ADHD Over the Years
Melchior Adam Weikard (German physician) published a text book with a description of ADHD-like behaviours.
“An inattentive person won’t remark anything but will be shallow everywhere. He studies his matters only superficially; his judgements are erroneous and he misconceives the worth of things because he does not spend enough time and patience to search a matter individually or by the piece with the adequate accuracy. Such people only hear half of everything; they memorize or inform only half of it or do it in a messy manner. According to a proverb they generally know a little bit of all and nothing of the whole…. They are mostly reckless, often copious considering imprudent projects, but they are also most inconstant in execution. They treat everything in a light manner since they are not attentive enough to feel denigration or disadvantages”.
[Reference link here.]
Sir Alexander Crichton’s (Scottish Physician) book contained a mental state similar to ADHD.
The incapacity of attending with a necessary degree of constancy to any one object, almost always arises from an unnatural or morbid sensibility of the nerves, by which means this faculty is incessantly withdrawn from one impression to another. It may be either born with a person, or it may be the effect of accidental diseases.
When born with a person it becomes evident at a very early period of life, and has a very bad effect, inasmuch as it renders him incapable of attending with constancy to any one object of education. But it seldom is in so great a degree as totally to impede all instruction; and what is very fortunate, it is generally diminished with age.
In this disease of attention, if it can with propriety be called so, every impression seems to agitate the person, and gives him or her an unnatural degree of mental restlessness. People walking up and down the room, a slight noise in the same, the moving of a table, the shutting a door suddenly, a slight excess of heat or of cold, too much light, or too little light, all destroy constant attention in such patients, inasmuch as it is easily excited by every impression.
[Reference link here. Pg. 271]
The start of formal recognition of ADHD.
Sir George Still uses the Royal Society of Physicians’ Goulstonian Lectures, later published in the Lancet, to speak on “abnormal psychical conditions in children”.
“There is a defect of moral consciousness which cannot be accounted for by any fault of environment”. [Note Moral Control is “the control of action in conformity with the idea of the good of all.”
“I would point out that a notable feature in many of these cases of moral defect without general impairment of intellect is a quite abnormal incapacity for sustained attention”.
“Another boy, aged 6 years, with marked moral defect was unable to keep his attention even to a game for more than a very short time, and as might be expected, the failure of attention was very noticeable at school, with the result that in some cases the child was backward in school attainments, although in manner and ordinary conversation he appeared as bright and intelligent as any child could be.”
[Reference link here.]
Symptoms linked to the Encephalitis epidemic
“Post-encephalitic behaviour disorder”.
Early and mid 1900's
ADHD unlinked from Encepaltius & understanding consolidated
Thought moved from caused by Encephalitis, to an underlying condition uncovered by Encephalitis or other brain damage, to recognising the symptoms didn’t require disease or brain damage.
Named as “brain-injured child syndrome”, “minimal brain damage” and “minimal brain dysfunction”. Then “learning/behavioural disabilities” and “hyperactivity”.
1968 - 1990
First official definition. “Hyperkinetic Reaction of Childhood”
1980 - 1987
Amended to “Attention-Deficit Disorder [ADD] with or without hyperactivity”
1987 - 1994
Amended to “Attention-Deficit Hyperactivity Disorder [ADHD]”
Recorded in DSM*-III-R. Many adults with a diagnosis of ADHD continue to prefer referring to themselves as ADD to reflect that they do not feel the hyperactive element is relevant to them.
(*Diagnostic and Statistical Manual of Mental Disorders, USA )
1994 to present
ADHD adjusted with detail of three sub-types.
(1) ADHD with inattentive presentation (no hyperactivity) [ADHD-I]
(2) ADHD with hyperactive presentation [ADHD-II]
(3) ADHD with combined presentation (hyperactivity and inattentiveness) [ADHD-III]
(*Diagnostic and Statistical Manual of Mental Disorders, USA)
NICE recognises childhood ADHD (Applies to England, Wales and Northern Ireland)
For the first time, the majority of the UK NHS through NICE formally recognises childhood ADHD. This is done via a technical recommendation TA13 around medication for ADHD. (NICE TA13 (retired) page).
NICE is automatically adopted in England and Wales, adopted by process in Northern Ireland, and taken note of in Scotland. Where adopted it has legal weight for required service delivery for patients.
This was one of the very first guidance notes, the 13th, issued by NICE. Which suggests the perceived importance of filling the gap. NICE currently has around 2,000 pieces of active advice and has up-rated its ADHD advice multiple times.
NICE recognises ADHD in adults
SIGN (Scottish Intercollegiate Guidelines Network) publishes guidance on ADHD and Children.
For the first time in history all nations in the UK formally recognise with healthcare support, funding, and guidance children with ADHD.
SIGN (Scottish Intercollegiate Guidelines Network) is the equivalent of NICE (National Institute of Clinical Excellence). SIGN is part of Scotland’s Evidence Directorate of Healthcare Improvement with core funding supporting the SIGN guideline programme.
Updated NICE guidelines on ADHD
NICE regularly reviews and updates its guidance. In this guidance NICE specifically calls out the issue of ADHD being under-recognised in Girls and Women. (See Section 1.2.2 of the 2018 Nice Guidelines)
SIGN (Scotland) withdraws its advice on ADHD in Children.
SIGN (Scottish Intercollegiate Guidelines Network) withdraws its 2009 advice on ADHD in Children for being out of date. It does not replace it with updated advice. Scotland is alone as a UK national in not providing guidance on Childhood ADHD. SIGN has never published guidance on Adult ADHD.