History
ADHD has been identified many times over the past 300 years and has gone through a host of names and diagnostic criteria.
In 1798 Sir Alexander Crichton first described a mental disorder that fits the characteristics of what we know today as ADHD (Lange et al., 2010). At the time mental illnesses were rarely studied from a medical or psychological perspective (Lange et al., 2010). In Western countries, such illnesses were usually associated with bad or imbalanced humors or resulting from the corruption of the soul (in a religious sense).
In 1902 Sir George Frederic Still described ADHD in a series of lectures at the Royal College of Physicians of London as “an abnormal defect of moral control in children.”(Lange et al., 2010)(Holland, 2021)(Masters, 2021). These children were of at least average intelligence, but could not control their behavior in a manner appropriate for their age or setting (Lange et al., 2010)(Holland, 2021)(Masters, 2021).
In 1932 Franz Kramer and Hans Pollnow described "hyperkinetic disease of infancy” and further distinguished it from other illnesses with similar symptoms (Lange et al., 2010).
In 1937, Charles Bradley somewhat accidentally discovered that stimulant medication Benzedrine had a positive effect on many of his patients with behavioral disorders (Lange et al., 2010)(Masters, 2021). However, his research and publications had almost no impact on the medical community for at least 25 years (Lange et al., 2010).
Throughout the 1930s-1940s there was a growing recognition in the scientific medical community that brain damage could be the cause of behavioral disorders (Lange et al., 2010). Due to this insight doctors would diagnose patients with minimal brain damage based on behavioral symptoms alone (Lange et al., 2010).
in 1954 Ritalin, a stimulant medication still favored today, was first marketed for several mental illnesses and related disorders, but it had a most notable effect on patients who would these days be identified as having ADHD.
Lange et al. (2010) explain how the 1960s saw an evolution in the diagnosis and understanding of the causes of what we now call ADHD. It was pointed out that while brain injuries could cause abnormal behaviors, damage should not automatically be assumed. Plenty of children presented the characteristic symptoms without any history of trauma or infectious diseases. Instead, it was argued that the abnormal behaviors were due to brain dysfunction rather than just brain damage and one should not assume brain damage based on behavioral symptoms alone. Lange et al. (2010) also note that it was clear the term 'minimal brain damage' was too broad a term and encompassed too wide a variety of symptoms and behaviors and eventually the term was broken down replaced with more specific labels such as 'hyperactivity' and 'dyslexia'.
ADHD was not officially recognized until the second edition of the DSM was released in 1968 where it was called Hyperkinetic Reaction of Childhood (Lange et al., 2010). it was defined simply as “characterized by overactivity, restlessness, distractability, and short attention span” (American Psychiatric Association 1968, p. 50, cited by Lange et al., 2010).
The 1970s saw growing concern over abuse of prescription drugs and amphetamines were listed first as schedule III then schedule II drugs limiting their use and refills. With the increased media onslaught of amphetamine abuse coverage also came Benjamin Feingold's claim that hyperactivity is the result of a child's diet and not any sort of brain disfunction (Rodden & Dodson, 2021) - a view that has colored attitudes towards ADHD for decades and contributed to the backlash against using stimulants to treat ADHD (Rodden & Dodson, 2021). The 1970's was also when a genetic link was identified in families (Rodden & Dodson, 2021).
Recent History
In 1980 the DSM-III was released and it replaced the term 'Hyperkinetic Reaction of Childhood' with 'Attention Deficit Disorder (ADD) (with or without hyperactivity)'. This reflected a shift in focus from the hyperactivity aspect of the disorder to the attention deficit and impulse control (Lange et al., 2010). The DSM-III no longer required hyperactivity as a diagnostic criterion for the disorder, it also instituted a numerical score requirement for symptoms, guidelines about the age of onset and duration of said symptoms, and the ruling out of other possible psychiatric conditions (Lange et al., 2010).
In 1987 the DSM-III was revised and Hyperkinetic Reaction of Childhood Attention Deficit Disorder (ADD) (with or without hyperactivity) was renamed Attention Deficit Hyperactivity Disorder (ADHD) (Lange et al., 2010). With this renaming, the APA also did away with the categorization of two distinct subtypes and combined the symptoms into one list with a single score requirement (Lange et al., 2010). ADD without hyperactivity was reclassified separately and referred to as 'undifferentiated ADD' (Lange et al., 2010)(Rodden & Dodson, 2021).
1990's the number of children diagnosed with ADHD rises, but according to the CDC (ADHD Throughout the Years, 2020), it is unclear if this rise is due to increased rates of diagnosis of ADHD or an increase in the number of individuals with ADHD (Rodden & Dodson, 2021).
DSM-III-R, released in 1994 " divided ADHD into three subtypes: predominantly inattentive type, predominantly hyperactive type, and a combined type3 attention deficit hyperactivity disorder." (Rodden & Dodson, 2021)(ADHD Throughout the Years, 2020).
In the early 2000s the AAP publishes guidelines first for the diagnosis, then the treatment of ADHD. They recommended a combination of behavioral therapy (usually CBT) and stimulant medication (Rodden & Dodson, 2021). Then in 2002 the first non-stimulant medication for ADHD is FDA approved.
The clinical guidelines are updated by the AAP in 2011 to broaden the age range of diagnosis and behavioral interventions (Rodden & Dodson, 2021).
In 2013 the DSM-V is released and is the contains the current definition and diagnosis for ADHD. The language changes make it somewhat easier for adults and adolescents to be diagnosed and get access to medications (Rodden & Dodson, 2021).
It is important to note that IDEA guarantees children with special needs have equal and free access to public education. However, not all children with ADHD automatically qualify for SPED assistance. In order to receive these services the child's ADHD must "seriously [impact] the child’s learning and/or behavior at school." (CHADD, 2018)
This shows how thinking changed as research developed. We see the balance of emphasis between the inattentive and hyperactive symptomology teetering this way and that as the scientific and medical communities debated what criteria were most relevant and whether the subtypes should be categorized as separate disorders entirely. We also see the wider use of ADHD-specific stimulant medications and the introduction of nonstimulant medications. Today there is a much wider variety of medication and treatment options than ever before.
Ignorance still exists and some people refuse to recognize ADHD for what it is and stigmatize those who have it as "lazy", or insist that difficulties are due to diet and nutrition, society has come a long way as has the medical community.
