History and Changing Diagnostic Criteria

Children who might now be diagnosed as having ADHD have been written

about and discussed in scientific publications since the mid-1800’s. Attention

to ADHD began in the United States after an encephalitis epidemic in

1917. Because the damage to the central nervous system caused by the disease

led to poor attention, impulsivity, and overactivity in children who survived,

researchers began to look for signs of brain injury in other children

who had similar behavioral profiles. By the 1950’s, researchers began to refer

to this disorder as “minimal brain damage,” which was then changed to

“minimal brain dysfunction” (MBD). By the 1960’s, however, the use of the

term MBD was severely criticized because of its overinclusiveness and nonspecificity.

Researchers began to use terms that more specifically characterized

children’s problems, such as “hyperkinesis” and “hyperactivity.”

The Diagnostic and Statistical Manual of Mental Disorders (DSM), is the primary

diagnostic manual used in the United States. In 1968, the second edition,

called DSM-II, presented the diagnosis of “Hyperkinetic Reaction of

Childhood” to characterize children who were overactive and restless. By

1980, when the third edition (DSM-III) was published, researchers had begun

to focus on the deficits of attention in these children, so two diagnostic

categories were established: “Attention Deficit Disorder with Hyperactivity

(ADD with H)” and “Attention Deficit Disorder without Hyperactivity (ADD

without H).” After the publication of DSM-III, many researchers argued that

there were no empirical data to support the existence of the ADD withoutH

diagnosis. In other words, it was difficult to find any children who were inattentive

and impulsive but who were not hyperactive. For this reason, in 1987,

when the revised DSM-III-R was published, the only diagnostic category for

these children was “Attention-Deficit Hyperactivity Disorder (ADHD).”

With the publication of the fourth version of the manual, the DSM-IV, in

1994, three distinct diagnostic categories for ADHD were identified: ADHD

Predominantly Hyperactive-Impulsive Type, ADHD Predominantly Inattentive

Type, and ADHD Combined Type. The type of ADHD diagnosed is dependent

upon the number and types of behavioral symptoms a child exhibits.

Six of nine symptoms from the Hyperactivity-Implusivity list but fewer

than six symptoms from the Inattention list lead to a diagnosis ofADHDPredominantly

Hyperactive-Impulsive Type. Six of nine symptoms from the Inattention

list but fewer than six symptoms from the Hyperactivity-Implusivity

list lead to a diagnosis of ADHD Predominantly Inattentive Type. A child

who exhibits six of nine behavioral symptoms simultaneously from both lists

receives a diagnosis of ADHD Combined Type.

While the diagnostic definition and specific terminology of ADHD will

undoubtedly continue to change throughout the years, the interest in and

commitment to this disorder will likely continue. Children and adults with

ADHD, as well as the people around them, have difficult lives to lead. The

research community is committed to finding better explanations of the etiology

and treatment of this common disorder.

ADHD, as well as the people around them, have difficult lives to lead. The

research community is committed to finding better explanations of the etiology

and treatment of this common disorder.

Diagnostic and Statistical Manual of Mental Disorders (DSM), is the primary