Author: John Ferry
Over-activity, poor concentration and impulsively in children were first conceptualized as medical phenomena earlier this century. The first recorded interest in children with poor attention and hyperactivity dates back to the turn of the century when a pediatrician, Frederick Still, described a group of children who showed an abnormal incapacity for sustained attention, restlessness and fidgetiness, and went on to argue that these children had deficiencies in volitional inhibition, but offered no treatment other than good discipline. Hyperactivity and poor attention in children then came to be viewed as linked when the diagnosis of minimal brain damage (MBD) was coined. The idea of MBD had originally gained favor following epidemics of encephalitis in the first decades of the twentieth century. Post-encephalitic children often presented with restless, personality changes and learning difficulties. Then, in the 1930s, came a chance discovery that psycho stimulant medication could reduce the restlessness, hyperactivity and behavioral problems that these children presented with. The claming effect observed is likely to apply to anyone who took low dose of stimulants, not just the hyperactive kids. Not long after this episode, a number of doctors began to speculate that children who presented as hyperactive might have organic lesions in the brain, which was causing their hyperactivity. This idea is strengthened further by that, in the absence of a family history of sub normality, should be considered as sufficient evidence for a diagnosis of brain damage, believing that the damage was too minimal to be easily found. By the 1960s, however, the term MBD was losing favor as evidence for underlying organic lesions in children who displayed poor attention and over-activity was not being found. Instead, with the growing interest in behaviorally defined syndromes, the goal posts were moved and a behaviorally defined syndrome was first articulated at that time. Despite the abandonment of the minimal brain damage hypothesis the assumption that this syndrome does not indeed have a specific and discoverable physical cause, related to some sort of brain dysfunction, survived in the new definition. Yet, studies have shown that demonstrable minimal brain damage due to a variety of causes predisposes the child to the development of wide range of psychiatric diagnosis as opposed to particular type, such as ADHD concluded that the available evidence show that over-activity is usually not a sign of brain damage and that brain damage does not usually lead to over-activity. So, it was that in the mid-1960s the North American-based Diagnostic Statistical manual (DSM), second edition (DSM-II), coined the label ‘Hyperkinetic reaction of childhood’ to replace the diagnosis of MBD. Over the following three decades this new behaviorally defined condition rose from a matter of peripheral interest in child psychiatric practice and research in North America to a place of central prominence. In the early 1980s, DSM II was replaced by the third edition (DSM-III). This disorder was now termed Attention Deficit Disorder or ADD. This could be diagnosed with or without hyperactivity and was defined using three dimensions (three separate lists of symptoms); one for attention deficits, one for impulsively and one for hyperactivity. The three-dimensional approach was abandoned in the late eighties when DSM III was revised, in favor of combining all the symptoms into one list (one dimension). The new term for the order was ‘Attention Deficit Hyperactivity Disorder’.
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