An Accurate ADHD Timeline

Jillian Enright

The History of ADHD

A More Accurate Timeline

Written by Jillian Enright, CYW, BA Psych.

When I started doing research for this article I was reading a book called NeuroTribes, written by Steve Silberman. It is a detailed history of Autism and Neurodivergence around the world, and the dark history of the treatment of individuals with neurodevelopmental disabilities. Some of the details are emotionally difficult to read, but important to understand. Intellectually it’s a very interesting read and it is certainly a thoroughly researched book.

This got me thinking about the history of ADHD specifically — the changing perspectives, criterion and rates of diagnosis, and evolving treatments.

I did some rudimentary searching online and found some out of date, poorly-researched articles in popular media. I found a decent U.S.-based history of Learning Disabilities and ADHD on Understood.org, but it is also now out of date, so my aim is to provide a more recent picture.

What is ADHD?

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder most commonly diagnosed in children. According to the Centers for Disease Control and Prevention, the average age at diagnosis is 7.

The prevalence of ADHD in Canada is thought to be approximately 5–9% in children and 3–5% in adults (Polanczyk et al., 2014), but these numbers are an estimate based on worldwide data.

It wasn’t until the late 1960s that the American Psychiatric Association (APA) formally recognized ADHD as a mental disorder, and originally called it hyperkinetic impulse disorder (DSM-II, 1968). However, recent research (Barkley & Peters, 2012) has discovered references to attention disorders as far back as 1775, so that is where I will begin.

1775

A German physician named Melchior Adam Weikard described attention disorders in a 1775 medical textbook, referring to “Mangel der Aufmerksamkeit” or “lack of attention” (Barkley & Peters, 2012).

1798

Dr. Alexander Crichton, from the Royal College of Physicians in the United Kingdom, published a medical textbook in 1798 describing attentional disorders in otherwise healthy individuals (Palmer & Finger, 2001).

1887

Désiré-Magloire Bourneville, Charles Boulanger, Georges Paul-Boncour, and Jean Philippe described an equivalent of ADHD in French medical and educational writings. In 1887, these doctors referred to “unstable” children who displayed symptoms of hyperactivity, impulsivity and inattention, today’s classic triad of ADHD symptoms (Bader & Hadjikhani, 2014).

Table

Terminology used in medical reports and textbooks in the 18th and 19th century to describe symptoms of inattention or hyperactivity resembling to the current concept of attention deficit hyperactivity disorder leading to Sir George F. Still’s clinical descriptions.

https://img.particlenews.com/image.php?url=2odmGw_0cwMFBxR00
Table data from Martinez-Badia & Martinez-Raga, 2015(Image created by author)

Early 1900s

ADHD was previously thought to have been first mentioned in 1902 (Lange et al., 2010). British pediatrician Sir George Still described “an abnormal defect of moral control in children.” He found that some affected children could not control their behaviour the way a typical child would, but they were still intelligent.

1902

In 1902 The British medical journal Lancet published the poem “The Story of Fidgety Philip,” which may be the first reference to ADHD in a medical journal (Dobson, 2004).

The story describes Struwwelpaul, which in German means “Troubled Paul”. The name was changed to Philip when the story was translated into English, perhaps to facilitate alliteration with the word fidgety.

The story of Fidgety Philip describes a boy who “… won’t sit still, wriggles and giggles, And then, I declare, Swings backwards and forwards, And tilts up his chair.” (Full poem at the bottom of this article).

Fidgety Philip, written in 1902 by Dr. Heinrich Hoffmann, a German psychiatrist

1907

Augusto Vidal Perera wrote the first Spanish compendium of child psychiatry. In 1907, he described the impact of inattention and hyperactivity among schoolchildren (Vidal Perera, 1907).

1917

Gonzalo Rodriguez-Lafora, a Spanish neurologist and psychiatrist, described symptoms of ADHD in children and said they were probably caused by a brain disorder with genetic origins (Lafora, 1917).

He wasn’t wrong.

1932

Franz Kramer and Hans Pollnow, from Germany, described an ADHD-like syndrome and coined the term “hyperkinetic disorder”, which was later adopted as a term by the World Health Organization (Kramer & Pollnow, 1932).

1937: The introduction of Benzedrine

In 1937, the American Medical Association (AMA) approved advertising of “Benzedrine Sulfate” racemic amphetamine tablets for narcolepsy, postencephalitic Parkinsonism, and minor depression (AMA, 1937).

Dr. Charles Bradley was among one of the volunteers who approached a pharmaceutical company for experimental supplies of Benzedrine. He did not intend to use amphetamine as a mental performance enhancer, but rather a treatment for severe headaches (Sandberg, 2002).

Dr. Bradley discovered that Benzedrine had no effect on the headaches, but caused a striking change in behaviour of the children, as most showed marked improvement in performance at school. He saw the promise in the idea that Benzedrine could modify behaviour and decided to undertake further research into this area (Bradley, 1937).

However, Bradley’s contemporaries largely ignored his findings. Doctors and researchers only began to recognize the benefit of what Bradley had discovered many years later.

1940

ADHD-like symptoms in children were described as “minimal brain dysfunction”. In the 1930s and 1940s, researchers believed ADHD-like symptoms and “deviant” behaviour were caused by brain damage (Lange et al., 2010).

No recognition

The APA issued the first “Diagnostic and Statistical Manual of Mental Disorders” (DSM) in 1952. This manual listed all of the recognized mental disorders. It also included known causes, risk factors, and treatments for each condition. Clinicians still use an updated version today, the DSM-V.

The APA did not recognize ADHD in the first edition.

1955: The introduction of Ritalin

In 1955, the FDA approved the drug Ritalin for treatment of depression and fatigue in the U.S. (physicians desk reference, 1956), but not for ADHD (Morton & Stockton, 2000).

Ritalin became more popular as an ADHD treatment as the disorder became better understood and diagnoses increased and is still used to treat ADHD today.

Unfortunately, ADHD wasn’t recognized by the U.S. medical community for another 13 years (DSM-II, 1968).

In 1984, Ritalin was first classified as a controlled substance under the federal Food and Drug Act in Canada. Methylphenidate, the active ingredient in Ritalin and other stimulant medications, is considered a Schedule IIIsubstance in Canada (Controlled Drugs and Substances Act, 1996).

U.S. Trends in the mid-nineties

Doctors and educators in the U.S. recognized learning disabilities and what would later be called ADHD, but most kids with these challenges were taught in separate classrooms, away from their peers.

1961–1968

In 1961 Ritalin was first used to treat “hyperkinetic” symptoms in kids in the U.S.

What is now called ADHD first appeared in the Diagnostic and Statistical Manual (DSM-II, 1968), the manual used to diagnose conditions. At that time, ADHD continued to be referred to as “hyperkinetic impulse disorder” (Denhoff et al., 1957).

The early 1980s

In 1980 “Hyperkinetic impulse disorder” was renamed attention-deficit disorder or ADD (Lange et al., 2010). ADDwas defined as a problem of inattention that could come with or without hyperactivity (Barkley, 2006).

The education and medical communities strived to understand learning disabilities and ADHD and how to help people who have them. ADHD became more widely known.

1987

The APA released a revised version of the DSM (DSM-III-R) in 1987. They removed the hyperactivity distinction and changed the name to attention deficit hyperactivity disorder (ADHD).

The APA combined the three symptoms (inattentiveness, impulsivity, and hyperactivity) into a single type and did not identify subtypes of the disorder (Rothenberger & Neumärker, 2005).

A climb in diagnoses

  • ADHD cases began to climb significantly in the 1990s. There may be a few factors behind the rise in diagnoses:
  • Doctors were able to diagnose ADHD more efficiently.
  • More parents became more aware of ADHD and therefore able to report on their children’s symptoms.
  • The DSM-IV expanded, refined, and improved its definition of ADHD (DSM-IV, 1994), allowing for more accurate diagnoses.
  • These factors allowed previously overlooked cases to be diagnosed and treated, including girls, adolescents, and inattentive but not hyperactive children.

Research also found a genetic component to ADHD, “The increased risk for ADD could not be accounted for by gender or generation of relative, age, social class, or the intactness of the family. These results confirm and extend previous findings indicating important family-genetic risk factors in ADD” (Beiderman et al., 1990).

These conclusions by Beiderman and colleagues also further support the idea that ADHD is not caused by poor parenting, diet, modern technology, or other prevalent myths.

1994-1996

In 1994 the DSM-IV was introduced, and in it ADHD was subdivided into three distinct subtypes: 1) predominately inattentive, 2) predominately hyperactive, and 3) combined type. The DSM-IV was also the first time that Adult ADHD was described. The APA recognized that ADHD could and should be diagnosed in adulthood and people do not grow out of it, their symptoms change as a result of maturity.

In 1996, Safer and colleagues concluded “the increase in methylphenidate treatment for ADD appears largely related to an increased duration of treatment; more girls, adolescents, and inattentive youths on the medication; and a recently improved public image of this medication treatment (Safer et al., 1996).

The Neurodiversity Movement

In 1998, Harvey Blume used the ecological model to reframe neurocognitive diversity as a normal and healthy manifestation of biodiversity, and Judy Singer coined the term neurodiversity.

“Neurodiversity is a political term to argue for the importance of including all neurotypes for a thriving human society.”—Judy Singer

The early 2000s

The APA released a text revision for the fourth edition of the DSM in 2000 (DSM-IV-TR, 2000).

The fourth edition established the three subtypes of ADHD (Lahey et al., 1994) that are still used by healthcare professionals today:

  • Predominantly inattentive type ADHD.
  • Predominantly hyperactive-impulsive type ADHD.
  • Combined type ADHD, encompassing both of the above types.

More and more medications to treat the disorder became available as the number of ADHD cases rose. The medications also became more effective at treating ADHD, and many have long-acting benefits for patients who need relief from symptoms for longer periods (Leonard et al., 2004).

Many additional researchers refuted earlier claims that children were being overdiagnosed and overmedicated for ADHD (eg. Barkley, 2006; Sciutto & Eisenberg, 2007).

2010

In 2010, researchers at the M.I.N.D. Institute at U.C. Davis identified differences in electrical patterns in the brains of kids with ADHD, demonstrating an underlying neurological reason for trouble with attention (U.C. Davis, 2010).

2013

In 2013, the American Psychiatric Association (APA) released the fifth version of the Diagnostic and Statistical Manual (DSM-V, 2013).

As noted by Epstein & Loren (2013), changes made to the definition of ADHD in the DSM-V are subtle, but important. The DSM specifies five different criterion categories: symptoms, age of onset, pervasiveness, impairment, and exclusionary conditions.

Criterion A — Symptoms

Changes made to criterion A (ADHD symptoms) are:

  • Added examples of how symptoms may manifest in adolescence and adulthood.
  • A reduction in the minimum number of symptoms in either symptom domain required for older adolescents and adults from six to five.

Criterion B — Age of Onset

Changes made to criterion B (age of onset) are:

  • Onset of symptoms and impairments before age 7 changed to onset of symptoms before age 12.

This is a very important change. Many youth and adults, like myself, were not diagnosed until later in life. I wrote about this experience back in April 2020.

Criterion C — Pervasiveness

Changes made to criterion C (pervasiveness) are:

  • Evidence of impairment was changed to evidence of symptoms in two or more settings.

This is significant for two reasons:

  • Because a person does not identify or recognize impairment does not mean it does not exist. Having lived with ADHD one’s entire life makes it impossible to know what it feels like to have a “normal” (neurotyipcal) brain. How can we identify impairment if we’ve never known any different? We have no frame of reference or control group for comparison.
  • Similarly, having ADHD one’s entire life means developing compensation and management strategies. We aren’t even fully aware of all the ways in which we compensate for our ADHD symptoms on a regular basis because these are behaviours we have gradually developed throughout our lives to meet the demand of a world made for neurotypicals.

Criterion D — Impairment

Changes made to criterion D (impairment):

  • Instead of requiring that impairment be considered “clinically significant”, functional impairments now only need to “reduce the quality of social, academic or occupational functioning”.

As noted by Spitzer & Wakefield back in 1999, “…the clinical significance criterion is redundant,” and “Often the clinical significance criterion has led to the possibility of false negative diagnoses” (Spitzer & Wakefield, 1999). The latter statement meaning this criteria potentially excluded people who really did have ADHD, but whose lives were not impaired enough in the opinion of the clinician.

Criterion E

Changes made to criterion E (exclusionary conditions):

  • The DSM-V no longer includes Autism Spectrum Disorder as an exclusionary diagnosis for ADHD.

This is extremely important because recent research (eg. Kern et al., 2015; Bathelt, 2020) is highlighting the many similarities between ASD and ADHD, as well as the high comorbidity between the two diagnoses (Antshel et al., 2013).

2016–2010

Finally, in 2016, the United Committee on the Rights of Persons with Disabilities (UN CRPD) adopted Article 24, the right to an inclusive education.

Canada ratified the CRPD in 2010 (CCD, 2011), to promote, defend, and reinforce the human rights of all persons with disabilities.

Among many points, article 24 states that reasonable accommodation of the individual’s requirements must be provided, so that:

  • Persons with disabilities receive the support required, within the general education system, to facilitate their effective education;
  • Effective individualized support measures are provided in environments that maximize academic and social development, consistent with the goal of full inclusion.

In short, article 24 of the CRPD prohibits discrimination against children with disabilities and mandates the right to inclusive education. The Parliament of Canada and each Canadian province have ratified the Convention and thus accepted this as law in our country (Inclusive Education Canada, 2014).

2017 — Present

Although great progress has been made, harmful myths and stereotypes prevail, and many professionals who work with children still only have a rudimentary understanding of ADHD and neurodiversity. This continues despite the growing wealth of information widely available.

-

-

References

Antshel, K. M., Yanli, Z., Faraone, S. V. (2013). The comorbidity of ADHD and autism spectrum disorder. Expert Review of Neurotherapeutics, 13:10, 1117–1128, https://10.1586/14737175.2013.840417

AMA Council on Pharmacy and Chemistry. (1937). Present Status of Benzedrine Sulfate. Journal of the American Medical Association, 109: 2064–2069.

American Psychiatric Association. (1952). Diagnostic and statistical manual of mental disorders (DSM).

American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders (DSM-II), 2nd ed.

American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (DSM-III), 3rd ed.

American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (DSM-III-R), 3rd ed rev.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (DSM-IV), 4th ed.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (DSM-IV-TR), 4th ed. Text revision.

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-V), 5th edition.

Bader, M., Hadjikhani, N. (2014). The concept of instability: a French perspective on the concept of ADHD.ADHD Attention Deficit and Hyperactivity Disorders 6, 11–17. https://doi.org/10.1007/s12402-013-0121-y

Bathelt, J., Caan, M., & Geurts, H. (2020). More similarities than differences between ADHD and ASD in functional brain connectivity. https://doi.org/10.31234/osf.io/4tfmn

Barkley RA.(2006). Attention-deficit hyperactivity disorder: A Handbook for Diagnosis and Treatment. Guilford Press.

Barkley, R. A., & Peters, H. (2012). The Earliest Reference to ADHD in the Medical Literature? Melchior Adam Weikard’s Description in 1775 of “Attention Deficit” (Mangel der Aufmerksamkeit, Attentio Volubilis). Journal of Attention Disorders, 16(8), 623–630. https://doi.org/10.1177/1087054711432309

Biederman J., Faraone SV., Keenan K., Knee D., Tsuang MT. (1990). Family-genetic and psychosocial risk factors in DSM-III attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 29: 526–533

Blume H. (1998). Neurodiversity. The Atlantic. http://www.theatlantic.com/magazine/archive/1998/09/neurodiversity/305909

Bradley C. (1937). The Behavior of Children Receiving Benzedrine. American Journal of Psychiatry. 94:577–581.

Chisholm, P. (2015). Ritalin Debate. The Canadian Encyclopedia. Retrieved from https://www.thecanadianencyclopedia.ca/en/article/ritalin-debate.

Conrad, P., & Potter, D. (2000). From Hyperactive Children to ADHD Adults: Observations on the Expansion of Medical Categories. Social Problems, 47(4), 559–582. https://doi.org/10.2307/3097135

Controlled Drugs and Substances Act, SC 1996. c. 19, s. 2(7). Government of Canada, Department of Justice. https://www.justice.gc.ca/eng/rp-pr/csj-sjc/jsp-sjp/qa02_2-qr02_2/qa02_2.pdf

Council of Canadians with Disabilities. (2011). UN Convention on the Rights of Persons with Disabilities: Making Domestic Implementation Real and Meaningful. http://www.ccdonline.ca/en/international/un/canada/making-domestic-implementation-real-and-meaningful-feb2011

Crichton, A. (1798). An inquiry into the nature and origin of mental derangement : comprehending a concise system of the physiology and pathology of the human mind, and a history of the passions and their effects. T. Cadell Hr. & W. Davies. (Reprinted by AMS Press, 1976).

Denhoff, Eric, Laufer, Maurice, W., Solomons, Gerald. (1957). Hyperkinetic Impulse Disorder in Children’s Behavior Problems, Psychosomatic Medicine, 19(1) , 38–49.

Dobson R. (2004). Could Fidgety Philipp be proof that ADHD is not a modern phenomenon?. BMJ : British Medical Journal, 329(7467), 643.

Epstein, J. N., & Loren, R. E. (2013). Changes in the Definition of ADHD in DSM-5: Subtle but Important. Neuropsychiatry, 3(5), 455–458. https://doi.org/10.2217/npy.13.59

Farone, S. V., Banaschewski, T., Coghill, D. Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H. Gignac, M., et al… Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder, Neuroscience & Biobehavioral Reviews. https://doi.org/10.1016/j.neubiorev.2021.01.022

Inclusive Education Canada. (2014). Right to Education. https://inclusiveeducation.ca/learn/right-to-education

Kern, J. K., Geier, D. A., Sykes, L. K., Geier, M. R., & Deth, R. C. (2015). Are ASD and ADHD a Continuum? A Comparison of Pathophysiological Similarities Between the Disorders. Journal of Attention Disorders, 19(9), 805–827. https://doi.org/10.1177/1087054712459886

Kramer, P.D.F., Pollnow, D.M.e.P.H. (1932). Über eine hyperkinetische Erkrankung im Kindesalter. Eur. Neurol. 82,21–40.

Lafora, G.R. (1917). Los Niños Mentalmente Anormales. University of California.

Lahey, B. B., Applegate, B., McBurnett, K., Biederman, J., Greenhill, L., Hynd, G. W., Barkley, R. A., Newcorn, et al… Shaffer, D. (1994). DMS-IV field trials for attention deficit hyperactivity disorder in children and adolescents. The American Journal of Psychiatry, 151(11), 1673–1685. https://doi.org/10.1176/ajp.151.11.1673

Lange, K.W., Reichl, S., Lange, K.M. et al. (2010). The history of attention deficit hyperactivity disorder. ADHD Attention Deficit Hyperactive Disorder 2, 241–255. https://doi.org/10.1007/s12402-010-0045-8

Leonard BE., McCartan D., White J., King DJ.(2004). Methylphenidate: a review of its neuropharmacological, neuropsychological and adverse clinical effects. Human Psychopharmacology: Clinical & Experimental, 19:151–180.

Martinez-Badía J., & Martinez-Raga, J. (2015). Who says this is a modern disorder? The early history of attention deficit hyperactivity disorder. World Journal of Psychiatry; 5(4): 379–386 https://10.5498/wjp.v5.i4.379

Morton, W. A., & Stockton, G. G. (2000). Methylphenidate Abuse and Psychiatric Side Effects. Primary care companion to the Journal of clinical psychiatry, 2(5), 159–164. https://doi.org/10.4088/pcc.v02n0502

NM M. (1956). Ritalin (methylphenidate). Physicians’ Desk Reference. 11th ed. Oradell, NJ: Medical Economics, 441–442.

Okie S. (2006). ADHD in adults. The New England journal of medicine, 354(25), 2637–2641. https://doi.org/10.1056/NEJMp068113

Palmer, E., & Finger, S. (2001). An Early Description of ADHD (Inattentive Subtype): Dr Alexander Crichton and ‘Mental Restlessness’ (1798). Child Psychology and Psychiatry Review, 6(2), 66–73. https://10.1017/S1360641701002507

Polanczyk, Guilherme V., Willcutt, Erik G., Salum, Giovanni A., Kieling, Christian, Rohde, Luis A. (2014). ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis, International Journal of Epidemiology, 43(2), 434–442. https://doi.org/10.1093/ije/dyt261

Quann, N. (2003). Questions and Answers on Drug Use and Offending. Government of Canada, Department of Justice. https://laws.justice.gc.ca/eng/regulations/C.R.C.,_c._870/page-175.html

Rothenberger A., Neumärker, K. J. (2005). Wissenschaftsgeschichte der ADHS. Steinkopff, Darmstadt: Kramer-Pollnow im Spiegel der Zeit.

Safer, D. J., Zito, J. M., Fine, E. M. (1996). Increased Methylphenidate Usage for Attention Deficit Disorder in the 1990s. American Academy of Pediatrics, 98(6).

Sandberg S. (2002). Hyperactivity and Attention Disorders of Childhood. Cambridge University Press. Historical Development.

Sciutto, M. J., & Eisenberg, M. (2007). Evaluating the Evidence For and Against the Overdiagnosis of ADHD. Journal of Attention Disorders, 11(2), 106–113. https://doi.org/10.1177/1087054707300094

Singer, J. (2020). What is Neurodiversity?. [Blog post]. https://neurodiversity2.blogspot.com/p/what.html

Spitzer, R. L. & Wakefield, J. C. (1999). DSM-IV Diagnostic Criterion for Clinical Significance: Does It Help Solve the False Positives Problem? American Journal of Psychiatry, 156:1856–1864.

UN Committee on the Rights of Persons with Disabilities (CRPD), General comment №4 (2016), Article 24: Right to inclusive education, 2 September 2016, CRPD/C/GC/4.

University of California, U.C. Davis. (2010). Disconnect between brain regions in ADHD. ScienceDaily. https://sciencedaily.com/releases/2010/01/100111155116.htm

Vidal Perera, A. (1907). Compendio de psiquiatría infantil, 1st ed. Librería del Magisterio, Barcelona.

-

Struwwelpeter

by Heinrich Hoffmann

The Story of Fidgety Philip

“Let me see if Philip can
Be a little gentleman;
Let me see if he is able
To sit still for once at the table.”
Thus spoke, in earnest tone,
The father to his son;
And the mother looked very grave
To see Philip so misbehave.
But Philip he did not mind
His father who was so kind.

But Fidgety Phil,
He won’t sit still;

He wriggles,
And giggles,
And then, I declare,
Swings backwards and forwards,
And tilts up his chair,
Just like any rocking horse —

“Philip! I am getting cross!”

See the naughty, restless child
Growing still more rude and wild,
Till his chair falls over quite.
Philip screams with all his might,
Catches at the cloth, but then
That makes matters worse again.
Down upon the ground they fall,
Glasses, plates, knives, forks and all.
How Mama did fret and frown,
When she saw them tumbling down!
And Papa made such a face!
Philip is in sad disgrace.

Where is Philip? Where is he?
Fairly cover’d up, you see!
Cloth and ll are lying on him;
He has pull’d down all upon him!
What a terrible to-do!
Dishes, glasses, snapt in two!
Here a knife, and ther fork!
Philip, this is naughty work.
Table all so bare, and ah!
Poor Papa and poor Mamma
Look quite cross, and wonder how
They shall make their dinner now.

Written by Dr. Heinrich Hoffmann in 1902

Comments / 9

Published by

Neurodivergent. 20+ years social work and psychology experience. I write about mental health, neurodiversity, advocacy, education, and parenting. Founder of ADHD 2e MB. CYW, BA Psychology.

2422 followers

More from Jillian Enright

Comments / 0