The condition has had numerous names over time as more was learnt about it, and yet ADHD is still not an accurate description. Attention Deficit Hyperactivity Disorder? There is no deficit in attention, our attention is on everything, all at the same time, whether is something we can see, touch or feel, smell, hear, taste, imagine, you name it, if we can be distracted by it we will shift out attention to it even if we don't want to. You don't have to be hyperactive to have ADHD, but it tends to be the overtly hyperactive ones that get diagnosed. Disorder? I would prefer Difference, like boys are different from girls kind of difference.
So on to the history bit starting over 200 years ago...
1798, Sir Alexander Crichton published "An inquiry into the nature and origin of mental derangement: comprehending a concise system of the physiology and pathology of the human mind and a history of the passions and their effects", which he continually updated and reprinted. In the second chapter of book II entitled "On Attention and its Diseases", he defines attention:
- When any object of external sense, or of thought, occupies the mind in such a degree that a person does not receive a clear perception from any other one, he is said to attend to it.
Later he writes about the perceived lack of attention in a person:
- The morbid alterations to which attention is subject, may all be reduced under the two following heads:
- First. The incapacity of attending with a necessary degree of constancy to any one object.
- Second. A total suspension of its effects on the brain.
- The incapacity of attending with a necessary degree of constancy to any one object, almost always arises from an unnatural or morbid sensibility of the nerves, by which means this faculty is incessantly withdrawn from one impression to another. It may be either born with a person, or it may be the effect of accidental diseases.
- When born with a person it becomes evident at a very early period of life, and has a very bad effect, inasmuch as it renders him incapable of attending with constancy to any one object of education. But it seldom is in so great a degree as totally to impede all instruction; and what is very fortunate, it is generally diminished with age.
He goes on to say:
- In this disease of attention, if it can with propriety be called so, every impression seems to agitate the person, and gives him or her an unnatural degree of mental restlessness. People walking up and down the room, a slight noise in the same, the moving a table, the shutting a door suddenly, a slight excess of heat or of cold, too much light, or too little light, all destroy constant attention in such patients, inasmuch as it is easily excited by every impression. The barking of dogs, an ill-tuned organ, or the scolding of women, are sufficient to distract patients of this description to such a degree, as almost approaches to the nature of delirium. It gives them vertigo, and headache, and often excites such a degree of anger as borders on insanity. When people are affected in this manner, which they very frequently are, they have a particular name for the state of their nerves, which is expressive enough of their feelings. They say they have the fidgets.
This ties in nicely with the next segment...
1844, Heinrich Hoffmann a successful psychiatrist, who was not in favour of the notion in his day that psychiatric patients were obsessed or criminal and preferred to view mental disorders as having a medical basis. He is famous for his 1845 children's book called Struwwelpeter. The following year he produced a second edition which included the story of Fidgety Phil, and Johnny Look-in-the-air which depict characters with symptoms of ADHD, which he no doubt got the ideas for, from the patients he saw.
1902, Sir George Frederic Still is marked by many authors as the scientific beginnings of the history of ADHD, and is seen as the Father of British Pediatrics. His study of children found some had a:
- defect of moral control as a morbid manifestation, without general impairment of intellect and without physical disease.
1932, German physicians Franz Kramer and Hans Pollnow reported about:
- A hyperkinetic disease of infancy
with the most characteristic symptom was motor restlessness.
1937, Charles Bradley reported positive effects of a stimulant medication called benzedrine when given to children with a range of behavioral disorders.
1944, Leandro Panizzon first synthesized the compound methylphenidate, now commonly used to treat ADHD, and is marketed as Ritalin, who name is derived from Leandro's wife Marguerite or "Rita".
1968, Diagnostic and Statistical Manual of Mental Disorders (DSM-II) contained an entry for "Hyperkinetic Reaction of Childhood" and was defined as "The disorder is characterized by overactivity, restlessness, distractibility, and short attention span, especially in young children; the behavior usually diminishes by adolescence"
1980, DSM-III defines ADD: Attention deficit disorder: with and without hyperactivity.
1987, DSM-III-R a revision of the 1980 DSM-III refined the definition to ADHD: Attention deficit-Hyperactivity Disorder, as symptoms of inattention, impulsivity, and hyperactivity.
1994, DSM-IV further refined the ADHD definition.
2000, DSM-IV-TR the descriptive text of ADHD was changed but the definition remained untouched.
2013, DSM-V the latest version defines ADHD as:
- A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
- Six or more of the symptoms have persisted for at least six months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. Please note: The symptoms are not solely a manifestation of oppositional behaviour, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), five or more symptoms are required
- Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years
- Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities)
- There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic or occupational functioning
- The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g. mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal)
