Intended for healthcare professionals

Rapid response to:

Head To Head

Is ADHD a valid diagnosis in adults? No

BMJ 2010; 340 doi: (Published 26 March 2010) Cite this as: BMJ 2010;340:c547

Rapid Response:

Lessons from the History of ADHD

As an historian who has researched the history of ADHD for many
years, I was intrigued by the debate published on the validity of Adult
ADHD. I think one of the reasons that debates such as these are still
raging about the legitimacy of ADHD as a diagnosis for either children or
adults, is a profound lack of understanding of the history of the
disorder. Drs. Moncrieff and Timimi are perfectly correct that drug
companies have marketed the concept of Adult ADHD to potential consumers -
certainly they did so at PTA meetings in the United States during the
1960s and 1970s - but this is only part of the story. Disorders such as
ADHD are not merely a diabolical construction of companies intended to
make profits, or an invention of psychiatrists and educators to boost
professional prestige and control children; instead they are a reflection
of the disconnect between society's expectations for the academic and
occupational performance of children and adults, and the ability of
children and adults to live up to such expectations.

My research demonstrates that ADHD, as we know it, emerged during the
1950s in the United States, during a time when enormous expecations were
placed on the backs of the baby boom generation, the first hyperactive
children and the largest cohort ever born in the U.S. Concerned about
perceived American deficiences in science and technology, as evidenced by
the Soviet launching of Sputnik, education critics demanded more of
students, particularly in the areas of science, mathematics, English and
foreign languages. Such demands were reified in the National Defense
Education Act of 1958. The behavioural characteristics of underachieving
children were soon identified, most of which could be enveloped in the
1957 term 'hyperkinetic impulse disorder', a precursor for ADHD, and
action was taken by school guidance counsellors, a new American
profession, to identify and help such underachieving children. This
coincided with the emergence of many psychoactive drugs to treat not only
hyperactivity, but also depression, psychosis and anxiety. One of these
drugs, which had previously been marketed to geriatric and depressed
patients as a 'pep pill', was Ritalin.

These sorts of factors, and many, many others, must be taken into account
if a reasonable account of the emergence of disorders, such as ADHD (and
PTSD, anorexia nervosa, anxiety disorder, OCD, etc...) can be made. We
need to understand the history of these concepts if we are to deal with
them effectively and get away from polarised debates that lead us nowhere.

Competing interests:
None declared

Competing interests: No competing interests

01 April 2010
Matthew PC Smith
Wellcome Trust Research Fellow
Centre for Medical History, University of Exeter, Amory Building, Rennes Drive, exeter EX4 4RJ