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ADHD: Attention Deficit Hyperactivity Disorder

Historical Development of ADHD

Margaret Austin, Ph.D., Natalie Staats Reiss, Ph.D., and Laura Burgdorf, Ph.D.

old bookThe symptoms of Attention-Deficit/Hyperactivity Disorder were first described in a children's book, "The Story of Fidgety Philip," written in 1845 by Dr. Heinrich Hoffman. The story described behaviors, thought be caused by faulty parenting, that are consistent with what we know as ADHD today. Later, in 1902, a series of lectures published by Sir George F. Still described problematic impulsive behaviors among a group of children. The lecture series, presented to the Royal College of Physicians in England, cited genetic dysfunction as the cause of such symptoms.

Twenty years later, an American physician Dr. Bradley, observed that children treated with stimulant medication showed fewer with hyperactive and impulsive behaviors. During an outbreak of encephalitis in the 1940's, physicians observed that affected children displayed symptoms similar to those of hyperactive children. As a result, the professional community theorized that hyperactive children were brain damaged.

In response to this line of thinking, the first stimulant medication, methylphenidate (Ritalin), became commercially available in 1957. It was prescribed for impulsive, hyperactive children. Today, it is still one of the most widely prescribed medications for the treatment of the symptoms of ADHD.

The concept of hyperactivity as a disorder caused by something other than brain damage was re-introduced by Stella Chess in 1960. She described the "Hyperactive Child Syndrome" as an environmentally-based problem caused by faulty parenting. Her theories led to a re-evaluation of the origins of ADHD throughout the field. As a result of her work, the official medical name of the disorder was changed to Minimal Brain Dysfunction (MBD). Also, in 1965, the American Psychiatric Association changed the name again to "Hyperkinetic Reaction of Childhood," supporting the theory that hyperactivity was not a biological disorder, but rather, an environmental problem. According to this theory, parents (particularly mothers) were to blame for the disorder. Thus, professional theories had cycled around to a pre-1902 way of thinking.

In 1980, the term "Attention Deficit Disorder", or ADD, "With and Without Hyperactivity" was included in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III; the official manual that provides descriptions and definitions of currently accepted psychiatric diagnoses) for the first time. Seven years later, the revised edition, (the DSM-IIIR) contained a variation in the title of the diagnosis, re-labeling it either as "Undifferentiated Attention Deficit Disorder" (for those cases without hyperactivity) or "Attention-Deficit Hyperactivity Disorder" (for cases that included hyperactivity as a symptom). The American definition used today was introduced in 1994, in the DSM-IV. This current definition classifies the characteristics of the disorder into three separate categories: Mainly Inattentive, Mainly Hyperactive-Impulsive; and a combined form of the two.

 

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