The History and Complexity of ADHD

By Nelson Tang

ADHD is probably something that most people have heard or are aware of, but also something they may not fully understand. It also seems like everyone these days has it or so it appears that way. There have been numerous arguments that have been made in recent years that suggest that everyone is on the spectrum in one way or another. However, there has been no conclusive evidence in proving this argument. Much like autism, it is not so easily defined or explained and is on a spectrum. In other words, this means that it will vary from individual to individual, impacting them in different ways and that it is not the same case for everyone. In this article, it will discuss the discovery and history of ADHD. Moreover, it will go over the signs and symptoms associated with this disorder as well as the different kinds of treatment that are available. Lastly, it will talk about the popular discourse on whether or not ADHD can be defined as a disability or if it is simply too broad or complex to be considered as one and take a look at both sides of the dispute. It has been a debate among several fields across the medical and scientific community for a while now. 

ADHD is also known as Attention-Deficit/Hyperactivity disorder and is a disorder that interferes with function or development. It is marked by an ongoing pattern of several types of behaviors, which are inattention, hyperactivity, and impulsivity. Inattention is not due to lack of comprehension or defiance, but rather it is an individual having difficulty staying on task, sustaining focus, and staying organized. Examples of this include overlooking details or making careless mistakes, being easily distracted by minor things or thoughts during times of importance, or not listening when spoken to. Hyperactivity comes in many forms causing a person to move about constantly such as excessive fidgeting, tapping, or talking even during situations that are not appropriate. Other examples include not being able to stay still or sit down or interrupting others by speaking out of turn or finishing other people’s sentences. Impulsivity refers to acting without reason or thinking due to the difficulties of self control. These are the symptoms that most individuals with ADHD have where they have at least one of them or a combination of two. Individuals may also have other conditions such as learning disabilities, anxiety disorder, conduct disorder, depression, and substance use disorder [1].

Despite not determining the root of ADHD, much research seems to indicate that it involves genetics. Other factors involve environmental factors where brain injuries, nutrition, and social environments have been studied to see if they also play a role in the development of ADHD. ADHD seems to be a more common occurrence in males than in females with females more likely to have the symptoms of inattention. It also appears that symptoms can change over time as individuals become older. When it comes to a diagnosis, symptoms need to have been present before the age of 12. Primary care providers are sometimes the ones who diagnose and treat ADHD, but usually they refer to a mental health professional such as a psychiatrist or clinical psychologist. They are more equipped in performing observation and  evaluation before diagnosis. There currently is no cure for ADHD, but there are numerous methods and treatments for it. Such treatments include medications such as stimulants and non-stimulants. Stimulants work by increasing one’s brain chemicals dopamine and norepinephrine, which play essential roles in thinking and attention. Non-stimulants take longer to work and include things such as antidepressants. Moreover, other solutions include psychotherapy and psychosocial interventions, behavioral therapy, cognitive behavioral therapy, family and marital therapy, behavioral parent management training, specific behavioral classroom management interventions or academic accommodations, stress management techniques, or support groups. Lastly, there are clinical trials that involve patients and healthy volunteers [1]. These trials are vital, as they test out new treatments to see if they are safe and more effective than previous treatments. It also aids in furthering the understanding of ADHD and gives way to detecting it more efficiently or preventing it from manifesting.

Over the years, ADHD was referred to as several different things and the results of different things. For example, it was originally considered a defect of moral control following the result of brain damage. It was first discovered and described by Sir George Frederick Still, who was a British pediatrician, in a lecture series at the Royal College of Physicians. Still observed that a group of twenty “behaviorally disturbed” children were easily distractible, inattentive, and unable to focus for long. His conclusions led him to dismiss that it was not related to intelligence or home environment. In 1922, Alfred F. Tredgold who was Britain’s leading expert on mental impairment at the time suggested that ADHD was physiological and the result of brain injury and medicalized the symptoms of the disorder. Researcher Franklin Ebaugh would build upon Tregold’s claim by providing evidence of ADHD arising from brain injury. Benzedrine (amphetamine) would be approved by the FDA as a way of treating ADHD in 1936. Dr. Charles Bradley, who was a psychiatrist at a home for children with emotional problems, noticed a side effect of this new drug. He noted that it improved interest in school, helped academic performance, and decreased disruptive behavior for certain children. It would go on to be renamed hyperkinetic impulse disorder in 1957 up until it was changed again to ADHD as more research and breakthroughs were made. Over the years, the FDA approved more drugs in treating ADHD for different symptoms [5].

One of the major debates surrounding ADHD is whether or not it exists or if it is something that is simply too broad to define as a disability. There are also those who believe that ADHD is something that is overdiagnosed. In other words, there are many sides to the argument among the scientific and medical community with conflicting opinions and evidence to support their claims. Dr. Ralph Lewis, a pyschiatrist, has diagnosed ADHD a few times during his career where it has left him wondering about it. Lewis reflects upon whether it is a real disorder or if it is an evolutionary mismatch or misstep. He does this by rethinking ADHD as a common set of traits and evaluates how it was viewed by different people over the years. Lewis concludes that it is one end of a continuum where one person either has it or that they do not have it [2].

The next side of the argument takes a look at whether or not ADHD is overdiagnosed or not. Julia Childs Heyl, a clinical social worker who focuses on mental health disparities, the healing of generational trauma, and depth psychotherapy, takes a look at reasons that support both sides. Evidence that supports overdiagnosed include the lack of experience of ADHD, diagnostic inflation, or medicalizing normal behavior patterns. On the other hand, Heyl also notes that the recent increase in diagnoses is because that it may have been underdiagnosed in the past. Due to more discoveries and breakthroughs made over the past few decades, there has been a greater understanding and awareness of ADHD [3]. Therefore, it has been easier in detecting ADHD and diagnosing it as a result of this.

Lastly, there is the argument on whether or not ADHD is real or not. Dr. Valentino A. Pironti, a lead psychologist in the field, debunks the myth and those who believe that ADHD does not exist. He dismisses such reasons as “everyone has those symptoms”or by that logic “everyone has ADHD” as these are just oversimplifications. He talks about how those who are doubtful assume that some things are symptoms of ADHD; but in reality, they are not actual symptoms of it. Pironti also argues how behavior has to be “intense and frequent” to be considered as a symptom and debunks the argument of everyone having the symptoms of ADHD. Rather, it is just a coincidence and someone may have common or ADHD-like symptoms without actually having ADHD and that other mental health conditions may be similar. Ultimately, Dr. Pitronti concludes that ADHD is very much a real thing [4]. ADHD may be hard to describe at times as it can be broad and have common symptoms with other disorders, conditions, and disabilities, but it can be defined as a disability. Just like autism, it is something that is more on the spectrum as it impacts individuals in different ways and that is not the same scenario for everyone. Thanks to more research and awareness, we now have a better understanding of ADHD and learn more about it as more discoveries are made. 

References:

[1]. “Attention-Deficit/Hyperactivity Disorder.” National Institute of Mental Health, U.S. Department of Health and Human Services, www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd 

[2]. “Is ADHD a Real Disorder or One End of a Normal Continuum?” Psychology Today, Sussex Publishers, www.psychologytoday.com/us/blog/finding-purpose/202101/is-adhd-real-disorder-or-one-end-normal-continuum

[3]. Julia Childs Heyl, MSW. “Is ADHD Overdiagnosed?” Verywell Mind, 18 Oct. 2023, www.verywellmind.com/is-adhd-overdiagnosed-facts-and-statistics

[4]. Pironti, Dr Valentino A. “Home.” Top Doctors, 11 Feb. 2021, www.topdoctors.co.uk/medical-articles/is-adhd-real-a-top-psychologist-explains-the-truth 

[5]. Rodden, Janice. “The History of ADHD and Its Treatments.” ADDitude, 7 June 2023, www.additudemag.com/history-of-adhd/