The History Of ADHD From Past To Present
ADHD is widely recognized by the medical community and the general public. Though there is almost certainly room for more public understanding of ADHD, you would likely be hard-pressed to find someone who has never heard of the disorder.
But how did this reality come to be, and what was life like for those living with ADHD before we had the language to name it?
Previous terms used for ADHD
Attention-deficit/hyperactivity disorder, also known as ADHD, is a somewhat new diagnosis for a condition that seems to have existed for as long as psychological research itself. Throughout history, both adults and children have been subject to a variety of labels attempting to describe the symptoms we now know to be related to ADHD.
Unfortunately, stigma and a lack of information surrounding mental health often led to harmful and incorrect interpretations of the differences ADHD can cause. Examples of previous terms used include:
- Hyperkinetic Impulse Disorder
- Hyperexcitability Syndrome
- Clumsy Child Syndrome
- Hyperactive Child Syndrome
- Minimal brain dysfunction
- Organic Brain Disease
- ADD (Attention Deficit Disorder)
The early years of ADHD research
Although its symptoms may not be anything new, the history of ADHD as a diagnosable condition doesn’t date back as far as you might think.
The earliest mention of a disorder that could later be categorized as ADHD is from the work of Sir Alexander Crichton from the late 18th century. In 1798, he documented a mental state with all the essential features of a subtype of ADHD, and his work concluded that there should be special educational accommodations necessary for children who exhibit these symptoms.
In 1902, Sir George Frederic Still, known to be the first practitioner of child medicine, concluded in a series of lectures built off the work of William James on moral control that children could experience a "defect of moral consciousness which cannot be accounted for by any fault of environment." It is here that we start to see an understanding that things like restlessness, an inability to sit still, and other symptoms are not due to external factors but instead the result of some sort of internal activity.
In the same decade, Alfred F. Tredgold conducted research focusing on children with behavior described as anti-school. Tredgold concluded that "high-grade feeble-minded" children experienced symptoms as a result of mild brain damage. While such a statement is certainly far from the most sensitive framing of the disorder, work like Tredgold’s was an essential step toward the understanding of ADHD that we have today. It once again affirmed the idea of the brain playing a crucial role in shaping the symptoms we attribute to ADHD; this was a crucial move away from believing personal morality or deliberate decision-making to be the root of these differences.
ADHD medications
Just as our understanding of what ADHD is and how it affects the human mind has changed, so too has the way we attempt to treat its symptoms. For decades, pharmacological solutions have been used to help adults, young adults, and children alike manage challenges related to ADHD.
Things didn’t start out so simple, though. In the late 1930s, a medication known as Benzedrine (racemic amphetamine) was being prescribed to children for severe headaches. Over time, one man, Dr. Charles Bradley, came to an accidental realization: many ADHD patients using the medication reported improved cognitive performance and behavior patterns. This discovery would mark a turning point. By 1967, there were several stimulant medications on the market, but Ritalin (methylphenidate) became the most popular.
This new type of ADHD treatment was not without controversy, though, particularly as the potential for abuse with these medications became more widely understood. Despite differing opinions about the efficacy of prescription medications for ADHD treatment, their rise in popularity has continued into the 21st century.
A brief history
Over the past century, the history of medication for ADHD has taken many twists and turns.
The journey started in 1937 when the medical director of what is today called Bradley Hospital noticed that a stimulant called Benzedrine led to better behavior in some children. Below is a brief rundown of different leading pharmaceutical developments aimed at treating ADHD:
1937 - Benzedrine (racemic amphetamine)
1943 - Desoxyn (methamphetamine hydrochloride)
1955 - Ritalin (methylphenidate)
1955-1983 - Biphetamine (mixed amphetamine/dextroamphetamine resin)
1960 - Adderall (mixed amphetamine/dextroamphetamine salts)
1970 - The Comprehensive Drug Abuse Prevention and Control Act of 1970 makes stimulants like Ritalin Schedule III medications
1971 - Stimulants such as Ritalin made Schedule II medications
1975-2003 - Cylert (pemoline)
1976 - Dextrostat (dextroamphetamine)
1976 - Dexedrine (dextroamphetamine)
1982 - Ritalin SR
1999 - Metadate ER (methylphenidate)
2000 - Concerta (methylphenidate)
2000 - Methylin ER (methylphenidate)
2001 - Metadate CD (methylphenidate)
2001 - Focalin (dexmethylphenidate)
2001 - Adderall XR (mixed amphetamine salts)
2002 - Ritalin LA
2002 - Methylin (methylphenidate) oral solution and chewable tablet
2002 - Strattera (atomoxetine)
2005 - Focalin XR (dexmethylphenidate)
2006 - Daytrana (methylphenidate patch)
2007 - Vyvanse (lisdexamfetamine dimesylate)
2008 - Procentra (liquid dextroamphetamine)
2009 - Intuniv (guanfacine hydrochloride)
2010 - Kapvay (clonidine hydrochloride)
2012 - Quillivant XR (liquid methylphenidate)
2016 - Adzenys XR-ODT (amphetamine oral disintegrating tablet)
2016 - Quillichew ER (chewable methylphenidate)
The Diagnostic and Statistical Manual of Mental Disorders and official recognition
According to the Centers for Disease Control, estimates for how many children have ADHD vary widely over time due to the changes in how the condition is diagnosed and how diagnostic criteria are applied. But what were these changes?
The DSM (Diagnostic and Statistical Manual of Mental Disorders) is essentially the guidebook of the human mind. It is a manual that outlines every psychological disorder accepted by the APA (American Psychiatric Association) and contains the diagnostic criteria any therapist or clinician will use to diagnose a patient.
Several different editions have been published since the original DSM-I was released in 1952. As of early 2022, the most recent publication of the DSM was released in 2013 and is referred to as the DSM-V. The DSM-I made no mention of ADHD or any disorder that describes ADHD-like symptoms. By 1968, “hyperkinetic impulse disorder,” a sort of primitive form of our modern ADHD diagnosis, had been a term in use for over a decade and appeared in the DSM-II.
Finally, in 1980, the APA released the DSM-III, which featured a condition by the name of attention deficit disorder (commonly known as ADD). The DSM-III specified that the disorder could present itself with or without hyperactivity. Seven years later, a reissue of the DSM (not a major revision, so this was labeled the DSM-III R) contained certain changes with criteria that legitimately recognized attention-deficit/hyperactivity disorder. Regardless of which point you decide is the beginning, 1980 marks when ADHD was recognized officially by the medical community.
In the DSM-V, ADHD is not only recognized but has also been studied to the extent of allowing researchers to pinpoint more specific iterations of the disorder, like the predominantly inattentive type. What was formally diagnosed as ADD without hyperactivity is now labeled ADHD-I or ADHD with inattentive presentation (no hyperactivity).
There are also ADHD-II (ADHD with hyperactive behavior presentation), which is far less common than the other expressions, and ADHD-III (ADHD with combined presentation), which is the most common manifestation. ADHD-II is typically characterized by hyperactivity rather than frequent inattention or easy distraction. Individuals with ADHD-III, on the other hand, may experience hyperactivity and impulsivity but also present symptoms of inattentiveness, such as having a hard time focusing or forgetting things easily.
Moving forward
The most recent major advancements occurred during:
- The release of Clinical Practice Guideline: Diagnosis and Evaluation of the Child With Attention-Deficit/Hyperactivity Disorder (AAP 2000) guiding parents and pediatricians on how to assess and treat children with ADHD
- The discovery and circulation of Strattera, the first non-stimulant medication for ADHD, which was first approved in 2002
- Warning labels were added to ADHD medication (2007) to include information about the possibility of cardiovascular risks and risks of adverse psychiatric symptoms (hallucinations, delusional thinking, or mania)
As public awareness of this mental disorder and its symptoms increase, it’s likely we’ll also see an uptick in the number of diagnoses received. The result may be further research and a shift toward discovering new and diverse ways to treat symptoms, particularly those that aren’t related to medication.
One opportunity to learn how to manage ADHD symptoms and understand how the disorder can affect behavior is through working with a licensed mental health professional. Options like online therapy make it simple to connect with a provider who understands your needs and goals. All you need to receive insight that can make a difference is an internet connection.
Online therapy is convenient and, based on current research, effective. One 2022 study noted that online therapy intervention can improve symptoms related to ADHD for adults and children alike. No matter your age or experience with ADHD cases, a licensed therapist may be able to offer problem-solving strategies, advice, and support that can help.
Takeaway
ADHD is not a new mental illness, but it’s one that’s been misunderstood for centuries. It’s only within the past few decades that we’ve seen significant growth in our understanding of what ADHD is, why it develops, and how to best treat those who exhibit its main three symptoms: inattention, impulsivity, and, for some, hyperactivity. Hopefully, as the internet continues to educate and connect those with ADHD across the world, more discoveries will come to light and enhance the way we view this mental health disorder and others.
What was ADHD once called in the 1950s?
In the 1950s, some researchers used the term hyperkinetic impulse disorder or hyperkinetic disorder for ADHD (attention-deficit hyperactivity disorder). ADHD was long thought to be a result of minimal brain damage. However, symptoms were observed in children who hadn’t experienced brain damage or encephalitis. Today, researchers believe that genetics and environmental factors may play a role in ADHD.
What was the first type of treatment?
In 1937, Benzedrine was found to improve school performance and behavior problems of children, but as a side effect. Years later, methylphenidate (Ritalin) was used to treat ADHD. Today, there are medications that may help hyperactive children and adults to experience relief from their symptoms.
What was it called in the 1900s?
For many years, ADHD was thought to be related to a brain injury. Then, in the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II), ADHD was referred to as hyperkinetic reaction of childhood. In the third edition (DSM-III), the term attention-deficit disorder (ADD) was used. The revision to this edition, the DSM-III-R, was where the term ADHD was first used. In the fourth edition (DSM-IV), the term attention-deficit hyperactivity disorder (ADHD) was used with sub-types.
When was it first added to the DSM?
The term ADHD was first added to the DSM-III-R. In the previous edition (DSM-III), the term ADD was used.
What was the old drug?
Several medications have been used for ADHD over the years. Benzedrine was approved by the FDA in 1936, and the next year Dr. Charles Bradley noticed that one of the side effects was that his patients performed and behaved better in school. Although doctors at the time had doubts about his observations, researchers recognized the benefit of the medication years later. In the 1955, methylphenidate (Ritalin) was approved by the FDA, and doctors began to use it for ADHD as awareness of the disorder grew.
What is the oldest medicine?
Benzedrine, approved by the FDA in 1936, was discovered to have an unintentional benefit on children’s behavior and performance at school. Years later, doctors began to prescribe Ritalin, which was approved in 1955, for ADHD. Drug therapy, including stimulant drugs, continues to be an important part of treatment for many people who live with ADHD. There may be some side effects, such as decreased appetite, but a health care provider may be able to find a medication that works well for you.
What is the Starbucks syndrome for ADHD?
Starbucks syndrome is the term used to refer to overstimulation as a result of a dose of ADHD medication that is too high.
What medicine was used in the early 2000s?
In the early 2000s, Ritalin was largely used for ADHD. Other people may have taken Adderall or Daytrana.
Why is ADHD considered to be a controversial diagnosis?
ADHD may be controversial for some people due to the rise in prevalence. Some people wonder if ADHD is truly more prevalent or if there is simply more awareness of the disease than there was in the past. If you have questions about hyperactivity disorders or behavioral disorders in general, it may help to speak with a licensed mental health professional. They may be able to help you distinguish between symptoms of other mental health disorders, such as anxiety and major depressive disorder.
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