The History of ADHD
ADHD (Attention Deficit Hyperactivity Disorder) also called Hyperkinetic Disorder and ADD (Attention Deficit Disorder)
are conditions increasingly diagnosed in the industrial western world
during the last two decades. In spite of the authoritative style in
which this subject is often presented in the media, ADHD research is
still in the area of hypotheses and not fact.
It is the most diagnosed childhood psychiatric condition, yet it is
also the most misdiagnosed and misunderstood childhood behavioral
ADHD history as a documented disorder is now a little over 200 years
old. In 1798, the Scottish physician Alexander Crichton, described quite
accurately the behavior pattern now called Attention Deficit
In his book, with the dreadful title, “An Inquiry into the Nature and Origin of Mental Derangement,”
Crichton described it as a “mental restlessness” and wrote that his
patients call it “The Fidgets.” Interestingly he was way ahead of his
time, noting that people were either born with it or that it was the effect or result of
accidental disease. Illnesses such as hypothyroidism and early onset
diabetes are some of the 100 odd causes of attention deficit and
hyperactivity. He also noticed that as the person got older the symptoms
diminished. This is due to maturity and intuitively learning coping
He even touched on one of the most important causes of attention
deficit in school, an intolerance of boredom, when he wrote, “Every
public teacher must have observed that there are many to whom the
dryness and difficulties of the Latin and Greek grammars are so
disgusting that neither the terrors of the rod, nor the indulgence of
any kind entreaty can cause them to give their attention to them.”
Crichton recommended special educational intervention for these
children and noted that it was obvious that they had a problem with
keeping attention no matter how hard they tried. What was commendable
with Crichton’s observations was that he did not show the bigoted
moralising arrogance with which George Still, a hundred years later, set
the tone of authority’s attitudes towards children with ADHD. This
arrogant attitude can still be found in some of the foremost figures in
ADHD research today.
In 1904, about a hundred years after Crichton’s observations, the
British paediatrician, George Still, published in the British medical
journal, The Lancet, a description of a set of behaviors he called, “a
morbid defect of moral control” which he believed to be “volitional
inhibition” disorder. We do not know what these children had. They could
have been emotionally disturbed or had Oppositional Defiant Disorder (ODD) or Conduct Disorder (CO)
and not what is today considered as ADHD, although they still have the
symptoms of attention deficit, impulsivity and hyperactivity.
George Still’s basic error of calling a pattern of behaviors a
disorder is still with us today. This condition we now call Attention
Deficit Disorder is complex, individual and difficult to generalize, so
we categorise it and give it a label to solve the problem. Basically,
researchers are searching for some kind of easy formula to explain a
condition that is very complex. A brief review of the literature would
show any open minded scientist with common sense, and with a basic
understanding of the difference between cause and effect, that we are
dealing with many varied conditions with a limited set of symptoms in
Correlation does not imply causation. A relationship between two variables does not imply there is a cause-and-effect relationship between the two.
A symptom is not a disorder; the cause of the symptom is the disorder.
George Still had only twenty patients, unlike today’s almost epidemic number of ADHD diagnoses. Looking at the range of causes of ADD/ADHD behavior
it is most likely that his twenty patients had the more difficult and
extreme ADHD behaviors. This means they probably were antisocial. They
were not the hyperactive-child-next-door variety of ADHD children. They
stuck out in that society which was more tolerant of hyperactive
children. This would mean that his patient were likely to have
Opposition Defiance Disorder, Conduct Disorder or an extreme form of autism. Autism was still an unknown condition in 1904.
Note on autism: Autism is a spectrum disorder
defined by a problem with social contact and most autistic people would
not be in Still’s patient group. Autistic people have contributed
greatly to humanity’s development in science, philosophy, literature,
etc. We would not have computers today if it were not for some autistic
mathematical geniuses who made computing possible.
Hippocrates (460 to 370 BC) made the first mention of attention
deficit, as he described an ADHD like behavior. Aristotle probably had
ADHD, as did Galileo, Leonardo da Vinci, Newton, Einstein, Picasso,
Robin Williams, Whoopi Goldberg, Richard Branson and a long list of
people who have benefited humanity and brought us to where we are today
in fields as varied as science, technology, economics, mathematics and
the arts. ADHD personalities have an innate creativity, enthusiasm and
intuitiveness if it is not suppressed by misguided education.
There is a paradox with attention deficit
and that is that attention deficit people have the ability to
hyperfocus. However this is difficult to study because the act of
observation in a study tends to put the person into attention deficit.
School has the same effect of inducing boredom intolerance and attention
deficit. This is a complex subject for which there is no magic recipe.
Shakespeare also mentioned adult attention deficit in Henry VIII, calling it a “malady of attention.”
In the 19th Century hyperactivity was again mentioned in literature.
Dr Heinrich Hoffman, a German doctor and author, wrote a collection of
poems for children called “Der Struwwelpeter” in 1844. The poems, with
entertaining illustrations on each page, were about some nasty little
children and some sad stories. Hoffman’s humor was like an ornery Roald
Dahl. One of the poems was “Die Geschichte vom Zappel-Philipp” or “The
Story of Fidgety Philip.”
The Story of Fidgety Philip
“Let me see if Philip can
Be a little gentleman;
Let me see if he is able
To sit still for once at the table.”
Thus Papa bade Phil behave;
And Mama looked very grave.
But Fidgety Phil,
He won’t sit still;
He wriggles, And giggles,
And then, I declare,
Swings backwards and forwards,
And tilts up his chair,
Just like any rocking horse.
“Philip! I am getting cross!”
See the naughty, restless child,
Growing still more rude and wild,
Till his chair falls over quite.
Philip screams with all his might,
Catches at the cloth, but then
That makes matters worse again.
Down upon the ground they fall,
Glasses, plates, knives, forks and all.
How Mama did fret and frown,
When she saw them tumbling down!
And Papa made such a face!
Philip is in sad disgrace.
Where is Philip, where is he?
Fairly covered up you see!
Cloth and all are lying on him;
He has pulled down all upon him.
What a terrible to-do!
Dishes, glasses, snapped in two!
Here a knife, and there a fork!
Philip , this is cruel work.
Table all so bare, and ah!
Poor Papa, and poor Mamma
Look quite cross, and wonder how
They shall make their dinner now.
In the aftermath of the encephalitis epidemic in North America in
1917-1918, many survivors showed ADHD like behaviour. This resulted in
the condition being upgraded from a “Morbid Moral Defect” to “Minimal Brain Damage” and then later to “Minimal Brain Dysfunction.”
The assumption was the survivors had suffered some brain damage. It had
been observed that head injury, disease and congenital defects affected
In 1937 it was discovered by chance that stimulants, like
amphetamines, resulted in calming restless children. The Second World
War probably caused these researchers to lose their focus, as the
practice of drugging children with Schedule II drugs was not at first
implemented. It was not until the late 1950s before giving stimulant
drugs to young children became routine. By the mid 1960s this was a
usual treatment for what was then still called “Minimal Brain Damage.”
In the 1960s Minimal Brain Dysfunction was relabelled as “Hyperactive Child Syndrome.”
The researcher who coined this phrase, Stella Chase, thought her
syndrome had a biological cause. There was no consensus on this, as many
other researchers believed the cause to be environmental. There is a
long list of conditions, which result in ADHD behaviour.
Then in 1980, the American Psychiatric Association, by a vote of
hands in a committee meeting, added Attention Deficit Disorder (ADD) to
the diagnostic list. From this point on the epidemic started, fuelled by
big pharma’s marketing campaigns. Many researchers who today are
considered leading authorities on the subject of attention deficit are
funded, directly or indirectly, by the pharmaceutical industry. This has
led to the schism between authoritative researchers and doctors who, on
the one hand are focussed treating the cause of attention deficit, and
on the other hand those fixated on masking symptoms by medication.
This can be summed up as follows:
- Find the cause and fix it, or
- Suppress the symptom and the problem is solved.
As our knowledge stands today, no researchers fully understand ADHD
themselves. Some aspects of ADHD and ADD are outside modern science and
in the sphere of philosophy. Many researchers are so busy digging their
hole in their particular niche, that they have lost sight of the hugely
complex subject they are referring to.
In 1987, ADHD was voted in by a similar informal vote, and placed into the DSM-IV (The Diagnostic and Statistical Manual of Mental Disorders).
Ritalin, Adderall and Concerta have all been marketed with an aura of
scientific exactitude and responsibility behind. Too many physicians
accept what the pharmaceutical industry says without question. It is
after all much simpler to medicate than to treat the patient with natural remedies for ADHD. Their consciences are stilled by the advertising mantras churned out by big pharma.
In 1998 this situation with no consensus between the pharmaceutical
companies and their doctors on one side, and doctors who focussed on
treating their patients on the other. The National Institute of Health
(NIH) held a “Consensus Development Conference.” This defined the
“consensus” attitude which we still have today.
Quotations from the “Consensus Developmental Conference” report:
“Despite progress in the assessment, diagnosis, and treatment of ADHD, this disorder and its treatment have remained controversial, especially the use of psycho stimulants for both short- and long-term treatment. Although an independent diagnostic test for ADHD does not exist, there is evidence supporting the validity of the disorder. Further research is needed on the dimensional aspects of ADHD, as well as the coexisting conditions present in both childhood and adult forms.”
“We do not have an independent, valid test for ADD/ADHD and there are no data to indicate that ADD/ADHD is due to a brain malfunction.”
“Finally, after years of clinical research and experience with ADHD, our knowledge about the cause or causes of ADHD remains largely speculative. Consequently, we have no documented strategies for the prevention of ADHD.”
In spite of that, this set the tone and direction of ADHD research for the next decade. The research is so focused on a neurological disorder
(one cause) that there is a lack of research on multiple causes. This
ignores the possibility of a hundred children with ADHD behaviors could
have these symptoms from a hundred different causes or combinations of
causes. Causes can be anxiety, frustration due to learning difficulties,
or frustration from boredom due to under stimulation in the classroom,
allergies and many many more.
In 1998 they said ADHD was controversial.
They did not have an independent validated test, such as a biological or blood test.
They admitted they had no proof that ADHD was a disease, as there was no a proven biological basis for ADHD.
That was in 1998, and neither do they have any test or proof in 2010.
A doctor diagnosing ADHD in a child today, uses subjective reports on
perceived behaviour of that child, from teachers and parents. Then they
look into the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders 4th edition) and base their diagnosis and decision to medicate, with powerful and addictive drugs, on this subjective base.
What are the DSM-IV criteria based on? The committee of the DSM-IV
meets in a committee room and by a show of hands, vote into existence
the disorder of the day, and give it a code number in the DSM. That is
how we get so many psychiatric disorders. No ADHD or ADD physiological
tests or criteria are considered today, which means little has changed
in 100 years, except that we are more confused now. ADHD as a disorder
is an opinion, not a fact.
ADHD is real! The error is in calling it a disease.
The main problem in the Attention Deficit Hyperactivity Disorder is the
last term, “disorder.” If we called it dysregulation instead, then we could have Attention Deficit Hyperfocussing Personalities. Even the “Attention Deficit” part is misleading. So called attention deficit people can be hyper focussed
if they are interested and stimulated. The problem is that they cannot
regulate when they are in attention deficit or hyper focus. This is
situational. An adult can create an environment where s/he can get into
the hyperfocus mode, but a school child cannot unfortunately create an
ADHD friendly classroom.
Do we have difficulties with attention deficit. Sure we do, but
having a disorder makes us victims, being enthusiastic, creative and
able to focus makes us conquerors.
On a personal note; I have attention deficit and experienced a
nervous breakdown trying to be “average.” Now I am modifying my
lifestyle around my Attention Deficit Hyperfocussing Personality. I take
certain supplements, which definitely help me focus, but I have little
sense of time, am still forgetful, sort of scatterbrained, and avoid
boring tasks. So I concentrate on what I can do well and delegate what I
cannot do. My wife tells me 15 minutes before, when it is time to get
ready to go out. I go early to appointments, sometimes getting there
half an hour early.
It is about time the history of ADHD started to focus on the positive sides of the attention deficit hyperfocussing subject.