ADHD Through Time: History, Criteria, and the Path to Diagnosis
Attention-Deficit/Hyperactivity Disorder (ADHD) and Post-traumatic Stress Disorder (PTSD) are two prominent diagnoses associated with myriad mental health symptoms. There can be many similarities in how the symptoms of the two distinct disorders present. In this series of articles, I will explore brief histories of both ADHD and PTSD respectively. I will also provide diagnostic criteria and considerations in the diagnostic process. The series will conclude with an analysis of the symptom overlap and considerations for arriving at the most appropriate diagnoses.
This is part one of the series - focusing on the history and diagnostic criteria of ADHD.
A brief history of ADHD
What we call Attention-Deficit/Hyperactivity Disorder (ADHD) today can trace its roots back to many early sources of understanding. Among them is the story of Zappelphilipp ("Fidgety Phil"), written by physician Heinrich Hoffmann- a children's book with medical undertones that was one of the first acknowledgments in the medical field of a mental origin for behaviors now understood as "failures of inhibition and norm adherence in some children." Attention to this type of child grew and theories like Postencephalitic Behavior Disorder and other Brain Damage Theories gained more traction. The symptoms observed were attributed to changes in behavior and personality following survival of childhood encephalitis or other minor brain injuries. The primary means of studying this theory was through pneumoencephalogram, which removed spinal fluid and replaced it with gas to make the brain more visible to an xray. Headaches were a side effect of the procedure and were treated with a stimulant medication that reportedly had more of an effect on desirable behavior change and school performance improvements than relief from the headaches. Recognizing the desirable effects on behavior and performance that the stimulant medication provided was the cornerstone for the psychopharmacological treatment of ADHD.
Attention was centering on Hyperactivity as the major criteria of the still evasive disorder. A major challenge was presented to the presiding Brain-Damage-Dogma as brain damage does not always result in Hyperactivity. Inattention at this time was largely understood as another product of Hyperactivity and Impulsivity. Still, with Hyperactivity as the focal point of the major criteria, it was believed that these symptoms, and with them the disorder, would resolve by mid-late adolescence. It was a shift by the American Psychiatric Association away from the World Health Organization’s focus on hyperactivity in the 1970s toward Inattention and Impulsivity that conceived Attention Deficit Disorder (ADD). The new disorder could either present with or without hyperactivity features. But after much confusion among practitioners and limited research on the differences between subtypes of ADD, Attention-Deficit/Hyperactivity Disorder (ADHD) was born as a unification of the two major criteria. Largely, the now combined ADHD developed out of an attempt for uniformity and clarity for diagnosticians and treatment. Now, with wisdom from ADD and new understandings of ADHD, we have recognition of the persistence of these symptoms into adulthood. Today, ADHD is best understood as neurodevelopmental, meaning that the “disorder” may be more accurately a “type of brain”. This perspective we hold today in contrast to the “defect of moral control” narrative shared by some of the founding researchers in the history of ADHD.
Diagnosing ADHD
Historical information from parents, caregivers, and teachers is very valuable in determining if ADHD is an appropriate diagnosis. A comprehensive diagnosis can be reached by including historical information, diagnostic interviews, and computerized assessment in combination. The current Diagnostic and Statistical Manual for Mental Disorders (DSM-5) established the diagnostic criteria for ADHD in children as 6 out of 9 symptoms (5 for adults) of Inattention and/or 6 out of 9 symptoms (5 for adults) of Hyperactivity, persistent for a minimum of six months, inconsistent with developmental level, and negatively impacting functioning across domains.
Attention-Deficit Hyperactivity Disorder - Predominantly Inattentive
Presentation: 6+ Inattention symptoms present at time of assessment(s), having been persistent for a minimum of six months, inconsistent with developmental level, and negatively impacting functioning across domains.
Attention-Deficit Hyperactivity Disorder - Predominantly Hyperactive/Impulsive
Presentation: 6+ Hyperactivity/Impulsivity symptoms present at time of assessment(s), having been persistent for a minimum of six months, inconsistent with developmental level, and negatively impacting functioning across domains.
Attention-Deficit Hyperactivity Disorder - Combined
Presentation: 6+ Inattention symptoms and 6+ Hyperactivity/Impulsivity symptoms present at time of assessment(s), having been persistent for a minimum of six months, inconsistent with developmental level, and negatively impacting functioning across domains.
By Trevor Holak, MA, LAC - ADHD Specialist
At Inner Purpose, we offer comprehensive ADHD assessments that combine a computerized assessment with an in-depth verbal interview, conducted by our ADHD specialists. This thorough approach helps ensure an accurate diagnosis, including ruling out differential diagnoses - other conditions that can present with similar symptoms - so you can feel confident in the clarity you walk away with.
Assessments and treatment are available both in-person and via telehealth, making it easier to access the support you need in the way that works best for you. Once your assessment is complete, our clinicians will walk you through your results, next steps, and discuss treatment options tailored to your specific needs.
If you're interested in learning more or scheduling an assessment, reach out to us - we're here to help.
