Although most of these symptoms are not directly associated with the current concept of ADHD, the keynote identified by Still fits an important finding of modern ADHD research. These descriptions are similar to the current concept of impulsivity.
Although not explicitly mentioned in DSM-IV-TR, impulsivity as a main symptom of ADHD is often associated with a lack of emotional impulse control, a low frustration tolerance and some abrupt outbursts of rage Barkley b. Still describes some cases with signs of impulsivity,. Difficulties at school are frequently observed in children with ADHD. Some of the cases cited by Still showed remarkable symptoms of inattention, for example,.
Another boy, aged six years, with marked moral defect was unable to keep his attention even to a game for more than a very short time, and, as might be expected, the failure of attention was very noticeable at school, with the result that in some cases the child was backward in school attainments, although in manner and ordinary conversation he appeared as bright and intelligent as any child could be Still, , p.
He furthermore described children who pathologically stole or lied with extraordinary insensitivity to any punishment, children who were aggressive and attacked strange children or threatened to hurt their mothers Still , p.
Still did not predominantly refer to inattentive-impulsive children, but rather described several types of deviant behavior observed in children. Among these cases, there were probably also some cases of ADHD such as the ones depicted above. Hyperactivity as a main symptom of ADHD is hinted at in one case, i. This was confirmed by the encephalitis lethargica epidemic, which spread around the world from to and affected approximately 20 million people Conners ; Rafalovich The residual effects appeared as fatal as the encephalitis itself.
The disease was thought to irreversibly damage the patients physically or mentally Rafalovich Many of the affected children who survived the epidemic encephalitis, subsequently showed remarkably abnormal behavior. Many descriptions of children with this disorder include some characteristic symptoms of ADHD, and some behaviors of postencephalitic cases might also be attributed to ADHD. Most of the afflicted children, however, would not have met the current ADHD criteria.
The era of the postencephalitic child pursued the course of Still and explained unconventional behavior of children physiologically and medicalized deviant child behavior. The most characteristic symptom of affected children was a marked motor restlessness Kramer and Pollnow , p. In their cases, the authors observed no bodily symptoms, sleep disturbances, or nocturnal agitation, which were specific to the postencephalitic behavior disorder Kramer and Pollnow , p.
In contrast to the postencephalitic motor drive, the restlessness observed in the cases of Kramer and Pollnow could be observed only by day Kramer and Pollnow , p. According to Kramer and Pollnow, the most obvious symptom of children with hyperkinetic disease is a remarkable motor activity, which appears to be very urgent Kramer and Pollnow , p.
These children cannot stay still for a second, run up and down the room Kramer and Pollnow , p. This description is very similar to the current characterization of hyperactivity, one of the main symptoms of ADHD. Kramer and Pollnow furthermore consider the observed motor activity as being characterized by a conspicuous lack of purposefulness Kramer and Pollnow , p.
Children with hyperkinetic disease indiscriminately touch or move everything available without pursuing a goal Kramer and Pollnow , p. They often do not use objects according to their function, but regard them as stimuli inducing activity Kramer and Pollnow , p. These children switch the light on and off, move chairs around the room, climb the table, the cupboard or the windowsill, jump around in their beds, turn keys in the keyhole, rip paper, go round in circles, throw objects out of the window, or beat their toys rhythmically on the floor without any purpose Kramer and Pollnow , p.
This aimlessness of action exemplified by quickly changing activities is possibly due to a distinct distractibility by new and intensive stimuli, which is another symptom mentioned by Kramer and Pollnow. The children described by Kramer and Pollnow often cannot complete a set task or do not answer to questions Kramer and Pollnow , p. They are unable to concentrate on difficult tasks Kramer and Pollnow , p.
These descriptions comply with the second main symptom of ADHD, i. This symptom is also described by Kramer and Pollnow as a further characteristic of the hyperkinetic child. According to these authors, hyperkinetic children show no perseverance in their activities, e. However, Kramer and Pollnow also noticed that the children were able to persevere at some activities of their interest for hours Kramer and Pollnow , p.
Both a lack of perseverance and the ability to concentrate on certain tasks can be observed in children with ADHD. Kramer and Pollnow describe furthermore that the children are unstable in their mood Kramer and Pollnow , p.
They observed an increased excitability, frequent fits of rage, and a tendency to become aggressive or to burst into tears for marginal reasons Kramer and Pollnow , p. These are characteristic signs of impulsivity, and all main symptoms of ADHD are therefore present in the record of Kramer and Pollnow. The description of the hyperkinetic disease also meets another criterion of ADHD.
Kramer and Pollnow describe that hyperkinetic children are often disobedient Kramer and Pollnow , p. At school, they may cause confusion or disturb the class Kramer and Pollnow , p. They often have difficulty playing harmoniously with other children and are generally unpopular among peers Kramer and Pollnow , p.
This criterion is also met by the cases of Kramer and Pollnow, since they reported an age of onset of the hyperkinetic disease as early as three or 4 years and a peak at the age of six. In many cases of Kramer and Pollnow, the abnormal behavior occurred following a feverish disease or epileptic convulsion Kramer and Pollnow , p. Kramer and Pollnow describe that the characteristics of the disorder, especially the motor restlessness, decline in intensity by the age of seven, and in most cases, the children recover in the subsequent years Kramer and Pollnow , p.
Since Kramer and Pollnow considered abnormal motor activity as the most characteristic symptom of the disorder, they possibly regarded affected children as recovered when, regardless of other symptoms, this sign receded. The introductory remark of Kramer and Pollnow that the pathological manifestation of the disorder had been known previously, but had not been recognized as a distinct disorder which had to be differentiated from other disorders with similar symptoms, is consistent with the historical literature.
In summary, Kramer and Pollnow established a concept of the hyperkinetic disease that closely resembles the current concept of ADHD. In , Charles Bradley reported a positive effect of stimulant medication in children with various behavior disorders Bradley This usually caused severe headaches, which were supposed to be the result of a significant loss of spinal fluid. However, benzedrine had a negligible effect on the headaches, but caused a striking improvement in behavior and school performance in some of the children Brown ; Gross Bradley subsequently started a systematic trial in 30 children of his hospital and observed remarkable alterations in behavior.
Bradley was surprised at this effect. These features are nowadays associated with ADHD. Although Bradley and his colleagues published their pioneering discovery in prominent journals Brown , their reports had almost no influence on research and practice for at least 25 years Brown ; Conners However, further investigations into this issue, for example by Laufer et al.
Benzedrine was the first stimulant drug administered to hyperactive children and is no longer in use. Methylphenidate is nowadays considered as drug of first choice Leonard et al.
The scientific history of hyperactivity was characterized by reports of brain damage in children presenting with abnormal behavior Ross and Ross This indicated the growing notion that brain damage was the cause of hyperactive behavior Ross and Ross Further research in the s and s supported the idea of a causal connection between brain damage and deviant behavior Ross and Ross Children with a history of head injury were found to develop behavior disorders similar to the postencephalitic behavior disorder, while studies of birth trauma discovered a causative link between birth injury and mental retardation in children Kessler Infections, lead toxicity, and epilepsy were also found to be associated with various cognitive and behavioral problems Barkley a.
Rosenfeld and Bradley gave an account of typical behavior sequelae in children who suffered asphyxiant illness in infancy. They reported,. Six cardinal behavior characteristics make up this syndrome and may be listed as follows: 1.
Unpredictable variability in mood; 2. Hypermotility; 3. Impulsiveness; 4. Short attention span; 5. Fluctuant ability to recall material previously learned; and 6.
Conspicuous difficulty with arithmetic in school. First, Tredgold had stated that mild forms of brain damage in infancy, although unnoticed at the time, could lead to behavioral sequelae, which became first apparent at school Ross and Ross Second, possible variations of brain damage in extent, locus, or type of lesion were discussed Kessler Under the influence of the work of Strauss and Lehtinen and Strauss and Kephart , it became general practice to infer brain damage solely from behavioral signs without any neurological evidence of damage Barkley a ; Ross and Ross In brain-injured and non-brain-injured mentally retarded children, Strauss and his colleagues identified a number of behavior patterns, on the basis of which they could distinguish these two groups Ross and Ross In particular, they considered the symptom of hyperactivity as a sufficient diagnostic sign of underlying brain damage Ross and Ross Minimal brain damage was therefore supposed to be clearly associated with a specific syndrome Conners Laufer et al.
It has long been recognized and accepted that a persistent disturbance of behavior of a characteristic kind may be noted after severe head injury, epidemic encephalitis and communicable disease encephalopathies, such as measles, in children. It has often been observed that a behavior pattern of a similar nature may be found in children who present no clear-cut history of any of the classical causes mentioned. But the current name, ADHD, had still not been used.
Alternatives to stimulant medications were also developed along the way. The first nonstimulant, atomoxetine, came out in under the brand name Strattera. Others followed, including alpha-2 adrenergic receptor agonists, or antihypertensives, such as guanfacine brand name Intuniv. More medication treatment options are being developed and tested even today.
Who says this is a modern disorder? The early history of attention deficit hyperactivity disorder. The history of attention deficit hyperactivity disorder. He blamed these behaviors on biology, having discovered that some of the children had other family members with psychiatric disorders. Early theories were that these children were the victims of poor parenting, and more discipline was the best treatment.
As our knowledge of ADHD has evolved, so have the name of this commonly diagnosed disorder and recommended treatments for it. By the latter part of the 20th century, ADHD was recognized as a true mental disorder, but was thought to be due to brain damage. Hunter, PhD, director of pediatric neuropsychology at the University of Chicago. Further research revealed its basis in the brain, and a genetic link between family members. He noted that the symptoms were more common in boys, and seemed unrelated to intelligence or home environment 2.
Charles Bradley, a psychiatrist at a home for children with emotional problems, gives Benzedrine to his patients to treat severe headaches. He discovers an unexpected side effect. The stimulant medication improves interest in school, helps academic performance, and decreases disruptive behavior for certain children 2. The DSM and the symptoms it includes are widely considered the authoritative reference for clinicians; it guides which conditions are diagnosed, and how.
This renews interest in treating hyperactive and emotionally disturbed children with pharmaceuticals. Chlorpramazine is suggested as a potential treatment for hyperactive children, but it does not become a serious competitor to Benzedrine and Dexedrine 2. Ritalin is first mentioned as a potential treatment for the condition by Laufer and Denhoff 2.
Congress passes the Comprehensive Drug Abuse Prevention and Control Act, classifying amphetamines and methylphenidate as Schedule III substances — limiting the number of refills a patient can receive, and the length an individual prescription can run 2.
0コメント