The History of ADHD and Its Treatments
ADHD wasn’t called ADHD until the late 1980s, but its core symptoms have been recognized as a condition since the early 1900s. The history of ADHD – and its treatment with medications – is still evolving today as we achieve greater understanding of this complex disorder.
Attention deficit hyperactivity disorder (ADHD or ADD) wasn’t formally recognized as a distinct medical condition by the American Psychiatric Association (APA) until the late 1960s. But its core symptoms – hyperactivity, impulsivity, and inattention – have been recognized together in a cluster for much longer.
Many authors say the history of ADHD dates back to the beginning of the 20th century with Sir George Frederick Still’s articles and lectures. Others believe its symptoms were first recorded by Sir Alexander Crichton as early as 1798, and described in the children’s stories of Fidgety Phil written by Heinrich Hoffmann in 18441.
ADHD’s exact origin is slightly unclear because the condition wasn’t always called attention deficit. Through the years, the symptoms we now recognize as ADHD were referred to as:
- Incapacity of attending with a necessary degree of constancy to any one object
- Defect of moral control
- Postencephalitic behavior disorder
- Brain damage
- Brain dysfunction
- Hyperkinetic disease of infancy
- Hyperkinetic reaction of childhood
- Hyperkinetic impulse disorder
- Attention deficit disorder: with and without hyperactivity (ADD)
- Attention deficit hyperactivity disorder (ADHD)
- ADHD with three subtypes
ADHD was first considered a defect of moral control, then a result of brain damage. Further research revealed its basis in the brain, and a genetic link between family members. Today, we still don’t know the exact causes of ADHD, but studies suggest three main factor: genetics, environmental factors, or a disruption of development – like a brain injury.
Colloquially, there’s still widespread confusion about whether the condition is called ADD or ADHD.
The History of ADHD: A Timeline
1902: The core symptoms of ADHD are first described by Sir George Frederick Still, a British pediatrician, in a lecture series at the Royal College of Physicians. He observed that a group of twenty “behaviorally disturbed” children were easily distractible, inattentive, and unable to focus for long. He noted that the symptoms were more common in boys, and seemed unrelated to intelligence or home environment2.
1922: Alfred F. Tredgold, Britain’s leading expert on mental impairment, suggests behavior patterns are from physiology – likely a difference in the brain, or brain damage – rather than character flaws or lack of discipline. This is a step toward “medicalizing” symptoms of ADHD as a result of brain activity instead of considering them simply bad behavior1.
1923: Researcher Franklin Ebaugh provides evidence that ADHD can arise from a brain injury by studying children who survived encephalitis lethargica2,3.
1936: Benezedrine (amphetamine) is approved by U.S. Food and Drug Administration (FDA).
1937: Dr. 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 children2.
1952: The first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is published4. The DSM and the symptoms it includes are widely considered the authoritative reference for clinicians; it guides which conditions are diagnosed, and how. There is no mention of a condition like attention deficit disorder or its symptoms, only a condition called “minimal brain dysfunction,” which inferred that a child showing hyperactive behavior had brain damage, even if no physical signs of it appeared1,3.
1955: New drugs become available to treat adults with mental illness, and a new phase of experimentation with tranquilizers and stimulants for mental health begins. 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 Dexedrine2.
1956: The National Institute of Mental Health (NIMH) creates the Psychopharmacological Research Branch (PRB) to develop new psychiatric drugs.
1957: The condition we know today as ADHD is named hyperkinetic impulse disorder by three medical researchers: Maurice Laufer, Eric Denhoff, and Gerald Solomons. Ritalin is first mentioned as a potential treatment for the condition by Laufer and Denhoff2.
1958: The PRB hosts the first-ever conference on the use of psychoactive drugs to treat children5.
1961: Ritalin is FDA-approved for use in children with behavioral problems2.
1967: The NIMH awards the first grant to study the therapeutic effect of stimulants in children with behavioral problems2, 3.
1968: The second edition of the DSM goes into print. It includes “hyperkinetic impulse disorder,” the first time symptoms now known as ADHD are recognized by the American Psychiatric Association (APA). (if you cut the DSM point above, this would need to be fleshed out)
1970: There’s a growing public concern over abuse of drugs – particularly stimulants. 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 run2.
1971: Amid widespread stimulant abuse across the United States, amphetamines and methylphenidates are reclassified as Schedule II drugs2,6. Dr. Paul Wender publishes a book that mentions how ADHD runs in families, setting the stage for genetic studies of ADHD. Dr. Leon Eisenberg and Keith Conners, Ph.D. receive a grant from the NIMH to study methylphenidate5.
1975: A widespread media blitz claims that stimulants are dangerous and shouldn’t be used to treat a “dubious diagnosis2.” Benjamin Feingold advances claims that hyperactivity is caused by diet, not a brain based condition2. There is public backlash against treating ADHD with stimulant medication, especially Ritalin.
1978: For decades, a positive response to stimulant medication was considered evidence that a child had a mental disorder. Judith Rappaport, a researcher for the NIMH discovered that stimulants have similar effects on children with or without hyperactivity or behavior problems – adding to the controversy around stimulant medication2.
1980: The third edition of the DSM is released. The APA changes the name of hyperkinetic impulse disorder to attention deficit disorder (ADD) — with hyperactivity and ADD without hyperactivity. It’s the first time this group of symptoms is called by its most commonly known modern name1,7.
1987: A revised version of the DSM-III, the DSM-III-R, is released. The subtypes are removed, and the condition is renamed attention deficit hyperactivity disorder (ADHD). What was previously called ADD without hyperactivity is now referred to as undifferentiated ADD3.
1991: In the 1990s, diagnoses of ADHD begin to increase. It’s not possible to know if this is a change in the number of children who have the condition, or a change in awareness that leads to increased diagnosis3. By 1991, methylphenidate prescriptions reach 4 million, and amphetamine prescriptions reach 1.3 million5.
1994: The DSM-III-R divides ADHD into three subtypes: predominantly inattentive type, predominantly hyperactive type, and a combined type3 attention deficit hyperactivity disorder.
2000: The American Academy of Pediatrics (AAP) publishes clinical guidelines for the diagnosis of ADHD in children8.
2001: The AAP publishes treatment guidelines for children with ADHD, and recommends stimulant medication alongside behavior therapy as the best course to alleviate symptoms8.
2002: The first non-stimulant medication, Strattera (atomoxetine), is approved by the FDA to treat ADHD9.
2011: The AAP releases updated diagnosis and treatment guidelines, expanding age range for diagnosis, scope of behavioral interventions, and new guidelines for clinical processes8.
2013: The DSM-V is published, and includes language changes for each of the diagnostic criteria for ADHD. The subtypes of ADHD are now referred to as “presentations,” and the condition can be described as mild, moderate, or severe. The descriptions are more applicable to adolescents and adults than previous versions, but new symptom sets were not created for these groups7.
The History of ADHD Medications
The list of available ADHD medications can seem overwhelming, but there are only two types of stimulants used to treat ADHD: methylphenidate and amphetamine.
All stimulant medications are different formulations of methylphenidate or amphetamine, which have been used for ADHD treatment since before it was even called ADHD. They can be short-acting or long-acting. They can come as a tablet, liquid, patch, or orally disintegrating tablet.
There are three FDA-approve non-stimulant medications.
- 1937: Benzedrine (racemic amphetamine)
- 1943: Desoxyn (methamphetamine)
- 1955: Ritalin (methylphenidate)
- 1955: Biphetamine (mixed amphetamine/dextroamphetamine resin)
- 1975: Cylert (pemoline)
- 1976: Dextrostat (dextroamphetamine)
- 1976: Dexedrine (dextroamphetamine)
- 1982: Ritalin SR (methylphenidate)
- 1996: Adderall (mixed amphetamine salts)
- 1999: Metadate ER (methylphenidate)
- 2000: Concerta (methylphenidate)
- 2000: Methylin ER (methylphenidate)
- 2001: Metadate CD (methylphenidate)
- 2001: Focalin (dexmethylphenidate)
- 2001: Adderall XR (mixed amphetamine salts)
- 2002: Ritalin LA (methylphenidate)
- 2002: Methylin (methylphenidate oral solution and chewable tablet)
- 2002: Strattera (atomoxetine)
- 2005: Focalin XR (dexmethylphenidate)
- 2006: Daytrana (methylphenidate patch)
- 2007: Vyvanse (lisdexamfetamine dimesylate)
- 2008: Procentra (liquid dextroamphetamine)
- 2009: Intuniv (guanfacine)
- 2010: Kapvay (clonidine)
- 2011: Zenzedi (dextroamphetamine sulfate)
- 2012: Quillivant XR (liquid methylphenidate)
- 2014: Evekeo (amphetamine)
- 2015: Aptensio XR (methylphenidate)
- 2015: Dyanavel XR (liquid amphetamine)
- 2015: Quillichew ER (chewable methylphenidate)
- 2016: Adzenys XR-ODT (amphetamine orally disintegrating tablet)
- 2017: Cotempla XR-ODT (methylphenidate orally disintegrating tablet)
- 2017: Mydayis (mixed amphetamine salts)
- 2018: Jornay PM (methylphenidate)
- 2019: Adhansia XR (methylphenidate)
- 2019: Evekeo ODT (amphetamine orally disintegrating tablet)
1 Lange, Klaus, et al. “The history of attention deficit hyperactivity disorder.” ADHD Attention Deficit and Hyperactivity Disorders, 2:4, pp. 241-255. December 2010. doi: 10.1007/s12402-010-0045-8
2 Mayes, Rick, et al. “Suffer the restless children: the evolution of ADHD and paediatric stimulant use, 1900—80.” History of Psychiatry, 18:4, pp. 435-457. December 2007. doi: 10.1177/0957154X06075782
3 CDC. “ADHD Throughout the Years.” Centers for Disease Control and Prevention. Updated September 28, 2018. https://www.cdc.gov/ncbddd/adhd/timeline.html
4 APA. “DSM History.” American Psychiatric Association. Web. 26 June 2019. https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm
5 Charach A, Dashti B, Carson P, et al. “Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment [Internet].” Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 Oct. (Comparative Effectiveness Reviews, No. 44.) Table 14, Timeline of identification of ADHD and development of treatment—derived from Eisenberg and Mayes. Available from: https://www.ncbi.nlm.nih.gov/books/NBK82373/table/results.t13/
6 Rasmussen, Nicholas, et al. “America’s First Amphetamine Epidemic 1929–1971. A Quantitative and Qualitative Retrospective With Implications for the Present.” American Journal of Public Health, 98:6, pp. 974-985. June 2008. doi: 10.2105/AJPH.2007.110593
7 Epstein, Jeffery, et al. “Changes in the Definition of ADHD in DSM-5: Subtle but Important.” Neuropsychiatry, 3:5, pp. 455-458. October 2013. doi: 10.2217/npy.13.59
8 “ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.” Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. Pediatrics Nov 2011, 128 (5) 1007-1022; DOI: 10.1542/peds.2011-2654
9 Rosack, Jim. “FDA Approves First Nonstimulant Medication for ADHD Treatment.” American Psychiatric Association. Web. 26 June 2019. doi: 10.1176/pn.37.24.0021b
10 Bourgeois, Florence T et al. “Premarket safety and efficacy studies for ADHD medications in children.” PloS one. 9:7. 9 Jul. 2014, doi: 10.1371/journal.pone.0102249
11 FDA. “Orange Book: Approved Drug Products with Therapeutic Equivalence Evaluations.” U.S. Food and Drug Administration. Current through May 2019. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
Updated on July 15, 2019