The history of ADHD

One of the misconceptions I think around ADHD is that it’s quite a new problem. So, could you give me a bit of an overview about the history of ADHD? Yeah. And, actually, there’s mention of the patterns of inattention, difficulty concentrating, impulsive lack of control way back in the 18th and 19th century, actually. The first time, I suppose, it was formally presented, was as a so-called ‘disorder of moral control’ by George Still, the founder of modern paediatrics, in The Lancet paper in 1902. That formulation pretty much mapped onto the current symptom profile. After that, what we see is a interest in thinking about those behaviours, in attention and so forth, and as a form of minimal brain disorder or dysfunction.

The idea that they were due to some sort of very subtle, organic difficulty the children had. That was in the 1960s– 50s/60s. That pretty soon came under attack, because it was so nonspecific. The children with those sorts of problems, of course, had many, many problems. And they weren’t all around concentration or impulse control– reading problems, learning problems and so forth. But, people, at least, acknowledged that group of children existed. The next key stage was over in the States. The American Psychiatric Association, within their Diagnostic and Statistical Manual, started to recognise this group of children. They initially called it ‘reactive disorder of childhood’. Then it quickly evolved into what we know today as ADHD.

First of all, it was described as attention-deficit disorder with or without hyperactivity. That was in the late 1960s/early 1970s. And, gradually, it evolved into what we think of today as ADHD. That can be with attentional problems primarily, or impulsive/hyperactive-type problems primarily, or both together. And that would be in, say, DSM-IV, so the fourth version of this manual. Most recently, what we’ve seen is DSM-5 introduced, which hangs on to many of the aspects of that earlier formulation in the DSM-IV, but it replaced those subtypes in predominantly inattentive, predominantly hyperactive/impulsive and combined type with presentations. Because they questioned how valid were these as separate subtypes of the disorder, because children seemed to flip between one or another of them.

So, that’s DSM-5, published in 2012. In parallel, the World Health Organization catalogue of mental disorders, has had the concept of hyperkinetic disorder, which has sort of evolved, also, over time. And, in fact, the most recent version has essentially come to exactly the same point as the DSM, and both of them have ADHD as their formulation for this group of children. So, is it the case that ADHD is restricted to childhood and adolescence? I mean, certainly initially– the initial formulations focused on childhood. Those very early ones in the 18th and 19th century, going through to the early 20th century.

Really, towards the middle and the end of the 20th century, with the DSM formulations, they were also focused on children and adolescents. But, now we realise that many of those children– we only know this really because we followed those children up– and many of them still either have a full-blown ADHD or, at least, are suffering impairment from ADHD. So, now we really think about ADHD as a lifespan condition, even to the extent, now, that people are calling for or identifying adults who have no history of childhood ADHD but are showing all the symptoms of ADHD in adulthood. So, people are saying, well, actually, we need a new type of ADHD. We need a type called adult-onset ADHD.

And this really illustrates how the concept has evolved since the beginning of the 20th century with George Still– a ‘disorder of moral control’– right the way through to these notions of lifespan ADHD. Well, thank you so much. It’s my pleasure.