Sir George Frederic Still In March 1902, Sir
George Frederic Still (1868–1941), known as the father of British
paediatrics, gave a series of lectures to the
Royal College of Physicians in London under the name
Goulstonian Lectures on ‘some abnormal psychical conditions in children’, which were published later the same year in
The Lancet. He described 43 children who had serious problems with sustained attention and self-regulation, who were often aggressive, defiant, resistant to discipline, excessively emotional or passionate, which showed little inhibitory volition, and could not learn from the consequences of their actions; though their intellect was normal. He wrote: "I would point out that a notable feature in many of these cases of moral defect without general impairment of intellect is a quite abnormal incapacity for sustained attention." Still views greatly disagreed with his peers, and probably his opinions were not very influential at a time. The child guidance movement believed that such behaviors had environmental causes, such as psychosocial changes. His work was rediscovered in the XX century by clinicians such as Schachar (1986). Approximately a third of children, specially boys between the ages of 5 and 18 years, who contracted
encephalitis lethargica suffered from psychiatric symptoms, including change of personality, restlessness, irregular sleeping habits, motional instability manifesting as irritability, crying spells, and temper tantrums, including impulsivity, and unpredictability, what
Constantin von Economo described as "moral insanity". More extreme cases include aggression and "shameless sexual activity". The
encephalitis lethargica pandemic led the United States pediatricians to claim that mental disturbances could be caused by organic disease.
Lumbar punctures were also included in the investigations in erratic behavior on children, which lead to the discovery of the beneficial effect of stimulants for its treatment in the 1930s. Following the pandemic, many forms of syndromes related to hyperactivity were described. In 1947, Strauss and Lehtinen reclassified the brain injury syndrome as "endogenous" and "exogenous", where the later would be equivalent to the secondary form of the disorder. The diagnosis also included motor changes, overactivity and underactivity. In the 1930s, Kramer and Pollnow described the "hyperkinetic disorder", very similar to Economo description of
encephalitis lethargica, that differed from ADHD for having severe symptomatology and with frequent recovery associated with
seizures. Their description became popular on Europe and was included in the
World Health Organization’s international classification of disease. Maurice Laufer and Eric Denhoff studied hyperactive children in Emma Pendleton Bradley Home. Only one third of their patients had brain damage, debunking the term "minimal brain damage" and replacing it with "minimal brain dysfunction". In 1957, they created the diagnosis "hyperkinetic impulse disorder", that was applicable to far more children. The broader definition of hyperkinetic impulse disorder led to its identification in many schools. Since the 1950s, pharmaceutical companies made significant investments in anti-psychotics and anti-depressants, as a way to challenge the hegemony of
psychoanalysis. The new approach soon became popular, as it had fast results with low cost. Even today, the ADHD terminology is objectionable to many. There is some preference for using the ADHD-I, ADD, and AADD terminology when describing individuals lacking the hyperactivity component, especially among older adolescents and adults who find the term "hyperactive" inaccurate, inappropriate and even derogatory.
Adult ADHD diagnostic expansion In the 1970s, American research began to study the symptoms and development of children diagnosed with ADHD. In 1976,
Paul Wender proposed 61 items (WURS-61) for the diagnostic of ADHD in adults, the so-called Wender-Utah or Wender-Reimherr Criteria. Later, 25 of the items were selected (WURS-25) and used by the DSM. By the 1980s, research was published confirming the continuation of ADHD symptoms beyond childhood. Some controversy exists over the findings of scholars such as Gabrielle Weiss in 1986, which showed a 66% continuation of symptoms into adulthood, contrasted with a lower 31% reported by Gittleman et al. in 1985. Research continued, often based on the model that ADHD could only be continued and not recognized and diagnosed newly in adults and adolescents. Publications by individuals, including Kelly and Ramundo as well as Hallowell and Ratey in the 1990s, complicated this model by not only leading to
self-diagnosis, but through promoting the
social model of disability. There exists significant social and medical debate surrounding medication. This is influenced by media and
agenda setting. As analyzed by Conrad and Potter, "ironically, controversy about ADHD raises the public's awareness and increases the diffusion of information about the disorder, which can indirectly contribute to diagnostic expansion." == Environmental factors ==