ADHD: An Overview

ADHD: An Overview

ADHD is neither a “new” mental health problem nor is it a disorder created for the purpose of personal gain or financial profit by pharmaceutical companies, the mental health field, or by the media.  It is a very real behavioral and medical disorder that affects millions of people nationwide.  According to the National Institute of Mental Health (NIMH), ADHD is one of the most common mental disorders in children and adolescents.  According to research sponsored by NIMH, estimated the number of children with ADHD to be between 3% – 5% of the population.  NIMH also estimates that 4.1 percent of adults have ADHD.  

Although it has taken quite some time for our society to accept ADHD as a bonafide mental health and/or medical disorder, in actuality it is a problem that has been noted in modern literature for at least 200 years.  As early as 1798, ADHD was first described in the medical literature by Dr. Alexander Crichton, who referred to it as “Mental Restlessness.”  A fairy tale of an apparent ADHD youth, “The Story of Fidgety Philip,” was written in 1845 by Dr. Heinrich Hoffman.  In 1922, ADHD was recognized as Post Encephalitic Behavior Disorder.  In 1937 it was discovered that stimulants helped control hyperactivity in children.  In 1957 methylphenidate (Ritalin), became commercially available to treat hyperactive children.

The formal and accepted mental health/behavioral diagnosis of ADHD is relatively recent.  In the early 1960s, ADHD was referred to as “Minimal Brain Dysfunction.”  In 1968, the disorder became known as “Hyperkinetic Reaction of Childhood.”  At this point, emphasis was placed more on the hyperactivity than inattention symptoms.  In 1980, the diagnosis was changed to “ADD–Attention Deficit Disorder, with or without Hyperactivity,” which placed equal emphasis on hyperactivity and inattention.  By 1987, the disorder was renamed Attention Deficit Hyperactivity Disorder (ADHD) and was subdivided into four categories (see below).  Since then, ADHD has been considered a medical disorder that results in behavioral problems.

Currently, ADHD is defined by the DSM IV-TR (the accepted diagnostic manual) as one disorder which is subdivided into four categories:

1.  Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type–previously known as ADD–is marked by impaired attention and concentration.

2.  Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive, Impulsive  
Type–formerly known as ADHD–is marked by hyperactivity without inattentiveness.

3.  Attention-Deficit/Hyperactivity Disorder, Combined Type–the most common type–
involves all the symptoms: inattention, hyperactivity, and impulsivity.

4.  Attention-Deficit/Hyperactivity Disorder Not Otherwise Specified. This category
is for the ADHD disorders that include prominent symptoms of inattention or    
hyperactivity-impulsivity, but do not meet the DSM IV-TR criteria for a  
diagnosis.  

To further understand ADHD and its four subcategories, it may be helpful to illustrate hyperactivity, impulsivity, and/or inattention through examples.

Typical hyperactive symptoms in youth include:
• Often “on the go” or acting as if “driven by a motor”
• Feeling restless
• Moving hands and feet nervously or squirming
• Getting up frequently to walk or run around
• Running or climbing excessively when it’s inappropriate
• Having difficulty playing quietly or engaging in quiet leisure activities
• Talking excessively or too fast
• Often leaving seat when staying seated is expected
• Often can’t be involved in social activities quietly

Typical symptoms of impulsivity in youth include:
• Acting rashly or suddenly without thinking first
• Blurting out answers before questions are fully asked
• Having a difficult time awaiting a turn
• Often interrupting others’ conversations or activities
• Poor judgment or decisions in social situations, which result in the child not being accepted by his/her own peer group.

Typical symptoms of inattention in youth include:
• Not paying attention to details or makes careless mistakes
• Having trouble staying focused and being easily distracted
• Appearing not to listen when spoken to
• Often forgetful in daily activities
• Having trouble staying organized, planning ahead, and finishing projects
• Losing or misplacing homework, books, toys, or other items
• Not seeming to listen when directly spoken to  
• Not following instructions and failing to finish activities,

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