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©2017 By Cathi Zillmann, CPNP, PMHNP & Timothy P. Aiello, PMHNP-BC

History of ADHD

Here is a History of ADHD, written in 2001 by Valerie de Armas. Valerie is not a medical person, but this is well written and accurate to the best of my knowledge.

 

Being a biological or biochemical disorder, I don’t know that I can answer where ADHD came from. It’s likely it’s been around as long as time itself. Careful observation of Jesus’ disciple, Peter, shows quite a bit of impulsive behavior. In fact, Peter could be the first written account of impulsive behavior. I don’t know.

In more recent history, ADHD symptoms were recorded in the mid 1800s in children with nervous system injuries and diseases. In 1848, a German physician wrote a children’s’ story, “Fidgety Phil”, describing hyperactive behavior.

British pediatrician, George Frederic Still was probably the first to do any comprehensive observations of ADHD children. He reported his observations in a series of lectures at the Royal College of Physicians in 1902. He described the children he observed as aggressive, defiant, lawless, overactive, attention impaired, dishonest and accident-prone. He also described them as having a “defect in moral control”. He didn’t paint a very pretty picture of the disorder for sure! His observations went on to note that the behavior was biological rather than a result of poor parenting. He theorized that the behavior was either inherited or the result of an injury at birth.

After an encephalitis epidemic in 1917-18, doctors noted that many children showed the symptoms that Still described. Doctors speculated that the behaviors were a result of brain damage. Children who displayed symptoms were labeled as brain damaged. Even if they did not suffer from encephalitis, they were give the “brain damaged” label. Later, when doctors realized that many of these children were too bright to have suffered brain damage, the disorder was labeled “minimal brain damage” and even later, “minimal brain dysfunction”.

As far back as 1937, doctors discovered that amphetamines were helpful in reducing hyperactive and impulsive behavior. Even with this knowledge, stimulant medications were not used much for treatment until the 1950s and 60s when there was an increase in psychiatric drug intervention. By the mid 1960s, stimulants were a common treatment.

In the early 1960s, Stella Chase and other researchers described “Hyperactive Child Syndrome”. Chase felt that the syndrome had a biological cause. Many others at the time believed the cause to be environmental. Many times poor parenting, food additive and environmental toxins have been blamed for a child’s ADHD behavior. Some of these environmental theories still persist, but with recent brain chemical studies, environmental theories are getting harder to buy into. There is simply too much research showing that the cause lies in the biochemical processes — in the neurotransmitters in the brain, and that it has a genetic factor.

Other researchers were also convinced of the biological nature of the disorder. The environmental theories have now been proven untrue with the current research showing a biochemical cause, but there are still those who believe that diet, allergies and the like have an influence on the behavior of the ADHD child.

 

In 1965, The American Psychiatric Association (APA) established a diagnostic category for “Hyperkinetic Reaction of Childhood”. This category was certainly a step in the right direction, but it ignored those who experienced attention problems with no hyperactivity.

Literally thousands of studies followed on hyperactivity. Researchers started to believe the presence of a neurological component to ADD. Virginia Douglas, a Canadian psychologist, discovered four major characteristics of ADD or ADHD as we now call it:

  1. Deficits in attention and effort.

  2. Impulsivity.

  3. Problems in regulating arousal levels.

  4. A need for immediate reinforcement.

 

In large part due to Douglas’ work, the ADA established a new diagnostic category, Attention Deficit Disorder, With or Without Hyperactivity. In 1987, the ADA further revised the name to Attention Deficit Hyperactivity Disorder. Then, in 1994, the ADA defined three subtypes:

  1. Attention Deficit/Hyperactivity Disorder Predominantly Inattentive.

  2. Attention Deficit/Hyperactivity Disorder Predominantly Hyperactive.

  3. Attention Deficit/Hyperactivity Disorder Combined Type

 

It is also significant to note that until the 1980s, it was thought that ADHD symptoms were only present in childhood. Although adults with ADHD may not have the same symptoms as children do, such as hyperactivity, ADHD can have a profound affect on an adults life. More frequently, adults have difficulties in the areas of attention and impulse control symptoms, which can be profound.

 

As research continues on the causes of ADHD, it's symptoms and it's treatments, we will continue to discover more about the biochemical causes, and the neurotransmitters in the brain that play a significant role in ADHD entomology. We may also find a genetic component of ADHD or other critically important pieces of information that will lead to great leaps in understanding and treatment methods used to treat ADHD.

 

Who knows...one day, ADHD may again be re-named upon discovery of a fact that is undeniable in it's relationship with the illness, and necessitate a change in our current view of what ADHD REALLY IS. 

 

For example, I tend to believe that ADHD is a title that reflect an inherent deficit motivation to be attentive. But, it's more like a an attention surplus than decreased interest. Those with ADHD have a problem with selective attention. In my personal experiences, my patient's have AN ABUNDANCE OF ATTENTION; They just aren't so great at paying attention to what they are told to!! Ask a patient with ADHD to sit down and do something that they enjoy, and you will quickly see a person who possesses an abundance of potential to maintain focused attention...