ADD and Attunement

After one of the readers of this blog recommended Gabor Mate’s In the Realm of Hungry Ghosts, which had a huge influence on me, I picked up his other book, Scattered. It describes the dynamics of early infant development and Attention Deficit Disorder. As I noted before, I resisted an ADD diagnosis for T for a long time, because it seemed to be the diagnosis du jour and I have a prejudice against medicating kids. While I still hold the belief that psychiatric medication should only be part of a treatment plan, I see now that I was wrong about ADD. Properly explained, it strikes me as a useful lens for helping kids like T and their adoptive parents get creative about addressing and sometimes repairing gaps in their emotional growth.

Besides the science, Mate is a lovely writer. I enjoy passages like this one, about early infancy:

Attunement is necessary for the normal development of the brain pathways and neurochemical apparatus of attention and emotional self-regulation. It is a finely calibrated process requiring that the parent remain herself in a relatively nonstressed, non-anxious, nondepressed state of mind. Its clearest expression is the rapturous mutual gaze infant and mother direct at each other, locked in a private and special emotional realm, from which, at the moment, the rest of the world is as completely excluded as from the womb.

Mate draws a connection between the disruption of the mother/infant bond and Attention Deficit Disorder, which he says might just as well be called Attunement Deficit Disorder. In other words, if the dynamic of attunement goes awry, the prefrontal cortex may not develop normally, resulting in later problems with impulse control and emotional regulation.

When we were taking our foster/adoptive parent training courses, I remember that the teacher said that we must become “attachment experts.” She meant that we needed to find ways to help them create the tight bond with us that is at the root of the parent/child relationship. I hadn’t thought about attunement, and learned only by trial and error the practice of trying to remain calm and receptive in my mind so that T is able to sense that I am available to him. It also took me some time to learn that such bonding is mostly nonverbal, heavily dependent on eye contact and physical proximity. I watched Tim and T play checkers last weekend, and it was obvious that it had a more direct affect on T than any conversation could have.

Mate also writes about the fact that the dance of attunement and attachment is up to the infant, not the parent. The infant engages and, when he becomes overstimulated, withdraws. The parent is the one who needs to match the baby’s rhythm so that he learns that she is able to perceive and respond to his state of mind, and, thus, that he is understood. I found that useful, and true of T in my experience. In the beginning, we learned quickly that we needed to be available, but not assertive, and let him come to us and go away again according to his own needs and tolerance for intimacy.

It has proven to be absolutely true that it’s only when we are nonstressed, relaxed and open-minded that T is able to calm himself. In fact, living with a kid like him can be revelatory, because he senses any stress or unhappiness that we might be trying to bury sometimes before we are even aware of it. He is like the canary in the emotional coal mine. If he tells me I need to calm down, or that I’m getting angry, he’s always right, intuiting a change in my rhythm that I haven’t even noticed yet.

When one of us is displeased with his behavior and shows it, he often becomes very agitated. Last Sunday, during our family visit at the residential treatment house, he and I had a small disagreement and I made an expression of displeasure, which sent him into a tailspin and he spent the next half hour anxiously checking my face and trying to re-regulate. That kind of separation anxiety might seem tragic, but mostly it just strikes me as a sign of where he's at in his emotional development. His anxiety strikes me as a lasting indication of what he learned about life’s harsher realities, and a sign of the vitality of his surviving instinct to connect.

It’s tiring sometimes to interact with such intensity, in somewhat the same way that the constant needs of a young child can be exhausting. It can also lead to somewhat awkward situations in public; some people are taken aback by such a tall child interacting with his obviously non-biological mother with infant intensity. We don't really care though. We are busy bonding and filling that deficit of attunement.