ADHD Can Impact - Home, School, Work, Family and Relationships

ADHD History

ADHD History shows a remarkable evolution in its recognition and the subsequent proper treatment of a mental disorder that impacts millions of individuals, their lives, school, work and relationships. It has only been in recent years (really the last 20-30 years of the 20 th century) that researchers have been able to identify specific brain pathways and processes, that has given researchers a framework around which to identify those pathways involved with the various mental illnesses, including ADHD. Because of the relative lack of knowledge in how the brain functioned, most mental illness developed a very real and detrimental stigma with it - including those with symptoms that came to be known as ADHD.

In the last 10 years of the 20th century a vast amount research into deep brain pathways and processes lead to greater understanding of how the brain works which resulted in the search for more specific treatments, including medications with fewer side effects and a more narrow spectrum of action. In addition, researchers are also better able to identify environmental and dietary factors, and rule in or out their possible contributions to individual cases. As you read the following timeline you can begin to see how stigmas arose simply by the definitions being used at the time.

ADHD History Timeline

Year
Event / Publication
460-370 BC Hippocrates: Sometimes known as the father of medicine - may have been the first to record ADHD History when he observed patients who demonstrated "quickened responses to sensory experiences" and went on to describe their inability to stay focused "because the soul moves on quickly to the next impression."
1798 Sir Alexander Crichton: In his book "An Inquiry Into The Nature and Origin of Mental Derangement" described mental restlessness (inattention); He observed that persons can show this at an early age, they are incapable of staying on one subject, but that it should not render them totally incapable of instruction and saw it can diminish with age. He also gave this a name: They say they have the "fidgets" which has become a permanent part of ADHD history.
1845 Dr. Heinrich Hoffmann: Author of stories and poetry for children, published one such story called "The Story of Fidgety Philip" about a young boy who had trouble sitting still and paying attention.
1902 Sir George Frederick Still, considered the father of British Paediatrics - described and published in the Lancet descriptions of 43 children with serious problems of sustained attention and self regulation. He also noted most of these children appeared to have a normal intellect. He used a term "Moral Defect" to describe lack of control to see future consequences. However, for many people this put a negative spin in ADHD History.
1908 Alfred F. Tredgold a physician: 1870-1952 describes high-grade-feeble minded children who must have a mild brain damage that causes them to have signs or symptoms of inattention or high activity impacting school work. He published his first addition of "Mental Deficiency" in 1908. Its 8th addition was published in the early 1950's and was used for physician training.
1918-1919 A severe world-wide influenza pandemic left many survivors with encephalitis which in turn caused neurological dysfunction. Some of these exhibited immediate behavioral problems similar to what we now call ADHD. This caused researchers and doctors to believe that the condition was the result of injury rather than heredity. It was not until the 1960's in the history of ADHD did we began to hear again the concept of hyperactivity being a result of heredity (Hyperactive Child Syndrome") and not brain damage.
1937 Dr. Charles Bradley published a study of the use of Benzedrine (amphetamine) in children with behavior problems observing this helped their behavior and school performance which was the first real example of using medication in ADHD History.
1952 First Edition of DSM is published by the APA (American Psychiatric Association) but it did not include any mention of an ADHD like disorder.
1957 Hyperkinetic Impulse Disorder is first described in the literature with children showing inattention and hyperactivity
1957 Herbert Freed and Charles Peifer studied the use of Thorazine (A Strong Psychotropic with heavy sedative and antiemetic properties) on hyperkinetic emotionally disturbed children. They reported a definite improvement in their willingness to learn. They also observed that there was improved emotional control and even improved interpersonal relations. The side effects were minimal compared with those of adults and did not necessitate the termination of treatment in any case. This encouraged others to conduct research into additional, safe medications that might be useful to control these symptoms.
1963 C. Keith Conners publishes a study on the effects of Ritalin (Methylphenidate) in emotionally disturbed children - this may have been the first real break through in treatment options in ADHD History.
1966 The term Minimal Brain Dysfunction Syndrome became a popular term to describe a wide variety of symptoms seen in children including perception, conceptualization, language, memory, control of attention-impulse or motor function.
1967-1968 NIMH (National Institute of Mental Health) gave grants to researchers to study the effect of stimulants on children with hyperactivity and inattention problems. The NIMH grants resulted in a great deal of interest into searching for solutions in treating ADHD like symptoms and played a big role in ADHD history.
1968 DSM II is published by the APA: The first official description of the symptoms that include hyperkinetic reaction of children
1969 C. Keith Conners first "Conner's Rating Scale" is published. Since that time we have now seen multiple revisions.
1970 The Washington Post published a story about school children in Omaha, Nebraska which stated that 5-10 percent of all school children there were receiving stimulants, like Ritalin, to control their behavior, The statistics referred to in this story were a subset of students who were in specialized programs, but the story seemed to imply that 5-10 percent of all students in Omaha were on stimulants. Also implied in the article - was that many parents were being coerced into giving their children a stimulant. You can imagine that this fueled a major controversy around the overuse of medications in our students and ADHD diagnosis in general was being way over diagnosed.
1970-1971 The Comprehensive Drug Abuse Prevention and Control Act created a separate class for drugs that had the highest potential for abuse and/or addiction. As a result stimulants such as methylphenidate were added to the schedule II class, placing tight controls on their prescribing and refills.
1973 The Rehabilitation Act of 1973 added ADHD as a qualification for additional help and services at school for children with ADHD to help them succeed.
1975 Several books were published claiming ADHD is not a real diagnosis, that hyperactivity is caused by food allergies and additives and not inherited, and further ADHD was created by drug companies to make more money - greatly increasing an anti-methylphenidate (Ritalin) movement.
1975 American Academy of Pediatrics (AAP) publishes their first statement about ADHD and Medication for Hyperkinetic Children; Stating that there is a place for stimulant drugs in the treatment of hyperkinetic children in addition to consideration of appropriate nondrug therapy. (This latter attention to nondrug therapy was confirmed in 1999 when the MTA study was published - see note in timeline below)
1980 DSM-III is published by the APA; For the First time includes Attention Deficit Disorder, including subtypes of ADD with Hyperactivity, ADD without Hyperactivity, and ADD Residual type.
1981 Dr. Russell A. Barkley publishes first of his 17 books about ADHD called: Hyperactive Children: A handbook for Diagnosis and Treatment
1987 DSM-III-R is published by the APA; This addition changes the name of ADD to ADHD (Attention Deficit Hyperactivity Disorder but does not name subtypes
1987 American Academy of Pediatrics (AAP) publishes a report called: Medication for Children with an Attention Deficit Disorder containing guidelines and indications for drug therapy in its treatment, naming several stimulant drugs and tricyclic antidepressants as being potentially useful.
1993 Dr. Russell A Barkley begins publishing "The ADHD Report Newsletter
1995 Dr. Joseph Biederman publishes one of the first of hundreds of medical clinical studies about children with ADHD
1996 AAP publishes an updated report "Medication for Children with Attention Disorders stressing that drug therapy should be combined with appropriate management of the child's environment and curriculum.
1999 NIMH (National Institute of Mental Health) publishes results from a 14-month study known as the Multimodal Treatment Study of ADHD (MTA Study); It involved more than 570 children with ADHD at 6 sites in the United States and Canada. Results showed that medication alone was more effective than psychosocial treatments alone, but that their combination was more beneficial.
2000 DSM-IV-TR is published by the APA naming 3 types of ADHD, including ADHD-Combined type, ADHD predominantly Inattentive Type, and ADHD Predominantly Hyperactive/Impulsive Type.
2000 The AAP published its Clinical Practice Guidelines including Diagnosis and Evaluation of the Child with Attention-Deficit/Hyperactivity Disorder giving clear clinical guidelines for pediatricians and parents on the assessment and treatment of children with ADHD.
2002 STRATTERA (atomoxetine) the first non stimulant approved for the treatment of ADHD is approved by the FDA.
2004 Study published in England by Bateman et al reporting on children who were given small amounts of food coloring plus sodium benzoate preservative. The results suggested there may be reactions that resemble symptoms of ADHD in some of these children and they might benefit if these items were removed from their diet.
2007 Follow up Study by McCann is published in England supporting results from this previous study showed that in the general population in children not diagnosed with anything, a modest amount of mixed coloring and a preservative increased hyperactive symptoms and decreased attention spans in toddlers and older children. This resulted in a push to reduce and/or replace these items in the food supply.
2007 The FDA adds warnings to ADHD medications that include the possibility of certain heart risks, (Sudden death in children and adolescents with structural cardiac abnormalities, plus risks of adverse psychiatric symptoms. Please see respective individual drug labeling for specific warnings relative to individual drugs.
2009 Intuniv (Guanfacine) the second non stimulant is approved by the FDA for use with ADHD
2010 Kapvay (Clonidine) is the third non stimulant approved by the FDA for use with ADHD

Summary

ADHD History can be traced back for centuries. In 2010 ADHD is considered a very real diagnosis which can be made when specific guidelines are followed. Is it over diagnosed? This is possible and has been the subject of several articles and books. By becoming informed and participating in the process parents and patients with symptoms of ADHD can certainly minimize the risk of a wrong diagnosis. Its causes may be varied, but clearly includes in many cases heredity. A family history taken by a trained professional can reveal the likelihood if this is the case for you as an an individual.

Other causes that can't be overlooked include: injury, other illness, allergies to nearly anything but in particular food, food additives and/or preservatives, and food dyes, and other environmental concerns like heavy metal contamination. If there is not strong family history of ADHD, then these factors need to be explored even more.

If symptoms of ADHD are present, family history of ADHD is present, and none of the above other possible causes are present, medical and behavior/social therapy can be very effective and done safely when monitored closely. There is a good chance that overall treatment can be enhanced even further if possible environmental concerns are addressed as well..