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ADHD Awareness: A Short History of Modern Excuses

ADHD Awareness: A Short History of Modern Excuses

My eldest son was diagnosed with ADHD at the tender age of 22, and he’s still only 22, so I’m right at the beginning of a learning journey as far as ADHD is concerned.

As he is an adult, my role as parent is largely that of outside observer, on stand-by to give sage advice and practical help as and when necessary: though this is made much more difficult when you are dealing with things you know nothing about.

But aren’t we all winging it to some extent in life?

One thing I have learned about ADHD so far is that some people, quite a lot of people, think that it was invented in the 1980s or 90s as a fashionable excuse for bad behaviour and a lack of discipline in children.

Well, anyone who thinks that has another think coming. ADHD wasn’t invented then, or at any time – it has been observed as a fact of life for as long as people have been recording their observations in a way that survives for later generations to find.

Hippocrates (c. 460 – c. 370 BC) made what may have been the first mention of what seems to be ADHD. He made at least one reference to some patients who could not keep their focus on any one thing for long and had exceptionally quick reactions to the things around them.

He described it as an ‘an overbalance of fire over water’. Of course that is a very long time ago, when it was generally believed that it was the balance of ‘humours’ -- vital elements and bodily fluids – that gave rise both to the temperament and the symptoms of illness, so it’s hardly scientific and we have no other details about these patients that would enable us to say whether or not they fitted the modern criteria necessary for a diagnosis of ADHD.

Indeed we do have to wait until the 90s before we get the first published description of what appears to be demonstrably ADHD – the 1790s that is!

In 1798 Scottish Physician Sir Alexander Crichton published a work spanning three books entitled: An Inquiry into the Nature and Origin of Mental Derangement (if he wasn’t already under the ground, I’d tell him to get in the sea for that title). In the second book he refers to what he describes as ‘the disease of attention’ and observes that people with this condition seemed to be ‘mentally restless’ and ‘have a hard time sticking with one task or game’.

He described: ‘the incapacity of attending, with a necessary degree of constancy, to any one object’: and ‘This faculty [of attention] is incessantly withdrawn from one impression to another'.

These descriptions are consistent with the symptom criteria listed in DSM IV (the current edition of the diagnostic manual of the American Psychiatric Association) thus:

‘Inattention: the difficulty sustaining attention in tasks or play activities’, and ‘is often easily distracted by extraneous stimuli’.

At about the same time philosopher and physician John Locke wrote an essay: Some Thoughts Concerning Education, in which, among other things, he discussed a group of students who, he observed, could not ‘keep their minds from straying’ (However, without further details I can’t help wondering whether he was just a boring lecturer.)

Medical textbooks of the 1800s refer to children who today we might recognise as displaying symptoms consistent with ADHD, but back then they were referred to in terms such as ‘nervous child’, ‘mental instability’, ‘unstable nervous system’, and ‘simple hyperexcitability’.

I don’t know about recognising ADHD from that list of unfortunate terminology, but I certainly recognise some of the descriptions applied to me as a child. I can’t count how many times I was described as ‘highly strung’ and ‘nervous’.

In 1902 Sir George Still, the first professor of paediatrics in England, at Kings College Hospital, often referred to as the ‘father of British Paediatrics, gave three lectures about children who had difficulty paying attention for a long time.

He noted they displayed difficulties with self-regulation, and could be aggressive, emotional or defiant (I have a sudden sense of déjà vu – here I am again: the little girl in a pink coat, with a bad attitude).

This he described as ‘an abnormal defect of moral conduct in children’. It should be noted that, though some of the symptoms he described are consistent with ADHD, many others are not.

He’s another one who can get in the sea as far as I’m concerned. In fact, I’ve a mind to exhume his coffin and float it out on the briny blue myself: ADHD has nothing to do with morality and the traits observed are not character defects, but rather manifestations of the difficulties that people with ADHD face in a world that is not supportive of their way of functioning.

Similarly, Conduct Disorder, ODD, PDA, and whatever other conditions may be consistent with those of his observations that do not fit ADHD, are not defects in a person’s morality or character.

In 1932, some 50-60 years before ADHD was supposedly invented to let lazy parents off the disciplinary hook, two German physicians, Franz Kramer and Hans Pollnow described a condition that they called Hyperkinetic Disorder of Infancy, the main symptoms of which are very similar to current concepts of ADHD.

It was in 1937, again, way before it became fashionable to medicate naughty children instead of disciplining them (I am being sarcastic, of course, in case you hadn’t noticed -- you can’t beat that out of people either -- my parents tried but it just made me worse) that American doctor Charles Bradley noted an improvement in behaviour and school performance in some children to whom he had administered Benzedrine (he was attempting to treat the severe headache, caused by the pneumoencephalogram procedure he had subjected them to in order to examine their brain, by stimulating the Choroid Plexus – it didn’t work).

He identified the children most likely to respond to Benzedrine in this way as ‘characterised by short attention span, dyscalculia, mood lability (not a typo), hyperactivity, impulsiveness, and poor memory’ – traits we would now associate with ADHD.

It wasn’t until the late 1960s that the APA (American Psychiatric Association) formally recognised what we now know as ADHD as a diagnosis. It was included in their diagnostic manual or DSM when the second edition was published in 1968. Then it was known as Hyperkinetic Impulse Disorder.

When the third edition of the DSM (DSM III) came out in 1980 the name was changed to Attention Deficit Disorder. The listing created two subtypes of ADD:
ADD with hyperactivity, and ADD without hyperactivity.

A revised edition in 1987 removed the hyperactivity distinction, and combined the three symptoms (inattentiveness, impulsivity and hyperactivity) into a single type now called Attention Deficit Hyperactivity Disorder or ADHD.

It was only with the release of the fourth edition of the DSM (DSM IV) in 2000 that the three subtypes of ADHD used by healthcare professionals today were established

1. Combined type ADHD

2. Predominantly inattentive type ADHD

3. Predominantly hyperactive type ADHD

Scientists are still trying to identify the causes of ADHD: research so far points to a very strong genetic link.

No, no, no, that can’t be right, says the woman who left the house yesterday not only without picking up her keys, but also without even shutting the front door.

So, to sum up – if you’re one of those people who blames the parents for their child’s ADHD then rest easy, because you still can.

You won’t have to change your views one iota, except the one about spanking the ADHD out of them.

And I hope you’ve brought your inappropriate speedos, because you know where you can get, don’t you …

That’s right …

And make it the North Sea. In February.

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