Research into this was prompted by the utterances of one Gabor Maté – a former Canadian Physician of world fame. This article will spend some time initially debunking Gabor Maté’s statements on ADHD. Gabor Maté is welcomed to sue me, at any time of the day or night! I would relish days in court and watching him invite shame upon himself. I am not afraid of Gabor Maté. This is not the first time he has been ‘attacked’, as this article will be seen to be doing. He stated in an interview at around 01:18:
“..I was diagnosed in my 50s and and two of my children were diagnosed afterwards the medical uh Mantra is that it’s a genetic brain disease. Well it isn’t genetic and it’s not a brain disease um when you look at the uh tuning out the absent-mindedness of ADD. Why do we have that capacity to tune out do you think nature gives us that capacity we all have that capacity to dissociate to tune out why well it’s very simple if I were to um threaten you right now stress you abuse you verbally you would uh the number of options available to you one would be to get up and leave which is called flight or you could stand up and assert yourself and tell me to stop which is called fight and if you couldn’t do either given that how many hundreds of people are here uh there’s about 400 between both rooms okay so got 400 people here you could ask for help those those would be the functional options but what if if you couldn’t escape because you’re too small and powerless what if you couldn’t fightback for the same reason and what if there’s nobody to ask for help then – what would you do well you wouldn’t do anything your brain would go into an automatic dissociative mode to protect you from the distress so what it is it’s actually it’s an adaptation to to overwhelming stress now if you put me back into my first year of life and there are times in the first year of life when every second like in this space of time and millions millions of connections are being made in the brain what’s happening in my first year of life..“
From his website Gabor Maté Addiction Expert: Contact Info – he states, “Please note that I am no longer in clinical practice or associated with a health clinic and as a result I cannot provide individual care, advice or counselling.” This means that he is no longer accountable to any regulatory body for any damage done. He continues to earn from sales of his several books, some of them still misleading the public via misinformation on this topic.
This article should be read in conjunction with this site’s previous article on ADHD (May 2023).
Table of Contents
- Dispelling myths
- Methodology of this review
- The Genetic Basis of ADHD
- How Brain Structure and Function are Affected by ADHD
- Implications for Diagnosis
- Implications for Treatment
- Synthesis of Research Findings
- CONCLUSIONS
Dispelling myths
It is important to understand the foundations and impetus for this article. Unlike in paper-based journals, I am not limited by ‘space’. Based on my current information, Gabor Maté has not publicly retracted his views on ADHD. He continues to assert that ADHD is primarily caused by trauma and not a genetic condition, despite the overwhelming scientific evidence to the contrary. The evidence is not new. It is concerning because his claims can mislead individuals seeking information about ADHD and may discourage them from pursuing evidence-based treatments. It is important for people with ADHD and their families to have access to accurate information so they can make informed decisions about their care.
While Maté’s perspective on trauma is valuable in many contexts, his stance on ADHD contradicts the scientific consensus and could potentially harm individuals with ADHD by:
- Dismissing the genetic and neurobiological basis of ADHD: This can lead to feelings of shame and self-blame, as individuals may believe they are solely responsible for their condition.
- Delaying or preventing access to effective treatments: If individuals believe ADHD is solely caused by trauma, they may not seek out medication or therapy that could significantly improve their symptoms.
- Creating a false sense of hope: While trauma-informed care can be helpful for some individuals with ADHD, it’s not the most prominent issue for most people who suffer with ADHD. Maté’s claims may give false hope to those who believe they can simply “heal” their ADHD through trauma work alone.
Attention-deficit/hyperactivity disorder (ADHD) is not about ‘tuning out’, mere ‘absent-mindedness’ or dissociative states of mind. Gabor Maté’s assertion that ADHD is not genetic and solely caused by trauma contradicts a large body of scientific evidence. While trauma can certainly have an impact on brain development and contribute to some ADHD-like symptoms, it is not the sole or primary cause of ADHD. I assert that Gabor Maté is wrong. He ought to update his knowledge base and admit that he is wrong. Then he should apologise for misleading the general public and distribute the profits he made from any of his books, other forms of publication, and publicity. When he was registered as a doctor Gabor Maté had a duty to rely on evidence-based research when making statements about ADHD in the public domain. Surprisingly – no one reported him to his regulatory body for very misleading statements over the years.
| Gabor Maté’s Assertions | Rebuttal | Comment |
|---|---|---|
| It isn’t genetic and it’s not a brain disease. | This is demonstrably false. Decades of research, including twin studies, family studies, adoption studies, and genome-wide association studies, have consistently shown a strong genetic component to ADHD . ADHD is indeed a brain-based condition, with observable differences in brain structure and function compared to neurotypical individuals. See lower down in this article for more information. | Maté is irresponsible in his assertion. How? The evidence is lower down in this article. |
| ..when you look at the tuning out the absent-mindedness of ADD why do we have that capacity to tune out? Why do we have that capacity to tune out do you think nature gives us that capacity we all have that capacity to dissociate to tune out… | Maté presents “tuning out” as a conscious, wilful act. In ADHD, this is not the case. An supposed (misunderstood) “tuning out” in ADHD is often an involuntary consequence of difficulties with attention regulation, working memory, and executive function. It is not a deliberate choice to disengage, but rather a result of underlying neurological differences. | Maté is fundamentally flawed in his understanding and knowledge about ADHD. He should know better because he claims that he and two of his children were diagnosed with ADHD. It is his duty as a person and when he was a medical doctor to update his knowledge before thrusting his opinions into the public. |
| …if I were to um threaten you right now stress you abuse you verbally you would uh the number of options available to you one would be to get up and leave which is called flight or you could stand up and assert yourself and tell me to stop which is called fight.. [etc] | While trauma can certainly lead to dissociation and difficulties with attention, Maté conflates a potential symptom with the cause of ADHD. | He suggests that ADHD is simply an adaptation to stress, ignoring the extensive evidence for its neurodevelopmental origins. While trauma can exacerbate ADHD symptoms or mimic them in some cases, it is not the primary cause of the disorder. |
| ..what would you do well you wouldn’t do anything your brain would go into an automatic dissociative mode to protect you from the distress so what it is it’s actually it’s an adaptation to to overwhelming stress now if you put me back into my first year of life..[etc] | Gabor Maté appears to conflate dissociation with the inattentiveness experienced by individuals with ADHD. While both may involve a sense of “tuning out” or mental disengagement, they are distinct phenomena with different underlying mechanisms. | Dissociation is a mental process where a person experiences a disconnection from their thoughts, feelings, memories, or sense of self . It often occurs as a response to trauma, stress, or overwhelming emotions. – Dissociation can manifest in various ways, including: – Feeling detached from oneself or one’s surroundings – Memory problems or gaps in recall Emotional numbness or detachment – Altered sense of identity Inattentiveness in ADHD, on the other hand, stems from neurodevelopmental differences that affect attention regulation, working memory, and executive function. It is characterized by: – Difficulty sustaining focus Distractibility – Forgetfulness – Disorganisation While some individuals with ADHD may experience dissociation, particularly if they have a history of trauma, it’s important to differentiate between these two experiences. Inattentiveness in ADHD is a core symptom of the disorder, while dissociation is a separate condition that may or may not co-occur with ADHD. |
ADHD is a neurodevelopmental disorder characterised by inattention, hyperactivity, and impulsivity. It affects approximately 5% of children and adolescents worldwide 1. Despite extensive research, physicians still struggle with the diagnosis and treatment of ADHD 2. This article will explore the latest research on the genetic basis of ADHD and how it affects brain structure and function. See this site’s previous article on ADHD (May 2023).
Methodology of this review
The information presented in this article is based on a comprehensive review of recent peer-reviewed research articles and reputable sources. The research process involved the following steps:
- Identifying relevant articles: A search was conducted for peer-reviewed research articles published in the last 5 years that explore the genetic basis of ADHD and investigate how brain structure and function are affected by ADHD.
- Selecting key articles: From the initial pool of articles, a selection was made based on relevance and representativeness of the available research.
- Extracting key findings: Key findings and data were extracted from the selected articles and organised into relevant sections.
- Synthesising information: The extracted information was synthesised to provide a comprehensive overview of the topic.
The Genetic Basis of ADHD
Studies of families, twins, and adopted children show that ADHD tends to run in families 3. Twin studies have shown that ADHD has a heritability of 60–90% 4. This means that genetic factors contribute significantly to the development of ADHD. The relative risk of ADHD in first-degree relatives is between 4.0 and 9.0 5, further highlighting the familial nature of this disorder. While the exact genes involved in ADHD are still being investigated, research has identified several candidate genes that may play a role.
Candidate Genes
While no single gene is solely responsible for ADHD, research suggests that variations in certain genes may increase the risk of developing the disorder. Some of the main candidate genes include:
- Dopamine D4 receptor gene (DRD4): This gene is involved in regulating dopamine, a neurotransmitter that plays a crucial role in attention, motivation, and reward. Studies have shown that variations in this gene may be associated with an increased risk of ADHD.
- Dopamine transporter gene (DAT1): This gene regulates the reuptake of dopamine in the brain. Variations in this gene may affect dopamine levels, potentially contributing to ADHD symptoms.
- Dopamine D5 receptor gene (DRD5): This gene, like DRD4, is involved in dopamine regulation and has also been linked to ADHD in some studies.
- Serotonin transporter gene (5-HTT): This gene regulates serotonin, another neurotransmitter involved in mood, sleep, and impulse control. Variations in this gene have been associated with ADHD.
It’s important to note that the research on these candidate genes has shown some inconsistencies, and the effect of any single gene on ADHD risk is likely to be small. Moreover, ADHD is a complex disorder, and it is likely that many genes, along with environmental factors, interact to contribute to its development. The latter is not surprising because multiple gene are involved in creating risk of other mental disorders such as schizophrenia.
Genome-Wide Association Studies (GWAS)
Genome-wide association studies (GWAS) have identified several genetic loci associated with ADHD 3. These studies involve scanning the entire genome of individuals with and without ADHD to identify genetic variations that are more common in those with the disorder. GWAS have implicated several genetic loci at the genome-wide level of statistical significance 3. These studies have also shown that about a third of ADHD’s heritability is due to a polygenic component comprising many common variants, each having small effects. It is important to note that the identified common genetic variants explain only a small fraction of the heritability of ADHD, suggesting that continued research is needed to uncover the full genetic architecture of ADHD.
Copy Number Variants (CNVs)
Copy number variants (CNVs) are another type of genetic variation that has been linked to ADHD. CNVs are deletions or duplications of DNA segments. Studies have shown that individuals with ADHD are more likely to have CNVs compared to those without the disorder 3.
Genetic Overlap with Other Neurodevelopmental Disorders
Recent genetic discoveries highlight the strong overlap between ADHD, autism spectrum disorder (ASD), and intellectual disability. This suggests shared genetic vulnerabilities across these neurodevelopmental disorders and supports the recent removal of the diagnostic exclusion criteria for ADHD in the presence of ASD in DSM-5.
How Brain Structure and Function are Affected by ADHD
ADHD is associated with structural and functional differences in the brain. These differences may be related to the genetic factors involved in the disorder.
Structural Differences
Studies have shown that individuals with ADHD may have smaller brain volumes compared to those without the disorder. Specifically, reductions in the volume of the prefrontal cortex, basal ganglia, cerebellum, and corpus callosum have been reported 6. These brain regions are involved in attention, executive function, motor control, and coordination. A meta-analysis of 55 MRI studies found that the amygdala and nucleus accumbens were smaller in individuals with ADHD, providing further evidence for specific structural abnormalities in ADHD brains. Additionally, research has shown that brains of children and adolescents with ADHD are 3–4% smaller than those of children who don’t have the disorder.
Structural abnormalities in the brains of ADHD patients have also been reported, such as:
- Low density of gray matter
- Abnormalities in the structure of the white matter
- Reduced cortical thickness in adults, especially of the cortical network responsible for focused attention
Functional Differences
While brain structure refers to the physical characteristics of the brain, brain function refers to how different brain regions work together to perform cognitive tasks. In ADHD, both structure and function are affected.
Functional magnetic resonance imaging (fMRI) studies have shown that individuals with ADHD have altered brain activity in certain regions, particularly in the prefrontal cortex and basal ganglia. These regions are involved in attention, executive function, and impulse control. Studies have found that ADHD is associated with weaker function and structure of prefrontal cortex (PFC) circuits, especially in the right hemisphere. The prefrontal association cortex plays a crucial role in regulating attention, behaviour, and emotion, with the right hemisphere specialised for behavioural inhibition.
Importantly, fMRI studies have revealed that ADHD patients have cognitive-domain dissociated complex multisystem impairments. This highlights the complexity of ADHD and the need for individualised assessment and treatment.
Neurotransmitters
ADHD is also associated with imbalances in neurotransmitter systems, particularly dopamine and norepinephrine. Dopamine is involved in reward processing, motivation, and attention, while norepinephrine plays a role in alertness and arousal. Studies have shown that individuals with ADHD may have lower levels of dopamine and norepinephrine in certain brain regions.
Research suggests that ADHD may disrupt noradrenaline transmission in the brain, potentially affecting information retention and inhibitory control. This provides a specific neurobiological mechanism that can be further explored in research and targeted in treatment.
Implications for Diagnosis
The research on the genetic basis of ADHD and its impact on brain structure and function has several potential implications for the diagnosis of the disorder.
A better understanding of the genetic factors involved in ADHD may lead to the development of more accurate diagnostic tools. Currently, ADHD diagnosis relies on clinical evaluation, which can be subjective. Genetic testing may help to identify individuals at risk for ADHD and improve the accuracy of diagnosis. However, it is important to note that genetic testing alone is not sufficient for diagnosis, and a comprehensive clinical evaluation is still necessary.
Implications for Treatment
Research on brain structure and function in ADHD can inform the development of more targeted treatments. For example, medications that modulate dopamine and norepinephrine levels in the brain are commonly used to treat ADHD. A deeper understanding of the neurobiological mechanisms underlying ADHD may lead to the development of new medications or therapies that are more effective and have fewer side effects.
Non-pharmacological interventions, such as behavioural therapy and cognitive training, can also be beneficial for individuals with ADHD. These interventions can help individuals develop coping strategies and improve their executive function skills.
Synthesis of Research Findings
The research presented in this article highlights the complex interplay between genetics and brain function in ADHD. Key findings include:
- Strong genetic component: ADHD is highly heritable, with twin studies indicating a heritability of 60–90%.
- Candidate genes: Several genes, including those related to dopamine regulation, have been implicated in ADHD.
- Brain structure and function: Individuals with ADHD exhibit structural and functional differences in brain regions associated with attention, executive function, and impulse control.
- Neurotransmitter imbalances: ADHD is linked to imbalances in dopamine and norepinephrine neurotransmitter systems.
These findings have significant implications for the diagnosis and treatment of ADHD. A deeper understanding of the genetic and neurobiological underpinnings of ADHD can lead to more accurate diagnoses, more targeted treatments, and improved outcomes for individuals with this disorder. Continued research in this area is crucial to further unravel the complexities of ADHD and develop more effective interventions.
CONCLUSIONS
While this article focuses on the genetic basis of ADHD, it is important to acknowledge that environmental factors also play a role in the development and expression of the disorder. These factors can include:
- Prenatal exposure to toxins, such as smoking and alcohol
- Low birth weight
- Premature birth
- Brain injury
It is vital to consider both genetic and environmental factors when assessing and treating individuals with ADHD. The latest research provides strong evidence for a genetic basis of ADHD. Studies have identified several candidate genes and genetic variations that may contribute to the disorder. The most reliable evidence to date in aggregate shows that ADHD is associated with structural and functional differences in the brain, particularly in regions involved in attention, executive function, and impulse control. This research has important implications for the diagnosis and treatment of ADHD. Further research is needed to fully understand the complex interplay of genetic and environmental factors that contribute to ADHD.
There is an underlying biological primacy to ADHD. It is genetic and it is a brain disease (and so is schizophrenia which is unrelated). The brain and therefore the mind, is the ultimate ‘victim’ of the genes. As is well known of other mental disorders such as schizophrenia and bipolar disorder, no one gene is accountable.
Nothing in this publication means that psychological, familial and environmental factors have no role in aetiology. And further – nothing said above means that treatment is ‘just with chemicals’. Holistic treatment approaches will engage the biopsychosocial model. See this site’s previous article on ADHD (May 2023).
The Gabor Maté situation is concerning in what it highlights:
- Authority Bias: People tend to trust information from those seen as experts, like doctors. When someone with authority promotes inaccurate views, it lends those views credibility they don’t deserve.
- Echo Chambers: The internet, while a powerful tool for information sharing, can also create echo chambers where misinformation is reinforced. People seeking information about ADHD might stumble upon Maté’s work and, without critical evaluation, accept it as truth.
- Profiting from Misinformation: Maté continues to sell books promoting his unsupported claims about ADHD, potentially profiting from misleading vulnerable individuals seeking answers and help.
- Impact on Individuals with ADHD: This misinformation can be harmful to people with ADHD, leading to self-blame, delayed treatment, and a reliance on ineffective interventions.
There is no robust methodology to quantify the harm caused by misinformation and perpetuated misinformation.
References
1. ADHD and Neurology: How ADHD Affects Your Brain – Healthline, https://www.healthline.com/health/adhd-neurology
2. The known and unknown about attention deficit … – Frontiers, https://www.frontiersin.org/journals/genetics/articles/10.3389/fgene.2024.1405453/full
3. Genetics of attention deficit hyperactivity disorder – PMC – PubMed Central https://pmc.ncbi.nlm.nih.gov/articles/PMC6477889/
4. Discoveries on the Genetics of ADHD in the 21st Century: New Findings and Their Implications – Psychiatry Online, https://psychiatryonline.org/doi/10.1176/appi.ajp.2018.18040383
5. An Overview on the Genetics of ADHD – PMC, https://pmc.ncbi.nlm.nih.gov/articles/PMC2854824/
6. Structural brain alterations and their association with cognitive function and symptoms in Attention-deficit/Hyperactivity Disorder families – PMC, https://pmc.ncbi.nlm.nih.gov/articles/PMC7210582/
7. www.neuromedclinicireland.ie, https://www.neuromedclinicireland.ie/resources-research#:~:text=ADHD%20and%20Brain%20Structure%3A%20A%20Meta%2DAnalysis%20of%2055%20MRI%20Studies&text=It%20found%20that%20certain%20brain,neurobiological%20underpinnings%20of%20the%20disorder.
8. The Science of ADHD – CHADD https://chadd.org/about-adhd/the-science-of-adhd/
9. How does ADHD Affect the Brain? – News-Medical https://www.news-medical.net/health/How-does-ADHD-Affect-the-Brain.aspx
10. Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation – Frontiers https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2018.00100/full
11. The Emerging Neurobiology of Attention Deficit Hyperactivity Disorder: The Key Role of the Prefrontal Association Cortex – PMC – PubMed Central https://pmc.ncbi.nlm.nih.gov/articles/PMC2894421/
12. Inside the ADHD Brain: Structure, Function, and Chemistry – ADDA, https://add.org/adhd-brain/
