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Historical descriptions and names of ADHD


Historical descriptions and names of ADHD

ADHD is not a modern disorder - ADHD has always existed. Historical medical descriptions of ADHD show that symptoms corresponding to today’s concept of ADHD were recognized many centuries ago.

1. Historical medical descriptions of ADHD

Ca. 400 BC: Hippocrates

The Greek physician and scientist Hippocrates described a condition that can be understood as ADHD. The patient showed “accelerated reactions to sensory experiences, but also less persistence, because the soul quickly moves on to the next impression”, which Hippocrates attributed to a “preponderance of fire over water”. Hippocrates recommended “barley instead of wheat bread, fish instead of meat, watery drinks and plenty of natural and varied physical activity”.1
Physical activity (endurance sports) is still a proven treatment method for ADHD with a relevant effect.

Ca. 300 BC: Theophrastus of Eresos

Theophrastus (371 to 287 BC) was a Greek philosopher and natural scientist. He was an important student of Aristotle and, as his successor, head of the Peripatetic school (based on Aristotle’s doctrine) with up to 2,000 students.
In his classic book “Characters”, he described character traits in the chapter “Obtuse Man” that are very similar to the modern description of ADHD. This could be one of the oldest descriptions in Western literature that is compatible with today’s concept of ADHD in adults.2

131 - 201 AD: Galen

Galen described different personality types that are vaguely related to today’s definition of ADHD.3

17. Century: Locke, John (England)

In the 17th century, the English philosopher and physician John Locke wrote a modern essay on child education. In it, Locke described a confused group of young schoolchildren who, despite their best efforts, did not manage to mentally stray.43

1775: Weikard, Melchior Adam (Germany): “Lack of attention / Attentio Volubilis”

In his medical book5, Weikard describes adults and children with an attention deficit as3

  • easily distracted by everything (even your own imagination)
  • persevering
  • overactive and impulsive
  • generally careless, flighty and bacchanalian
  • superficial everywhere
  • mostly reckless
  • highly unstable in design

Weikard described that inattention is more common in younger people than in older people and that women are more inattentive than men.

Weikard attributed this to a general lack of discipline and stimulation, a poor upbringing in early childhood or, even more unusual and new in his day, a dysregulation of brain fibers as a result of over- or understimulation 67

1789: Crichton, Alexander (Scotland): “Disease of attention”

Sir Alexander Crichton (1763-1856) was a well-known Scottish doctor who graduated from Leiden University in the Netherlands and then worked in Paris, Stuttgart, Vienna, Halle, Berlin and Göttingen. Crichton lived in Russia between 1804 and 1819 and was royal physician to Tsar Alexander.
Crichton describes attention problems.83 He already distinguishes between the hyperactive and inattentive subtypes.9

1809: Haslam, John (England)

In 1809, the English physician John Haslam described a toddler who, from the age of two, was spoiled, mischievous and uncontrollable, and who tended to destroy things and was very oppositional and cruel to animals both at school and at home. The child also had a limited attention span.103

1812: Rush, Benjamin (USA): “Syndrome of inability to focus attention”

The American physician Rush describes a case of severe inattention and disorganization that would fit ADHD-I:
The person in question forgets the time while fishing and thus misses his own wedding, falls out of the boat while reading an emotionally moving book, a huge amount of things accumulate in his pockets, he mixes up sheets of paper from different versions of a sermon and has a drinking problem.
Benjamin Rush was one of the members of Congress who signed the Declaration of Independence and is regarded as the “father of American psychiatry”.3

He also describes - possibly by chance - the idea of treatment with stimulants:11
“It is possible moderate depletion, succeeded by constant and noisy company, might produce in the mind a predominance of impressions from present objects, over those of the ideas of absent subjects. Stimulants, particulary such as act upon the brain an nervous system, would probbly be useful, when the disorder arises from torpor of mind, or insensibility of the senses.”

“It is possible that a moderate exhaustion, obtained by a constant and noisy society, may produce in the mind a predominance of impressions of present objects over those of ideas of absent subjects. Stimulants, especially those acting on the brain and nervous system, would probably be useful when the disturbance results from inertia of mind or insensibility of the senses.”

1844: Hoffmann, Heinrich (Germany): “Zappelphilipp” and “Hanns Guck-in-die-Luft”

In his book “Der Struwwelpeter”, the doctor Heinrich Hoffmann described the hyperactive subtype of ADHD with the fidget spinner. In contrast, “Hanns Guck-in-die-Luft” can be seen as a description of the ADHD-I subtype. “Der böse Friederich” describes the frequently comorbid behavioral disorder (conduct disorder, CD).12

1848: West, Charles (England): “The nervous child”

Charles West was an eminent pediatrician at Great Ormond Street Hospital. In his “Lectures on the Diseases of Infancy and Childhood”, he described the new type of difficult child, the “nervous child”, who is neither an idiot nor mentally ill.133

1859: Neumann, Heinrich (Germany): “Hypermetamorphosis”

In 1859, the German psychiatrist Heinrich Neumann used the term “hypermetamorphosis” to describe children. He described them as being unable to concentrate, very unstable in their inclinations, restless, in constant motion, unable to sit still, having difficulty sitting down and showing ambivalent feelings. “Hypermetamorphosis” was later adopted by Wernicke, who was one of his assistants, exclusively for psychotic children.143

1867: Maudsley, Sir Henry (England): “Driven by impulse”

In his book “The physiology and pathology of the mind”, the British psychiatrist Sir Henry Maudsley described the case of a child who “is driven by an impulse, of which he can give no account, to a destructive action, the true nature of which he does not recognize: a natural instinct is exaggerated and perverted by disturbed nerve centers, and the character of its morbid manifestation is often determined by accidents of external circumstances”.153

1877: Ireland, William (Scotland)

The Scottish physician William W. Ireland described behavioral disorders in children that are similar to hyperactivity disorder.163

1880: Beard, George Miller (USA): “Neurasthenia”

The American doctor George Miller Beard developed the medical concept of “neurasthenia”, which is similar to ADHD in many respects.12

1887: Bourneville, Désiré-Magloire (France): “Mental instability”

French doctors described “mental instability” from 1885 onwards. Désiré-Magloire Bourneville at the Bicêtre Hospital in Paris led the way.1718

1890: James, Willliam (USA): “Explosive will”

The American psychologist James William James described impulse control problems in particular.19 In his book “Principles of Psychology”, he described an “explosive will”.3

1890: Von Strümpell, Ludwig (Germany): “Constitutional character defects”

The philosopher and educationalist Ludwig von Strümpell describes restlessness and inattention as “constitutional character defects” in the affected children.12 This corresponds to the model of the genetic causes of ADHD.

1892: Albutt, Thomas Clifford (England): “Unstable nervous system”

Thomas Clifford Albutt described children with an “unstable nervous system” 203

1899: Clouston, Sir Thomas Smith (Scotland): “Overexcitability”

Sir Thomas Smith Clouston was an eminent Scottish psychiatrist. He was chief physician at the Royal Edinburgh Asylum. Clouston was the first official lecturer in mental illness at the University of Edinburgh. In 1899, Clouston published on the “stages of hyper-excitability, hypersensitiveness and mental explosiveness”, which he tried to treat with bromide. Clouston described the symptoms of hyperactivity, impulsiveness and distractibility. Clouston reported three cases of children whom he described as neurotic and who were characterized by hyper-excitability, hypersensitivity and mental explosiveness. He described the hyper-excitable child as “incessantly active, but constantly changing his activity” and suffering from “excessive reactivity of the brain to mental and emotional stimuli”. Even then, he noticed parallels to the overactivity of the motor cortex in epilepsy and suspected overactivity of the nerve cells in the cerebral cortex, as was proven almost 100 years later 21 123

1902: Still, George Frederick (England)

In 1902, the English pediatrician George Frederick Still described 43 children with poor ‘‘moral control’’ in his Goulston Lectures, who were often aggressive, defiant, resistant to discipline and overly emotional or passionate. He described inattention as a central symptom.222324 Still drew the connection to brain damage for the first time.12

1905: Kräplin, Erich (Germany)

Kräplin’s notes represent the beginning of modern psychiatric classification. His descriptions also describe ADHD in adults.25

1905: Specht, Gustav (Germany): “Chronic mania”

Gustav Specht was a psychiatric colleague of Kraepelin in Erlangen and the first director of the Erlangen University Psychiatric Clinic as well as Vice-Rector of the Friedrich-Alexander University Erlangen. Specht was a co-founder of the Erlangen School.

Specht described “chronic mania” as a constitutional psychopathic disorder and differentiated it from phasic forms. He integrated Kraepelin’s querulant mania and described “chronic mania” as “not a rarity”. He described the manic symptoms as a low level of intensity (hypomania), with possible impulsivity (“furious raving”) and “delirious confusion”. He described an ADHD-typical onset in childhood, a hereditary nature of the disorder and the dimensionality of the severity of the disorder. Specht mentions occupations such as “barker” or “joker” as typical.26

1905: Phillipe, Jean; Paul-Boncour, Georges (France): “Unstable children”

Based on Bourneville (1887), Jean Phillipe and Georges Paul-Boncour described a subgroup of “unstable” children within the population of “abnormal” schoolchildren (the terminology of the time) at the beginning of the twentieth century. The new pathological entity of unstable children included symptoms of hyperactivity, impulsivity and inattention, corresponding to the ADHD symptoms known today.27318

1907: Perera, Augusto Vidal (Spain)

Augusto Perera wrote the first Spanish compendium of child psychiatry.28 He describes the effects of inattention and hyperactivity in schoolchildren.29

1908: Tredgold (USA)

Tredgold described a connection between early brain damage, such as that caused by birth defects or perinatal anoxia, and later behavioral disorders or learning difficulties.30 This was bitterly confirmed shortly afterwards by the worldwide encephalitis epidemic from 1917 to 1928, which affected around 20 million people. Encephalitis destroys dopaminergic cells in the brain and thus also triggers ADHD symptoms.31
Encephalitis affected all age groups and caused a variety of neurological symptoms: mainly lethargy and catatonic symptoms and sometimes excited hyperactivity, involuntary movements, sleep disorders, mood swings and manic behavior and, as a late consequence, parkinsonism. Children also developed severe behavioral disorders, emotional instability, compulsive misbehavior and “mental defects”.23

1908, 1916: Czerny, Adalbert (Germany)

Czerny was head of the pediatric clinic at the Charité hospital in Berlin and described children with a conspicuous urge to move, a lack of stamina in class and at play, poor concentration and increased disobedience.12

1910: Nitsche, Paul (Germany): “Chronic manic conditions”

During the Third Reich, Nitsche was one of the masterminds and protagonists of Nazi “euthanasia” and the murder of hundreds of thousands of patients. Prior to this, he was a humane and progressive institutional psychiatrist and left behind an extensive body of purely psychiatric literature.
With reference to Kraeplin, under whom he had worked for several years, Nitsche named a number of symptoms of ADHD: Cases with “manic excitement”, in “a mild, non-psychotic degree”, which at show “slightest motor excitement, an inferior urge to act, sometimes also social inactivity, irritability, tendency to cross-talk”, as well as distractibility, rambling, memory falsification and “temporary reactive fluctuations with very unstable affect”. Nitsche considered the disorder he described to be hereditary.26

1917: Rodriguez-Lafora, Gonzalo (Spain)

The Spanish neurologist and psychiatrist Gonzalo Rodriguez-Lafora describes the symptoms of ADHD in children and explains that they are probably caused by a genetic brain disorder.3229

1926: Homburger, August (Germany)

Homburger describes children with an ADHD-like disorder: “A momentary desire is satisfied in unrelated individual actions without any of them providing satisfaction in their success … All movements are characterized by a certain vehemence and the whole movement pattern is characterized by the lack of regulating dimensions. There is neither sense nor order in all this.”12

1930, 1932: Kramer, Franz and Pollnow, Hans (Germany)

These two doctors published articles on “Hyperkinetic conditions in childhood” and “On a hyperkinetic disorder in childhood”.12 ADHD was then also referred to as Kramer-Pollnow syndrome for a long time.
They described severe and chaotic hyperactivity in the children, frequent learning problems, anxiety and an onset of illness often around the age of 3. Some recovered completely23

1935, Childers, A.T.

Childers found that hyperactive children often come from dysfunctional families.23 This is in line with the current state of research on environmental influences in ADHD.

1937: Bradley, Charles (USA)

Charles Bradley discovered that Benzedrine (DL-amphetamine333435

1954, 1958: Speer, Frederic (USA)

in 1954 and 1958, Frederic Speer published two studies on a new clinical entity, allergic tension-fatigue syndrome (SATFS).
This syndrome defined by Speer contained many symptoms of ADHD.36

1960: Chess, Stella (USA)

Stella Chess wrote one of the first modern descriptions of ADHD in 1960, even before the precursor to ADHD was included in the DSM-II in 1968 as “Hyperkinetic Reaction of Childhood’”.37

2. Historical artistic descriptions

250 BC: Herondas

In an ode, Herondas describes a mother complaining about her son.
He robs her of her last nerve, scratches the blackboard instead of writing nicely on it, doesn’t do any homework, doesn’t learn well, forgets quickly, runs around everywhere and is constantly up to mischief.24

1613: Shakespeare, William

In his play “King Henry VIII”, William Shakespeare describes an adult with serious attention problems. Shakespeare refers to an “attention deficit disorder” in one of his characters.3

1832: Goethe, Johann Wolfgang von

In the second part of Faust, Goethe describes the boy Euphorion as a character of predominant hyperactivity, persistent excessive motor activity and constant impulsive actions. Euphorion pays no attention to his parents’ warnings or to adverse consequences.38

1870: Steen, Jan (Holland)

The Dutch painter Jan Steen may have portrayed children with ADHD-HI or ADHD-C in “The Village School” (around 1670). In contrast, another work by him of the same name shows children who are obedient and behave impeccably.3

1908: Montgomery, Lucy Maude

In her 1908 novel “Anne of Green Gables”, Lucy Maude Montgomery describes the protagonist Anne Shirley as having hyperactive and inattentive characteristics that correspond to the current definition of ADHD.39

in 1963, Astrid Lindgren’s Michel from Lönneberga quite clearly described a boy with ADHD-HI.

3. ADHD in the history of medicine

Despite the centuries-old descriptions of ADHD, it was only medically recognized in the last century. The following description is based on Dodson40 and Strohl41.

At the beginning of the 20th century, a still unknown virus caused a worldwide encephalitis epidemic with many deaths. The significant brain damage and slowed thinking that the adult survivors showed throughout their lives led to the name encephalitis lethargica. Surviving children showed other symptoms, namely hyperactivity, impulsivity and high distractibility. (Even today, viral diseases are a possible cause of ADHD).
In the 1930s, doctors realized that a subset of children with these symptoms had not had encephalitis. Initially, it was assumed that the encephalitis had simply been overlooked and had caused so little brain damage that it was not recognizable. This resulted in the first name for ADHD, “minimal cerebral dysfunction”.
benzedrine, a DL-amphetamine sulphate42, was launched on the market in 1932 for the treatment of asthma and was first used to treat narcolepsy in 1935.
In 1937, Charles Bradley tested mild tranquilizers on a group of severely affected and therefore hospitalized children. Paradoxically, however, these increased hyperactivity and impulsivity.
Bradley initially used Benzedrine not for minimal cerebral dysfunction, but to treat the severe headaches caused by pneumonencephalograms (a visualization technique in which air or gases are introduced into the spine).41 While the Benzedrine was ineffective against the headaches, the children reported to Bradley that they were able to learn much better with it - which was confirmed by their teachers and caregivers. Bradley then began to research the effect of amphetamines on behavioral problems in children. He found that amphetamines, which were first synthesized in 1887, caused a significant improvement in all three cardinal symptoms of minimal cerebral dysfunction (ADHD).

Over the next 50 years, psychostimulants became the central treatment and have remained so to this day, while the name of the disorder has changed several times. It was not until 1980 that the main symptom of inattention found expression in the term attention deficit disorder (ADD).

Bradley’s studies went largely unnoticed for several decades, in part because Bradley could not identify organic causes of the behavioral problems, could not predict which children would respond to the drug, and Benzedrine showed a number of unexplained paradoxical effects. Most child psychiatrists were looking for a clear organic etiology, which is why tranquilizers, which showed clear and reproducible effects, dominated the medication of behavioral disorders41
While Bradley’s studies focused on children with brain disorders, the manufacturer of Benzedrine, Smith, Kline & French, wanted to market the drug to a larger target group of healthy schoolchildren.
At the same time, in the late 1930s, public criticism of the use of amphetamine to enhance mental performance first arose due to newspaper reports of abuse scandals among students, which coincided with reports from the medical community of addiction risks. As a result, Smith, < Kline &amp; French advised against further research with Benzedrine and its use for the treatment of behavioral disorders was discontinued41
Doubts about the existence of ADHD and treatment with stimulants were later promoted by a campaign by the Church of Scientology.40

In the 1950s, psychiatrists increasingly turned their attention to the specific behavioral disorder of hyperactivity and began to use amphetamines and related stimulants for the regular treatment of behavioral problems. Bradley’s studies were also taken up again and served as a starting point for further research into stimulants for the treatment of hyperactivity.41

Methylphenidate was first used to treat narcolepsy in 1958 and was approved by the FDA in 1968 to treat ADHD, then called “childhood hyperactive reaction disorder”. Methylphenidate soon displaced amphetamines as the most widely used active ingredient, not because of a better effect, but because of the social concerns that had grown as a result of the Scientology campaign and the drug abuse of the hippie culture.40

In 1971, Wender was one of the first to research a connection between ADHD and catecholamines. In the urine samples he examined, however, no correlations could be found (as is still the case today),43 because the changes in catecholamine levels in the brain do not affect the body.
In 1976, Kalat hypothesized for the first time that ADHD was due to a dopamine deficiency and a delay in brain development, while at the same time assuming excessive noradrenaline levels.44 4 months later, Shaywitz et al showed the first evidence of reduced dopamine turnover in ADHD45
in 1991, Levy presented his dopamine hypothesis for ADHD, according to which a lack of dopamine in certain regions of the brain (cortex and striatum) causes ADHD symptoms,46 which is now widely accepted.
At the end of the 1990s, research into dopamine in ADHD rapidly gained momentum, peaking around 2012. From 2017 onwards, the number of publications on dopamine in ADHD fell again by around a third

The current name Attention Deficit Hyperactivity Disorder was manifested in 1980 / 1987 by DSM-III and DSM-III-R.
in 1990, it was included in the ICD 10 as a “simple disorder of activity and attention”.

in 2003, the first guideline on “ADHD in adulthood” was published in Germany.

A review by the American Medical Association confirmed this in 1998:
“Overall, ADHD is one of the best-researched disorders in medicine, and the overall data on its validity is far more compelling than for many other medical conditions.”47

4. Other and older names of ADHD

  • ADHD - Attention Deficit Hyperactivity Disorder: common international term, refers to the totality of all subtypes
  • ADHD-C - Attention Deficit Hyperactivity Disorder, Combined Type (presentation form (subtype): ADHD-C)
  • ADHD-HI, ADHD-H/I, ADHD-H, ADHD-PH - Attention Deficit Hyperactivity Disorder, Predominantly Hyperactive (subtype: predominantly hyperactive)
  • ADHD-I, ADHD-PI - Attention Deficit Hyperactivity Disorder, Predominantly Inattentive (presentation form (subtype): predominantly inattentive)
  • ADD - Attention Deficit Disorder (subtype: predominantly inattentive, international term)
  • ADD-H - Attention Deficit Disorder + Hyperactivity (presentation form (subtype): predominantly hyperactive, outdated international term)
  • ADDRET ADD Residual Type
  • ADD - attention deficit/hyperactivity disorder (presentation form (subtype): predominantly inattentive, colloquial)
  • ADHD - attention deficit/hyperactivity disorder
    • On the one hand: collective term for ADHD with all subtypes
    • On the other hand, sometimes colloquial term for the presentation forms (subtypes) with hyperactivity/impulsivity (ADHD-HI and ADHD-C), in distinction to ADHD without hyperactivity
  • Attention and hyperactivity disorder (designation according to DSM-III-R, 1987)
  • Attention deficit disorder with/without hyperactivity (designation according to DSM-III, 1980)
  • DAMP - Deficits in Attention, Motor Control and Perception. Common term for ADHD-HI in Scandinavia.
  • Figyelemhiányos hiperaktivitás-zavar - ADHD in Hungarian
  • Brain dysfunction, mild or minimal
  • Hyperkinetic behavior syndrome: term for ADHD in the 1970s43
  • HKS - Hyperkinetic syndrome / Hyperkinetic disorder (designation according to ICD 9, 1982)
  • Hyperactive children (for ADHD-HI)
  • Hyperactivity disorder (for ADHD-HI)
  • Hyperkinesis
  • Hypoactivity (subtype: predominantly inattentive, Simchen)
  • Kramer-Pollnow syndrome (after the authors of “Hyperkinetische Zustandsbilder im Kindesalter”, 1930 and “Über eine hyperkinetische Erkrankung im Kindesalter”, 1932)19
  • MBD - Minimal Brain Damage / Minimal Brain Dysfunction: term for ADHD in the 1970s43
  • McD - Minimal cerebral dysfunction: term for ADHD in the 1970s43
  • MzD - Minimal cerebral dysfunction: term for ADHD in the 1970s43
  • PSO - Psychoorganic Syndrome (Switzerland)
  • Sensory integration disorder
  • (Síndrome de) Déficit de Atención con Hiperactividad (TDAH) - ADHD in Spanish
  • Partial performance disorders (rather inaccurate, actually refers to dyslexia, dyscalculia, face blindness and other partial performance disorders)
  • Trouble déficit d’attention/hyperactivité (Trouble du déficit de l’attention avec ou sans hyperactivité) (TDAH) - ADHD in French
  • Undifferentiated attention-deficit disorder / Undifferentiated attention-deficit disorder (UADD)
    • The term was first used in the DSM-III-R of 1987 for a mixed category without formal diagnostic criteria. UADD corresponds roughly to ADHD-I. In the DSM-III-R (1987), an ADHD diagnosis at that time also required hyperactive-impulsive symptoms.
  • Delayed brain maturation
  • Perceptual disturbance
  • Central auditory processing disorder

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  2. Victor, da Silva, Kappel, Bau, Grevet (2018): Attention-deficit hyperactivity disorder in ancient Greece: The Obtuse Man of Theophrastus. Aust N Z J Psychiatry. 2018 Jun;52(6):509-513. doi: 10.1177/0004867418769743. PMID: 29696989.

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  7. Dr. Russell Barkley 2014 Sluggish Cognitive Tempo ADD vs ADHD Lynn Univ Transitions, ca. bei 02:40

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  26. Steinberg, Strauß (2022): Die Aufmerksamkeitsdefizit‑/Hyperaktivitätsstörung (ADHS) bei Erwachsenen in den klinischen Beschreibungen und klassifikatorischen Reflexionen von Gustav Specht (1905) und Hermann Paul Nitsche (1910) [Adult attention deficit hyperactivity disorder (ADHD) in the clinical descriptions and classificatory reflections of Gustav Specht (1905) and Hermann Paul Nitsche (1910)]. Nervenarzt. 2022 Jul;93(7):735-741. German. doi: 10.1007/s00115-021-01233-7. PMID: 34820682; PMCID: PMC9276547.

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  32. Lafora (1917): Los Niños Mentalmente Anormales. Madrid

  33. Iversen L, Iversen F, Bloom S, Roth R (2009): Introduction to Neuropsychopharmacology, S. 448}}) die Verhaltensauffälligkeiten von ADHS verbessern konnte, nachdem ihm zuvor verhaltensauffällige Kinder, die Benzedrin gegen Kopfschmerzen erhalten hatten, berichteten, dass sie damit deutlich besser lernen konnten und die Lehrer und Bezugspersonen diese Beobachtungen bestätigten.{{

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