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How has the Medical Treatment of ADHD Evolved?

Posted on 24.10.2019
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ADHD has had many different names. Hyperactive child syndrome, hyperkinetic impulse disorder, even organic brain disease - these were terms used to explain the symptoms of what we now call attention deficit hyperactivity disorder. It is usually diagnosed by the age of 6 and has two main presentations, the first of which is inattentiveness and the second is hyperactivity and impulsiveness. 
 
According to the NHS, the symptoms of inattentiveness are:
  • having a short attention span and being easily distracted
  • making careless mistakes – for example, in schoolwork
  • appearing forgetful or losing things
  • being unable to stick to tasks that are tedious or time-consuming
  • appearing to be unable to listen to or carry out instructions
  • constantly changing activity or task
  • having difficulty organising tasks
 
The symptoms of hyperactivity and impulsiveness are:
  • being unable to sit still, especially in calm or quiet surroundings
  • constantly fidgeting
  • being unable to concentrate on tasks
  • excessive physical movement
  • excessive talking
  • being unable to wait their turn
  • acting without thinking
  • interrupting conversations
  • little or no sense of danger
 
As with many medical conditions that have an effect on behaviour, early cases were often diagnosed as having to do with good and evil rather than physical health. In fact, some of the earliest descriptions of children with ADHD-like symptoms (made in 1902 by Sir George Frederick Still) claimed they had a “defect of moral control”. 
 
In terms of treatment, the first breakthrough happened in 1937. Dr Charles Bradley, learned about the benefits of administering Benzedrine accidentally, when prescribing it to children with severe headaches. He was amazed to find that instead of pain relief, it improved their behaviour and school performance. 
 
However, it wasn’t until 1957 that the term “hyperkinetic impulse disorder” was coined, leading to a study on the effects of Ritalin (methylphenidate) in “emotionally disturbed children”. In the ensuing decades the use of the drug to treat ADHD became more widespread, eventually causing controversy and prompting some to accuse the pharmaceutical companies of inventing the condition to make money. Instead, parents attributed symptoms to things like food additives and allergies.
 
By the eighties, ADHD was widely accepted as a diagnosis, although treatment with stimulants was beginning to also be tempered with other treatments including tricyclic antidepressants. As with depression and other forms of mental illness, the combination of medication and a certain amount of management of external factors like school and home life became more common. 
 
So, what do things look like for those suffering from ADHD in 2019? Things haven’t really changed much since the advent of Ritalin. The five licensed medications in the UK are methylphenidate, dexamfetamine, lisdexamfetamine, atomoxetine and guanfacine and the first three of those are all stimulants as well as being the most common.
 
There is still an element of contention surrounding giving children stimulants. Most medical professionals tend to stress that such a course of treatment, would only be advised, after a comprehensive clinical evaluation with collateral information before a diagnosis of ADHD was reached. Then and only then would psychostimulants be recommended.
 
What has changed, is the perception of ADHD. Therapy is often recommended alongside medication, and the NHS lists psychoeducation, behaviour therapy, CBT and social skills training as useful tools. Teacher now know how to recognise the signs of ADHD and instead of isolating the children or labelling them as “difficult” can now help them. Most importantly, we recognise it as a medical condition that can be treated, not a personality flaw to be dismissed or mocked.
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