History and Evolution of ADD

Written by Edward M. Hallowell, MD. and John J. Ratey, MD

Read about the history of ADD, attention deficit disorder. When were ADD symptoms first recognized and how was the disorder named?

Where the story began is impossible to say. Certainly, the symptoms of ADD (attention deficit disorder) have been with us as long as history has been recorded. However, the modern story of ADD, the story of bringing those symptoms out of the realm of morality and punishment and into the realm of science and treatment, began somewhere around the turn of the century.

In 1904 one of the world's most prestigious medical journals, the British journal Lancet published a little doggerel verse that might be the first published account of ADD in the medical literature.

The Story of Fidgety Philip

"Let me see if Philip can
Be a little gentleman;
Let me see if he is able
To sit still for once at the table."
Thus Papa bade Phil behave;
And Mama looked very grave.
But Fidgety Phil,
He won't sit still;
He wriggles,
And giggles,
And then, I declare,
Swings backwards and forwards,
And tilts up his chair,
Just like any rocking horse--
"Philip! I am getting cross!"
See the naughty, restless child
Growing still more rude and wild,
Till his chair falls over quite.
Philip screams with all his might,
Catches at the cloth, but then
That makes matters worse again.
Down upon the ground they fall,
Glasses, plates, knives, forks and all.
How Mama did fret and frown,
When she saw them tumbling down!
And Papa made such a face!
Philip is in sad disgrace . . .

Fidgety Phil has had many incarnations in popular culture, including Dennis the Menace and Calvin from "Calvin and Hobbes." Most everybody knows a little boy who bangs into things, climbs to the top of trees, scales the furniture, beats up on his siblings, talks back, and displays all the characteristics of being out of control, maybe a little bit of a bad seed, despite the generosity and best efforts of the parents. How can this be explained? And how is it that this person has existed throughout the centuries?

Noticing the Symptoms of ADD

The story might start with . . . George Frederic Still, M.D., who in 1902 described a group of twenty children who were defiant, excessively emotional, passionate, lawless, spiteful, and had little inhibitory volition. This group consisted of three boys for every girl, and their troubling behaviors all had appeared before the age of eight. What was most striking to Still was that this group of kids had been raised in benign environments, with "good-enough" parenting. Indeed, those children who had been subject to poor child-rearing were excluded from his analysis. He speculated, in light of the adequate rearing these children received, there might be a biological basis to the unbounded behavior, a genetically inherited proneness toward moral corruption. He gained confidence in his theory when he discovered that some members of these children's families had psychiatric difficulties such as depression, alcoholism, and conduct problems.

While it was certainly possible that the pathology was psychological only, and was passed down from generation to generation as a kind of family neurosis, Still proposed that genetics and biology should be considered at least as much as free will in assessing the cause of these children's problems. This was a new way of thinking.

Although it would be decades before there was conclusive evidence bearing Still out, his new way of thinking was pivotal. In the nineteenth century--and before--"bad" or uncontrollable behavior in children was seen as a moral failing. Either the parents or the children or both should be held responsible. The usual "treatment" for these children was physical punishment. Pediatric textbooks from that era are full of descriptions of how to beat a child and exhortations on the necessity of doing so. As clinicians began to speculate that neurology, rather than the devil, was governing behavior, a kinder, more effective approach to child-rearing emerged.