The History of ADHD – #1

Hi – this is Dr. Kenny Handelman. I am very excited to share with you the first edition of the ADHD Audio Newsletter. The first topic is “Looking Back, the History of ADHD”.

ADHD was first described in 1902 by Dr. Still. He recognized significant behavioral difficulties in a number of children in his practice. He realized that these behaviors were not related to brain damage or poor parenting. This is not a belief which was held for many years after that. In 1918 and 1919 there was a flu pandemic which led to many people developing brain damage related to it. These people had neurological difficulties and there were some people who also had concentration difficulties. This led to the recognition or calling of people who had inattention as having ‘minimal brain damage’. This was a common term in the 1930′s for what later became known as ADHD.

In the late 1950′s and early 1960′s it was thought that there was not actually brain damage in these individuals who have trouble with concentration but rather ‘minimal brain dysfunction’ (or ‘MBD’) so this term was used.

In the late 1960′s hyperactivity was thought to be the main issue in ADHD children, and the name ‘Hyperkinetic Reaction of Childhood’ came out in 1968. Research of course carried on and it was a Canadian researcher named Virginia Douglas who came up with a concept that attention was the main issue and that ‘attention deficit’ was the core concept.

In 1980 the DSM-III which is the Diagnostic and Statistical Manual, 3rd edition, of the American Psychiatric Association came out with a term ‘Attention Deficit Disorder with or without Hyperactivity’. So it was ‘ADD +/- H’ for the hyperactivity.

In 1987 there was the term ‘Attention Deficit Hyperactivity Disorder’ which came out or ‘ADHD’.

In 1994, the newest edition of the DSM came out – being version 4 (DSM-IV). The terminology for ADD or ADHD became: ADHD inattentive type, ADHD hyperactive impulsive type, or ADHD combined type (for those with both the inattentive and hyperactive impulsive subtypes).

As of 1994, the term ‘ADD’ is no longer an official diagnosis. That said, it is still used quite commonly.

Now I want to be clear about this on the first newsletter because some people in my office practice get upset when I say “ADHD” because they say that they have ADD or their child has ADD. In this situation, I always acknowledge them and say, “I understand that, just please don’t be upset if I say ADHD because my training is that that is the current terminology.” And then I say something like ‘tomato (US accent) vs. tomato (British accent)’.

So even if you have ADD or your child has ADD please stick with me when I’m saying ADHD, we’re talking about the same thing. I would just call it ‘ADHD inattentive type’.

Now we will spend a lot of time talking about treatments in future editions of the newsletter, but I just wanted to let you know about some of the history in this first newsletter. In 1937 Dr. Bradley first used a stimulant medicine. The medicine was shown to help the hyperactive children that it was tested on.

In 1957 methylphenidate or Ritalin was introduced and this became the start of using medications regularly to treat ADHD. Of course over time there have been newer medications developed and changes in the preparations available such as longer acting formulations etc. The newest addition to the ADHD armamentarium is the introduction of Atomoxetine (Strattera) which is a non stimulant for ADHD that came out in the U.S. in 2003 and has come out in eight or nine other countries to date.

Well, there is quick overview of some of the history of ADHD. I will be in touch next week with the next edition of the ADHD audio newsletter.

Thank you very much for joining me.

Thanks very much.

Dr. Kenny Handelman

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