Timeline of the Evolution of ADHD Understanding
Timeline of the Evolution of ADHD Understanding
Attention deficit hyperactivity disorder (ADHD) may be a popular topic today, dominating headlines and online discussions. However, what might surprise many is that its roots delve deep into history, spanning centuries of gradual understanding.
From the late 18th century, when attention difficulties in children were first documented by Crichton, to the groundbreaking observations of Bradley in the mid-20th century, the journey of understanding ADHD has been long and complex, and continues to this day.
As we zoom in on our history of understanding ADHD, we not only witness the evolution of diagnostic frameworks but also witness the changing societal attitudes towards the neurodiverse condition.
History of ADHD: A Timeline:
- 1798: Crichton publishes a book with a chapter titled ‘On attention and its diseases’ discusses attention difficulties in children.
- 1846: It is thought that one of the earliest accounts that included both a focus on inattention and hyperactivity is that written by the psychiatrist Hoffman to capture the hyperactivity of Zappel-Phillip (fidgety Phillip) in 1846 (Dobson, 2004).
- 1902: Sir George Frederic Still defines cases of children with a “defect in moral control as a morbid fascination, without general impairment of intellect and without physical disease,” laying early groundwork for understanding ADHD symptoms.
- 1932: Kramer and Pollnow identify symptoms of motor-restlessness in children, leading to the concept of “Hyperkinetic disease,” (Kramer and Pollnow, 1932) which shares core symptoms with ADHD.
- Late 1930s: Charles Bradley observes stimulants improving attention outcomes in children with emotional problems, setting the stage for stimulant treatment of ADHD symptoms.
- 1980: The third edition of the DSM changed the name to “attention deficit disorder” (ADD), recognizing two subtypes: ADD with hyperactivity and ADD without hyperactivity.
- 1987: A revised version of the DSM-III renamed the condition to “attention deficit hyperactivity disorder” (ADHD) and combined the subtypes into a single diagnosis.
- Mid-1990s: ADHD is still predominantly viewed as a childhood disorder in boys, with limited recognition of adult ADHD.
- 2000s: Establishment of adult ADHD clinics in the UK to meet the needs of young adults diagnosed in childhood and undiagnosed adults.
- Present: The current DSM-5 shows ADHD is now situated under ‘neurodevelopmental disorders,’ a shift from the previous classification under ‘disorders usually diagnosed in infancy, childhood, and adolescence.’
Despite recognition in diagnostic systems, ADHD remains under-recognised, with doubts about its validity and treatment. However, it’s considered one of the most treatable disorders in psychiatry, with significant undertreatment noted by experts like Dr. Barkley.
As Dr Barkley noted in his Keynote speech at the Burnett lecture in 2012. “This is the most treatable disorder that we face, the biggest problem is that most people don’t get treatment, 40% of children and 90% percent of adults with ADHD are not recognised or treated for their disorder. That is the problem. Not that we are overtreating, we are undertreating, and we are undertreating the most treatable disorder in psychiatry.”
Just like with autism, many academics, ADHD advocates, and experts argue the need to de-medicalise ADHD. This, for many, starts with renaming it and moving away from seeing ADHD as an attention deficit and capitalising on a strengths-based approach where the right environment and support can make ADHD traits a considerable asset.
Drs Ratey and Hallowell write: “ADHD Is Not a Deficit Disorder. ADHD is an inaccurate — and potentially corrosive — name. The term “deficit disorder” places ADHD in the realm of pathology, or disease. Individuals with ADHD do not have a disease, nor do they have a deficit of attention; in fact, what they have is an abundance of attention. The challenge is controlling it.
“Therefore, we argue that a more accurate descriptive term is “variable attention stimulus trait” (VAST), a name that allows us to “de-medicalize” ADHD and focus instead on the huge benefits of having an ADHD brain.”
Attention Deficit Hyperactivity Disorder (ADHD)
ADHD is characterised by a predominance of either inattentive or hyperactive-impulsive symptoms, or a combination of both. The condition involves challenges in managing attention, with considerable variability in how individuals focus on tasks based on their relevance. ADHD individuals often seek sensory stimulation and may have a strong need for movement, which can aid in concentration, anxiety regulation, or serve as a form of release. Organisational tasks can be particularly challenging, and there may be difficulties in retaining information in working memory. Written instructions or note-taking can be beneficial. Support in breaking down tasks and managing organisation is often needed.
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Neurodiversity
Neurodiversity acknowledges the natural variations in human brain function and behavioural traits as integral to human diversity, viewing conditions like autism, ADHD, dyslexia, dyspraxia, and dyscalculia not as disorders but as different aspects of neurocognitive functioning. It advocates for societal shifts towards greater acceptance, rights, and accommodations for those with neurological differences, emphasizing inclusion and support. The concept of a "spiky profile" integrates with this view, illustrating how individuals may exhibit significant strengths in certain areas while facing challenges in others, further highlighting the diverse spectrum of human abilities and the need for tailored support.
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Dyspraxia
Dyspraxia affects both fine and gross motor skills, significantly impacting writing, typing, and self-care activities. Dyspraxic individuals may also face challenges with memory, attention, perception, and processing, leading to difficulties in planning, organisation, executing actions, or following instructions in the correct order.
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Dyscalculia
Individuals with dyscalculia struggle with mastering arithmetic skills, calculations, number sense, and mathematical reasoning. Challenges often extend to understanding quantities, time, and abstract numerical concepts. Dyscalculia is frequently accompanied by working memory difficulties. Approximately 50% of individuals with dyscalculia also face reading challenges, and many experience significant maths anxiety.
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Dyslexia
Dyslexia is a learning difficulty that affects the ability to develop automatic and fluent word reading and spelling skills. It is often associated with challenges in phonological awareness, which involves understanding and manipulating the sounds in words, and may also impact orthographic processing—the recognition of whole words, letter strings, or spelling patterns. Dyslexic individuals might be self-conscious about reading aloud, which can also hinder comprehension, and may avoid using complex vocabulary in writing to prevent spelling errors. Though not officially part of the diagnostic criteria, dyslexic individuals often struggle with organisation, sequencing, and may have low academic self-esteem. A notable discrepancy exists between their confidence in verbal tasks versus written tasks.
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Autism
According to current diagnostic criteria, autistic individuals face challenges primarily in social communication and exhibit restricted, repetitive patterns of behaviour. The severity of these challenges can vary significantly. Many autistic individuals have sensory sensitivities that are particularly challenging in new and unfamiliar environments. Furthermore, they often prefer structured and predictable settings, benefiting from ample time to process information and adapt to changes. Social anxiety can pose a significant challenge in unstructured and unpredictable social situations. While the challenges of autism might be less visible in certain settings, they can still have a profound, cumulative effect on mental health, well-being, and may lead to burnout.
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