The 18th and 19th Centuries
In 1798, Scottish physician Alexander Crichton described a “disease of attention” in children that today would be identified as the inattentive subtype of ADD. It gave its bearers a “mental restlessness” that rendered them “incapable of attending with constancy.” This is the beginning of the history of attention deficit disorder (ADD) in the medical literature.
Fifty years later, a German psychiatrist, Heinrich Hoffman, also described characteristics of the disorder. In 1845, he published a children’s book containing a poem titled “Zappel-Philipp” or Fidgety Philipp. Philipp cannot sit still to eat dinner, cannot pay attention to his parents, fidgets and squirms and rocks back in his chair, then grabs the tablecloth as the chair tilts too far, pulling dishes, food and silverware onto the floor as he goes tumbling. Another poem, “Harry Who Looks in the Air” seems to describe the inattentive behavior associated with ADD.
The 20th Century
In 1902, British physician George F. Still described for the Royal College of Physicians a disease in which children could not inhibit their behavior and were defiant, restless and inattentive. Though he termed it a “defect in moral character,” he felt the behavior might be the result of brain damage, but could also have a biological basis. He suggested that parenting was not the cause of this aberrant behavior. Children with such behavior, however, were judged morally; but, doctors finally began to look at the disorder scientifically.
In the 1930s, researchers studied the behavior of children who had been affected by flu and encephalitis during the worldwide influenza pandemic in 1917-1918. Children who recovered from the encephalitis exhibited unusual restlessness, impulsivity, and distractibility—behaviors which are now considered the “diagnostic triad” of ADD, according to Dr. Edward M. Hallowell and Dr. John J. Ratey, authors of Driven to Distraction. The 1930s also brought the first use of stimulants to treat children with behavioral disorders. The stimulants, paradoxically, had a dramatic calming effect on hyperactive, inattentive, impulsive children.
By the 1950s, the idea of ADD as a brain disorder emerged and began to be studied. Ritalin was the stimulant most used to treat the disorder, known then as minimal brain dysfunction. By the 1960s, the genetics connection became evident, along with the idea that, again, biological malfunction, and not poor parenting, was at the root of attention deficit disorder. In the 1960s, too, the first description of symptoms appeared in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), emphasizing hyperactivity over inattention. In the 1970s, impulsivity and distractibility joined hyperactivity as hallmark symptoms of this syndrome, and by 1980, it became known as attention deficit disorder. In the 1990s, research into the condition exploded, and it was renamed attention deficit hyperactivity disorder.
The 21st Century
Attention deficit disorder is no longer an obscure condition. Doctors, parents and teachers are more educated about it than ever. As research and knowledge have increased, the condition is more often recognized and this has been the cause of some controversy. In 2006, three to seven percent of school-age children had attention deficit disorder, according to the Centers for Disease Control and Prevention. Over half are treated with medications, both stimulant and non-stimulant, and with counseling and behavioral management techniques. The growing number of children being diagnosed and put on medication has led some to believe the condition is over-diagnosed and over-treated. Some also believe the condition is non-existent or a hoax perpetrated by pharmaceutical companies.
The Diagnostic and Statistical Manual of Mental Disorders
In the DSM-IV-TR, the disorder is known as attention deficit hyperactivity disorder, or ADHD. ADHD has three subtypes: predominantly hyperactive/impulsive, predominantly inattentive, and combined type. To be diagnosed with ADHD, you must have at least six symptoms of inattentiveness and/or and six symptoms of impulsivity/hyperactivity. The symptoms must have been present since before the age of seven, and they must be present in more than one setting (for example, at school and at home).
The history of attention deficit disorder will gain a new chapter in 2013, when the DSM-V, is scheduled to be published, and the changes to the diagnosis will once again reflect the current understanding of the disorder. Proposed changes include adding a subtype that will allow the diagnosis of inattention without hyperactivity or impulsivity, grouping the hyperactive and impulsive symptoms together, and changing the age of onset of symptoms from “on or before age 7” to “on or before age 12.”
Driven to Distraction; Edward M. Hallowell, M.D. and John J. Ratey, M.D.; 1994
Delivered from Distraction; Edward M. Hallowell, M.D. and John J. Ratey, M.D.; 2006