What is ADHD and where is it from? Tristram Jones, Ph.D. Kaplan University Exceptional Children Unit V.

What is ADHD and where What is ADHD and where is it from?is it from?

Tristram Jones, Ph.D.Tristram Jones, Ph.D.Kaplan UniversityKaplan University

Exceptional Children Unit VExceptional Children Unit V

Dr. Henrich Hoffman may have given the first Dr. Henrich Hoffman may have given the first list of ADHD symptoms in 1845 –he wrote list of ADHD symptoms in 1845 –he wrote

children's books.children's books. A portion of Fidgety Philip, from the German:A portion of Fidgety Philip, from the German: See the naughty, restless child See the naughty, restless child

Growing still more rude and wild, Growing still more rude and wild, Till his chair falls over quite. Till his chair falls over quite. Philip screams with all his might, Philip screams with all his might, Catches at the cloth, but then Catches at the cloth, but then That makes matters worse again. That makes matters worse again. Down upon the ground they fall, Down upon the ground they fall, Glasses, plates, knives, forks, and all. Glasses, plates, knives, forks, and all. How Mamma did fret and frown, How Mamma did fret and frown, When she saw them tumbling down! When she saw them tumbling down! And Papa made such a face! And Papa made such a face! Philip is in sad disgrace. Philip is in sad disgrace.

Did somebody discover ADHD?Did somebody discover ADHD?

YES! As a matter of fact somebody did! Credit usually goes to Dr. George Still, an Englishman who considered it a medical disorder beyond the control of the patient. He called it “DEFECT OF MORAL CHARACTER” in 1902 which probably wasn’t the best possible label!

Post-Encephalitic Behavior Post-Encephalitic Behavior Disorder?Disorder? Symptoms

identical to those we ascribe to ADHD were listed in 1922 in the United States, but were ascribed to Encephalitis and deemed the ramifications of that disease.

How About Stimulants?How About Stimulants?In 1937 Dr. Charles Bradley introduced the use of stimulants (benzedrine) to treat children exhibiting ADHD symptoms of hyperactivity. “It appears odd that a drug known to be a stimulant should produce subdued behavior.” Bradley thought a center in the brain was responsible for inhibiting activity. Many still believe that amphetamines in low doses calm hyperactive children. This effect, they believe, is distinct from the stimulating properties that amphetamines have on healthy children or adults.

But is that true?But is that true? Bradley’s theory of reverse Bradley’s theory of reverse

effect was challenged in 1980 by effect was challenged in 1980 by Judy Rapoport NIMH. Under well-Judy Rapoport NIMH. Under well-controlled conditions, they controlled conditions, they surveyed the cognitive and surveyed the cognitive and behavioral effects of stimulants behavioral effects of stimulants on on bothboth hyperactive and non- hyperactive and non-hyperactive children. hyperactive children. BothBoth groups performed better when groups performed better when taking stimulants. taking stimulants.

SOME OF US KNEW IT ALL ALONG!

By the 1960s it had become:By the 1960s it had become:“Hyperkinetic Disorder of “Hyperkinetic Disorder of

Childhood”Childhood” During the sixties the diagnosis for these symptoms During the sixties the diagnosis for these symptoms

changed twice to "Minimal Brain Dysfunction” and changed twice to "Minimal Brain Dysfunction” and then to "Hyperkinetic Reaction of Childhood.” then to "Hyperkinetic Reaction of Childhood.” (Note (Note the the

Psychoanalytic influence from 1968)Psychoanalytic influence from 1968)

The symptoms were certainly familiar:The symptoms were certainly familiar: restless, fidgety and overactive restless, fidgety and overactive continuously chatter and interrupt people continuously chatter and interrupt people easily distracted and do not finish things easily distracted and do not finish things cannot concentrate on tasks cannot concentrate on tasks impulsive, suddenly doing things without thinking first impulsive, suddenly doing things without thinking first difficulty waiting their turn in games, in conversation or in a difficulty waiting their turn in games, in conversation or in a

queue.queue.  

In 1980 we were given In 1980 we were given ADDADDand lack of focus, inattention, and lack of focus, inattention,

and verbal/cognitive/motor and verbal/cognitive/motor impulsiveness as symptoms.impulsiveness as symptoms.

Attention Deficit became widely reviewed in the 1960s and 1970s. The focus then was primarily on hyperactivity. This changed in the 1970s when researchers began making the connection between the inward daydreaming and lack of focus and the outward impulsivity. By the 1990s, Attention Deficit became widely studied, discussed, debated and diagnosed.

Today we have ADHD in Today we have ADHD in three varieties! three varieties!

mainly inattentive mainly inattentive mainly hyperactive-impulsive mainly hyperactive-impulsive and both in combination. and both in combination.

Dr. Fred A. Baughman, Jr.Dr. Fred A. Baughman, Jr.

““Twenty five Twenty five years of years of research, not research, not deserving of the deserving of the term 'research.,' term 'research.,' has failed to has failed to validate validate ADD/ADHD as a ADD/ADHD as a disease.”disease.”

Doris J. Rapp, MDDoris J. Rapp, MD Eliminate foods with large quantities of dyes. Reduce or eliminate sugar and sugary sodas. Plan a consistent routine in the home. Snack on whole foods as found in nature

instead of packaged snacks. Look for allergens in the home

and see if eliminating them helps.

Psychoanalysis sees it Psychoanalysis sees it differently:differently:

ADHD is centered in ADHD is centered in infantile development, infantile development, attachment, object attachment, object relations (regulation of relations (regulation of drives and affects, ego drives and affects, ego functions) of the role of functions) of the role of infantile trauma (object infantile trauma (object loss) and psychic loss) and psychic conflict. ADHD conflict. ADHD symptoms may symptoms may manifest as manifest as intrapsychic conflict on intrapsychic conflict on the level of self-the level of self-representationrepresentation

Environment or Genetics?Environment or Genetics?

There is little compelling There is little compelling evidence that ADHD can arise evidence that ADHD can arise purely from social factors or purely from social factors or child-rearing methods child-rearing methods but cigarettes but cigarettes and alcohol and alcohol DURING PREGNANCY ARE SUSPECTED DURING PREGNANCY ARE SUSPECTED

CContributorsontributors..   Most of the possible causes of ADHD Most of the possible causes of ADHD

are currently hypothesized to be are currently hypothesized to be related to neurobiology and genetics. related to neurobiology and genetics.

What treats it?What treats it?

cognitive-behavioral interventions cognitive-behavioral interventions clinical behavior therapy clinical behavior therapy direct contingency management direct contingency management intensive, packaged behavioral intensive, packaged behavioral

treatments treatments DRUGSDRUGS

Is it medical, mental, or Is it medical, mental, or mythical?mythical?

Effective treatment protocols and Effective treatment protocols and etiological theories for ADHD have yet to be etiological theories for ADHD have yet to be created…because ADHD, often renamed, created…because ADHD, often renamed, has yet to be defined! What’s yourhas yet to be defined! What’s your belief?belief?