Elucidating the behavior
The recognition that the disorder was not caused by brain damage seemed to follow a similar argument made somewhat earlier by the prominent child psychiatrist Stella Chess (1960).
It set off a major departure between professionals in North America and those in Europe that continues, to a lessening extent, to the present.
Further serious clinical interest in ADHD did not occur again until the appearance of three lectures by the English physician George Still (1902) before the Royal Academy of Physicians. Described as aggressive, passionate, lawless, inattentive, impulsive, and overactive, many of these children today would be diagnosed not only as ADHD but also as having oppositional defiant disorder (ODD).
Still reported on a group of 20 children in his clinical practice whom he defined as having a deficit in “volitional inhibition” (p. Still’s observations were quite astute, describing many of the associated features of ADHD that would come to be corroborated in research over the next century: (1) an overrepresentation of male subjects (ratio of 3:1 in Still’s sample); (2) high comorbidity with antisocial conduct and depression; (3) an aggregation of alcoholism, criminal conduct, and depression among the biological relatives; (4) a familial predisposition to the disorder, likely of hereditary origin; (5) yet with the possibility of the disorder also arising from acquired injury to the nervous system.
Current critical issues related to these matters will be raised along the way. Literary references to individuals having serious problems with inattention, hyperactivity, and poor impulse control date back to Shakespeare, who made reference to a malady of attention in King Henry VIII. Parent characteristics and parent-child interactions in families of nonproblem children and ADHD children with higher and lower levels of oppositional-defiant disorder.
Given the thousands of scientific papers on this topic, this course must, of necessity, concentrate on the most important topics in this literature. A hyperactive child was the focus of a German poem, “Fidgety Phil,” by physician, Heinrich Hoffman (see Stewart, 1970).
In 1987, the disorder was renamed as attention-deficit hyperactivity disorder in DSM-III-R (American Psychiatric Association, 1987), and a single list of items incorporating all three symptoms was specified.
Nevertheless, the manner in which clinicians and educators view the disorder remains quite disparate; in North America, Canada, and Australia, such children have ADHD, a developmental disorder, whereas in Europe they are viewed as having conduct problem or disorder, a behavioral disturbance believed to arise largely out of family dysfunction and social disadvantage. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 798-801.
By the 1970s, research emphasized the problems with sustained attention and impulse control in addition to hyperactivity (Douglas, 1972).
Despite a continuing belief among clinicians and researchers of this era that the condition had some sort of neurological origin, the larger influence of psychoanalytic thought held sway.
And so, when the second edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-II) appeared, all childhood disorders were described as “reactions,” and the hyperactive child syndrome became “hyperkinetic reaction of childhood” (American Psychiatric Association, 1968). Anxiety and depressive disorders in attention deficit disorder with hyperactivity: New Findings.
Also important here was the placement of the condition of ADD without hyperactivity, renamed undifferentiated attention-deficit disorder, in a separate section of the manual from ADHD with the specification that insufficient research existed to guide in the construction of diagnostic criteria for it at that time.