Attention-deficit hyperactivity disorder: History

The clinical definition of “” dates to the mid-20th century, when physicians developed a diagnosis for a set of conditions variously referred to as “minimal brain damage”, “minimal brain dysfunction”, “learning/behavioural disabilities” and “hyperactivity”. Researchers speculate that earlier references to the condition as mentioned in the examples below, have been made throughout history.

In 493 BCE, physician-scientist Hippocrates described a condition that seems to be compatible with what we now know as . He described patients who had “quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression”. Hippocrates attributed this condition to an “overbalance of fire over water”. His remedy for this “overbalance” was “barley rather than wheat bread, fish rather than meat, water drinks, and many natural and diverse physical activities.”[72] Shakespeare made reference to a “malady of attention”, in King Henry VIII.

In 1845, Dr. Heinrich Hoffmann (a German physician and poet who wrote books on medicine and psychiatry) became interested in writing for children when he couldn’t find suitable materials to read to his 3-year-old son. The result was a book of poems, complete with illustrations, about children and their undesirable behaviours. “Die Geschichte vom Zappel-Philipp” (The Story of Fidgety Philip) in Der Struwwelpeter was a description of a little boy who could be interpreted as having disorder,[73] or as merely a moral fable to amuse young children and encourage them to behave properly.

In 1902, the English pediatrician George Still gave a series of lectures to the Royal College of Physicians in England, and described a condition which some have claimed is analogous to . Still described a group of children with significant behavioral problems, caused, he believed, by an innate hereditary dysfunction and not by poor child rearing or environment.[74]

In 1918–19, the world-wide influenza pandemic left many survivors with encephalitis, affecting their neurological functions. Some of these exhibited immediate behavioral problems which may correspond to (although no diagnosis for such a disorder existed at the time). This caused many later commentators to believe that the condition was the result of injury rather than heredity. (The concept of hyperactivity not being caused by brain damage was first described by Stella Chess as, “”Hyperactive Child Syndrome” in 1960.[75]) This caused a significant rift in the understanding of the disorder. Europeans saw hyperkinesis as unusual and often associated it with retardation, brain damage, and conduct disorders, and changes to the ICD were not made until 1994. In the USA by 1966, following observations that the condition existed without any objectively observed pathological disorder or injury, researchers changed the terminology from Minimal Brain Damage to Minimal Brain Dysfunction.)

In 1937, Dr. Charles Bradley in Providence, RI reported that a group of children with behavioral problems improved after being treated with stimulant medication. In 1957, the stimulant methylphenidate (Ritalin, which was first produced in 1950) became available under various names (including Focalin, Concerta, Metadate, and Methylin); it remains one of the most widely prescribed medications for . Initially the drug was used to treat narcolepsy, chronic fatigue, depression, and to counter the sedating effects of other medications. The drug began to be used for in the 1960s and steadily rose in use.

Psychiatry officially codified a condition called “hyperkinetic reaction of childhood” in 1968, displaying the psychoanalytical influences of that time. The name Attention Deficit Disorder (ADD) was first introduced in DSM-III, the 1980 edition. By 1987 – The DSM-IIIR was released changing the diagnosis to “Undifferentiated Attention Deficit Disorder.” Further revisions to the DSM were made in 1994 – DSM-IV described three groupings within , which can be simplified as: mainly inattentive; mainly hyperactive-impulsive; and both in combination.

In 1975, pemoline (Cylert) was approved by the FDA for use in the treatment of . While an effective agent for managing the symptoms, the development of liver failure in 14 cases over the next 27 years would result in the manufacturer withdrawing this medication from the market. New delivery systems for medications were invented in 1999 that eliminated the need for multiple doses across the day or taking medication at school. These new systems include pellets of medication coated with various time-release substances to permit medications to dissolve hourly across an 8–12 hour period (Metadate CD, Adderall XR, Focalin XR) and an osmotic pump that extrudes a liquid methylphenidate sludge across an 8–12 hour period after ingestion (Concerta).

During 1996, accounted for at least 40% of child psychiatry references.[76]

In 2003, atomoxetine (Strattera) received the first FDA approval for a nonstimulant drug to be used specifically for . In 2007, lisdexamfetamine (Vyvanse) becomes the first prodrug to receive FDA approval for . The landmark study of 1999 – The largest study of treatment for in history – is published in the American Journal of Psychiatry. Known as the Multimodal Treatment Study of (MTA Study), it involved more than 570 children with at 6 sites in the United States and Canada randomly assigned to 4 treatment groups. Results generally showed that medication alone was more effective than psychosocial treatments alone, but that their combination was beneficial for some subsets of children beyond the improvement achieved only by medication. More than 40 studies have subsequently been published from this massive dataset.

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May 24, 2008 | Filed Under Mental Disorders 

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