only sabotage the child's emotional growth, and make him/her more anxious, distracted, and hyper in the long term. Furthermore, any benefit is short lived. Eventually the child will emotionally detach from the parent, adopt an "I don't care" attitude-and even the temporary "value" of the time out technique is at an end. In the meanwhile, the child will have built up a lot of unconscious rage at what he/she senses is abandonment by the parent.

In summary, it's not the parent's intention that is wrong here. But we have to understand that what parents intend and what the child experiences are two different things. It's the child's experience of a given technique, not our own intentions that we have to consider. And the child's experience of "time out"-even if there is temporary improvement in behavior-is entirely negative. Compliance does not necessarily mean that we have really taught the child what we wanted: it may mean only that we have managed to intimidate him. As I try to show in many chapters of Scattered, there are much more loving and humane and much more effective ways of helping our children.

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Q: A Spouse's Question

I enjoyed the book, Scattered because it correctly and clearly described my husband who has been diagnosed with ADD and depression. What the book did not address was how to survive in a marriage with a spouse who is always
late, resistant, cannot make long term plans, consistently uses poor judgment, is unreliable, is so overwhelmed by life that he has nothing left to give to me. After 15 years of marriage, I am about done. I have given him all I have to give. We have tried marriage counseling. He is on medications. Nothing is working.

A: I am not sure I have an answer. Unfortunately, not every situation can be improved, not every relationship will survive--not because there are no solutions possible, but because perhaps the will to do the hard work may not be there. My guess is that in your marriage you have done most of the emotional work and that probably, in many ways, you may have tried to "parent" your husband. Now you are fatigued and burnt out, and who wouldn't be. The question is whether your husband has fully taken responsibility for his problems, and whether he is up to taking some initiative to deal with them--not because he feels pushed to do so by you, but because that is what he wants. If not, the marriage is in
serious trouble--not that it isn't already.

The only advice I can give you is to take care of your own needs, if you are not already doing so. Become "selfish". Stop doing more than your share. Create some space for yourself to do what you want to do. Don't push your husband to do anything for which the motivation doesn't arise from him--it won't work anyway, as I would imagine you've already
experienced. Then you will just have to see what happens. If you need therapy just for yourself to be able to move in that direction, by all means seek it out, if that is possible for you.

Of course, if there are children involved the matter becomes immensely complicated. But the same principles apply. Whatever is best for you will be best for the children.

And you are quite right. I wish I had included a chapter just on this subject--what should spouses do--because it is an important and nearly universal problem when dealing with ADD.

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Q: Did "Terrible Events" Cause My Child's ADD?

I am confused that your book suggests that ADD is caused by "terrible events" that may have happened in one's childhood. We have a very loving family, and we help our ADD daughter as much as possible. We had to
read books and search for answers, and then ask the doctor to test for ADD. The doctors never considered ADD, and didn't even know much about it. She has so many of the same characteristics that exist in her grandparents' family; I can clearly see she has inherited those characteristics.

A: Thanks for writing. I wonder where the phrase "terrible events" came from, since it is nowhere mentioned in the book as a general cause of ADD. (I do mention "terrible realities" only in the specific context of my infancy in
Hungary during the Nazi occupation.) I do wonder, therefore, whether you have read the book or are responding to a misinterpretation in a review somewhere.

My own children also have ADD, as do I, and we also have a loving family: my wife and I are about to celebrate our 30th anniversary. There were no "terrible events" in our children's lives. However, I do believe there are emotional stresses in parents' lives that do affect children's brain development: that's not my idea, simply a conclusion arrived at by most current brain research. In our case, it had to do with my own ADD-driven workaholism and difficulties being in the present, calm, and relaxed, and with stresses in our marriage that were significant despite our commitment to each other and to the children. This is all described in the book, and it's rather typical for many ADD families, not just by my observations but also according to the research evidence.

I also show that brain development can take place later on in life, if we create the appropriate circumstances for it. That really is the brunt of what I have to say: how do we create the conditions for emotional/psychological/neurophysiological development to occur. The goal is to help children-and even adults-grow out of ADD, not just to control symptoms and behaviors.

Furthermore, I agree there is an important genetic component, although I do not believe it is decisive. Genes may predispose, but they do not predetermine: there is a huge difference. However, just because something runs in families does not make it genetic: it is a common mistake to think that it does. Obviously a condition that recurs from one generation to the next in a family could be genetic, but similar circumstances could be recreated from one generation to the next that could give rise to the same problems in each generation. Usually, it's a combination of genes and environment. If in my book I emphasize environment, it is for two reasons: one, it's a decisively important factor virtually ignored by most other writers and experts and is rarely addressed in the treatment of ADD; two, it's the factor we can actually work with, change, do something about. After all, we are stuck with whatever genes we've got.

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Q: Why Does One Child Differ From Another?

Thank you for writing Scattered Minds. I've found it tremendously helpful with my parenting, and it has already made a big difference. I was forced to take another look at myself, which is difficult to do, but necessary as you say in the book.

What I still don't understand, however, is why the middle son, born just 15 months after the first challenging ADD son, should have been (and still is), so easy-going and placid, and free of ADD symptoms altogether. He was a welcome relief, but theoretically should have been under more stress than the first, as well as the third, born 4 1/2 years later. Just lucky genetics, which overpowered environmental factors, or an aberration?

A: You are asking why, if the environment is as decisive as I say it is, your children have turned out so differently. After all, you have tried to give them the same loving parenting and, as you point it, there were plenty of stresses when your second and third children were born, too. Yet only the first one has ADD.

First, there is a genetic component: ADD children tend to be more sensitive by temperament, and are often physically so as well, with allergies, frequent ear infections, etc. Being sensitive means that the same factors in the environment will have a greater impact than on people who are less affected by whatever is going on. Second, no two children have the same parenting. For example, birth order can be a major influence: we tend to be more anxious around our first born children, and we also tend to be harder on them in terms of our expectations and responses. Also, what emotions the child triggers in us emotionally will be different in each case, depending on our own states of mind and on the temperamental characteristics of the child. These are subtle points and have nothing to do with how much we love the child or what our best intentions are, but they can be very important factors in terms of how the child experiences our parenting. Finally, what the stress levels of the parents are during the infant's crucial months of brain development can vary a lot: the marriage relationship may be less or more stable from one time to the next, or economic concerns may vary, or general family circumstances, etc. etc. So these variables all affect the formative environment of each child. And, again, the child's inborn temperament is also a major factor.

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