Understanding ADHD: Current Research and Practice | Week 1 | Step 1.

6 |
Introducing ADHD

The history of ADHD Please note that this is

a transcript of an online
Dr Mark Kennedy | Senior Research Fellow and Researcher lecture or interview, and
Professor Edmund Sonuga-Barke | Professor of Developmental Psychology, is not an academic paper.
Psychiatry and Neuroscience

Dr Mark Kennedy: 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?

Professor Sonuga-Barke: 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.

Dr Mark Kennedy: So, is it the case that ADHD is restricted to childhood and
adolescence?

Professor Sonuga-Barke: 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.

Dr Mark Kennedy: Well, thank you so much.

Professor Sonuga-Barke: It's my pleasure.