Fidgety Phil, Minimal Brain Damage, and the DSM 5: a History of ADHD Over Two Centuries

In this session, we will review the historical development of the recognition and treatment of ADHD. We will use images, videos, and excerpts and include interactive components as well.

We will begin with some examples from early fiction literature of children with disruptive behaviors. These descriptions will then take us to the early understanding of these behaviors as "defects in moral control". This understanding developed quicky in the early 20th century, due to multiple factors, into the understanding of severe impulsivity and hyperactivity as manifestations of brain dysfunction. We will discuss some of these factors, including the encephalitis lethargica epidemic, soldiers with traumatic brain injuries returning from WWI, and early research with the rhesus monkey. This etiologic understanding was expanded to include children with symptoms of severe hyperactivity and impulsivity but no clear brain dysfunction and became known as "minimal brain dysfunction". This lesion-based model was soon over-taken by psychoanalytic models, which will be explored. We will then look at the more recent history and the development of our present diagnosis through the sequential versions of the DSM, up to the present. We will explore some alternate models of the diagnosis as well.

The serendipitous discovery of stimulants in the 1930s will also be examined. Because of the prominence of psychoanalysis at the time, it took 25 years for these findings to become widely accepted. We will explore Charles Bradly`s understanding of the mechanism of stimulants at the time, which is surprisingly close to our present understandings.