The oldest known account of what appears to be ADHD appears in Hippocrates aphorisms.
Hippocrates described patients who had…. “quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression”.
He attributed this condition to an “overbalance of fire over water”. His remedy for this overbalance was “barley rather than wheat, water drinks, and many natural and diverse physical activities.
From Hippocrates: Aphorisms. translation:
The Genuine Works of Hippocrates, Adams F (ed) 1849
Melchior Adam Weikard
In 1775, Melchior Adam Weikard, a prominent German physician, published the textbook Der Philosophische Arzt- approximate translation: The Philosophical Physician: Philosophical Arzeneykunst or infirmity of the sensations of the mind, and will, Volume 3
Weikard’s text contained a description of ADHD-like behaviours, Weikard described many of the symptoms now associated with the inattentive dimension of ADHD in the DSM For instance, according to the English translation provided by Barkley and Peters, Weikard stated that:
- “An inattentive person won’t remark anything but will be shallow everywhere. He studies his matters only superficially; his judgements are erroneous and he misconceives the worth of things because he does not spend enough time and patience to search a matter individually or by the piece with the adequate accuracy. Such people only hear half of everything; they memorize or inform only half of it or do it in a messy manner. According to a proverb they generally know a little bit of all and nothing of the whole….They are mostly reckless, often copious considering imprudent projects, but they are also most inconstant in execution. They treat everything in a light manner since they are not attentive enough to feel denigration or disadvantages.”
According to Weikard, the treatment recommended was:
- “The inattentive person is to be separated from the noise or any other objects; he is to be kept solitary, in the dark, when he is too active. The easily agile fibres are to be fixated by rubbing, cold baths, steel powder, cinchona,mineral waters, horseback riding, and gymnastic exercises.”
Scottish-born physician and author, Sir Alexander Crichton described a mental state much like the inattentive subtype of ADHD, in his book An Inquiry into the Nature and Origin of Mental Derangement.More detailed in his observation than Weikard, Crichton described attention problems as:
- “The incapacity of attending with a necessary degree of constancy to any one object, almost always arises from an unnatural or morbid sensibility of the nerves, by which means this faculty is incessantly withdrawn from one impression to another. It may be either born with a person, or it may be the effect of accidental diseases.
- “When born with a person it becomes evident at a very early period of life, and has a very bad effect, inasmuch as it renders him incapable of attending with constancy to any one object of education. But it seldom is in so great a degree as totally to impede all instruction; and what is very fortunate, it is generally diminished with age.”
Crichton further observed:
- “In this disease of attention, if it can with propriety be called so, every impression seems to agitate the person, and gives him or her an unnatural degree of mental restlessness. People walking up and down the room, a slight noise in the same, the moving of a table, the shutting a door suddenly, a slight excess of heat or of cold, too much light, or too little light, all destroy constant attention in such patients, inasmuch as it is easily excited by every impression.”
Crichton noted that “…they have a particular name for the state of their nerves, which is expressive enough of their feelings. They say they have the fidgets.”:272 Dr. Crichton suggested that these children needed special educational intervention and noted that it was obvious that they had a problem attending even how hard they did try. “Every public teacher must have observed that there are many to whom the dryness and difficulties of the Latin and Greek grammars are so disgusting that neither the terrors of the rod, nor the indulgence of kind intreaty can cause them to give their attention to them.”
Both Melchior Adam Weikard and Alexander Crichton wrote about the occupationally disabling features of this disorder, including attentional problems, restlessness, early onset, and how it can affect schooling, without any of the moralism introduced by George Still and later authors.
Dr. Heinrich Hoffmann, a medical doctor working in a lunatic asylum, wrote an entire collection of stories about “difficult” children” One of these stories was “the Story of Fidgety Phillip”: about a young boy who had trouble sitting still and paying attention. Several of the other stories have a distinctly ADHD feel to them. ie “Johhny Head in Air” and “The Dreadful Story of Harriet and The Matches”
Sir George Frederick Still described and published in the Lancet descriptions of 43 children with serious problems of sustained attention and self regulation. He also noted most of these children appeared to have a normal intellect. He used a term “Moral Defect” to describe lack of control to see future consequences.
Alfred F. Tredgold, a physician: 1870-1952 describes high-grade-feeble minded children who must have a mild brain damage that causes them to have signs or symptoms of inattention or high activity impacting school work. He published his first addition of “Mental Deficiency” in 1908.
A severe world-wide influenza pandemic left many survivors with encephalitis which in turn caused neurological dysfunction. Some of these exhibited immediate behavioral problems similar to what we now call ADHD. This caused researchers and doctors to believe that the condition was the result of injury rather than heredity. It was not until the 1960’s in the history of ADHD did we began to hear again the concept of hyperactivity being a result of heredity (Hyperactive Child Syndrome”) and not brain damage. It is note that this epidemic was associated with an increased risk of Parkinson’s disease. (There is some evidence suggesting that ADHD may be associated with Parkinson’s disease in later life though it has not yet been systematically researched to the best of this author’s knowledge.
Dr. Charles Bradley published a study of the use of Benzedrine (amphetamine) in children with behavior problems observing this helped their behavior and school performance which was the first real example of using medication in ADHD History.
Hyperkinetic Impulse Disorder is first described in the literature with children showing inattention and hyperactivity
C. Keith Conners publishes a study on the effects of Ritalin (Methylphenidate) in emotionally disturbed children – this may have been the first real break through in treatment options in ADHD History.
The term Minimal Brain Dysfunction Syndrome became a popular term to describe a wide variety of symptoms seen in children including perception, conceptualization, language, memory, control of attention-impulse or motor function.
NIMH (National Institute of Mental Health) gave grants to researchers to study the effect of stimulants on children with hyperactivity and inattention problems. The NIMH grants resulted in a great deal of interest into searching for solutions in treating ADHD like symptoms and played a big role in ADHD history.
DSM II published, including the first “official” description of the symptoms that include hyperkinetic reaction of children
C. Keith Conners first “Conner’s Rating Scale” is published.
Attention Deficit Disorder With orWithout Hyperactivity
Attention Deficit Hyperactivity Disorder & Undifferentiated Attention Deficit Disorder
Attention Deficit Hyperactivity Disorder
Predominantly Hyperactive Impulsive
The Earliest Reference to ADHD in the Medical Literature? Melchior Adam Weikard’s Description in 1775 of “Attention Deficit” (Mangel der Aufmerksamkeit, Attentio Volubilis)
Russell A. Barkley and Helmut Peters2
Journal of Attention Disorders 16(8) 623–630 © 2012 SAGE Publications
An Inquiry Into the Nature and Origin of Mental Derangement: Comprehending a Concise System of the Physiology and Pathology of the Human Mind. And a History of the Passions and Their Effects,
Alexander Crichton MD London 1798 (Google eBook)
Struwwelpeter. Merry Stories and Funny Pictures