How did the view of ADHD and the lives of people with ADHD change over time?

First recognition of ADHD

Sir Alexander Crichton in 1798 was the first to notice a similar disorder to ADHD according to Lange et al. (2010). He studied the attention span of various individuals and noticed some clear differences. His conclusion was that there were 2 explanations of these differences. The first one is that a person can have trouble focusing on one thing for longer periods of time, the second one is completely losing the ability to focus at all. The first problem is caused by the incapacity of attending with a necessary degree of constancy to any one object, which is caused by sensitive nerves. In this first short description of differences in attention Crichton (1798) gives multiple indications that he was talking about ADHD, his definition falls in the current DSM-IV-TR criteria of ADHD.

In 1844 Heinrich Hoffman created a children’s book called ‘‘Struwwelpeter’’, in this book he used many colorful drawings which were used to calm children which he treated as a physician. 1 story called “Fidgety Phil” described a kid who showed a lot of symptoms of ADHD which also fall under the DSM-IV-TR criteria of ADHD, this kid was unable to sit still or listen to the stories his parents told him. This led to his parents getting angry a lot of the time, which is another indicator of ADHD. Although Henrich Hoffman was unfamiliar with the concept of ADHD since it wasn’t known as a disorder at this time, the story is still used quite often to describe children with ADHD.

Franz Kramer 1978-1967 and Hans Pollnow 1902-1943 reported a hyperkinetic disease of infancy, the key symptom of affected children was marked motor restlessness. The authors point out that the symptoms of this “hyperkinetic disease” had previously been observed and described by several authors, but the disorder had not been distinguished from other diseases with similar symptoms, such as the residual effects of the encephalitis lethargica epidemic (Lange et al., 2010). This shows that Kramer and Pollnow were the first to distinguish an attention disorder on its own instead of a symptom from some other brain damage.

Medical History

The Diagnostic and Statistical Manual of Mental Disorders (DSM)* describes recognized mental disorders. It specifies symptoms and other criteria for clinicians to evaluate in order to decide on a diagnosis and organizes these diagnoses together into a classification system. When looking through the history of ADHD these DSM’s are clear landmarks on how far society is in understanding ADHD and its symptoms.

Hyperkinetic reaction of childhood (1968, second edition of the diagnostic and statistical manual of mental disorders: DSM-II)

Introduced as a concept in the mid-20th century, MBD (minimal brain dysfunction) was originally not intended to be a definitive diagnosis, but more of a placeholder. The term persisted into the 1980s but began to face criticism for its inconsistency of symptoms in the 1960s. It was a broad and vague term used to describe behavioral issues thought to be caused by mild problems in the brain. Critics argued the presence of neurodevelopmental abnormalities was broad and common in multiple psychiatric disorders (Schaffe et al., 1985, cited by Conners 2000). Some children with confirmed brain damage did not display hyperactivity, challenging the link between brain dysfunction and behavior.
MBD was criticized for being too general, lacking specificity and empirical basis, and was ultimately replaced by better terms like: Hyperactivity, learning disabilities, dyslexia and language disorders. Rie (1980) emphasized that MBD lacked objective evidence and needed a shift towards observable behaviors instead of possible brain dysfunction.
After research hyperactivity emerged as the most prominent and recognizable symptom, noted as early as 1957 by Laufer, Denhoff, and Solomons.
Their concept of "hyperkinetic impulse disorder" was the start of our modern understanding of ADHD. The term "Hyperkinetic Reaction of Childhood" was included in the DSM-II (1968), marking the first formal recognition of hyperactivity as a mental disorder.

Attention deficit disorder: with and without hyperactivity (1980, third edition of the diagnostic and statistical manual of mental disorders: DSM-III)

During the 1970’s society was busy reframing the disorder, the focus shifted from hyperactivity to attention deficits in children that were affected. Psychologist Virginia Douglas played an important role by arguing that children who do less well in area’s like sustained attention and impulse control should be more important in research compared to children with hyperactivity. Douglas also found out that these symptoms responded better to stimulant medication than hyperactivity. With the creation of DSM-III in 1980, the American Psychiatric Association renamed the disorder from hyperkinetic reaction of childhood to Attention Deficit Disorder (ADD), they recognized ADD in 2 forms, the first one was ADHD with hyperactivity while the second one was just ADD. This change removed hyperactivity from being a central and necessary feature for diagnosis and made attention and impulse control issues more central and important. DSM-III also introduced new ways in which the disorder could be diagnosed. For starters it introduced a symptom list: 1. Inattention 2. Impulsivity 3. Hyperactivity, it also needed a clear age-of-onset criteria and a minimum symptom duration to rule out temporary issues a child could be dealing with. It was also required to rule out other psychiatric disorders in children. The World Health Organization however still emphasized hyperactivity as the biggest symptom of this disorder.

Attention deficit hyperactivity disorder (1994, fourth edition of the diagnostic and statistical manual of mental disorders: DSM-IV)

In the 1980’s researchers were considering the possibility that ADD was not a uniform disorder, but that each case could be different. An example of this was that in the subform of ADD (ADHD) without hyperactivity children could show different behavior compared to other children with the same subform of ADHD. Researchers started rethinking the role of attention and brain function. They became less sure that attention deficits were at the core of this disorder, instead they thought it was possible that motivational factors and reinforcement mechanisms deficits were central to ADD. Advancements in neuroimaging showed that children with ADHD structural abnormalities, especially smaller prefrontal-striatal networks (Attention-deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, 3rd Ed., n.d.). Until the 1990’s ADHD was considered exclusive to childhood, but over the years it became more and more recognized as a chronic condition, adults could also show ADHD symptoms. This was a major discovery in the framework of ADHD. With this discovery DSM-IV was created, which included adult symptoms like trouble with deadlines or general workplace struggles.

Society's view

Since it was a quantitative study we have no direct answers on why they agree, but Bisset speculates that this shift in public view is mostly caused by social media, there are a lot of people on social media showing their difficulties with ADHD, 15 years ago this was not really a thing yet. ADHD was widely known as a disorder that made people more hyperactive and less potent in paying attention. Now almost every student has purposefully or unintentionally gained more of an insight into ADHD and how it works. The idea that some brains are wired differently and the fact that it is not a bad thing has gained traction in youth culture.