A brief history of ADHD
Throughout history, the concept of attention deficit hyperactivity disorder (ADHD) has been the subject of controversy and debate. Both its nomenclature, the diagnostic criteria used, and the way the disorder is treated have varied over the years.
A brief tour of its history can help us understand the current definition and concept of the disorder.
The first reference to what is now called ADHD can be attributed to the German physician Melchior Adam Weikard , in an article on attention disorders dating from 1775. Weikard includes in the chapter dedicated to attention disorders (Attention volubilis) of his book Der Philosophische Artz the first medical description of ADHD known to date.
According to Weikard, people lacking attention were characterized by being reckless, careless, capricious and unbridled, had superficial knowledge, left things half-done and carried out tasks in a disorganized manner, since they did not devote enough time and patience to achieve the necessary skills. In addition, they lacked rigor, correctness and accuracy and were inconsistent. He also described some treatments that coincide with some of the current recommendations, such as the practice of exercise and the reduction of stimuli.
The first reference to ADHD dates back to 1775 and is attributed to the German physician Melchior Adame Weikard, who in his book Der Philosophische Artz contains a medical description of this disorder
A few years later, in 1798 , the doctor Alexander Crichton described a clinical picture that includes the main characteristics of what we today call ADHD with a predominant presentation of attention deficit ( mental restlessness), in which he refers to the inability to maintain attention with the necessary degree of constancy, giving an image of restlessness. This disorder, according to Crichton, could be present at birth or occur as a result of an accident. On the other hand, he thought that this disorder was detected at an early age and that it resolved before reaching adulthood.
Although under a literary and non-medical presentation, the psychiatrist Heinrich Hoffman published in 1845 a book of children's poems in which he described two cases of ADHD . Among its contents, The Story of Restless Philip showed a child who could not stay still at the table despite his father's warnings. Some of the qualities that were reflected in his work were prolonged inattention and hyperactivity over time. The descriptions thus coincided with some of the characteristics of the current concept of ADHD.
The first scientific reference does not arrive until the 20th century.
But the first scientific reference to recognize ADHD as a disorder is attributed to pediatrician George F. Still , in a 1902 publication, and was based on the observation of children with inattention and hyperactive and impulsive behavior. Still described 43 cases of children who presented attention problems, aggression, defiant behavior, resistance to discipline, excessive emotionality, problems inhibiting their behavior, resentment, cruelty and dishonesty. It was called defect of moral control and referred precisely to these children with difficulties in maintaining attention and reflective thinking, and with excessive motor activity. His observations at that time described characteristics associated with ADHD that would be corroborated in later years by research: greater representation in the male gender, high comorbidity with antisocial behaviors and mood disorders, family history of alcohol use disorders, criminal behavior and depression, family predisposition for the disorder (probably of hereditary origin) and the possibility that the disorder originated due to an acquired brain injury.
One of the first publications in Spanish describing this syndrome appeared in 1907. The author was Augusto Vidal Parera , who in his Compendium of Child Psychiatry detailed the symptoms presented by children with ADHD. The author characterized the disorder by the presence of alterations due to both excess and deficiency of cognitive functions (perception, attention, memory and reasoning), affective (emotions and feelings) and volitional.
In 1902, pediatrician F. Still described 43 cases of children who presented attention problems, aggression, defiant behavior, resistance to discipline, excessive emotionality, problems inhibiting behavior, cruelty, and dishonesty.
Another notable moment in the history of ADHD was the discovery, in 1937 , of the usefulness of Benzedrine, a psychostimulant, in the treatment of symptoms of inattention and hyperactivity in children.
In 1957 , the concept of " hyperkinetic impulse disorder" was introduced to refer to children with ADHD. At that time, it was considered that the brain dysfunctions were located in the thalamic area, and that they produced a deficit in the filtration of stimuli in these patients, which caused an excess of cerebral stimulation.
Stella Chess , one of the most relevant authors of the time, redefined hyperactivity as " hyperkinetic disorder", the behavioral disorder of a child who is constantly in motion or who presents higher than normal rates of activity and precipitation, or both characteristics.
The inclusion of ADHD in psychiatry manuals
It was in 1965 that psychiatric compendia included this disorder in their classifications, incorporating the concept of "hyperkinetic syndrome of childhood" in the ICD-9. In 1968 , the American Psychiatric Association included a definition formulated by Chess under the name "hyperkinetic reaction of childhood".
With the publication of the DSM-III in 1980 , attention deficit was placed as the main symptom of the disorder within the framework of international classifications. The name "attention deficit disorder, with or without hyperactivity" was adopted.
In the DSM-III-R , published in 1987 , hyperactivity was once again placed as one of the central symptoms and the name "attention deficit hyperactivity disorder" was established.
After successive changes in the different versions of this manual, it was not until 1994 , with the publication of the DSM-IV , that the term "attention deficit hyperactivity disorder" was introduced, and the three subtypes of ADHD that remain today were defined: combined, inattentive, and hyperactive-impulsive.
ADD in adulthood
The first articles on ADHD in adults appeared in the late 1960s .
In the 1970s, important work by Anneliese Pontius demonstrated that the symptoms presented by adult patients were the same as those described in children and adolescents, and that they were associated with dysfunctions in the frontal lobe and caudate nucleus. It is from here that alterations in executive functions began to be related to the symptoms of ADHD.
Simultaneously, the first studies on the pharmacological treatment of minimal brain dysfunction in adults emerged. Both imipramine and stimulants were postulated as effective drugs for the treatment of ADHD in adults. Despite the various studies published during the 1970s, the prevailing opinion was that ADHD was a relic of adolescence.
The great increase in knowledge of ADHD in adults occurred throughout the 1990s , with the publication of several studies demonstrating that the same symptoms that occur in children can also affect adults and that there is a biological dysfunction at their base. On the other hand, multiple studies emerged to monitor ADHD symptoms in adulthood, psychiatric comorbidity, social repercussions, the effectiveness of treatments and their biological bases.
Despite the various studies published during the 1970s, the prevailing opinion was that ADHD was confined to adolescence.
In Spain, the first healthcare center to have a specialized program in the diagnosis and treatment of ADHD in adults was the Vall d'Hebron University Hospital in Barcelona, in 2002 , with the creation of what was called the Comprehensive Care Program for Adults with ADHD.
Ana Gómez Salcedo
All these initiatives in Europe led to the creation, in 2003 , of the European Network Adult ADHD . Subsequently, other research consortia were created focused on the study of ADHD in adults, both in genetic and clinical aspects, such as the International Multicentre Persistent ADHD CollaboraTion or the International Collaboration on ADHD and Substance Abuse, which continue to give rise to various works and research.
As a result of advances in the knowledge of ADHD, several authors requested the validation of ADHD in the adult population, as there was increasing evidence that ADHD was a chronic and persistent disorder in adulthood. In addition, it was increasingly evident that ADHD in adulthood is linked to serious economic, occupational, academic and family repercussions, as well as traffic accidents and the presence of other psychiatric pathologies.
Several authors requested the validation of ADHD in the adult population, as there was increasing evidence that ADHD was a chronic and persistent disorder in adulthood.
Finally, in 2013 , with the publication of the DSM-5 , several changes were introduced compared to the DSM-IV-TR ; specific criteria were incorporated for the diagnosis of the disorder in adulthood (with clinical descriptions more typical of adults) and the minimum age of onset of symptoms was also modified, from "before seven years" to "before twelve years". In this edition, the concept of "ADHD subtypes" was also changed to "clinical presentations".
ADHD is currently considered to be a complex, heterogeneous and multifactorial neurodevelopmental disorder that begins in childhood or adolescence and can continue into adulthood, characterized by the presence of persistent symptoms of inattention, hyperactivity and impulsivity.
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