History of ADHD
History of ADHD
Where did ADHD come from?
Being a biological or biochemical disorder, I don’t know that I can answer where ADHYD 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.
We left off last time with the early 1960s when some researchers were beginning to believe that ADD may have been caused by environmental factors. Other researchers were 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 (ADA) 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. impusivity 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 Predominately Inattentive 2. Attention Deficit/Hyperactivity Disorder Predominately 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 an adult may not display as many symptoms of hyperactivity as a child might, attention and impulse symptoms can be profound.
As research continues, I believe we will continue to discover more about the biochemical causes of ADHD and more about the neurotransmitters in the brain that seem to play a role in ADHD. I think we will find out more about the genetic component of ADHD and that because of these advances we will be able to better help our children and ourselves. We may even re-name the disorder yet again. I believe that the name should reflect that we really don’t have an attention deficit, but an attention surplus. We just seem to have a problem with selective attention. My personal experience proves I have an abundance of attention; I just don’t usually pay attention to what I’m supposed to!
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