We Owe a Lot to the “Dean of ADHD”
Dr. Paul H. Wender was the most visible believer in a mental health condition that many people said wasn’t real.
Rarely in science and medicine are we able to trace the establishment of a standard diagnosis to one person the way we can Attention Deficit Hyperactivity Disorder (ADHD) to Paul H. Wender. M.D. In 1971 Dr. Wender published the first monograph on children who had what was then called Minimal Brain Dysfunction, and in 1995 the first description of adults with ADHD. In doing so, he established the basic understandings of diagnosis and treatment of ADHD that remain unchanged to this day. In recent years, the field of ADHD has come full circle to rediscover many of Dr. Wender’s insights that were not recognized as fundamental to ADHD at the time.
The criteria that define ADHD in the Diagnostic and Statistical Manual (DSM), and that are used around the world, started as the Wender-Utah or Wender-Reimherr Criteria. In order to be considered valid, every piece of research in the field of ADHD starts with having to meeting these largely unchanged criteria. Dr. Wender also performed the first studies of the medications that are now accepted as the Standard of Care for the treatment of ADHD.
Dr. Wender would have been famous in psychiatry even if he had not been “the Father of ADHD.” Psychoanalytic thinking dominated psychiatry at the time he started his psychiatric training in 1960. Contrary to that approach, Dr. Wender wanted evidence, not speculation. He and two colleagues struck on the idea of following children adopted at birth to see if schizophrenia followed nature (genetics) or nurture (the upbringing in their adoptive homes). The discovery that schizophrenia was almost entirely genetically based started the radical change from a psychodynamic explanation to one that looked to genetics and biochemistry as the cause of psychiatric conditions. This was the single biggest and most fundamental change in the history of the understanding of mental disorders.
Wender brought that same open mind (what he called being “a critical psychiatric free thinker”) to his study of ADHD. Those early years required great personal courage to be the most visible believer in a controversial mental health condition that many people did not acknowledge as being real. Wender responded with research-based evidence that proved beyond doubt that ADHD was genetic, neurological, lifelong, and so highly impairing to every aspect of life that it demanded to be recognized and treated. He laid the foundation on which the rest of us now stand.
It is hard now to imagine the task that faced Dr. Wender and his colleagues when they first tried to make sense of the chaotic, hyperactive, and impulsive behaviors of children who were considered to be brain damaged. Unlike theorists then and now, he talked with people for hours about how they experienced their lives. When he heard the same things from almost every patient with whom he spoke, he knew their condition had to be fundamental and important, whether or not it fit the prevailing thinking of the time.
Dr. Wender remained active up to his sudden death back in July, at the age of 82. He had just finished the final editing, with a colleague, of the 5th edition of his groundbreaking book, The Hyperactive Child, Adolescent, and Adult. I can’t wait to get my hands on a copy.
I never met Dr. Wender. Nonetheless, he has had a profound effect on my understanding of ADHD and how I think. He did not accept anything without evidence. He was always open minded, and never participated in the group-think consensus that stifles critical thought. Most important, he listened to people. The truth that he found in their life experiences was more valuable (and accurate) than any amount of technically perfect research.