A History of ADHD

All children have difficulty sitting still, paying attention, and waiting their turn some time or another. So why are these behaviors increasingly being classified as Attention-Deficit Hyperactivity Disorder (ADHD)? I often hear this question from parents and acquaintances alike.

Public skepticism has surged in the past two decades over the rising rates of ADHD diagnoses. While the contemporary concept of ADHD as defined in the DSM-5 is relatively new, excessive hyperactive, inattentive, and impulsive children have been described in the literature since the nineteenth century.

Medical documentation of ADHD was first detailed in 1902 by a British pediatrician, ironically named Sir George Still. He found that some affected children could not effectively control their behavior. Over the past century, detailed studies of the behavior of hyperactive children and increasing knowledge of brain function have changed the concepts of the fundamental behavioral and neuropathological deficits underlying the disorder. It is true that the rate of diagnosed ADHD in children has increased approximately 5% every year (National Survey of Children’s Health, 2003—2011).

This has led many to wonder if the condition is being over-diagnosed. But the report based on the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome found that children are being carefully diagnosed by healthcare practitioners. The vast majority (9 out of 10) of the 2,976 children diagnosed with ADHD had been diagnosed by practitioners using best practice guidelines (Visser et al. 2015).

Possible explanations for increased diagnostic rates include improved awareness about ADHD among healthcare practitioners and parents, more screenings by pediatricians and other primary care givers, decreased stigma about ADHD, availability of better treatment options, and more cases arising from suspected environmental causes such as prenatal exposure to toxins or high blood lead levels. Determining whether a child, adolescent, or young adult has ADHD is a complex process. Next month, I will review the signs and symptoms that warrant a diagnostic evaluation.