Historical descriptions of ADHD

ADHD is not a recent disorder - ADHD has always existed. Below are some accounts of ADHD by historical physicians.

• 1. Historical medical descriptions of ADHD
  • Ca. 400 BC: Hippocrates
  • Ca. 300 BC: Theophrastus of Eresos
  • 131 - 201 AD: Galen
  • 17. Century: Locke, John (England)
  • 1775: Weikard, Melchior Adam (Germany): “Lack of Attention / Attentio Volubilis”
  • 1789: Crichton, Alexander (Scotland): “Disease of Attention”
  • 1809: Haslam, John (England)
  • 1812: Rush, Benjamin (USA): “Syndrome of inability to focus attention”
  • 1844: Hoffmann, Heinrich (Germany): “Zappelphilipp” and “Hanns Guck-in-die-Luft
  • 1848: West, Charles (England): “The Nervous Child”
  • 1859: Neumann, Heinrich (Germany): “Hypermetamorphosis
  • 1867: Maudsley, Sir Henry (England): “Driven by impulse”
  • 1877: Ireland, William (Scotland)
  • 1880: Beard, George Miller (USA): “Neurasthenia”
  • 1887: Bourneville, Désiré-Magloire (France): “Mental instability”
  • 1890: James, Willliam (USA): “Explosive will”
  • 1890: Von Strümpell, Ludwig (Germany): “Constitutional Defects of Character”
  • 1892: Albutt, Thomas Clifford (England): “Unstable nervous system”
  • 1899: Clouston, Sir Thomas Smith (Scotland): “Overexcitability”
  • 1902: Still, George Frederick (England)
  • 1905: Kräplin, Erich (Germany)
  • 1905: Specht, Gustav (Germany): “Chronic mania”
  • 1905: Phillipe, Jean; Paul-Boncour, Georges (France): “Unstable Children”
  • 1907: Perera, Augusto Vidal (Spain)
  • 1908: Tredgold (USA)
  • 1908, 1916: Czerny, Adalbert (Germany)
  • 1910: Nitsche, Paul (Germany): “Chronic manic states”
  • 1917: Rodriguez-Lafora, Gonzalo (Spain)
  • 1926: Homburger, August (Germany)
  • 1930, 1932: Kramer, Franz and Pollnow, Hans (Germany)
  • 1935, Childers, A.T..
  • 1937: Bradley, Charles (USA)
• 2. Historical artistic descriptions
  • 250 BC: Herondas
  • 1613: Shakespeare, William
  • 1832: Goethe, Johann Wolfgang von
  • 1870: Steen, Jan (Holland)
  • 1908: Montgomery, Lucy Maude

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 size.

Ca. 300 BC: Theophrastus of Eresos¶

Theophrastus (371 to 287 BC) was a Greek philosopher and naturalist. He was an important student of Aristotle and, as his successor, head of the peripatetic (based on the thinking/teaching of Aristotle) school with up to 2000 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 may 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 students who, despite intensive efforts, failed to digress mentally.⁴³

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

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

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

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, poor upbringing in early childhood, or, more unusually and more recently in his time, to dysregulation of brain fibers due to over- or under-stimulation ⁶⁷

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

Sir Alexander Crichton (1763-1856) was a prominent Scottish physician who received his doctorate from Leiden University in the Netherlands and subsequently worked in Paris, Stuttgart, Vienna, Halle, Berlin, and Göttingen. Crichton lived in Russia in 1804 and 1819 and was royal personal physician to Tsar Alexander.
Crichton describes attention problems.⁸³ He already distinguishes the hyperactive and inattentive subtype.⁹

1809: Haslam, John (England)¶

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

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

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

In addition, he describes - possibly rather accidentally - 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 and nervous system, would probbly be useful, when the disorder arises from torpor of mind, or insensibility of the senses.”

“It is possible that moderate exhaustion, brought about by 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 physician Heinrich Hoffmann described the hyperactive subtype of ADHD with the “Zappelphilipp”. Hanns Guck-in-die-Luft“, on the other hand, can be understood as a description of the ADHD-I subtype. “Der böse Friederich” describes the frequently comorbid 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 a mental patient.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, highly volatile in their tendencies, restless, in constant motion, unable to sit still, having difficulty sitting down, and showing conflicting emotions. “Hypermetamorphosis” was later adopted exclusively for psychotic children by Wernicke, who was one of his assistants.¹⁴³

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

The British psychiatrist Sir Henry Maudsley, in his book “The physiology and pathology of the mind,” 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 of children similar to those of hyperactivity disorder.¹⁶³

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

American physician George Miller Beard developed the medical concept of “neurasthenia,” which resembles ADHD in many respects.¹²

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

French physicians described “mental instability” from 1885 on. Leading in this was Désiré-Magloire Bourneville at the Bicêtre Hospital in Paris.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 Defects of Character”¶

The philosopher and educator Ludwig von Strümpell describes restlessness and inattention as “constitutional character defects” of the affected children.¹² This corresponds to the model of 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 a senior physician at the Royal Edinburgh Asylum. Clouston was the first official lecturer in mental illness at Edinburgh University. Clouston published in 1899 on the “stages of hyperexcitability, hypersensitiveness, and mental explosiveness,” which he attempted to treat with bromide. Clouston described the symptoms of hyperactivity, impulsivity, and distractibility. Clouston reported three cases of children he described as neurotic, characterized by hyperexcitability, hypersensitivity, and mental explosiveness. He described the hyper-excitable child as “ceaselessly active, but constantly changing his activity” and suffering from “excessive responsiveness of the brain to mental and emotional stimuli.” He noted parallels even then with the hyperactivity of the motor cortex in epilepsies and suspected overactivity of neurons in the cerebral cortex, as was proven almost 100 years later ^{21 123}

1902: Still, George Frederick (England)¶

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

1905: Kräplin, Erich (Germany)¶

Kräplin’s records represent the beginning of modern psychiatric classification. His accounts 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 Neurological Clinic as well as prorector of the Friedrich Alexander University in Erlangen. Specht was a co-founder of the Erlangen School.

Specht described “chronic mania” as a constitutional psychopathic disorder and distinguished it from phasic forms. He integrated Kraepelin’s Querulantenwahn and described “chronic mania” as “not belonging to the rarities”. He described manic symptomatology as low intensity level (hypomania), with possible impulsivity (“furibund raving”) and “delirious confusion.” He posited an ADHD-typical onset in childhood, verbosity of the disorder, and 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” school children (the terminology of the time) in the early twentieth century. The new pathological entity of unstable children included symptoms of hyperactivity, impulsivity, and inattention, corresponding to the ADHD symptoms we know 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 school children.²⁹

1908: Tredgold (USA)¶

Tredgold described a link 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 thereafter by the worldwide encephalitis epidemic of 1917 to 1928, which affected about 20 million people. Encephalitis destroys dopaminergic cells in the brain and thus also triggers ADHD symptoms.³¹
Encephaltis affected all age groups and caused multiple neurological synptoms: mainly lethargy and catatonic symptoms, and sometimes excited hyperactivity, involuntary movements, sleep disturbances, mood swings and manic behavior, and as a late sequela, 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 lessons as well as in play, a poor ability to concentrate, and increased disobedience.¹²

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

Nitsche was one of the masterminds and acting agents of Nazi “euthanasia” and the murder of hundreds of thousands of patients during the Third Reich. Before that, 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 some years, Nitsche named several symptoms of ADHD: cases with “manic excitement”, in “a lightest, not psychotic degree”, who show with “lightest motor excitement, an inferior urge to act, partly also social inactivity, irritability, tendency to cross-talk”, as well as distractibility, prolixity, memory falsifications and “transient reactive fluctuations with very labile affect”. Nitsche considered the disorder he described to be hereditary.²⁶

1917: Rodriguez-Lafora, Gonzalo (Spain)¶

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

1926: Homburger, August (Germany)¶

Homburger describes children with an ADHD-like pattern of disorders: “In unrelated individual actions, an instantaneous desire is satisfied without any of them granting 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. In all this there is neither sense nor order.”¹²

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

These two physicians published articles on “Hyperkinetic Conditions in Childhood” and “On a Hyperkinetic Disorder in Childhood.”¹² ADHD was then also called Kramer-Pollnow syndrome for a long time.
They described in the children severe and chaotic hyperactivity, frequent learning problems, anxiety showed and an onset of illness often around the age of 3. Some recovered completely²³

1935, Childers, A.T..¶

Childers found that hyperactive children were more likely to come from dysfunctional families.²³ This is consistent with current research on genetic and environmental influences.

1937: Bradley, Charles (USA)¶

Charles Bradley discovered that Benzedrine (an amphetamine) could improve the behavioral problems of ADHD after previously behaviorally challenged children who had received Benzedrine for headaches reported to him that it helped them learn significantly better, and teachers and caregivers confirmed these observations.³³³⁴³⁵

2. Historical artistic descriptions¶

250 BC: Herondas¶

Herondas describes in an ode a mother complaining about her son.
He steals her last nerve, scratches the blackboard instead of writing nicely on it, does no homework, learns badly, forgets quickly, gymnastics everywhere and constantly makes nonsense.²⁴

1613: Shakespeare, William¶

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

1832: Goethe, Johann Wolfgang von¶

In the second part of Faust, Goethe describes with the boy Euphorion a character of predominant hyperactivity, persistent excessive motor activity and constant impulsive actions. Euphorion pays no attention to the warnings of his parents or to adverse consequences.³⁶

1870: Steen, Jan (Holland)¶

The Dutch painter Jan Steen may have portrayed children with ADHD-HI or ADHD-C in “The Village School” (c. 1670). In contrast, another work by him of the same name shows children who obey 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 consistent with the current definition of ADHD.³⁷

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