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We all struggle to sit still, pay attention or control impulsivity at times, but for some people this tendency manifests so strongly and frequently that it impairs their ability to function normally.
This behaviour has been called attention deficit hyperactivity disorder (ADHD) since 1987, and is a condition that is usually diagnosed at age seven. Medical professionals use a checklist of symptoms that define ADHD to diagnose it.
A diagnosis of ADHD is more likely in boys than in girls, but adults can also be diagnosed. ADHD manifests in three ways: hyperactivity, inattention and impulsivity.
There has been a steady increase in the diagnosis of ADHD since the late nineties, and some people are worried about possible overdiagnosis, compounded by concerns about the use of ADHD medication.
Part I
'Mental restlessness' and 'the fidgets'
Impulsive, hyperactive and inattentive children have been mentioned in medical literature for hundreds of years, and the descriptions and theories are in many cases similar to what we know today as ADHD.
Hippocrates, who is often called the father of medicine, mentioned people who were unable to stay focused, but the earliest description of what sounds like “modern” ADHD is by Scottish doctor Sir Alexander Crichton (1763-1856). In his book, An inquiry into the nature and origin of mental derangement, he describes a “mental restlessness”. He also refers to people as having the “fidgets”.
Read: Diagnosing ADHD
Crichton made astute observations about the ”inattention” subtype of ADHD and wrote about restlessness and problems with paying attention in children, and how it can affect school performance.
In 1845 in Germany Heinrich Hoffmann published the short story of Zappelphilipp (Fidgety Phillip) who couldn’t sit still and pay attention. Today Fidgety Phillip would almost certainly be diagnosed with ADHD.
'Moral defect'
Sir George Frederick Still, the “father of British paediatrics” presented a series of three lectures to the Royal College of Physicians in London in 1902 on “some abnormal psychical conditions in children” that were subsequently published in the Lancet.
He studied 43 children who were, among other things, defiant, aggressive, undisciplined and had problems with paying attention, although they had normal intellect. He judged these children quite harshly and used the term “moral defect” to describe their inability to see future consequences of their lack of control.
Read: Taking control of ADHD
In 1908 Alfred F. Tredgold published the book Mental Deficiency about children who displayed signs of hyperactivity. He described them as “high-grade feeble minded” and believed that their behaviour was inherited. He also didn’t believe that environmental factors caused their hyperactivity in any way. His book was used for the training of physicians for many years.
Moving away from moral judgement
Many survivors of the Spanish Flu of 1918/19 were left with encephalitis, causing neurological dysfunction. This resulted in symptoms similar to ADHD which led the medical establishment to pin the cause of the condition to injury rather than heredity.
In 1924 research by Franklin Ebaugh produced evidence that attention deficit disorder (ADD) could arise from physical head trauma or brain damage. This was significant because it presented a physical cause for ADD, moving away from moral judgement. His research also led to the adoption of the term “Minimal Brain Dysfunction” for the hitherto unnamed condition.
American physician Dr Charles Bradley observed in 1937 that Benzedrine had a positive effect on the school performance of children with behavioural problems. This was the first notable example of the use of medication in the history of ADHD and paved the way for the current use of pharmaceuticals in the treatment of the condition. The FDA subsequently approved Benzedrine as a medicine.
Part II
Enter Ritalin
In 1955 the psychostimulant Ritalin (methylphenidate) was approved and became a popular pharmaceutical treatment for attention deficit disorder as diagnosis of the condition increased. Ritalin is still the most commonly prescribed medication for ADHD.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA) and is recognised as the authoritative classification of mental disorders. In 1980 the third edition of DSM included attention deficit disorder for the first time, with the inclusion of subtypes. In 1987 the current term ADHD (attention deficit hyperactivity disorder) was adopted.
Read: Ritalin debate flares up
In recent years the number of choices for ADHD medication has grown far beyond Ritalin. Newer drugs release stimulants over a longer period of time and require fewer dosages, and both Concerta and Adderall are longer lasting than Ritalin. The demand for non-stimulating drugs has also increased although they are not as effective.
Overdiagnosis of ADHD?
Diagnosis of ADHD cases began to climb significantly in the 1990s. Three main probable reasons include:
- ADHD is diagnosed more efficiently
- Parents are becoming more aware of ADHD and its symptoms
- There are currently more children developing ADHD
Mainly because of the increased diagnosis, there is a common conception reflected in public perceptions and media coverage that the condition is overdiagnosed. An article (“Evaluating the Evidence For and Against the Overdiagnosis of ADHD”), published in the Journal of Attention Disorders, concluded that there doesn’t appear “to be sufficient justification for the conclusion that ADHD is systematically overdiagnosed".
Today
Scientists are currently trying to get to the root of ADHD, and the latest research indicates a strong genetic link. Children with parents or siblings with ADHD have a stronger likelihood of being diagnosed with the condition. It is not clear what role environmental factors play in the development of ADHD.
Researchers are working hard to identify the underlying cause of ADHD, and in the meantime every effort is made to make treatments more effective.
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