A Short History of Mental Health

Looking backward to move forward

The ADHD Increase in Context

New York Times report on Center for Disease Control's ADHD statistics

The New York Times recently caused controversy by reporting a story about the new Centers for Disease Control and Prevention (CDC) figures on ADHD.  When you crunch the numbers in a certain way, it appears that nearly 20 percent of high school age boys and 11 percent of school-aged children over all have been diagnosed with the disorder.  While such figures shock and may appall, statistics notwithstanding, they gloss over a more fundamental - and historical - question, that never gets asked: why were kids first diagnosed with ADHD?

This question occurred to me when I was a youth counsellor back in Canada. I worked for a charity that helped get troubled kids back into school. Drop-outs could access government funding to re-boot their education and we, as counsellors, found that kids got many more "get-out-of-jail-free-cards" if they were had an ADHD diagnosis, an explanation for their academic and social shortcomings. Of course, we counsellors knew that many other factors were responsible - abuse, drugs, gangs, poverty - but ADHD was a much easier pill to swallow, so to speak.

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When I left for graduate studies in history, the question occurred to me again. Why were there all these kids with ADHD? I didn’t recall ADHD kids when I was in school, so where did they come from? Mental disorders don’t just pop out of the ground like fairy rings; what were the origins of the pandemic? 

When I began to look, I realized that ADHD (though it wasn’t called that) went back further than I thought, but not as far as many would have you believe. Concern about children who were hyperactive, inattentive, impulsive, defiant, and possibly aggressive goes back to about the late 1950s. Look through the medical and education journals before that and you’ll find little mention of such behaviors. When you do find such symptoms mentioned, it is either in association with food allergy, or they are described in much more severe terms. The hyperactive and impulsive children described by early-twentieth-century doctors are severely disturbed, capable of injuring themselves or others, and usually ended up in psychiatric institutions. Often such behavior was associated with head injuries, ranging from blows to the head or post-encephalitic disorder, the terrible aftermath in some cases of encephalitis.

So, what sort of children were identified as psychiatrically problematic before the 1950s? It turns out, the opposite kind of child. Shy, nervous, withdrawn, introverted children were the ones to look out for, not the boisterous, active, trouble-making types. Mark Twain identifies this quite nicely in The Adventures of Tom Sawyer: while the distractible and impulsive Tom and Huck clearly have the ADHD symptoms, it’s these very characteristics that make them heroic. The kid who’s at risk of having psychiatric problems is the poor little German boy who studies too hard.

What about the late 1950s, then, triggers such concern in children like Tom and Huck? An awful lot, it turns out. But although many, many factors (ranging from the impact of the Baby Boom generation on the school system to the burgeoning psychopharmaceutical industry) can be blamed, two 1957 developments can be singled out.

The first is the coining of a new term in 1957 to describe the Toms and Hucks of this world: hyperkinetic impulse disorder. Whereas previous depictions of such behavior (such as the term ‘minimal brain damage’) insinuated a specific cause or portrayed such children as being significantly disturbed, hyperkinetic impulse disorder, first employed by a team of Rhode Island child psychiatrists, was almost intentionally vague. As such, it could be applied, as the psychiatrists said themselves, to an astonishingly-wide range of school children.

One of the reasons hyperkinetic impulse disorder was applied with such alacrity points to a completely different development: the Soviet launch of Sputnik in 1957. Sputnik forced Americans living in the Cold War to contend with the possibility that they were no longer the preeminent scientific and, by extension, military force on the planet.

The blame for American technological shortcomings fell squarely with the lax, child-centered education system. As a result, the National Defense Education Act was passed in 1958, which put more focus on core subjects, such as science and math, and provided funding for thousands of guidance counsellors to identify potential drop-outs, determine what lay behind their academic difficulties, and refer them to physicians for medical treatment. The reason for a great deal of the academic underachievement? You guessed it - hyperkinetic impulse disorder, the ADHD of the 1950s.

Of course many other factors have contributed to the juggernaut that is ADHD today. And it is likely that there have always been kids, just like Tom and Huck, who were active, distractible and impulsive. But it is also important for all those now involved with ADHD that there was a time, not too terribly long ago, when such children were not seen as particularly problematic, by their parents, by their teachers, and certainly not by their doctors. ADHD wasn’t simply invented to pad the profits of drug companies or to let bad parents off the hook. But if we don’t recognize that that ADHD is at least in part a product of culture, demographics, education, and even the geopolitics of the Cold War, then the polarized debates about the disorder will simply continue, which doesn’t help anyone, let along kids struggling to succeed.

Why are even more kids being diagnosed with ADHD today? Well, just like during the 1950s, we live in difficult times. The economic stresses we deal with today may be very different from the nuclear annihilation people faced during the height of the Cold War (apologies to North Korea), but they are no less of a burden, especially upon our children. With youth unemployment throughout the world at record highs, is it no wonder that 1 in 5 high school boys might welcome a disorder that helps to explain their academic woes, not to mention a pill that might give them an edge.

The sad thing is that ADHD, then and now, is that it’s never been just about children. It’s also been about the expectations adults put upon children, as well as the world adults force children to live in. Perhaps if we saw childhood as an end in itself, rather than a means to creating a certain sort of adult, we’d see disorders like ADHD much differently.

Matthew Smith, Ph.D. is a Lecturer and Wellcome Trust Research Fellow at the University of Strathclyde in Glasgow.

 

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