“Never existed in my day!” A short history of ADHD.

How many times have you heard the phrase, “It never existed in my day!” As our elders look back through rose-tinted spectacles to simpler times. That phrase could be attributed to anything, but it is something that I hear or read all the time with regards to ADHD.

When researching this blog post, I came across the following statement from a young teacher amidst a discussion about ADHD, which turned into more of a debate on its existence;

“When I was young I was in a class of 25 and no one misbehaved like they do. It’s a lot of nonsense this ADHD. I grew up in a small town, so I would know.” (Anon, 2017)

Reading through the thread I pondered my own school experience- not one of my classmates knew that I had ADHD and similarly I did not know that information about any of them, who shared their medical history with classmates at primary school?

Discussing the topic of classroom behaviour with my 88 year-old grandmother, she remembers children who,

“got the strap all the time, they daren’t tell their mothers about it of course, but when I think back on it, why did no one ask why that child got the strap every day? We all feared the strap, but did no one stop to ask why those children who got it every day couldn’t help themselves?” (My gran, 2017)

The idyll of a classroom where children all sat nicely, doing what they were supposed to be doing and listening to the teacher is not one that I remember from either of my primary schools in the 1980s and it is not something I recognise in any classes that I have taught in more than a decade. I think it is fair to say that we didn’t know everything about the children that we went to school with and this sort of reminiscing, where we claim the past was wonderful, is both unhelpful and naive.

If you are reading this blog, you may have ADHD or you may be an educator interested in learning more about the condition, regardless of your background you will probably be familiar with some of the discussion and debate surrounding the existence of ADHD and the various things attributed to causing it- that is the subject for a later blog, “Causes of ADHD, Myths vs Facts.”

ADHD has a long history in medicine, spanning more than two centuries, and is far from some kind of new-fangled excuse for unruly behaviour invented by big pharma to dish out pills or a convenient label for lazy parents as an excuse to get away with not parenting. ADHD is a neurodevelopmental condition that is recognised in science, medicine and psychology, it transcends race and class divides and is VERY real for those of us who have it. Like all neurodevelopmental conditions, our understanding of ADHD has simply evolved over time and with increased awareness, understanding and research we will know much more about it in the future.

So, today’s blog post is dedicated to that history, I hope you find it as interesting as I did researching it.

A Short History of ADHD

While stories of undisciplined and restless children (and adults) are as old as time, (ADHD in literary characters is the subject of another blog post this month), we can trace reports of fidgety and restless children in a medical context back over 200 years. ADHD has been called different things in its history including, ‘Minimum Brain Dysfunction,’ ‘Hyperkinetic Impulse Disorder’ and the more familiar, ‘Attention Deficit Disorder.’

  • In 1798 Alexander Crichton writes in, “An Inquiry Into The Nature and Origin of Mental Derangement,” of a mental state similar to what we now describe as the predominantly inattentive type of ADHD.

 

  • Around 1844 German doctor Heinrich Hoffmann publishes his children’s book “Struwwelpeter” which was a gift for his son and included the story of “Fidgety Phil.” Hoffmann was the founder of an innovative mental hospital in Frankfurt and was known for using illustrations with his youngest patients and trying to improve public perception of mental illness. Researchers have even matched his stories line by line against ADHD DSM criteria to prove the link.

 

  • A notable Scottish psychiatrist Thomas Smith Clouston describes states of, ‘over-excitability and mental explosiveness in children,’ in 1899.

 

  • This is followed in 1902 by Sir George Still who described, “an abnormal defect of moral control in children,” and spoke of children who could not control their behaviour in comparison to their peers- but were still intelligent.

 

  • Still’s observations were extended in 1908 by Alfred Tredgold in his publication, ‘Mental Deficiency.’

 

  • Kramer and Pollnow write an article referencing the condition in 1932 titled “Über eine hyperkinetische Erkrankung im Kindesalter.” Which google translate tells me is, “About a hyperkinetic disease in childhood” in English.

 

  • Also in 1932, Smith, Kline and French introduce an inhaler under the trade name “Benzedrine”. Benzedrine is of course, the first drug licensed that contained amphetamine.

 

  • In 1937, Dr. Charles Bradley happened across some unexpected side effects of Benzedrine on the behaviour and performance of some of his young patients in school and writes of them in, “The behaviour of children receiving Benzedrine.” Bradley discovered the connection accidently when giving the children Benzedrine to help improve headaches caused by spinal taps and while it did not help the headaches, the teachers reported great improvements in academic performance and behaviour. The children also called the Benzedrine tablets “math pills.”

 

  • And in the same year Molitch and Sullivan report on the beneficial effects of Benzedrine on children taking the “New Stanford Achievement Test.” A form of standardised assessment still used across the United States and now in its 80th year.

 

  • In the late 1930s and 1940s Dub and Lurie describe the effect of Benzedrine on 48 depressed female patients and a several studies following up the work on Benzedrine already referenced show its beneficial effects.

 

  • Then in 1944, while working for the Swiss pharmaceutical company CIBA, Leandro Pannizon synthesizes methylphenidate.

 

  • CIBA then patents methylphenidate in 1954 and introduces it in Germany and Switzerland under the brand name “Ritaline”. A drug still commonly prescribed in treatment of ADHD today.

 

  • Laufer and Denhoff write about “Hyperkinetic Behavior Syndrome in Children” in 1957, describing the disorder as “Hyperkinetic Impulse Disorder.”

 

  • In 1963, Conners and Eisenberg report on the effects of methylphenidate in disturbed children.

 

  • Whilst the first, “Diagnostic and Statistical Manual of Mental Disorders” (DSM) listing all recognised mental disorders, causes, risk factors, and treatments for each condition was published in 1952, it was in the second edition, published in 1968, that Hyperkinetic Impulse Disorder was mentioned for the first time. As a matter of interest Doctors still use this manual to this day.

 

  • Virginia Douglas investigates specific disabilities of hyperactive children in 1970, suggesting that a core group of symptoms including the inability to sustain attention and to control impulsivity account for most of the deficits in hyperactive children.

 

  • The third edition of the DSM is released in 1980 where they change the name of Hyperkinetic Impulse Disorder to Attention Deficit Disorder (ADD). At this time, Scientists believed hyperactivity was not a common symptom of the disorder thus creating two subtypes of ADD: ADD with hyperactivity, and ADD without hyperactivity.

 

  • A revised version of the third DSM was published in 1987 where they removed the hyperactivity distinction and changed the name to Attention Deficit Hyperactivity Disorder (ADHD). The three symptoms, inattentiveness, impulsivity, and hyperactivity were combined into a single type and did not identify subtypes of the disorder.

 

  • The fourth edition of the DSM was publishedin 2000 and established the three subtypes used today: combined type ADHD, predominantly inattentive type ADHD and predominantly hyperactive-impulsive type ADHD.

 

ADHD has a long history and there are thousands of clinical and scientific publications on the condition. As research advances the early considerations of moral and nervous system defects have been refined and diagnostic criteria are still being refined with some recent research looking at eye movement.

I think it’s fair to say though, that the next time someone tells you that ADHD didn’t exist in their day… send them the link to this blog.

 

Laura

Sources

ADHD World Federation (Unknown) ‘A Short History of ADHD’ [online at] http://www.adhd-federation.org/adhd-world-federation/short-history-on-adhd/ Accessed 27th September 2017

Bilmoria, P (2012) “3 Interesting Characters in ADHD History” [online at] https://eibalance.com/2012/04/27/3-interesting-characters-in-adhd-history/ Accessed 27th September 2017

Carr-Fanning, K and McGuckin, (2012) ‘A Brief History of ADHD’ {online at] http://www.adhdeurope.eu/common-issue-texts/history/1246-a-brief-history-of-adhd.html Accessed 29th September 2017

Healthline (Unknown) ‘The History of ADHD: A Timeline’ [online at] https://www.healthline.com/health/adhd/history#overview1 Accessed 27th September 2017