Hello to all my ADHD peeps and ADHD loved ones currently living with ADHD today I am going to talk about the history of ADHD which may not seem like something that can help us, but I believe knowing our history can help us understand that ADHD is something that has been around and something people have struggled with for quite some time. It is also nice to see that progress has been made and we are continuously learning more and more about ADHD.
Today I want to talk about what ADHD actually is. When I grew up I was always told that the kid that was bouncing off of the walls was a kid that had ADHD. (Yes that kid was myself) And the kid that just couldn’t pay attention no matter what was going on was the kid with ADD. As with all things, things have changed and adapted over time. This post is going to discuss a little bit of the history of this diagnosis and what the current diagnosis is.
The discovery of an ADHD-like disorder started all the way back in 1798 by a Scottish physician by the name Sir Alexander Crichton. This physician was unique because mental health issues were often overlooked during this period. Crichton defines inattention as “The incapacity of attending with a necessary degree of constancy to any one object.” Pretty straight forward, and I think everyone today would still agree this is a spot on definition. Crichton did a wonderful job, but did miss one point, he believed as all of these kids became older they grew out of the inattentive symptoms. This belief was held for almost 200 years until the 1990’s. The current research shows that about 50% of people diagnosed with ADHD will retain symptoms into adulthood.
We skip forward to 1902 and scientific research on ADHD starts to begin. A British pediatrician born in London by the name Sir George Frederic Still started his research into childhood diseases and wrote full length textbooks on his findings. In the Goulstonian Lectures by Still he discusses a finding of certain children having issues with morals. He defines moral control as, “the control of action in conformity with the idea of the good of all.” Still designs an experiment with two groups one group with physical diseases such as tumors or head injuries. The other group is composed of children without physical impairment or without intellect impairment. Let me explain the reasoning behind this if it isn’t fully clear. He separated these two groups to compare them. At this time people believed that the only people that were having problems following societal rules were either fully mentally disabled or had a physical ailment that was causing these individuals to have problems following these societal norms. So Still went out of the current scientific bounds and believed that he had found a group that was having problems with impulsive decision making that did not fall into either of these groups. Still determined that children without intellectual or physical impairments were able to lack moral control and this helped people understand this disorder. Still ends up mentioning that the kids that he is observing exhibit an “abnormal incapacity for sustained attention.”
So when did stimulants become a treatment for a hyperactive disorder? A man named Charles Bradley working in East Providence, Rhode Island was working as a medical director in 1937. He was working in a hospital that was founded to treat children that had neurological impairments. Some of the kids in this hospital had emotional problems and extreme difficulty learning and controlling their behavior. These children today would have a good chance of being diagnosed with ADHD. As with all good scientific discoveries Mr. Bradley accidentally stumbled across a treatment for these individuals. Bradley was performing pneumoencephalograms in order to look at structural brain abnormalities. These would in turn cause extremely bad headaches. Bradley attempted to treat these headaches with Benzedrine which at the time was the most potent stimulant. This drug didn’t help the headaches but they ended up causing improvements in school performance and behavioral issues in some of the children. This led to Bradley starting a trial of 30 children in the hospital. Bradley, like people today, was surprised with these results Bradley states, “It appears paradoxical that a drug known to be a stimulant should produce subdued behavior in half of the children.” During the study Bradley determined that the children who benefited from the Benzedrine treatment were the children that had ADHD like symptoms.
So it looks like everything is fixed, this is going to revolutionize ADHD treatment right……… wrong. No influence on modern treatment for 25 years. You may ask why that is. We figured out how to fix something yet it doesn’t make an impact for two and a half decades. Well, during this time the Freudian Revolution is occurring. Modern day psychoanalysis is developing. We always hear about the good that psychoanalysis has created, but we don’t hear about the bad aspects from it, and this is one of those examples. If you don’t know Freud, he is the father of Western Psychology and the guy had some serious issues with his parents. If you don’t believe me look into his Oedipus complex theory… All jokes aside Freud did a lot of good and ended up helping a lot of people, but the current mental health revolution was talking and not connecting a biological basis for mental health issues.
In 1944 Leandro Panizzon creates methylphenidate better known as “Ritalin.” It starts getting mass produced in 1954 by the Geigy Pharmaceutical Company. This drug was initially used for multiple ailments including depression, narcolepsy, depressive states, and of course our all time favorite, ADHD. The most impressive results came from people that had symptoms of ADHD. This drug is still used today and is still one of the front-line drugs for chemical treatment.
By 1966 doctors had to separate symptoms that were caused by brain injury and symptoms that were caused by minimal brain dysfunction due to neurological factors. This is where we get our main three symtpoms of ADHD and they are separated and unique from other disorders. The main three are inattention, impulsivity, and hyperactivity. This created a new grouping which separated these children from children with brain damage, and their peers that were not experiencing issues with intelligence due to the three main symptoms I just discussed.
In the 1970’s researchers are still trying to figure out why some of these kids are hyper and why some of the kids are not hyper. They seem to be suffering from the same symptoms, the biggest difference is one group doesn’t exhibit the hyperactivity of the other group. The group with hyperactivity are also showing a better response in alleviating symptoms with the stimulant medication that is currently being used. In the 1970’s Virginia Douglas writes a paper to the Canadian Psychological Association in this paper Mrs. Douglas states that the issues with attention and impulse control were more significant than the hyperactivity. This paper was extremely influential to the point that it caused a change in the label of ADHD. We end up with the first appearance of ADD with or without hyperactivity. The Diagnostic Manual III for mental health disorders states that hyperactivity is no longer essential criteria to diagnose the disorder.
This splitting and changing of the name, like with all things, caused confusion. The Diagnostic Manual changed so quickly that practitioners were confused on if this was two different disorders or just one. So by 1987 the Diagnostic Manual gets rid of these two subtypes of ADD and goes back to ADHD. ADHD at this time has a subtype of disorder called undifferentiated ADD. This is ADHD without the hyperactivity. These two diagnoses continued to be separated from one another and researchers found that children with hyperactivity tended to be more aggressive and had a more difficult time making friends, whereas the children without hyperactivity had more issues in academics and were more lethargic.
So what do we know now? After 220 years of seeing, treating, and experiencing ADHD we must have some pretty good knowledge of it. Of course we do, and the current standards are laid out, in my opinion, very clearly. We no longer use ADD, but a new subtype describes the symptoms that were seen in ADD. I will discuss these types from least common to most common forms of ADHD. First, we have ADHD impulsive/hyperactive type. This type is characterized by impulsive and the hyperactive behaviors. These individuals will not have inattention and distractibility like their counterparts. The next type is ADHD inattentive and distractible type. Like this type sounds these are the individuals that are going to have issues with maintaining attention and will be distracted more easily. They will not exhibit the hyperactivity of the other two types. This is the group that was considered ADD non-hyperactive. The last group is what I have, which is the most common group, but never assume everyone falls into this group. This last group is the ADHD combined type and like it sounds these individuals are going to have the impulsive and hyperactive symptoms along with the inattention and easy distractibility.
To finish this off I want to discuss some of the stats that researchers have discovered over time. Between 4-12% of children have ADHD. Boys are 2-3 times more likely to have ADHD combined or hyperactive than girls. This may be due to masking, but only research will tell us this over time. If you are not sure what masking means, it is when someone is concealing their emotions by portraying another emotion. Girls are more likely to do this, and they typically conceal negative emotions like sadness or anger and display a more positive emotion.
I hope that this post explains some of the history of ADHD and how we have gotten to where we are at now.
I did end up using some sources and I want to make sure to credit these websites because they were extremely helpful in the research that I did in order to make this post.
Thank you for reading and I hope that everyone learned something.
Until next time this is Living With ADHD I hope you all have a wonderful day.