If you were to believe current popular media, you might think that ADHD is a current fad – the "illness du jour." Nothing could be further from the truth. The name has changed over the years, but the symptoms that we now call ADHD have been evident in children for many years. In order to better understand the disorder, some background and history may be helpful.
The first known published description of the symptoms of what today is ADHD was written by Dr. Heinrich Hoffmann in 1844. In 1902, George Still, an English pediatrician, observed in his clinic the behaviors of forty-three children who were having difficulty with sustained attention. He also observed that these children were sometimes aggressive, mean and dishonest. He called this cluster of symptoms "a morbid defect of moral control." Dr. Still theorized that these children's behaviors were caused by a medical condition and that their behavior was beyond their control. Additionally, he recognized a hereditary link to the disorder.
After an encephalitis epidemic in 1917, many of the children who survived the illness began displaying the same cluster of symptoms described more than a decade earlier by Dr. Still. This led to the name, "Post-Encephalitic Behavior Disorder." These children were observed to have difficulty with sustained attention and impulse control. Doctors theorized that the children's encephalitis had resulted in some type of damage to the brain. Once again, it was proposed that something organic caused these behaviors, and that it was not just a matter of a "bad kid" or "bad parenting."
In 1947, as soldiers were returning home from World War II, physicians began noticing that those who had sustained injuries to the brain had difficulty concentrating and were hyperactive. The similarity between these soldiers' behaviors and the behaviors displayed by children who had survived encephalitis further supported the idea that the behaviors in the children must have been caused by some unnoticed brain injury.
This led to the name, "Minimal Brain Damage." However, as doctors continued to study the brain as well as the symptoms, it became apparent that these children, for the most part, did not have any brain damage! So the name changed again in 1960 – this time to "Minimal Brain Dysfunction." By 1968, the name had become "Hyperkinetic Reaction of Childhood." When the Diagnostic and Statistic Manual, Third Edition (DSM-III) was published in 1980, it contained diagnostic criteria for what was being called "Attention Deficit Disorder." During this time, the media discovered the disorder and the name "ADD" became a staple of our language. (The DSM, which is now in its fifth edition, is the "bible" of behavioral and psychological disorders.)
The disorder's name would change one more time. When the DSM-III-R was published in 1987, the disorder was called "Attention Deficit Hyperactivity Disorder" or "ADHD." There still is some confusion about whether a child has "ADD" or "ADHD," but for diagnostic purposes, it is now all "ADHD."
Why all the name changes? First, this disorder has been studied extensively for more than a century. In fact, it may be the most studied disorder in child psychology. As we develop a better understanding of the issues involved, the name occasionally changes to better reflect what we believe is actually happening. And since we still are not sure and are continuing to study the disorder, we will continue to refine the name.
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