ADHD (attention deficit hyperactivity disorder) has a rich and long history. One of the earliest descriptions of a child with hyperactivity is in a German book of nursery rhymes first published in the mid-1800s by the physician Heinrich Hoffman. The story of “fidgety Phil” came with graphic pictures of a youngster who created havoc at the dinner table. It included the following lines: “But fidgety Phil, he won’t sit still; he wriggles and giggles, and then, I declare, swings backwards and forwards and tilts up his chair.”1

In 1902, the British pediatrician, Sir George Still, gave a series of three lectures describing 20 children who were often aggressive, defiant, and resistant to discipline and who exhibited impaired attention and overactivity.2 He described these children as having a “defect of moral control” and noted a male-female ratio of nearly 3 to 1.

In the United States, interest in this disorder can be traced to the pandemic encephalitis in 1917. Numerous observers reported on a “postencephalitis behavior disorder” that included “hyperkinesis” and “organic driveness.” This resulted in comparisons to other brain injuries and their behavioral manifestations. Strauss3 found that symptoms of disinhibition, hyperactivity, and distractibility differentiated brain-injured mentally retarded children from those who were not brain-injured. These comparisons led to the concept of minimal brain damage and, eventually in the early 1960s, to minimal brain dysfunction (MBD). Over time, the label MBD was increasingly criticized for its overinclusiveness and the increasing understanding that hyperactivity can be present in the absence of organicity. The term MBD eventually was dropped, giving rise to the term hyperactive child syndrome.

In 1968, compilers of the Diagnostic and Statistical Manual of Mental Disorders, second edition (DSM-II),4 changed the term to hyperkinetic reaction of childhood. Research in the 1970s that examined the role of attention and impulsivity in the disorder eventually gave rise to the position taken by DSM-III5 that one could have attention-deficit disorder with or without hyperactivity. DSM-III grouped symptoms into three lists: inattention, hyperactivity, and impulsivity. A revision of the DSM-III6 combined all the symptoms into a single list. Finally, in 1994, DSM-IV7 was published, providing the criteria shown in Table: Diagnostic Criteria For ADHD

Adapted from: Hirsch GS and Koplewicz HS. Attention-deficit hyperactivity disorder. In: Devinsky O and Westbrook LE, eds. Epilepsy and Developmental Disabilities. Boston: Butterworth-Heinemann; 2001;187–204.
With permission from Elsevier (www.elsevier.com).
Reviewed and revised June 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.