I much prefer the Canadian title, because it gives a more precise sense of what this book is about. It really is about scattered minds, which is how I have always experienced my own, and it's about a new look at what shapes such minds and how to heal them. The U.S. title, while not incorrect, makes it sound too much like another do-it-yourself self-help book, which Scattered most decidedly is not. Scattered combines my own personal experience as an adult with ADD, as the parent of ADD children, and as a physician frequently asked to deal with condition, with the latest findings of neuroscience and brain developmental research, along with the insights of developmental psychology, family systems theory and family therapy, medical science, psychology, and much else. It is not an academic work-witness its success on the Canadian bestsellers lists-but it respects the readers' intelligence and curiosity. It provides of a synthesis of many different disciplines to give what I believe to be the most comprehensive-and most hopeful-view of this much-misunderstood condition.

Readers are welcome to download several chapters from Scattered to gain a flavor of how this book is written and what approach it takes. What follows on this page is a summary of the book's thesis as to what causes ADD, and the rationale for the treatment approach I favor. In my approach medications may play a role, but not a major one. The most important thing is to create the right conditions, for both adults and children, because under the right circumstances brain development can take place at any time in life. So the goal is not simply symptom control, or behavior control. The long term goal is development-when people develop properly their symptoms automatically abate and their behavior naturally corrects itself.

The astonishing findings of modern neurological research make it impossible that a complex condition of the brain such as attention deficit disorder could be a simple matter of biological heredity. For the true causes of ADD we have to look at the social and psychological conditions that shape the brains of children in late twentieth century-and early twenty first century-Western societies.

We now know that the anatomy of the brain-the shape and configuration of the myriads of circuits that make up the brain's apparatus-is not set by heredity alone, but by also the environment. Environment, too, helps to determine the chemistry of the brain.

Unlike with other mammals, most of human brain development occurs outside the safety of the uterus, in the first years of life, when highly vulnerable to circumstances. Nerve cells and neurological circuits compete for survival in a process that has been called "neural Darwinism": those receiving the necessary stimulation are strengthened and become wired in, those that do not fail to develop and may even die. A child kept in a dark room for the first five years, for example, will never develop visual circuits and will be irretrievably blind.

In attention deficit disorder the chief physiological problem appears to be located in the frontal lobe of the brain, in the area of the cortex (or gray matter) where attention is allocated and emotions and impulses are regulated. Just as the visual circuits need the stimulation of light, the circuits of attention and emotion control also need the appropriate input: a calm, non-stressed connection with a non-stressed and non-distracted primary maternal caregiver. Stresses on the mothering adult-or disruption of contact with her, as in adoption-predispose children to ADD because they directly affect the developing electrical circuits of the infant's brain. The very chemistry of the infant's brain is affected.

Infant monkeys separated from their mothers for only a few days had in their frontal lobes diminished quantities of dopamine, a chemical messenger important for attention and motivation. (Dopamine is the chemical we are trying to supplement when we prescribe a stimulant such as Ritalin.)

Although there is in ADD an inherited predisposition, a heightened sensitivity, the condition itself is rooted in social factors that have placed nearly intolerable burdens on the parenting environment. It is not bad or unloving parenting that is the problem, but stressed parenting. The erosion of community, the breakdown of the extended family, the pressures on marriage relationships, the harried lives of nuclear families still intact and the growing sense of insecurity even in the midst of relative wealth have all combined to create an emotional milieu in which calm, attuned parenting is becoming alarmingly difficult. The human brain being a social product, so is attention deficit disorder.

Fortunately, brain research also tells us that, unlike with vision, the attentional and emotional circuits of the cortex can still develop new connections later in life, even in adulthood. This development, more than just behavioral control through medications or various parenting techniques, ought to be the long term goal of healing in ADD.

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