adhd medication essay

162 ADHD Essay Topics & Examples

Looking for ADHD topics to write about? ADHD (attention deficit hyperactivity disorder) is a very common condition nowadays. It is definitely worth analyzing.

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In your ADHD essay, you might want to focus on the causes or symptoms of this condition. Another idea is to concentrate on the treatments for ADHD in children and adults. Whether you are looking for an ADHD topic for an argumentative essay, a research paper, or a dissertation, our article will be helpful. We’ve collected top ADHD essay examples, research paper titles, and essay topics on ADHD.

• ADHD and its subtypes
• The most common symptoms of ADHD
• The causes of ADHD: genetics, environment, or both?
• ADHD and the changes in brain structures
• ADHD and motivation
• Treating ADHD: the new trends
• Behavioral therapy as ADHD treatment
• Natural remedies for ADHD
• ADD vs. ADHD: is there a difference?
• Living with ADHD: the main challenges
• Everything You Need to Know About ADHD The frontal hemisphere of the brain is concerned with coordination and a delay in development in this part of the brain can lead to such kind of disorder.
• Learning Disabilities: Differentiating ADHD and EBD As for the most appropriate setting, it is possible to seat the child near the teacher. It is possible to provide instructions with the help of visual aids.
• Attention Deficit Hyperactivity Disorder (ADD / ADHD) Some critics maintain that the condition is a work of fiction by the psychiatric and pharmacists who have taken advantage of distraught families’ attempts to comprehend the behaviour of their children to dramatise the condition.
• Is Attention Deficit Hyperactivity Disorder Real? In fact, the existence of the condition, its treatment and diagnosis, have been considered controversial topics since the condition was first suggested in the medical, psychology and education.
• ADHD and Its Effects on the Development of a Child In particular, this research study’s focus is the investigation of the impact of household chaos on the development and behavior of children with ADHD.
• The History of ADHD Treatment: Drug Addiction Disorders Therefore, the gathered data would be classified by year, treatment type, and gender to better comprehend the statistical distribution of the prevalence of drug addiction.
• Attention Deficit Hyperactivity Disorder and Recommended Therapy The condition affects the motivational functioning and abnormal cognitive and behavioural components of the brain. Dysfunction of the prefrontal cortex contributed to a lack of alertness and shortened attention in the brain’s short-term memory.
• Rhetorical Modes Anthology on Attention Deficit Disorder It clearly outlines the origin and early symptoms of the disorder and the scientist who discovered attention deficit hyperactivity disorder. Summary & Validity: This article describes the causes of hyperactivity disorder and the potential factors […]
• Attention-Deficit Hyperactivity Disorder in a Young Girl The particular objective was to assist Katie in becoming more focused and capable of finishing her chores. The patient received the same amount of IR Ritalin and was required to continue taking it for an […]
• Similarities and Differences: SPD, ADHD, and ASD The three disorders, Sensory Processing Disorder, Attention Deficit Hyperactivity Disorder, and Autism Spectrum Disorder, are often confused with each other due to the connections and similarities that exist.
• Attention Deficit Hyperactivity Disorder Awareness According to Sayal et al, ADHD is common in young boys as it is easier to identify the problem. The disorder is well-known, and there is no struggle to identify the problem.
• Assessing the Personality Profile With ADHD Characteristics On the contrary, the study was able to understand significant changes in the emotional states and mood of the children when the observations and the tests ended.
• Aspects of ADHD Patients Well-Being This goal can be achieved through the help of mental health and behavioral counselors to enhance behavioral modification and the ability to cope with challenges calmly and healthily.
• ADHD and Problems With Sleep This is because of the activity of a person in the middle of the day and the condition around them. The downside of the study is that the study group included 52 adults with ADHD […]
• The Attention Deficit Hyperactivity Disorder Treatment It has been estimated that when medicine and therapy are applied as treatment together, the outcomes for children with ADHD are excellent.
• Attention Deficit Hyperactivity Disorder Organization’s Mission Children and Adults with Attention-Deficit/Hyperactivity Disorder is an organization that is determined to handle individuals affected by ADHD. The organization was founded in 1987 following the rampant frustration and isolation that parents experienced due to […]
• Case Conceptualization: Abuse-Mediated ADHD Patient The case provides insight into the underlying causes of James’s educational problems and the drug abuse of his parents. The case makes it evident that the assumption from the first case conceptualization about James’s ADHD […]
• Change: Dealing With Patients With ADHD In the current workplace, the most appropriate change would be the increase in the awareness of nurses regarding the methods of dealing with patients with ADHD.
• Dealing With Attention Deficit Hyperactivity Disorder Although my experience is not dramatic, it clearly shows how untreated ADHD leads to isolation and almost depression. However, the question arises of what is the norm, how to define and measure it.
• Parents’ Perception of Attending an ADHD Clinic The main principles of the clinic’s specialists should be an objective diagnosis of the neurological status of the child and the characteristics of his/her behavior, the selection of drug treatment only on the basis of […]
• ADHD: Mental Disorder Based on Symptoms The DSM-5 raised the age limit from 6 to 12 for qualifying the disorder in children and now requires five instead of six inattentive or hyperactive-impulsive symptoms.
• Understanding Attention-Deficit/Hyperactivity Disorder Thus, the smaller sizes of the reviewed brain structures associated with ADHD result in problems with attention, memory, and controlling movement and emotional responses.
• Effective Therapies for Attention Deficit Hyperactivity Disorder The problem at hand is that there is a need to determine which of the therapies administered is effective in the management of ADHD.
• Participants of “ADHD Outside the Laboratory” Study The participants in the testing group and those in the control group were matched for age within 6 months, for IQ within 15 points and finally for performance on the tasks of the study.
• Variables in “ADHD Outside the Laboratory” Study The other variables are the videogames, matching exercise and the zoo navigation exercise used to test the performance of the boys.
• Different Types of Diets and Children’s ADHD Treatment The last factor is a trigger that can lead to the development of a child’s genes’ reaction. Thus, diet is one of the factors that can help prevent the development of ADHD.
• Attention Deficit Hyperactivity Disorder in Children The consistent utilization of effective praises and social rewards indeed results in the behavioral orientation of the child following the treatment goals.
• Reward and Error Processing in ADHD: Looking Into the Neurophysiological and the Behavioral Measures The study was mainly concerned with looking into the neurophysiological and to some extent the behavioral measures utilized in self regulation particularly in children suffering from attention – deficit hyperactivity disorder and those who are […]
• Vyvanse – ADD and ADHD Medicine Company Analysis It is produced by Shire and New River Pharmaceuticals in its inactive form which has to undergo digestion in the stomach and through the first-pass metabolic effect in the liver into L-lysine, an amino acid […]
• Dealing With the Disruptive Behaviors of ADHD and Asperger Syndrome Students While teaching in a class that has students with ADHD and Asperger syndrome, the teacher should ensure that they give instructions that are simple and easy to follow.
• Behavioral Parenting Training to Treat Children With ADHD These facts considered, it is possible to state that the seriousness of ADHD accounts for the necessity of the use of behavioral parental training as the treatment of the disorder.
• Current Issues in Psychopharmacology: Attention-Deficit Hyperactivity Disorder This is the area that is charged with the responsibility for vision control as well as a regulation of one’s brain’s ability to go to aresynchronize’ and go to rest.
• Cognitive Psychology and Attention Deficit Disorder On top of the difficulties in regulating alertness and attention, many individuals with ADD complain of inabilities to sustain effort for duties.
• ADHD Symptoms in Children However, there are some concerns in identifying the children with ADHD.described in a report that support should be initiated from the parents in, recognizing the problem and seeking the help of the educational professionals.2.
• Adult and Paediatric Psychology: Attention Deficit Hyperactivity Disorder To allow children to exercise their full life potential, and not have any depression-caused impairment in the social, academic, behavioral, and emotional field, it is vital to reveal this disorder as early in life, as […]
• Attention-Deficit Hyperactivity Disorder: Biological Testing The research, leading to the discovery of the Biological testing for ADHD was conducted in Thessaloniki, Greece with 65 children volunteering for the research. There is a large difference in the eye movement of a […]
• Issues in the Diagnosis of Attention-Deficit Hyperactivity Disorder in Children Concept theories concerning the nature of attention-deficit/hyperactivity disorder influence treatment, the approach to the education of children with ADHD, and the social perception of this disease.
• Attention Deficit Hyperactivity Disorder Care Controversy The objective of this study was to assess the efficacy, in terms of symptoms and function, and safety of “once-daily dose-optimized GXR compared with placebo in the treatment of children and adolescents aged 6 17 […]
• Attention Deficit Hyperactivity Interventions The authors examine a wide range of past studies that reported on the effects of peer inclusion interventions and present the overall results, showing why further research on peer inclusion interventions for children with ADHD […]
• Sociodemographic and Cultural Factors of Attention Deficit Hyperactivity Disorder Children at this age have particular difficulties in retaining and concentrating attention and in controlling behavior, and this stage is sensitive to the development of these abilities. The general problem is the increase in prevalence […]
• Attention Deficit Hyperactivity Disorder (ADHD) in a Child A child counselor works with children to help them become mentally and emotionally stable. The case that is examined in this essay is a child with attention deficit hyperactivity disorder.
• Attention Deficit Hyperactivity Disorder: Drug-Free Therapy The proposed study aims to create awareness of the importance of interventions with ADHD among parents refusing to use medication. The misperceptions about ADHD diagnosis and limited use of behavioral modification strategies may be due […]
• Attention Deficit Hyperactivity Disorder: Psychosocial Interventions The mentioned components and specifically the effects of the condition on a child and his family would be the biggest challenge in the case of Derrick.
• The Diagnosis and Treatment of ADHD Cortese et al.state that cognitive behavioral therapy is overall a practical approach to the treatment of the condition, which would be the primary intervention in this case.
• The Attention Deficit Hypersensitivity Disorder in Education Since ADHD is a topic of a condition that has the potential to cripple the abilities of a person, I have become attached to it much.
• Attention Deficit Hyperactivity Disorder: Comorbidities Due to the effects that ADHD has on patients’ relationships with their family members and friends, the development of comorbid health problems becomes highly possible.
• Medicating Kids to Treat ADHD The traditional view is that the drugs for the disorder are some of the safest in the psychiatric practice, while the dangers posed by untreated ADHD include failure in studies, inability to construct social connections, […]
• Attention Deficit Hyperactivity Disorder: Signs and Strategies Determining the presence of Attention Deficit Hyperactivity Disorder in a child and addressing the disorder is often a rather intricate process because of the vagueness that surrounds the issue.
• Cognitive Therapy for Attention Deficit Disorder The counselor is thus expected to assist the self-reflection and guide it in the direction that promises the most favorable outcome as well as raise the client’s awareness of the effect and, by extension, enhance […]
• “Stress” Video and “A Natural Fix for ADHD” Article There certainly are some deeper reasons for people to get stressed, and the video documentary “Stress: Portrait of a Killer” and the article “A Natural Fix for A.D.H.D”.by Dr.
• Attention Deficit Disorder: Diagnosis and Treatment The patient lives with her parents and 12-year-old brother in a middle-class neighborhood. Her father has a small business, and her mother works part-time in a daycare center.
• Bright Not Broken: Gifted Kids, ADHD, and Autism It is possible to state that the book provides rather a high-quality review of the issues about the identification, education, and upbringing of the 2e children.
• Attention Deficit Hyperactive Disorder: Case Review On the other hand, Mansour’s was observed to have difficulties in the simple tasks that he was requested to perform. Mansour’s appears to be in the 3rd phase of growth.
• Treatment of Children With ADHD Because of the lack of sufficient evidence concerning the effects of various treatment methods for ADHD, as well as the recent Ritalin scandal, the idea of treating children with ADHD with the help of stimulant […]
• Attention Deficit Hyperactivity Disorder Medicalization This paper discusses the phenomenon of medicalization of ADHD, along with the medicalization of other aspects perceived as deviant or atypical, it will also review the clash of scientific ideas and cultural assumptions where medicalization […]
• Medication and Its Role in the ADHD Treatment Similar inferences can be inferred from the findings of the research conducted by Reid, Trout and Schartz that revealed that medication is the most appropriate treatment of the symptoms associated with ADHD.
• Children With Attention-Deficit Hyperactivity Disorder The purpose of the present research is to understand the correlation between the self-esteem of children with ADHD and the use of medication and the disorder’s characteristics.
• Psychology: Attention Deficit and Hyperactivity Disorder It is important to pay attention to the development of proper self-esteem in children as it can negatively affect their development and performance in the future.
• Natural Remedies for ADHD The key peculiarity of ADHD is that a patient displays several of these symptoms, and they are observed quite regularly. Thus, one can say that proper diet can be effective for the treatment of attention […]
• Cognitive Behavior Therapy in Children With ADHD The study revealed that the skills acquired by the children in the sessions were relevant in the long term since the children’s behaviors were modeled entirely.
• Is Attention Deficit Disorder a Real Disorder? When Medicine Faces Controversial Issues In addition, it is necessary to mention that some of the symptoms which the children in the case study displayed could to be considered as the ones of ADHD.
• Foods That Effect Children With ADHD/ ADD Therefore, it is the duty of parents to identify specific foods and food additives that lead to hyperactivity in their children.
• Toby Diagnosed: Attention Deficit Hyperactivity Disorder The symptoms of the disorder are usually similar to those of other disorder and this increases the risks of misdiagnosing it or missing it all together.
• Identifying, Assessing and Treating Attention Deficit Hyperactivity Disorder For these criteria to be effective in diagnosing a child with ADHD, the following symptoms have to be present so that the child can be labelled as having ADHD; the child has to have had […]
• ADHD Should Be Viewed as a Cognitive Disorder The manifestation of the disorder and the difficulties that they cause, as posited by the American Psychiatric Association, are typically more pronounced when a person is involved in some piece of work such as studying […]
• Attention Deficit Hyperactivity Disorder Influence on the Adolescents’ Behavior That is why the investigation was developed to prove or disprove such hypotheses as the dependence of higher rates of anxiety of adolescents with ADHD on their diagnosis, the dependence of ODD and CD in […]
• Stroop Reaction Time on Adults With ADHD The model was used to investigate the effectiveness of processes used in testing interference control and task-set management in adults with ADHD disorder.
• Attention Deficit Hyperactivity Disorder Causes Family studies, relationship studies of adopted children, twin studies and molecular research have all confirmed that, ADHD is a genetic disorder.
• Diagnosis and Treatment of ADHD The diagnosis of ADHD has drawn a lot of attention from scientific and academic circles as some scholars argue that there are high levels of over diagnosis of the disorder.
• Attention-Deficit Hyperactivity Disorder As it would be observed, some of the symptoms associated with the disorder for children would differ from those of adults suffering from the same condition in a number of ways.
• Working Memory in Attention Deficit and Hyperactivity Disorder (ADHD) Whereas many studies have indicated the possibility of the beneficial effects of WM training on people with ADHD, critics have dismissed them on the basis of flawed research design and interpretation.
• Attention-Deficit Hyperactivity Disorder: The Basic Information in a Nutshell In the case with adults, however, the definition of the disorder will be quite different from the one which is provided for a child ADHD.
• How ADHD Develops Into Adult ADD The development of dominance is vital in processing sensations and information, storage and the subsequent use of the information. As they become teenagers, there is a change in the symptoms of ADHD.
• Medical Condition of Attention Deficit Hyperactivity Disorder A combination of impulsive and inattentive types is referred to as a full blown ADHD condition. To manage this condition, an array of medical, behavioral, counseling, and lifestyle modification is the best combination.
• Effects of Medication on Education as Related to ADHD In addition, as Rabiner argues, because of the hyperactivity and impulsivity reducing effect of ADHD drugs, most ADHD suffers are nowadays able to learn in an indistinguishable class setting, because of the reduced instances of […]
• Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment Generally the results indicate that children with ADHD had a difficult time in evaluating time concepts and they seemed to be impaired in orientation of time.
• The Ritalin Fact Book: Stimulants Use in the ADHD Treatment Facts presented by each side of the critical issue The yes side of the critical issue makes it clear that the drugs being used to control ADHD are harmful as they affect the normal growth […]
• Behavior Modification in Children With Attention Deficit Hyperactivity Disorder Introduction The objective of the article is to offer a description of the process of behavior modification for a child diagnosed with ADHD.
• What Is ADHD and How Does It Affect Kids
• The Benefits of Physical Activities in Combating the Symptoms of ADHD in Students
• The Effects of Exercise and Physical Activity as Intervention for Children with ADHD
• What Are the Effects of ADHD in the Classroom
• Are Children Being Diagnosed with ADHD too Hastily
• The Effectiveness of Cognitive Behavioral Therapy on ADHD
• Understanding ADHD, Its Effects, Symptoms, and Approach to Children with ADHD
• ADHD Stimulant Medication Abuse and Misuse Among U.S. Teens
• Severity of ADHD and Anxiety Rise if Both Develop
• The Best Approach to Dealing with Attention Deficit/Herpactivity Disorder or ADHD in Children
• An Analysis of the Potential Causes and Treatment Methods for Attention Deficit Hyperactivity Disorder (ADHD) in Young Children
• The Best Way to Deal with Your Child Who Struggles with ADHD
• Response Inhibition in Children with ADHD
• Behavioral and Pharmacological Treatment of Children with ADHD
• Symptoms And Symptoms Of ADHD, Depression, And Anxiety
• Bioethics in Intervention in the Deficit Attention Hyperkinetic Disorder (ADHD)
• The Effects of Children’s ADHD on Parents’ Relationship Dissolution and Labor Supply
• The Effects of Pharmacological Treatment of ADHD on Children’s Health
• The Educational Implications Of ADHD On School Aged Children
• Differences in Perception in Children with ADHD
• The Effects Of ADHD On Children And Education System Child
• Students With ADD/ADHD and Class Placement
• The Advantage and Disadvantage of Using Psychostimulants in the Treatment of ADHD
• How to Increase Medication Compliance in Children with ADHD
• Effective Teaching Strategies for Students with ADHD
• Scientists Probe ADHD Treatment for Long Term Management of the Disease
• Should Stimulants Be Prescribed for ADHD Children
• The Rise of ADHD and the an Analysis of the Drugs Prescribed for Treatment
• The Correlation Between Smoking During Pregnancy And ADHD
• Exploring Interventions Improving Workplace Behavior In Adults With ADHD
• The Promise of Music and Art in Treating ADHD
• The Struggle Of ADHD Medication And Over Diagnosis
• The Problems of Detecting ADHD in Children
• The Harmful Effects of ADHD Medication in Children
• The Symptoms and Treatment of ADHD in Children and Teenagers
• The Impact of Adult ADD/ADHD on Education
• The Experience of Having the ADHD Disorder
• The Young Children And Children With ADHD, And Thinking Skills
• The Use of Ritalin in Treating ADD and ADHD
• The Ethics Of Giving Children ADHD Medication
• The Importance of Correctly Diagnosing ADHD in Children
• The Rise in ADHD Diagnosis and Treatment within the United States of America
• The World of ADHD Children
• The Use of Drug Therapies for Children with ADHD
• What Are the Effects of ADHD in the Classroom?
• Does ADHD Affect Essay Writing?
• What Are the Three Main Symptoms of ADHD?
• How Does ADHD Medication Affect the Brain?
• What Can ADHD Lead To?
• Is ADHD Legitimate Medical Diagnosis or Socially Constructed Disorder?
• How Does Art Help Children With ADHD?
• What Are the Four Types of ADHD?
• Can Sports Affect Impulse Control in Children With ADHD?
• What Age Does ADHD Peak?
• How Can You Tell if an Adult Has ADHD?
• Should Antihypertensive Drugs Be Used for Curing ADHD?
• How Does ADHD Affect Cognitive Development?
• Is Adult ADHD a Risk Factor for Dementia or Phenotypic Mimic?
• How Are People With ADHD Seen in Society?
• Can Additional Training Help Close the ADHD Gender Gap?
• How Does School Systems Deal With ADHD?
• Are Children With Low Working Memory and Children With ADHD Same or Different?
• How Does ADHD Affect School Performance?
• Should Children With ADHD Be Medicated?
• How Does Society View Children With ADHD?
• What Do Researches Tell Us About Students With ADHD in the Chilean Context?
• Why Should Teachers Understand ADHD?
• Does DD/ADHD Exist?
• What Are Some Challenges of ADHD?
• Why Is ADHD an Important Topic to Discuss?
• Is ADHD Born or Developed?
• Can ADHD Cause Lack of Emotion?
• Does ADHD Affect Females?
• Is ADHD on the Autism Spectrum?
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Essays on Adhd Medication

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ADHD ( Attention Deficit Hyperactivity Disorder) Essay Examples

Adhd essay topics and outline examples, essay title 1: understanding adhd: causes, symptoms, and treatment.

Thesis Statement: This research essay aims to provide a comprehensive understanding of Attention-Deficit/Hyperactivity Disorder (ADHD), including its possible causes, common symptoms, and various treatment approaches.

• Introduction
• Defining ADHD: An Overview
• Possible Causes of ADHD: Genetic, Environmental, and Neurological Factors
• Symptoms and Diagnosis: Recognizing ADHD in Children and Adults
• Treatment Options: Medication, Behavioral Therapy, and Lifestyle Interventions
• The Impact of ADHD on Daily Life: School, Work, and Relationships
• Current Research and Future Directions in ADHD Studies
• Conclusion: Enhancing Understanding and Support for Individuals with ADHD

Essay Title 2: ADHD in Children: Educational Challenges and Supportive Strategies

Thesis Statement: This research essay focuses on the educational challenges faced by children with ADHD, explores effective strategies for supporting their learning, and highlights the importance of early intervention.

• Educational Implications of ADHD: Academic, Social, and Emotional Impact
• Supportive Classroom Strategies: Individualized Education Plans (IEPs) and 504 Plans
• Teacher and Parent Collaboration: Creating a Supportive Learning Environment
• Alternative Learning Approaches: Montessori, Waldorf, and Inclusive Education
• ADHD Medication in the Educational Context: Benefits and Considerations
• Early Intervention and the Role of Pediatricians and School Counselors
• Conclusion: Nurturing Academic Success and Well-Being in Children with ADHD

Essay Title 3: ADHD in Adulthood: Challenges, Coping Strategies, and Stigma

Thesis Statement: This research essay examines the often overlooked topic of ADHD in adults, discussing the challenges faced, coping mechanisms employed, and the impact of societal stigma on individuals with adult ADHD.

• ADHD Persisting into Adulthood: Recognizing the Symptoms
• Challenges Faced by Adults with ADHD: Work, Relationships, and Self-Esteem
• Coping Strategies and Treatment Options for Adult ADHD
• The Role of Mental Health Support: Therapy, Coaching, and Self-Help
• ADHD Stigma and Misconceptions: Impact on Diagnosis and Treatment
• Personal Stories of Triumph: Overcoming ADHD-Related Obstacles
• Conclusion: Raising Awareness and Providing Support for Adults with ADHD

Understanding ADHD: a Comprehensive Analysis

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The Effect of ADHD on The Life of an Individual

Analysis of treatment decisions for a child with adhd, the effects of methylphenidate on adults with adhd, personal experience of the struggles associated with asperger's syndrome and adhd, let us write you an essay from scratch.

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ADHD: The Child/teacher Struggle

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How Fidgeting Actually Contributes to a Lack of Focus in Students

Diagnosing dyscalculia and adhd diagnosis in schools, the issue of social injustice of misdiagnosed children with adhd.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by excessive amounts of inattention, carelessness, hyperactivity (which evolves into inner restlessness in adulthood), and impulsivity that are pervasive, impairing, and otherwise age-inappropriate.

The major symptoms are inattention, carelessness, hyperactivity (evolves into restlessness in adults), executive dysfunction, and impulsivity.

The management of ADHD typically involves counseling or medications, either alone or in combination. While treatment may improve long-term outcomes, it does not get rid of negative outcomes entirely. Medications used include stimulants, atomoxetine, alpha-2 adrenergic receptor agonists, and sometimes antidepressants. In those who have trouble focusing on long-term rewards, a large amount of positive reinforcement improves task performance.ADHD stimulants also improve persistence and task performance in children with ADHD.

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ADHD is my superpower: A personal essay

A Story About a Kid

In 1989, I was 7 years old and just starting first grade. Early in the school year, my teacher arranged a meeting with my parents and stated that she thought that I might be “slow” because I wasn’t performing in class to the same level as the other kids. She even volunteered to my parents that perhaps a “special” class would be better for me at a different school.

Thankfully, my parents rejected the idea that I was “slow” out of hand, as they knew me at home as a bright, talkative, friendly, and curious kid — taking apart our VHS machines and putting them back together, filming and writing short films that I’d shoot with neighborhood kids, messing around with our new Apple IIgs computer!

The school, however, wanted me to see a psychiatrist and have IQ tests done to figure out what was going on. To this day, I remember going to the office and meeting with the team — and I even remember having a blast doing the IQ tests. I remember I solved the block test so fast that the clinician was caught off guard and I had to tell them that I was done — but I also remember them trying to have me repeat numbers back backwards and I could barely do it!

Being Labeled

The prognosis was that I was high intelligence and had attention-deficit disorder (ADD). They removed the hyperactive part because I wasn’t having the type of behavioral problems like running around the classroom (I’ll cover later why I now proudly identify as hyperactive). A week later, my pediatrician started me on Ritalin and I was told several things that really honestly messed me up.

I was told that I had a “learning disability” — which, to 7-year-old me, didn’t make any sense since I LOVED learning! I was told that I would take my tests in a special room so that I’d have fewer distractions. So, the other kids would watch me walk out of the classroom and ask why I left the room when tests were happening — and they, too, were informed that I had a learning disability.

As you can imagine, kids aren’t really lining up to be friends with the “disabled” kid, nor did they hold back on playground taunts around the issue.

These were very early days, long before attention deficit hyperactivity disorder (ADHD) was well known, and long before people had really figured out how to talk to kids with neurodiversities . And as a society, we didn’t really have a concept that someone who has a non-typical brain can be highly functional — it was a time when we didn’t know that the world’s richest man was on the autism spectrum !

Growing Past a Label

I chugged my way through elementary school, then high school, then college — getting consistent B’s and C’s. What strikes me, looking back nearly 30 years later, is just how markedly inconsistent my performance was! In highly interactive environments, or, ironically, the classes that were the most demanding, I did very well! In the classes that moved the slowest or required the most amount of repetition, I floundered.

Like, I got a good grade in the AP Biology course with a TON of memorization, but it was so demanding and the topics were so varied and fast-paced that it kept me engaged! On the opposite spectrum, being in basic algebra the teacher would explain the same simple concept over and over, with rote problem practice was torturously hard to stay focused because the work was so simple.

And that’s where we get to the part explaining why I think of my ADHD as a superpower, and why if you have it, or your kids have it, or your spouse has it… the key to dealing with it is understanding how to harness the way our brains work.

Learning to Thrive with ADHD

Disclaimer : What follows is NOT medical advice, nor is it necessarily 100% accurate. This is my personal experience and how I’ve come to understand my brain via working with my therapist and talking with other people with ADHD.

A Warp Speed Brain

To have ADHD means that your brain is an engine that’s constantly running at high speed. It basically never stops wanting to process information at a high rate. The “attention” part is just an observable set of behaviors when an ADHD person is understimulated. This is also part of why I now openly associate as hyperactive — my brain is hyperactive! It’s constantly on warp speed and won’t go any other speed.

For instance, one of the hardest things for me to do is fill out a paper check. It’s simple, it’s obvious, there is nothing to solve, it just needs to be filled out. By the time I have started writing the first stroke of the first character, my mind is thinking about things that I need to think about. I’m considering what to have for dinner, then I’m thinking about a movie I want to see, then I come up with an email to send — all in a second. 

I have to haullll myself out of my alternate universe and back to the task at hand and, like a person hanging on the leash of a horse that’s bolting, I’m struggling to just write out the name of the person who I’m writing the check to! This is why ADHD people tend to have terrible handwriting, we’re not able to just only think about moving the pen, we’re in 1,000 different universes.

On the other hand, this entire blog post was written in less than an hour and all in one sitting. I’m having to think through a thousand aspects all at once. My dialog: “Is this too personal? Maybe you should put a warning about this being a personal discussion? Maybe I shouldn’t share this? Oh, the next section should be about working. Should I keep writing more of these?”

And because there is so much to think through and consider for a public leader like myself to write such a personal post, it’s highly engaging! My engine can run at full speed. I haven’t stood up for the entire hour, and I haven’t engaged in other nervous habits I have like picking things up — I haven’t done any of it! 

This is what’s called hyperfocus, and it’s the part of ADHD that can make us potentially far more productive than our peers. I’ve almost arranged my whole life around making sure that I can get myself into hyperfocus as reliably as possible.

Harnessing What My Brain Is Built For

Slow-moving meetings are very difficult for me, but chatting in 20 different chat rooms at the same time on 20 different subjects is very easy for me — so you’ll much more likely see me in chat rooms than scheduling additional meetings. Knowing what my brain is built for helps me organize my schedule, work, and commitments that I sign up for to make sure that I can be as productive as possible.

If you haven’t seen the movie “Everything Everywhere All At Once,” and you are ADHD or love someone who is, you should immediately go watch it! The first time I saw it, I loved it, but I had no idea that one of its writers was diagnosed with ADHD as an adult , and decided to write a sci-fi movie about an ADHD person! The moment I read that it was about having ADHD my heart exploded. It resonated so much with me and it all made sense.

Practically, the only real action in the movie is a woman who needs to file her taxes. Now, don’t get me wrong — it’s a universe-tripping adventure that is incredibly exciting, but if you even take a step back and look at it, really, she was just trying to do her taxes.

But, she has a superpower of being able to travel into universes and be… everywhere all at once. Which is exactly how it feels to be in my mind — my brain is zooming around the universe and it’s visiting different thoughts and ideas and emotions. And if you can learn how to wield that as a power, albeit one that requires careful handling, you can do things that most people would never be able to do!

Co-workers have often positively noted that I see solutions that others miss and I’m able to find a course of action that takes account of multiple possibilities when the future is uncertain (I call it being quantum brained). Those two attributes have led me to create groundbreaking new technologies and build large teams with great open cultures and help solve problems and think strategically. 

It took me until I was 39 to realize that ADHD isn’t something that I had to overcome to have the career I’ve had — it’s been my superpower .

Published Jul 15, 2022

Features 2 comments

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Pros and cons of ADHD medication

Medication helps many children with attention deficit hyperactivity disorder (ADHD), but it's not a cure-all, as our survey of 934 parents revealed. We found that most of the families turned to medication—84 percent at some point. And more than half of the children in our survey had tried two or more medications in the past three years. The children who were prescribed medication tended to be older and their symptoms more severe before treatment than those who had never tried medication. The average age of the children who had tried medication was 13, while the average age of those who had never tried medication was 10.

A closer look at ADHD drugs

The drugs usually prescribed to treat ADHD are generally effective and safe. Most children and teenagers (60 percent to 80 percent) who take them become less hyperactive and impulsive, are better able to focus, and are less disruptive at home and school. But there is no good evidence showing that these benefits last longer than about two years, and the long-term consequences of taking stimulants for years on end have not been fully evaluated in studies. Fortunately, many children with ADHD—even when they are not treated—improve as they reach the teenage years and early 20s. But the disorder can persist into adolescence and adulthood about 30 percent to 70 percent of the time. All of the ADHD stimulant medicines have been linked to rare cases of heart attack, stroke, and sudden death, so children should first be evaluated for underlying heart problems. The severity of symptoms and abnormal behavior patterns in children and teenagers with ADHD varies widely. Diagnosis, too, can be quite subjective, varying from doctor to doctor. Because diagnosis of the condition can be difficult, and a variety of medical and psychiatric disorders can cause symptoms that mimic ADHD, many children and teenagers taking medication might not have ADHD or have only mild symptoms that do not require it. Be sure to get a diagnosis from a physician or mental-health professional with expertise in ADHD and a second opinion if you have doubts. Even if your child meets the criteria for ADHD, he or she might not need a drug. A pediatrician can refer you to a mental-health specialist (some specialize in ADHD), who should begin by ruling out other possible reasons for the behavior. The most effective strategy for treating ADHD consists of more than one approach. There is some evidence that the combination of behavioral therapy with medication can work better than drugs alone for some children. But behavior therapy alone does not work for all children, especially those who have severe symptoms. As with most disorders for which multiple medications are available, there are no definitive comparison studies to show which ones work best in specific circumstances, according to Michael L. Goldstein, M.D. , a child neurologist with Western Neurological Associates in Salt Lake City, and a former vice president of the American Academy of Neurology. Two classes of medication are available for treating ADHD:

• Stimulant medications, such as dextroamphetamine-based drugs (Adderall, Vyvanese) and methylphenidate-based drugs (Concerta, Daytrana, Ritalin). They are also available as generics.
• Nonstimulant medication, such as the antidepressant bupropion (Wellbutrin and generic) or atomoxetine (Strattera), which is not available as a generic.

Those medicines don't cure ADHD but they can keep symptoms under control, which may improve a person's daily functioning. Each raises different safety issues, however, which your doctor should discuss with you. Dosing convenience (taking one pill a day instead of two or more; oral solutions for those who have difficulty swallowing tablets; or the use of a patch) and how long the medicine is active are critical elements of ADHD treatment. You should be skeptical if a doctor or therapist diagnoses ADHD at the first visit and immediately prescribes a drug and should seek a second opinion. The stimulants are controlled substances, while Straterra is not. Fewer restrictions apply to prescriptions for Straterra, and some parents think that makes it safer. If families are worried about using a controlled substance for children, Straterra might be more acceptable, Goldstein says, although many professionals think it might be less effective.

Medication was helpful

Related topics.

• Guide to ADHD

In our survey, parents of children who tried medication reported positive changes within a few days of starting amphetamines or methylphenidates. Second-line medications (Strattera) took longer to work, but most parents noticed positive changes within a few weeks. About 10 percent of the parents whose children tried amphetamines and methylphenidates said they didn't notice any positive changes. According to the parents we surveyed, children on medication had slightly better outcomes than those who weren't. And while medication was cited as the strategy most helpful in managing ADHD (see ADHD treatments that work ), parents were not very satisfied with it overall. In fact, only 52 percent of the parents agreed strongly that if they had to do it over again, they would have their kids take medication, and 44 percent wished there was another way to help their child. (See Parent satisfaction with medication below.) Medication helped more in some areas than others. Parents in our survey said medication helped equally—and most of all—with academic performance (very helpful for 35 percent) and behavior at school (very helpful for 35 percent). It also helped well with behavior at home (very helpful for 26 percent), and fairly well with social relationships (very helpful for 19 percent) and self-esteem (very helpful for 18 percent). Furthermore, the degree of helpfulness with academic performance, behavior at school, and behavior at home most likely accounted for how helpful the parents rated medication as a specific strategy. Medication seems to lessen some ADHD symptoms, but behavioral strategies can help manage the condition for the long-term. Children taking either stimulants or nonstimulants who started off with serious symptoms showed the most change, with a greater likelihood of improvement. (Kids whose symptoms started off mild also improved, but the difference wasn't as great.) Amphetamines and methylphenidates were equally associated with symptom changes in all areas (See more about ADHD symptoms .) Most children in our survey who were taking medication for ADHD had tried methylphenidate (84 percent) or an amphetamine (51 percent) in the past three years. A smaller percentage (17 percent) had tried a nonstimulant medication. There were no differences in the type of medication children were prescribed either by age or length of time since they had been diagnosed. Most children taking these medications had been taking them for longer than two years (35 percent overall), while 22 percent had been taking them for one to two years. Our survey found there were no major differences in effectiveness between amphetamines and methylphenidates. But there were more reports of "irritability and anger" and "high mood/energy (manic behavior)" among children who used amphetamines. Here's how the children fared with medication in these specific areas:

Source: Consumer Reports National Research Center.

We asked parents to rate how helpful each medication was in the following areas: academic performance, behavior at school, behavior at home, self-esteem, and social relationships. Both amphetamines and methylphenidates were equally likely to be helpful in all areas with the exception of behavior at school, where amphetamines were rated as slightly more helpful. Although we don't have enough cases of children taking "second line" medications (e.g. Straterra) to report specific findings, the data we have indicates that they were generally less likely to be "very helpful" than amphetamines or methylphenidates in the areas we asked about. If a child is struggling in the areas of self-esteem and relationships, and medication is not helpful, it might be useful to have him or her see a clinical psychologist or other mental-health professional. Whenever the result of taking a drug is less than desired, it might be time to consider changing medication, Goldstein suggests. Some children experience different effects from a different formulation of the same medication. "Many children with appetite, sleep, or irritability problems with a methylphenidate-based medication do very well with an amphetamine-based drug, or vice versa," he notes.

Who prescribes and monitors ADHD medication?

A vast majority of children in our survey received medication from a pediatrician (60 percent), followed by a child psychiatrist (18 percent) and a general psychiatrist (15 percent). All of the drugs carry a warning about rare cases of sudden, unexplained death. It is recommended practice to test for life-threatening conditions, including heart-related issues, before prescribing these medications. Overall, physicians did a decent job of screening before prescribing medication. Eighty-five percent of the children we surveyed received some sort of screening, and 76 percent were given a general medical exam. But only 52 percent had their blood pressure tested, 43 percent had blood tests done, and 22 percent were given an ECG/EKG exam for heart conditions. "Blood pressure should be measured, since medications that treat ADHD sometimes cause a slight increase in blood pressure," says Michael L. Goldstein, M.D. It should be checked before starting medication, and at least once while the child is taking medication. And even though 85 percent of the children were screened before starting medication, 15 percent did not receive any type of screening. A parent should always request basic screening of their child before starting medication for ADHD. We also asked parents about other things they wished their prescribing physician had done. While 43 percent didn't express any concerns with the physician prescribing ADHD medication for their child, 29 percent said they wished the physician would "welcome their input about their child more than he/she currently does." Twenty-six percent said they wished doctors would "provide information about any financial relationships he/she may have with companies that sell ADHD medications," and 25 percent said they wished doctors would "discuss the long-term safety of prescription medications for my child."

Tips for working with your child's doctor

Parents didn't rate doctors well for managing their child's medication. "Patients or families should call whenever they have questions about a medication," Goldstein urges. He offers these additional tips:

Always call the doctor with questions. Even if all is well, check in by phone two weeks after beginning medication and schedule a visit one month after for a follow-up.

After that, return visits will depend on the success of the treatment and side effects. In general, children doing well can be seen every six months.

Reassessment should consist of a physical examination and direct questioning of the child and family member(s). Teacher evaluations are also helpful.

A complete re-evaluation with the family and input from others (including teachers) should be considered every year, although waiting two to three years is common.

ADHD drug side effects

Side effects are a major area of concern for many parents considering medication for their child's ADHD. Indeed, side effects might add to the overall stress of managing a child's condition . Our survey found that parents of children taking amphetamines and methylphenidates reported a high frequency of side effects. Overall, 84 percent of the children who tried amphetamines and 81 percent who tried methylphenidates experienced side effects. And among those who reported no longer taking a specific medication, 35 percent said it was because of side effects. Decreased appetite, sleep problems, weight loss, irritability, and upset stomach were the side effects most frequently reported by parents for both types of medication. Amphetamines and methylphenidates were equally likely to produce these side effects with the exception of irritability, which was more likely to be reported as a side effect by parents whose children tried amphetamines. Although elevated mood or excessive energy wasn't among the more frequently reported side effects, it was more commonly reported by parents whose children were taking amphetamines compared with methylphenidates. Talk with your doctor if irritability, anger, or manic behavior become an issue. Side effects such as a loss of appetite are very common but usually not significant, and they tend to improve over time, Michael L. Goldstein, M.D. says. Other problems children have after taking medication might not be due to the drugs at all. Sleep problems might have occurred before starting medication, for example. And taking medication at the correct time is another factor in determining side effects. "Some children don't want to take medication," Goldstein says. "It must be determined if they are doing well on the medication but just don't want to bother taking it despite the positive effects, or whether they are really having increased anxiety or mood changes from the medication." Parents of children who tried second-line medications, which are often prescribed because of concerns about the side effects associated with amphetamines and methylphenidates, also reported a high frequency of side effects, but they were somewhat less frequent than with the other medications. Although many parents reported side effects, they can often be managed. For example, some children have problems later in the day and a long-acting formulation is best, but sometimes the effect might persist into the evening, suppressing appetite for dinner and delaying bedtime. "There is no substitute for carefully evaluating the effect of a medication after it has been used to determine if it should be increased, decreased, or switched to something else," Goldstein says. Parents should also note that a child might begin to show withdrawal symptoms when a dose wears off, and might need tips for avoiding this . These management skills are something that can be developed with the doctor responsible for prescribing the medication. For more help understanding ADHD and what you can do to help your child, including whether to medicate, see HealthPoint.net's ADHD guide and Decision Point tool .

Parent satisfaction with ADHD medication

Taking all this into consideration, how satisfied are parents with medications their children are taking for ADHD? Overall, only 41 percent were highly satsfied (16 percent were "completely satisfied" and 25 percent were "very satisfied"). About one-third (29 percent) were dissatisfied and the remainder were fairly satisfied (30 percent). There were no differences in overall satisfaction between those groups trying amphetamines or methylphenidates. Most amphetamines and methylphenidates are available in standard doses and extended- or sustained-release forms. Standard release means that the medication will be in your child's system for a given period of time (usually about three hours), at which point another dose needs to be administered to maintain the effect. Extended- or sustained-release medications are usually given in the morning and slowly release the effective component of the medication throughout the day. Parents were more likely to report that the extended-release formulations were "very helpful" with academic performance, behavior at school, behavior at home, and social relationships. With extended-release formulas, parents don't have to rely on their child's school to give the medication. If you're considering medication for your child with ADHD, ask your treatment provider about this option. We asked parents how strongly they agreed with a number of statements about having their child take medication. While most agreed strongly that if they had to do it over again they would still have their child take medication (52 percent), 44 percent agreed strongly that they wished there was another way to help their child besides medication, and 32 percent agreed strongly that they worried about the side effects of medication. Overall, the process of having a child take medication for ADHD is one of constantly weighing the costs and benefits. As described above, parents reported that side effects are common. And the two major classes of medication (amphetamines and methylphenidates) were not "very helpful" in many of the areas we asked about. (For example, they were only "very helpful" with behavior at home in 30 percent of the cases.) But when compared with other common strategies used to manage ADHD , having a child take medication was the most helpful one for parents in managing ADHD. So in many cases, medication might be something a parent could try to help his or her child with ADHD. If your child is going to try medication, first establish a baseline of behavior and academic performance so that you'll be able to make sure it is indeed working—especially since our results found that for some children, they don't work very effectively at all. And once he or she starts medication, make sure that the person prescribing it is aware of the degree of improvement you notice, along with any side effects. This will allow the professional to make an informed decision, along with you and your child, about the appropriateness of the medication. Having a child take medication is not a simple fix, and balancing its effectiveness with the side effects (and difficulty of managing these side effects) should be constantly monitored. (See more tips for being your child's treatment coordinator .)

Tips for monitoring medications

Keep a log of your child's progress and "down" times to make sure dosing is correct and side effects are manageable.

Help your family manage stress by being patient and understanding during new experiences and among unfamiliar people.

If side effects are overwhelming, talk with your doctor about switching medications or dosing.

Talk with your doctor about taking time off (a drug "holiday") from medication, such as during the summer or vacations.

Record everything to create a baseline for your child. Document not just test results and dates, but also practitioners, dosages, and frequencies.

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How to Remove Hurdles to Writing for Students with ADHD

Half of all kids with adhd struggle with writing, which can make every assignment — from straightforward worksheets to full-length essays — feel like torture. boost your child’s skills with these 18 strategies for school and home..

Studies suggest that more than half of children with attention deficit disorder ( ADHD or ADD ) struggle with writing. These students may have an overflow of creative ideas , but often struggle when it comes to getting these ideas onto paper.

Children with ADHD have a hard time getting started — and following through — on writing assignments because they have difficulty picking essay topics, locating appropriate resources, holding and manipulating information in their memory, organizing and sequencing the material, and getting it down on paper — all before they forget what they wanted to say.

But these hurdles don’t have to stop them from writing. Discuss the following ADHD writing strategies with your child’s teacher so you can work together to ease the difficulties attention deficit children have with writing.

Solutions in the Classroom: Guide the Writing Process

—Set up a note system. Ask the student to write her notes about a topic on individual sticky notes. She can then group the notes together that feature similar ideas so she’ll be able to easily identify the major concepts of the subject from the groupings.

—Start small and build skills. Ask students with ADHD to write a paragraph consisting of only two or three sentences. As their skills improve, the students can start writing several paragraphs at a time.

[ Free Download: 18 Writing Tricks for Students with ADHD ]

—Demonstrate essay writing. With the use of an overhead projector, write a paragraph or an entire essay in front of the class, explaining what you are doing at each step. Students can assist you by contributing sentences as you go. Students with ADHD are often visual learners , and tend to do better when they see the teacher work on a task.

—Give writing prompts. Students with ADHD usually don’t generate as many essay ideas as their peers. Help the children with ADHD increase their options for essay assignments by collecting materials that stimulate choices. Read a poem, tell a story, show pictures in magazines, newspapers, or books.

If the student is still struggling to get started, help him by sitting down and talking about the assignment with him. Review his notes from the brainstorming session and ask, “What are some ways you could write the first sentence?” If he doesn’t have an answer, say, “Here’s an idea. How would you write that in your own words?”

—Encourage colorful description. Students with ADHD often have difficulty “dressing up” their written words. Help them add adjectives and use stronger, more active verbs in sentences.

[ How Teens with Learning Differences Can Defeat Writing Challenges ]

—Explain the editing process. Students with ADHD have a hard time writing to length and often produce essays that are too short and lacking in details. Explain how the use of adjectives and adverbs can enhance their composition. Show them how to use a thesaurus, too.

Solutions in the Classroom: Use Accommodations Where Necessary

—Allow enough time. Students with ADHD, especially those with the inattentive subtype, may take longer to process information and should receive extended time to complete assignments.

—Don’t grade early work. Sensitive students are discouraged by negative feedback as they are developing their writing skills. Wait until the paper is finished before assigning it a grade.

—Don’t deduct points for poor handwriting or bad grammar. Unless an assignment is specifically measuring handwriting and grammar skills, when a child is working hard to remember and communicate, let some things slide.

—Use a graphic organizer. A graphic organizer organizes material visually in order to help with memory recall. Distribute pre-printed blank essay forms that students with ADHD can fill in, so they’ll reserve their efforts for the most important task — writing the essay.

—Grade limited essay elements. To encourage writing mastery and avoid overwhelming students, grade only one or two elements at any given time. For example, “This week, I’m grading subject-verb agreement in sentences.” Tighter grading focus channels students’ attention to one or two writing concepts at a time.

Solutions at Home

—Encourage journals. Have your child write down his thoughts about outings to the movies, visits with relatives, or trips to museums. Add some fun to the activity by asking your child to e-mail you his thoughts or text-message you from his cell phone.

—Assist with essay topic selection. Children with ADHD have difficulty narrowing down choices and making decisions. Help your student by listening to all of his ideas and writing down three or four of his strongest topics on cards. Next, review the ideas with him and have him eliminate each topic, one by one – until only the winner is left.

—Brainstorm. Once the topic is identified, ask him for all the ideas he thinks might be related to it. Write the ideas on sticky notes, so he can cluster them together into groupings that will later become paragraphs. He can also cut and paste the ideas into a logical sequence on the computer.

—Stock up on books, movies, games. These materials will introduce new vocabulary words and stimulate thinking. Explore these with your child and ask him questions about them to solicit his views.

—Be your child’s “scribe.” Before your child loses his idea for the great American novel, or for his next English assignment, have him dictate his thoughts to you as you write them out by hand or type them into the computer. As his skills improve over time, he’ll need less of your involvement in this process.

—Go digital. Children with ADHD often write slower than their classmates. Encourage your child to start the writing process on a computer. This way, she’ll keep her work organized and won’t misplace her essay before it’s finished. Also, by working on the computer she can easily rearrange the order of sentences and paragraphs in a second draft.

—Remind your child to proofread. Let your child know that he’ll be able to catch errors if he proofreads his rough draft before handing it in.

High-Tech Writing Helpers for Kids with ADHD

Portable word processor

These battery-operated devices look like a computer keyboard with a small calculator screen. Light and durable, portable word processors can be used at school for note-taking and writing assignments. Back home, files can be transferred to a PC or Mac. Basic models cost about $20.

Speech-recognition software

Word-prediction software

Software such as Co:Writer Solo ($325) helps with spelling and builds vocabulary, providing a drop-down list of words from which a student can choose. It also fills in words to speed composition. Some programs read sentences aloud, so the writer can hear what he has written and catch mistakes as they occur.

Electronic spell-checkers and dictionaries

Enter a word phonetically, and these portable gadgets define the word and provide the correct spelling. Talking devices read the words aloud. Franklin Electronics offers models beginning at about $20.

[ The Common Problems that Lead to Writer’s Block ]

Chris Zeigler Dendy, M.S., is a member of ADDitude’s  ADHD Medical Review Panel .

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• Open access
• Published: 19 June 2023

Balancing access to ADHD medication

B.m.c. medicine.

BMC Medicine volume  21 , Article number:  217 ( 2023 ) Cite this article

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Imagine going to your local pharmacy to pick up your repeat prescription and being told they are out of stock. You then hear the same news from every chemist in the area. That is the situation facing people with attention deficit hyperactivity disorder (ADHD), characterized by inattention, excessive impulsivity, and hyperactivity. Unlike other drug shortages caused primarily by supply chain problems, the reasons for this ongoing scarcity are more complicated.

Total psychostimulant prescriptions jumped 10% among American adolescents and adults in 2020–2021, the first year of the COVID-19 pandemic. This rise in ADHD diagnoses was attributed to the January 2020 suspension of the 2008 Ryan Haight Act by the USA Department of Health and Human Services, which strictly regulated the prescription of controlled substances through telepsychiatry. This emergency policy allowed telehealth providers to prescribe controlled substances online without needing in-person examination. This Act’s suspension meant there had never been an easier time to obtain psychostimulant prescriptions in the USA. Partially better awareness and detection of ADHD may also have played a role in increased diagnoses, driven by advances in diagnostic criteria, public awareness, and less stigmatization.

In October 2022, the Food and Drug Administration (FDA) announced a shortage of several Adderall formulations in the USA. Citing “intermittent manufacturing issues,” supply still cannot meet market demand 8 months on. Adderall, a mixed amphetamine salt, improves executive function and ameliorates ADHD symptoms. It is a medication essential for many to live normally and productively. Adderall withdrawal can severely affect one’s ability to function. Short supply has left many children and parents in turmoil, with reports citing significant school/work performance loss and turning to street drugs as illegal substitutes. Further deepening this problem, research indicates that the COVID-19 pandemic exacerbated the core symptoms of ADHD and comorbidities.

Compounding the shortfall of available medicines, exploitative companies are targeting those who do not truly need ADHD medication. One recent BBC investigation exposed the issue of private clinics lacking regulation, which led to inappropriate psychostimulant prescriptions in the UK. An undercover reporter revealed that three online clinics diagnosed him with ADHD using unreliable mental health assessments. The reporter was subsequently prescribed Ritalin for long-term use, a psychostimulant used to treat the condition. But a subsequent in-person NHS assessment showed that the journalist did not fit the diagnostic criteria for ADHD. Another investigation by ABC News found that psychostimulant prescriptions for ADHD in Australia had more than doubled in 2018–2023, with private clinics capitalizing and charging $3000 for online consultations. Both reports illustrate potential ADHD misdiagnosis and prescription misuse in these countries.

American telemedicine start-ups have been accused of prioritizing profit by former employees and government lawyers. Some are under federal investigation for violating the Controlled Substances Act. Most early pandemic prescribers have either ceased operations or had their licenses revoked, yet the number of Americans officially diagnosed with ADHD remains in the millions. Psychostimulant prescriptions are for life, meaning that they have no expiry date. In a letter to drugmakers last summer, the FDA pointed to “the sheer volume of ADHD medications on the market coupled with aggressive marketing practices” has led to a shortfall in the supply of ADHD medications.

Government regulators have known about a potential shortfall of Adderall in the USA since 2021 but have been slow to act. The FDA announced plans to update box labels to curb misuse by guiding clinicians and patients, but this does nothing to address Adderall’s short supply. Psychostimulants used to treat ADHD are designated as schedule II controlled substances, so they possess therapeutic use but come with “a high potential for abuse.” The Drug Enforcement Administration (DEA) regulates production so that there is just enough supply while minimizing the risk of misuse or addiction. Monitoring rules on “suspicious orders” are proposed to become stricter under a proposed draft. Psychostimulant orders with unusual features would be flagged to the DEA so customers could be reported to this law enforcement agency for investigation. Though this move would prevent potentially inappropriate prescriptions, misuse of this proposed policy would add yet another barrier to legitimate patient access.

The number of child and adolescent psychiatrists is low, and their patients are one of the most underserved populations—fewer than ten specialists per every 100,000 children in the USA. New prescriptions must be obtained if one’s existing pharmacy runs out of stock, disproportionately discriminating against those who do not own private health insurance. In the US Congress, Rep. Abigail Spanberger pressed the FDA to solve this public health emergency. However, the FDA’s outlook looks like one of law enforcement fearful of a repeat of another opioid epidemic.

Pandemic changes shifted the pendulum on ADHD medication supply to trigger shortages in an already tightly restricted market. Lack of access to Adderall for patients is an unnecessary crisis that needs swift action. There is a need to tackle misuse by regulating private providers and increasing funding for child and adolescent psychiatrists in the medium to long term. Additionally, ensure that short-term production and distribution constraints are adjusted to guarantee appropriate providers are fully supplied with medication. A balance between prohibitive policies protecting patients and providing reasonable access to ADHD medication must be a public health priority.

This editorial highlights the vital issue of fair access to diagnosis/treatment during May’s mental health awareness month. BMC Medicine recently announced a call for papers welcoming submissions on neurodevelopmental disorders. This article collection plans to focus on often underserved, misunderstood conditions and patients.

Abbreviations

Attention deficit hyperactivity disorder

Drug Enforcement Agency

Food and Drug Administration

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How to Write a College Essay About ADHD

Admissions officer reviewed by Ben Bousquet, M.Ed Former Vanderbilt University

Written by Ben Bousquet, M.Ed Former Vanderbilt University Admissions

Key Takeaway

ADHD and ADD are becoming more prevalent, more frequently diagnosed, and better understood.

The exact number of college students with ADHD is unclear with estimates ranging wildly from just 2% to 16% or higher.

Regardless of the raw numbers, an ADHD diagnosis feels very personal, and it is not surprising that many students consider writing a college essay about ADHD.

If you are thinking about writing about ADHD, consider these three approaches. From our experience in admissions offices, we’ve found them to be the most successful.

First, a Note on the Additional Information Section

Before we get into the three approaches, I want to note that your Common App personal statement isn’t the only place you can communicate information about your experiences to admissions officers.

You can also use the additional information section.

The additional information section is less formal than your personal statement. It doesn’t have to be in essay format, and what you write there will simply give your admissions officers context. In other words, admissions officers won’t be evaluating what you write in the additional information section in the same way they’ll evaluate your personal statement.

You might opt to put information about your ADHD (or any other health or mental health situations) in the additional information section so that admissions officers are still aware of your experiences but you still have the flexibility to write your personal statement on whatever topic you choose.

Three Ways to Write Your College Essay About ADHD

If you feel like the additional information section isn’t your best bet and you’d prefer to write about ADHD in your personal statement or a supplemental essay, you might find one of the following approaches helpful.

1) Using ADHD to understand your trends in high school and looking optimistically towards college

This approach takes the reader on a journey from struggle and confusion in earlier years, through a diagnosis and the subsequent fallout, to the present with more wisdom and better grades, and then ends on a note about the future and what college will hold.

If you were diagnosed somewhere between 8th and 10th grade, this approach might work well for you. It can help you contextualize a dip in grades at the beginning of high school and emphasize that your upward grade trend is here to stay.

The last part—looking optimistically towards college—is an important component of this approach because you want to signal to admissions officers that you’ve learned to manage the challenges you’ve faced in the past and are excited about the future.

I will warn you: there is a possible downside to this approach. Because it’s a clear way to communicate grade blips in your application, it is one of the most common ways to write a college essay about ADHD. Common doesn’t mean it’s bad or off-limits, but it does mean that your essay will have to work harder to stand out.

2) ADHD as a positive

Many students with ADHD tell us about the benefits of their diagnosis. If you have ADHD, you can probably relate.

Students tend to name strengths like quick, creative problem-solving, compassion and empathy, a vivid imagination, or a keen ability to observe details that others usually miss. Those are all great traits for college (and beyond).

If you identify a strength of your ADHD, your essay could focus less on the journey through the diagnosis and more on what your brain does really well. You can let an admissions officer into your world by leading them through your thought processes or through a particular instance of innovation.

Doing so will reveal to admissions officers something that makes you unique, and you’ll be able to write seamlessly about a core strength that’s important to you. Of course, taking this approach will also help your readers naturally infer why you would do great in college.

3) ADHD helps me empathize with others

Students with ADHD often report feeling more empathetic to others around them. They know what it is like to struggle and can be the first to step up to help others.

If this rings true to you, you might consider taking this approach in your personal statement.

If so, we recommend connecting it to at least one extracurricular or academic achievement to ground your writing in what admissions officers are looking for.

A con to this approach is that many people have more severe challenges than ADHD, so take care to read the room and not overstate your challenge.

Key Takeaways + An Example

If ADHD is a significant part of your story and you’re considering writing your personal statement about it, consider one of these approaches. They’ll help you frame the topic in a way admissions officers will respond to, and you’ll be able to talk about an important part of your life while emphasizing your strengths.

And if you want to read an example of a college essay about ADHD, check out one of our example personal statements, The Old iPhone .

As you go, remember that your job throughout your application is to craft a cohesive narrative —and your personal statement is the anchor of that narrative. How you approach it matters.

Liked that? Try this next.

The Incredible Power of a Cohesive College Application

How A Selective Admissions Office Reads 50k Applications In A Season

12 Common App Essay Examples (Graded by Former Admissions Officers)

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ADHD Medication Essay

Drugs are advertised in the newspapers and school authorities press of parents to make their children take these drugs. The situation described isn’t a scene from the fiction movie but a real situation American society faces at the moment.

Parents of the children with deficit/hyperactivity disorder (ADHD) make an effort to confront big industry producing ADHD drugs, which can be dangerous and cause addiction. New legislative initiative such as the signing of a law in Connecticut quickly spreads all over the country. The parents, disturbed by the growing pressure to put their children on ADHD drugs express their concern and turn to legislation to defend their rights. They have to confront a serious power presented by the whole industry, which produces these drugs. It will take time to develop such legislative levers, which would take ADHD advertising under control without breaking the right of producers but the process is worth effort as it concerns the health of children.

New legislative trend aiming to limit advertising of drugs in mass media and to limit social pressure on the parents who have children with ADHD appeared lately. This initiative expressed by the parents of children with deficit/hyperactivity disorder (ADHD) gains more and more popularity in many states of the country. Medicines, used for children and adults with ADHD are “considered Schedule II controlled substances by the Drug Enforcement Administration, they are among the most addictive and abused drugs that are still legal”. Unfortunately, this information is very often kept in secret and companies aiming to disclose it and to limit the selling and production of such drugs meet obstacles.

ADHD drugs producers create resistance to new legislative trend and use any means to prove their right to make such kind of advertisements. They justify their actions by the wish to inform the public about the existence of the ADHD medicine. As Clarke Ross, head of Children and Adults with Attention-Deficit/Hyperactivity Disorder states, such kinds of ads has no other aim than “public awareness of the existence of ADHD.” It’s worth to mention, though, that this association is partially financed by drug-making firms. From the other side, ads provoke additional demand for this type of medicines. In their advertisements they don’t tell all the truth. “And that’s particularly dicey in the case of drugs like those used for ADHD, which the DEA puts in the same category with morphine, cocaine, Demerol and Oxycontin.”

Practically, there is now official tool to stop this kind of advertisements as in the most of cases ADHD drugs advertisements don’t name the drugs directly and only shape the problem and hint on the possible remedy. This means that they are not within the Food and Drug Administration jurisdiction. Unfortunately, this “agency doesn’t have the authority “to treat advertisements for controlled substances any differently” from those for other drugs.”

Society must put attention to the problem of ADHD drugs advertising as the scale of the problem grows with every day and the concern of the parents and public organizations shows that the problem can’t be neglected any more. New legislative initiative of the parents has to fight big industry of ADHD drugs production and it looks like that withstand will be severe. Both have things to lose. Parents think about the health and normal life of their children and ADHD drugs producers can lose millions of dollars. The question is whose part will take local and state authorities.

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We need to talk about adhd medication.

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Concerta pills ADHD medication are seen in this illustration photo in Warsaw, Poland on 13 February, ... [+] 2024. (Photo by Jaap Arriens/NurPhoto via Getty Images)

The UK National Health Service has announced a task force to review ADHD provision, in light of an unprecedented rise in diagnoses and prescriptions. Demand has exceeded supply of services and medication, rising 60% in recent years, compared with the expected 22% rise forecast by historical trends, the Financial Times reported . This trend is not unique to the UK, indeed, researchers have found increases across the global, albeit with disparities in treatment according to resources, race and gender. There is a race to automate services, without care for the risks this poses to a vulnerable group, for example if prescriptions for medication wind up with insufficient oversight.

ADHD medication can be stimulant-based, or non-stimulant based. The medications affect Dopamine and Norepinephrine (aka Noradrenalin). Dopamine helps us feel a particular type of pleasure - satisfied. It lets us know when we have had “enough”. People who have lower baseline levels experience distraction, searching for the “next thing” to satiate them, this expresses itself in hyperactivity and finding it difficult to concentrate on mundane tasks which don’t stimulate natural dopamine activity. Norepinephrine acts to ready the body for action, it stimulates the nervous system and makes us more alert. People with a lower baseline of norepinephrine will find it hard to concentrate and remember. It must be noted that these are just two of multiple theories as to the cause of ADHD , and there isn't a single, unifying explanation. It is possible that for a complex, adaptive set of behaviours there are multiple, complex and adaptive causes, not all of which involve dopamine and / or norepinephrine and are therefore unresponsive to medication.

Risk Assessment

However, ADHD meds have significant psychoactive effects, and are sometimes controlled substances. They have a number of serious potential adverse effects and risk factors. They should not be prescribed without supervision and careful assessment of the right dose, known as “titration.” With services stretched to the limit, it is hard to find enough psychiatrists to diagnose, let alone titrate. To be clear, titration good practice would involve the following:

1. Starting with thorough background history taking, and prescribing a starter medication and dose that accounts for weight, gender, hormone profile (e.g. menarche and menopause), thyroid and cardiac function, trauma history, anxiety, insomnia, experience of other drugs including self-medication with alcohol and drugs – etc, etc.

2. Checking back with the patient weekly or fortnightly in the initial phase, offering diligent enquiry of possible adverse reactions such as agitation, mania, rapid mood cycling, severe insomnia, anxiety, paranoia.

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3. Checking back in periodically throughout the prescribing period, frequency according to risk profile, as the baseline conditions described above can change according to our environmental supports and / or physiological state of health.

It is not safe to assume that once on a prescription, all will be well. A patient who fails to show up for follow up appointments is a safeguarding risk. ADHD meds, in the hands of someone who is having an adverse reaction, can lead to serious issues such as self-medication to calm the nervous system with alcohol. Life can unravel very quickly if an already dysregulated nervous system is over medicated. Commenting on the news, Dr Ulrich Müller-Sedgwick, spokesperson for the Royal College of Psychiatrists, said: “People with ADHD often have a co-occurring mental illness, and so it is important they receive holistic care which addresses all their needs.”

A risk assessment and safeguarding protocols are essential. There are no acceptable short cuts to this process. If you are an ADHDer in titration, make sure you build a strong relationship with your physician and raise the flag for additional support if you are not getting what you need. There are a wide range of medications and hormone therapies that can improve your cognitive functioning, you don’t have to choose between adverse impact or no support. A recent client of mine saw a psychiatrist only twice for ADHD medication support by video, despite having a history of multiple suicide attempts and a complex trauma history. This is dangerous.

Whether you are paying for yourself, in public health care or paying for an employee, you are well within your rights to ask for supervision and due diligence from professionals in the field. My client, for example, managed ADHD perfectly well through exercise and conducive working practices in their twenties and thirties, only to experience extreme cognitive fog in their forties. They needed peri-menopause treatment as a first point of call, rather than unsupervised prescription of a controlled substance. This case was particularly alarming given that women are the fastest growing group of new diagnoses.

No Med Shaming

Conversely, medication can be the difference between a functioning life and a constant barrage of missed appointments, lost passwords, late payment charges, incomplete work – all of which risks career fulfilment and social inclusion. As with any societal change, the increased understanding of ADHD has caused a backlash , in which ADHD is minimized and people are shamed for taking medication for what the neuronormative world term “life laundry”, and view as a lower order, relatively easy set of behaviors.

We’re seeing life’s basics are often the significant disabling factor for ADHD, which can be confusing since more creative complex tasks can seem easy. Don’t be fooled, the ADHDer is frequently disabled in everyday scenarios, such as paying for parking, prepping for a performance review or reading essential health advice, even when they appear to be thriving and in control.

Advice on nutrition, exercise, sleep and efficiency apps is flooding our social media, giving the impression that if people only tried harder they wouldn’t need medication. But “trying harder” costs money, time and resources. If you are already flat out, this feels like yet another insurmountable task on your to do list. Medication (that suits you) might give you the window of relative ease to make life changes that improve things going forward. It's not a silver bullet, even for those who have positive reactions, but it can be the start of a tide change.

An Employer’s Role

ADHD medication is a complex area of medicine and clinical practice. For some people, the risks outweigh the benefits. For others, occasional use is appropriate. For yet others, medication is life-changing. Over simplifying ADHD diagnosis and medication is dismissive and likely to increase adverse outcomes. Trauma, overlapping conditions including Autism, physiological health, peri-menopause effect the impact of medication, you need to be in the care of someone who understands these possibilities.

From an employer’s perspective, we need to be responsive to changes that occur following medication. We need to note that short term effectiveness may be offset by long term risk. We can’t mandate someone to medicate (yes, I have heard of this in practice) any more than we can mandate them to not medicate (yes, I have also heard of this). We have no right to act as clinicians and tell our staff how they should manage their health.

Within our remit is sensible, pragmatic review of performance and engagement, as well as a duty of care to refer to occupational health if we are worried. We also need to note that a medicated ADHDer still deserves accommodations, a pill doesn’t reduce our obligation to provide environmental, technological and managerial support for disablement. I wish I could write the “here are four basic rules” style article, but for this topic I cannot. And anyone who professes to do so is misleading you.

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ADHD Medication essay

ADHDMedication

Medicationforms one of the most important precepts of ADHD treatment. Differentdrugs could be used to treat ADHD depending on the level ofcomplication. The determination of the right kind of medication isdecided upon by the patient and the doctor. After determination ofthe kind of medication, the dose and schedule are also determined tofulfill the needs of both the patient and the doctor. Medication ofADHD occurs in different forms that will be discussed below.

StimulantMedication

Related essays:

• Article Critique Advances in Understanding and Treating ADHD essay

Theworking of stimulant medicine is based on the focus of thoughts andavoidance of distractions. The stimulants can treat both severe andmoderate ADHD. They could be of great help to all age groups andchildren who have a hard time concentrating at school. Theprobability of stimulants working as treatment for ADHD is 72% to82%. Examples of stimulant drugs include Amphetamine Sulfate whichis also known by the common name Evekeo, Dextroamphetamine(Dexedrine), Dexmethylphenidate, Lisdexamfetamine (Vyvanse) andMethylphenidate (Concerta) (Levinthal,,2011).

Non-stimulantMedication

Consequently,there exist the non-stimulant medications for ADHD. In instanceswhere the stimulants fail to perform, non-stimulant medication isused to treat ADHD. The working of non-stimulant medication is basedon the improvement of impulse control and concentration. Atomoxetinewas the first drug to be approved by the FDA under the non-stimulantdrugs to provide medication to adolescents, adults and children.Clonidine Hydrochloride is consequently another drug that togetherwith stimulants it helps in reduction of ADHD. Non-stimulantmedications have been utilized in the recent past due to theirability to provide fewer side effects as compared to stimulantmedications (Levinthal,,2011).

Inconclusion, both stimulants and non-stimulants sometimes fail to cureADHD because of the subsequent complications that occur due togenetics. The use of stimulants is enhanced by increased developmentof medical assumptions towards drugs that do not cause excessive sideeffects. The innovation in the medical field has seen the developmentof other drugs which have fewer side effects compared to the existingversion of drugs.

Levinthal,C.F. (2011). Drugs,Society and Criminal Justice .Pearson

I was nervous and lonely after I got put on a PIP at work. But I survived and think it helped me grow.

• A woman who works in digital marketing was put on a performance-improvement plan in a new job.
• As a result of an ADHD diagnosis and treatment, she was able to improve her performance, she said.
• She survived her PIP and has tried to help new hires so they don't feel as isolated as she did.

This as-told-to essay is based on a conversation with a woman based in the US who works in digital marketing. She was put on a performance-improvement plan several months into a new job. She'd been fired from a prior role and didn't expect to survive the PIP. However, diagnosis and treatment for attention-deficit/hyperactivity disorder helped improve her focus. She asked that Business Insider withhold her identity because she didn't want her story to reflect poorly on her employer's training process. The following has been edited for brevity and clarity.

I work in digital marketing. When I was placed on a PIP, I had a lot of people tell me to start looking for another job. Some said not to even fight the PIP because my bosses already had it in their minds to fire me. Even recruiters and my friends who work in HR said that.

But my circumstances were a little different. Most of the bosses are pretty young. They're my age — early 30s — and I think they really did have the intention of sharpening me up a bit. They did exactly what the performance improvement plan is supposed to be for, which is to get team members up to the standards they expect.

The problem I had was that my boss hired me and then went on maternity leave. Once I started, there was a period of several months when she was gone, and I felt like I was just left out in the woods. I was relying on my teammates to train me — people who didn't have experience doing that. When my boss got back, she seemed frustrated that the two new hires — myself and someone else — weren't up to par.

I did feel it was unfair to be placed on a PIP because of that, but I'd had a history of losing jobs. I had always had a lot of focus issues. However, during the PIP, I was diagnosed with ADHD, which I think explains why I sometimes struggled at work.

I survived my PIP, but a coworker didn't

Two of us were placed on a PIP at the same time — the two new people. Everyone else on the team had been there for four or five years. They ended up firing the other new team member. When they fired him, I thought I was also on the chopping block, though eventually, my coworkers told me he just wasn't meeting the expectations of the PIP.

The PIP meeting was the first time my employer formally stated expectations and standards. How can you meet expectations if you don't know what they are? I heard things like, "You need to reply to clients within 24 hours. Send meeting notes 30 minutes prior to a call." No one had ever said any of that.

I've heard that the more realistic the objectives, the more you can pass a PIP. Ours are pretty well-defined and pretty realistic. It was things like being online by 8 a.m. and having your camera on for meetings. These things hadn't been stated but were easy to achieve.

A lot of my job is meeting with clients. When my boss returned from maternity leave, she was on all of my calls supervising. Afterward, she would send me notes with, "Here's what I would have said." That was the first time that I ever had any real feedback. Before she came back, my other workers were supervising. Everyone would just say, "Oh, good job on the call."

Both my managers are very busy. Before my PIP, I felt like I had to ask my coworkers questions on calls. I didn't want to send a message through Teams because I didn't want any trace of it. I didn't want it to seem like I didn't know anything. I didn't know what they expected me to know.

After my PIP, we eventually got two new hires. I told my boss, "Here's what went wrong. Here's what the new hires need to know so they are not placed on a PIP." There was a lot of company knowledge that I didn't glean when she was gone. I felt like I didn't have anyone to turn to because I didn't want to keep bugging my coworkers. We work remotely, and I think that in an office setting, I would have had more opportunities to ask questions. I feel like I was thrown to the wolves in some regard.

I just made sure the new hires knew that they could ask me anything at any time. I felt very alone during my PIP, and I don't want others to experience that feeling. I am a first-generation college graduate. I was the first generation to work in a corporate role. So I have nobody to go to when something like this happens.

ADHD medication is helping me focus

The ADHD medication is helping a lot. It's helping with my focus. Once I was diagnosed and started learning more about ADHD, I felt like I understood my whole life. I remember being a teenager, and I was a straight-A student. I had wanted to be a doctor, but I told myself, "I can't handle that." I didn't know that I had this attention-deficit disorder. The diagnosis and medication have really changed the game for me.

When I was put on the PIP, I was in crisis mode. I was considering switching to a different career. I was thinking of becoming an EMT. Random stuff. But I thought, let me knuckle down in this job first and give it 110%. At the time, I didn't have an ADHD diagnosis.

I never felt confident during the PIP that I was going to survive it. I would get messages from my bosses like, "Good work. You're coming up to speed on things." Everything that they said during it was positive, but because of what I'd heard about PIPs, I expected to get fired.

Then, after my diagnosis, I was taking my medication every day and working around the clock. I was very vocal and transparent with both of my bosses about what I was doing because we had weekly check-ins for the PIP.

But it was hard to know what to disclose. On one call, I was very hesitant to mention it, but I said, "I was recently diagnosed with ADHD, and I know that it's affecting my performance. I apologize if there were any gaps." I told them I was on medication that's really helping. They said, "Thank you so much for telling us. We're really glad that you opened up to us about that. We wish you would have said something sooner because we could make accommodations." It ended up being a positive for me to say that, but I was taking a gamble because it can also be used against you.

It's not the warmest office. It's not the most transparent management. I didn't feel like I had a rapport with one of my bosses until I met her in person. Then she ended up apologizing for the PIP and saying that after she had her baby, she had postpartum depression and was kind of going through a lot and needed the team to be at 100% because it would help her out, too.

I didn't have the final PIP meeting. They just sent an email saying that I passed and that we wouldn't have the check-ins and everything was fine. And they copied HR. I felt very relieved. But I still felt weary and like I needed to tread lightly. You still have to continue the standard that they set.

The PIP process, on the whole, was positive — having so much transparency for the first time. Now I know I can go to my bosses and say, "Hey, I'm not able to get a refill of my medication because of a shortage. I'm sorry if you need to remind me about anything. Just feel free to be harder on me during this."

Overall, I feel more job security now. They're even putting me on new accounts.

Do you have something to share about a PIP or what you're seeing in your workplace? Business Insider would like to hear from you. Email our workplace team from a nonwork device at [email protected]  with your story or to ask for one of our reporter's Signal numbers. Or check out   Business Insider's source guide  for tips on sharing information securely.

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The history of attention deficit hyperactivity disorder

Klaus w. lange.

1 Department of Biological and Abnormal Psychology, University of Regensburg, Regensburg, Germany

3 Institute of Experimental Psychology, University of Regensburg, 93040 Regensburg, Germany

Susanne Reichl

Katharina m. lange.

2 Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands

Oliver Tucha

The contemporary concept of attention deficit hyperactivity disorder (ADHD) as defined in the DSM-IV-TR (American Psychiatric Association 2000 ) is relatively new. Excessive hyperactive, inattentive, and impulsive children have been described in the literature since the nineteenth century. Some of the early depictions and etiological theories of hyperactivity were similar to current descriptions of ADHD. Detailed studies of the behavior of hyperactive children and increasing knowledge of brain function have changed the concepts of the fundamental behavioral and neuropathological deficits underlying the disorder. This article presents an overview of the conceptual history of modern-day ADHD.

Introduction

The characteristic features of children and adolescents with attention deficit hyperactivity disorder (ADHD) are excessive motor activity, inattention, and impulsiveness. The contemporary concept of ADHD as defined in the DSM-IV-TR (American Psychiatric Association 2000 ) is relatively new. However, an analysis of historical literature suggests that children presenting with symptoms of inattention, hyperactivity, and impulsivity have previously been described by several authors during the last 200 years. The clinical characterizations, underlying concepts, and nomenclature of the described dysfunctions have changed over the time. Many of the historical descriptions are, however, consistent with the modern diagnostic criteria for ADHD. The present article gives an overview of the conceptual history of modern-day ADHD.

The incapacity of attending with a necessary degree of constancy to any one object (Sir Alexander Crichton, 1763–1856)

The first example of a disorder that appears to be similar to ADHD was given by Sir Alexander Crichton in 1798. Crichton was a Scottish physician who was born in Edinburgh in 1763. In 1785, he received his M.D. from the University of Leiden, The Netherlands (Palmer and Finger 2001 ; Tansey 1984 ). He then decided “to undertake a European medical tour” (Tansey 1984 , p. 243) and practiced in hospitals in Paris, Stuttgart and Vienna (Tansey 1984 ). In his clinical practice, Crichton observed many cases of insanity and became increasingly interested in mental illness (Palmer and Finger 2001 ). In 1798, he published “An inquiry into the nature and origin of mental derangement: comprehending a concise system of the physiology and pathology of the human mind and a history of the passions and their effects”. In this work of three books, he demonstrated observations of clinical cases of mental illness (Palmer and Finger 2001 ). Up until the end of the eighteenth century, when Crichton published his inquiry, it was uncommon to focus on mental issues from a physiological or medical perspective (Palmer and Finger 2001 ). Crichton mentioned that at the time there were only two other authors who had “written fully on the subject of Mental Diseases” (Crichton 1798 , pp. ii–iii, cited by Palmer and Finger 2001 ).

The second chapter of book II “On Attention and its Diseases” is of special interest to the present subject. Crichton begins this chapter with a definition of attention: “When any object of external sense, or of thought, occupies the mind in such a degree that a person does not receive a clear perception from any other one, he is said to attend to it” (Crichton 1798 , reprint p. 200). Crichton emphasizes that the intensity of healthy attention varies within a normal range both between individuals and even within a person at different times (Crichton 1798 ). A distraction of attention does not necessarily have to be pathological, e.g. mental stimuli, volition, or education can have a great impact on healthy attention (Crichton 1798 ). Crichton distinguishes two possibilities of abnormal inattention as the oppositional poles of pathologically increased or decreased “sensibility of the nerves” (Crichton 1798 ):

The morbid alterations to which attention is subject, may all be reduced under the two following heads: First. The incapacity of attending with a necessary degree of constancy to any one object. Second. A total suspension of its effects on the brain. The incapacity of attending with a necessary degree of constancy to any one object, almost always arises from an unnatural or morbid sensibility of the nerves, by which means this faculty is incessantly withdrawn from one impression to another. It may be either born with a person, or it may be the effect of accidental diseases. When born with a person it becomes evident at a very early period of life, and has a very bad effect, inasmuch as it renders him incapable of attending with constancy to any one object of education. But it seldom is in so great a degree as totally to impede all instruction; and what is very fortunate, it is generally diminished with age. (Crichton, 1798 , reprint p. 203)

In this short description of the first alteration of attention, Crichton gives several indications that he was depicting the same disorder as defined in the current DSM-IV-TR criteria of ADHD. His characterization of the disorder as “the incapacity of attending with a necessary degree of constancy to any one object” is consistent with the second symptom of criterion A1, Inattention: the “difficulty sustaining attention in tasks or play activities” (American Psychiatric Association 2000 ). Crichton further describes that “this faculty is incessantly withdrawn from one impression to another”, which fits with a second DSM-IV-TR symptom of inattention, namely the circumstance that the patient “is often easily distracted by extraneous stimuli” (American Psychiatric Association 2000 ). The American Psychiatric Association ( 2000 ) furthermore determines that for the diagnosis of ADHD, the symptoms have to be present before the age of seven. Crichton also reports that the disorder can be “born with a person” and “when born with a person it becomes evident at a very early period of life” (Crichton 1798 ). The proximate conclusion that “it renders him incapable of attending with constancy to any one object of education” (Crichton 1798 ) suggests that Crichton observed school difficulties in these children, which are commonly seen in children with ADHD. Crichton states that the disorder “generally diminished with age ” (Crichton 1798 ). The notion that ADHD is a disorder of childhood and affected children “grow out” of ADHD during puberty (Okie 2006 ) was common until the 1990s (Barkley 2006a ). Recent studies have shown that about 50% of children diagnosed with ADHD retain symptoms of ADHD into adulthood (Okie 2006 ; Arolt 2008 ).

According to Crichton, the incapacity of attending, if not innate, can also be caused by nervous disorders. This notion was later rediscovered in the concepts of minimal brain damage or dysfunction.

In this disease of attention, if it can with propriety be called so, every impression seems to agitate the person, and gives him or her an unnatural degree of mental restlessness. People walking up and down the room, a slight noise in the same, the moving a table, the shutting a door suddenly, a slight excess of heat or of cold, too much light, or too little light, all destroy constant attention in such patients, inasmuch as it is easily excited by every impression. The barking of dogs, an ill-tuned organ, or the scolding of women, are sufficient to distract patients of this description to such a degree, as almost approaches to the nature of delirium. It gives them vertigo, and headache, and often excites such a degree of anger as borders on insanity. When people are affected in this manner, which they very frequently are, they have a particular name for the state of their nerves, which is expressive enough of their feelings. They say they have the fidgets. (Crichton, 1798 , reprint p. 203)

By citing these examples of his patients’ behaviors, Crichton depicts a great distractibility by extraneous and even slight stimuli, a considerable restlessness and perhaps some kind of impulsivity when the disorder “excites such a degree of anger as borders on insanity” (Crichton 1798 , reprint p. 203). All symptoms observed by Crichton can be associated with ADHD. However, his descriptions do not entirely reflect the current concept of ADHD. He does not mention any symptoms of hyperactivity (Palmer and Finger 2001 ). It is possible that Crichton observed hyperactive or impulsive symptoms in his patients (Palmer and Finger 2001 ), but failed to recognize a correlation and decided not to specify them in this context. Another possibility is that he described the inattentive subtype of ADHD as suggested by Palmer and Finger ( 2001 ). His brief description is consistent with some of the symptoms of this ADHD subtype, but does not fully meet the criteria for a clinical diagnosis.

We do not know for certain whether the “morbid alteration” of attention described by Crichton is identical with the current concept of ADHD. Crichton’s patients might have suffered from another disorder associated with attention problems, such as a metabolic dysfunction, epilepsy, or head injury. However, Crichton’s descriptions provide some evidence for the existence of ADHD at the end of the eighteenth century.

Fidgety Phil (Heinrich Hoffmann 1809–1894)

In 1844, the German physician Heinrich Hoffmann created some illustrated children’s stories including “Fidgety Phil” (“Zappelphilipp”), who is nowadays a popular allegory for children with ADHD. Hoffmann was born in Frankfurt/Main in 1809. He studied medicine in Heidelberg, Halle, and Paris (Herzog et al. 1995 ). In 1835, he became a general practitioner and obstetrician in Frankfurt/Main (Herzog et al. 1995 ). In 1851, he was employed at the mental hospital of Frankfurt (“Anstalt für Irre und Epileptische”) and became a successful psychiatrist (Herzog et al. 1995 ). Hoffmann rejected the common opinion of his time that psychiatric patients were obsessed or criminal, but rather regarded mental disorders as medical issues (Thome and Jacobs 2004 ). In 1861, he founded a new and very advanced hospital in Frankfurt. He was head of this institution until his retirement in 1888 (Herzog et al. 1995 ; Thome and Jacobs 2004 ) and was known for his revolutionary efforts to improve the conditions of psychiatric patients (Thome and Jacobs 2004 ).

In Germany, Hoffmann has become famous as the author of “Struwwelpeter”, a storybook created in 1844 as a Christmas present for his 3-year-old son Carl Philipp (Hobrecker 1933 ). As Hoffmann detailed in his autobiography, he had several times previously pulled a piece of paper out of his notebook and had made little drawings to calm and amuse crying children, thus making possible an undisturbed medical examination (Hoffmann 1985 , cited by Seidler 2004 ; Thome and Jacobs 2004 ). Hoffmann conceived “Struwwelpeter” for private use in order to delight his son. However, the publisher Löwenthal who had seen his manuscript convinced him to publish the colorful drawings (Thome and Jacobs 2004 ). In 1845, the first edition of the “Struwwelpeter”, initially called “Cheerful Stories and Funny Pictures with 15 colored plates for children from 3 to 6 years” (“lustige Geschichten und drollige Bilder mit 15 kolorierten Tafeln für Kinder von 3 bis 6 Jahren”, Köpf 2006 ), was released with great success. The second edition followed a year later and Hoffmann added some stories, which included among others the story of Fidgety Phil (Hobrecker 1933 ). Hoffmann’s Struwwelpeter was published in numerous editions and translated into several languages. The 400th edition was released in 1917 and the number of editions can no longer be counted these days (Herzog et al. 1995 ).

In the story of Fidgety Phil, Hoffmann illustrates a family conflict at dinner caused by the fidgety behavior of the son and culminating in his falling over together with the food on the table. This can be interpreted as an early case of ADHD. At the beginning of the story, the father asks “in earnest tone” (Hoffmann 1846, English edition): “Let me see if Philip can be a little gentleman; Let me see if he is able to sit still for once at table” (Hoffmann 1846, English edition). The initial statement suggests that the father had anticipated some misbehavior of his son at table, indicating that this was no singular or occasional event. It is a first hint at the presence of an underlying persistent disorder. The DSM-IV-TR currently postulates that, for a diagnosis of ADHD, the symptoms “have persisted for at least 6 months” (American Psychiatric Association 2000 ). Subsequently, Hoffmann describes symptoms of inattention and hyperactivity in Philipp. The boy’s reaction to his father’s admonition reads in the original German text as follows: “Doch der Philipp hörte nicht, was zu ihm der Vater spricht” (Hoffmann 1948 ), which, literally translated, means “but Philipp did not listen to what the father was saying to him”. This behavior represents explicit symptoms of inattention. The DSM-IV-TR describes that the patient “often does not seem to listen when spoken to directly” and “often does not follow through on instructions (…) [what is] not due to oppositional behavior” (American Psychiatric Association 2000 ). Instead of following his father’s request, Philipp “wriggled and giggled, and then, I declare, swung backward and forward and tilted his chair” (Hoffmann 1846, English edition). This description can be interpreted as symptoms of “motoric overactivity” (Burd and Kerbeshian 1988 ) and is close to the first symptom of hyperactivity characterized in the DSM-IV-TR: “often fidgets with hands or feet or squirms in seat” (American Psychiatric Association 2000 ). Hoffmann depicts Philipp’s motor activity as being excessive enough that “his chair falls over quite. Philip screams with all his might, catches at the cloth, but then that makes matters worse again. Down upon the ground they fall, glasses, bread, knives forks and all” (Hoffmann 1846, English edition). The fact that Philipp’s parents become very angry in the story (Hoffmann 1948 ) may hint at another DSM-IV-TR criterion, i.e. the behavior of children suffering from ADHD often causes conflicts and a “significant impairment in social (…) functioning” (American Psychiatric Association 2000 ).

Another story in Hoffmann’s “Struwwelpeter” relevant to the present review is that of “Johnny Look-in-the-air”, which was added in the 5th edition in 1847 (Seidler 2004 ). In this story, Hoffmann depicts a boy showing significant symptoms of inattention. Johnny was always “looking at the sky and the clouds that floated by” (Hoffmann 1846, English edition) and was therefore “often easily distracted by extraneous stimuli” (American Psychiatric Association 2000 ). Johnny’s inattentiveness resulted in the collision with an approaching dog and climaxed in an accident as “Johnny watch’d the swallows” (Hoffmann 1846, English edition). He finally fell into a river.

Some authors are convinced that the stories of Johnny Look-in-the-air and Fidgety Phil are early descriptions of ADHD (Burd and Kerbeshian 1988 ; Köpf 2006 ; Thome and Jacobs 2004 ). However, Johnny Look-in-the-air’s retropulsion of the head may also be interpreted as a description of a petit mal absence (Nissen 2005 ). Petit mal absences show a wide variety of mild to moderate motor accompaniment, and retropulsion of the head is quite common (retropulsive petit mal, Janz 1969 ). There are also critics who advance the view that Hoffmann’s Fidgety Phil is simply an example of a naughty child (Seidler 2004 ). Seidler ( 2004 ) refers to the fact that the final version of the scene’s pictures published in 1859, which is the artwork still used in modern editions, differs from the original version of 1845. Seidler ( 2004 ) sees in the slightly different gestures of the protagonists a completely different situation, namely an open conflict between a father and his naughty, misbehaving son. The father’s initial admonition provokes the son’s deliberate defiant behavior indicated by eye contact and the active gripping of the tablecloth by the son (Seidler 2004 ). Hoffmann’s storybook was published at a time when educational warning stories were very popular (Herzog et al. 1995 ). Each of Hoffmann’s stories demonstrates a child’s misconduct leading to fatal consequences including death of the child. It is therefore possible that he wanted children to learn from his stories. Hoffmann’s script is an illustrated children’s book and he is therefore unlikely to have intended to address a broad medical readership and to describe a pathological condition. Since at his time the symptoms of inattention and hyperactivity were not established as a psychiatric disorder, Hoffmann may have presented observations of conspicuous behavior without considering describing a disorder. One cannot conclude whether or not Hoffmann’s described a case of ADHD in the early nineteenth century, since the story of Fidgety Phil is too short and the depicted behavioral features are not sufficient to establish the diagnostic criteria of ADHD. Fidgety Phil has nevertheless become a commonly used allegory for ADHD.

Defect of moral control (Sir George Frederic Still, 1868–1941)

The Goulstonian Lectures of Sir George Frederic Still in 1902 are by many authors considered to be the scientific starting point of the history of ADHD (Barkley 2006a ; Conners 2000 ; Palmer and Finger 2001 ; Rafalovich 2001 ; Rothenberger and Neumärker 2005 ). Still was a British pediatrician who was born in Highbury, London, in 1868. He became involved in research into childhood diseases and wrote several medical textbooks about his findings (Farrow 2006 ). The most widely known findings are his descriptions of “a form of chronic joint disease in children” (Still 1897 ), which today is called “Still’s disease” (Farrow 2006 ). In 1906, Still became the first professor of pediatrics in England at King’s College Hospital London (Farrow 2006 ). In 1933, he was president of the first international pediatric congress (Hamilton 1968 ). Still has therefore frequently been called “the father of British pediatrics” (Dunn 2006 ).

In his Goulstonian Lectures, a series of three lectures to the Royal College of Physicians of London “On Some Abnormal Psychical Conditions in Children” (Still 1902 ), Still discusses “the particular psychical conditions (…) which are concerned with an abnormal defect of moral control in children” (Still 1902 , p. 1008). He defines moral control as “the control of action in conformity with the idea of the good of all” (Still 1902 , p. 1008). Still states that “moral control (…) is dependent upon three psychical factors, a cognitive relation to environment, moral consciousness, and volition” (Still 1902 , p. 1077). Since both “cognitive relation to environment”, which implies a “capacity for reasoning comparison”, and moral consciousness are intellectual capacities (Still 1902 , p. 1008), Still states that defective moral control as a morbidity can often be observed in cases of mentally retarded children (Still 1902 ). However, “there are other cases which cannot be included in this category” (Still 1902 , p. 1008) and which, as he points out, “in particular (…) call for careful observation” (Still 1902 , p. 1008). They comprise the cases considered as historical descriptions of ADHD, i.e. children with a defect of moral control but without a “general impairment of intellect” (Still 1902 , p. 1077). Still divides these cases in two further groups, children with a “morbid defect of moral control associated with physical disease” (Still 1902 , p. 1077), such as a cerebral tumor, meningitis, epilepsy, head injury or typhoid fever, and children with a “defect of moral control as a morbid manifestation, without general impairment of intellect and without physical disease” (Still 1902 , p. 1079). Some of the latter group, however, showed a “history of severe cerebral disturbance in early infancy” (Still 1902 , p. 1081). This differentiation was the origin of later concepts of brain damage, minimal cerebral dysfunction, and hyperactivity as historical precursors to ADHD (Rothenberger and Neumärker 2005 ).

Still described 20 cases of children with a “defect of moral control as a morbid manifestation, without general impairment of intellect and without physical disease” (Still 1902 , p. 1079). Interestingly, Still observed 15 cases of boys and five cases of girls. This is “a disproportion which [in Still’s opinion] (…) is not altogether accidental” (Still 1902 , p. 1080) and which is consistent with the commonly observed uneven male to female sex ratio of 3:1 in child and adolescent ADHD (Barkley 1990, cited by Palmer and Finger 2001 ). Most children for whom the first manifestation of the defect was determined showed symptoms before the age of 7 (7 out of 9 cases), which currently is a diagnostic criterion of DSM-IV-TR. Still furthermore recognized that a morbid manifestation of a child’s moral control can be considered only when the child does not meet the standard for moral conduct at a certain age within a “range of variation which we arbitrarily recognize as normal” (Still 1902 , p. 1009). The American Psychiatric Association also states that for a diagnosis of ADHD, symptoms have to be present “to a degree that is maladaptive and inconsistent with developmental level” (American Psychiatric Association 2000 ). Still argued that a “lack of moral control may be shown in many ways” (Still 1902 , p. 1009). The symptoms listed are:

(1) passionateness; (2) spitefulness – cruelty; (3) jealousy; (4) lawlessness; (5) dishonesty; (6) wanton mischievousness – destructiveness; (7) shamelessness – immodesty; (8) sexual immorality; and (9) viciousness. The keynote of these qualities is self-gratification, the immediate gratification of self without regard either to the good of others or to the larger and more remote good of self. (Still, 1902 , p. 1009).

Although most of these symptoms are not directly associated with the current concept of ADHD, the keynote identified by Still fits an important finding of modern ADHD research. Delay of gratification appears to be “a major problem for children with ADHD” (Barkley 2006b ) and reactions without regard to consequences, whether “to the good of others or (…) [the] good of self” (Still 1902 , p. 1009), are strongly associated with impulsivity, a main symptom of ADHD. The most common symptom observed by Still in these cases was “an abnormal degree of passionateness” (Still 1902 , p. 1009). Passionateness did not mean affection (Barkley 2006b ), but some “impulsivity regarding some immediate goal” (Conners 2000 , p. 176) and a kind of “quickness to display all emotion and especially those of frustration, anger, hostility, and aggression” (Barkley 2006b , p. 137), for example expressed “in outbursts of rage” (Still 1902 , p. 1165). Similarly “jealousy” does, according to Still, not mean “the mere emotion but its uncontrolled expression” (Still 1902 , p. 1009). Still attributes these symptoms to “a morbid failure to control (…) emotional activities” (Still 1902 , p. 1165), which is due to an “exaggeration of excitability” (Still 1902 , p. 1165). These descriptions are similar to the current concept of impulsivity. Although not explicitly mentioned in DSM-IV-TR, impulsivity as a main symptom of ADHD is often associated with a lack of emotional impulse control, a low frustration tolerance and some abrupt outbursts of rage (Barkley 2006b ). Still describes some cases with signs of impulsivity,

for instance, the case of the boy, aged 11½ years (…): his mother stated that in the midst of playing quietly with other children he would suddenly seize two of them and bang their heads together, making them cry with pain and (…) he seems unable to resist it. (Still, 1902 , p. 1165).

Still also mentions that many of his depicted cases showed “a quite abnormal incapacity for sustained attention. Both parents and school teachers have specially noted this feature in some of my cases as something unusual” (Still 1902 , p. 1166). An attention deficit is a main symptom of ADHD and, according to the current DSM-IV-TR criteria, a child with ADHD “has difficulty sustaining attention in tasks or play activities” (American Psychiatric Association 2000 ). Difficulties at school are frequently observed in children with ADHD. In particular, the notion of children with a significant attention deficit, but “without general impairment of intellect” (Still 1902 , p. 1079) fits modern-day ADHD. Recent studies have shown that the IQ of children with ADHD is within the normal range (MTA Cooperative Group 1999 ; Schuck and Crinella 2005 ). Some of the cases cited by Still showed remarkable symptoms of inattention, for example,

the case of a boy with moral defect who would repeat the process of saying ‘Good-night’ several times before he was aware that he had done so; the same boy would often put his boot on the wrong foot apparently without noticing it. Another boy, aged six years, with marked moral defect was unable to keep his attention even to a game for more than a very short time, and, as might be expected, the failure of attention was very noticeable at school, with the result that in some cases the child was backward in school attainments, although in manner and ordinary conversation he appeared as bright and intelligent as any child could be (Still, 1902 , p. 1166).

Many of Still’s descriptions appear to indicate that children in the early twentieth century showed clear symptoms of ADHD. However, most of the symptoms listed by Still and described in his cases do not refer to ADHD. Still also reported children who “seemed to take a delight in tormenting the other children” (Still 1902 , p. 1080), for example by throwing other children’s toys in the fire and laughing at their grief. He furthermore described children who pathologically stole or lied with extraordinary insensitivity to any punishment, children who were aggressive and attacked strange children or threatened to hurt their mothers (Still 1902 , p. 1081), “lawless” children with “a reckless disregard for command and authority” (Still 1902 , p. 1009), children with “a complete lack of natural affection” (Still 1902 , p. 1165) even to their parents, and children who showed cruelty to animals for example by attempting to put a cat in the fire (Still 1902 , p. 1081) or by “cutting a rabbit alive (…) smothered in blood” (Still 1902 , p. 1081).

Still’s concept of a “defect of moral control” is not consistent with the concept of ADHD. Still did not predominantly refer to inattentive-impulsive children, but rather described several types of deviant behavior observed in children. “His description included the full range of externalizing behavior disorders” (Conners 2000 ), presumably many cases that would meet today’s criteria for conduct disorder, oppositional defiant disorder, learning disabilities, or antisocial personality disorder (Palmer and Finger 2001 ; Barkley 2006b ; Conners 2000 ). All these cases were combined in the concept of “defect of moral control”. Among these cases, there were probably also some cases of ADHD such as the ones depicted above. Although the signs described by Still are consistent with some symptoms of ADHD, they are not sufficient for a clinical diagnosis of ADHD. Hyperactivity as a main symptom of ADHD is hinted at in one case, i.e. a girl who showed “marked fidgety, almost choreiform movements” (Still 1902 , p. 1082). Still’s work, nevertheless, “represents a break from the more general medical discussions of morality” (Rafalovich 2001 ) and his original notion of an impulsive syndrome which was distinguishable from general intellectual retardation and symptoms caused by physical diseases is pioneering (Conners 2000 ). He discusses both nature and nurture as possible factors underlying a lack of “moral control” and includes an elaborate description of family history in his cases. Still’s Goulstonian lectures can be considered “the groundwork for a category of mental illness that is (…) specific to child deviance” (Rafalovich 2001 ) and a historically significant moment for child psychopathology in general (Barkley 2006b ). Regardless of whether or not Still’s descriptions include some cases of ADHD, his work is nevertheless important in the analysis of historical ideas concerning ADHD. Still’s demonstration of a connection between brain damage and deviant behavior in children was highly influential regarding the further conceptualization of ADHD.

Postencephalitic behavior disorder

Some authors including Tredgold in 1908 gave an account of a correlation between early brain damage, for example caused by birth defect or perinatal anoxia, and subsequent behavior problems or learning difficulties (Tredgold 1908 , cited by Rothenberger and Neumärker 2005 ). This was confirmed by the encephalitis lethargica epidemic, which spread around the world from 1917 to 1928 and affected approximately 20 million people (Conners 2000 ; Rafalovich 2001 ). The residual effects appeared as fatal as the encephalitis itself. The disease was thought to irreversibly damage the patients physically or mentally (Rafalovich 2001 ). Many of the affected children who survived the epidemic encephalitis, subsequently showed remarkably abnormal behavior. The residual effects were described as “postencephalitic behavior disorder” (Barkley 2006a ; Rothenberger and Neumärker 2005 ). Frequently observed features included a significant change in personality, emotional instability, cognitive deficits, learning difficulties, sleep reversals, tics, depression, and poor motor control (Conners 2000 ; Kessler 1980 ; Rothenberger and Neumärker 2005 ). Children often became “hyperactive, distractible, irritable, antisocial, destructive, unruly, and unmanageable in school. They frequently disturbed the whole class and were regarded as quarrelsome and impulsive, often leaving the school building during class time without permission” (Ross and Ross 1976 , p. 15). Bender ( 1942 ) described the postencephalitic behavior disorder to be “best understood as an organic driveness of brain stem origin. (…) This hyperkinesis leads the child to contact the environment continually, by touching, taking and destroying” (cited by Kessler 1980 , p. 19). Many descriptions of children with this disorder include some characteristic symptoms of ADHD, and some behaviors of postencephalitic cases might also be attributed to ADHD. Most of the afflicted children, however, would not have met the current ADHD criteria. The postencephalitic behavior disorder aroused, nevertheless, a broad interest in hyperactivity in children, and the findings were influential for the further scientific development of the concept of ADHD (Rothenberger and Neumärker 2005 ). The era of the postencephalitic child pursued the course of Still and explained unconventional behavior of children physiologically and medicalized deviant child behavior. The assumption of a causal connection between brain damage and symptoms of hyperactivity and distractibility was important to the further conceptualization of ADHD (Rafalovich 2001 ; Rothenberger and Neumärker 2005 ).

Hyperkinetic disease of infancy (Franz Kramer 1878–1967, and Hans Pollnow 1902–1943)

In 1932, the German physicians Franz Kramer and Hans Pollnow reported “On a hyperkinetic disease of infancy” (“Über eine hyperkinetische Erkrankung im Kindesalter”). The most characteristic symptom of affected children was a marked motor restlessness (Kramer and Pollnow 1932 , p. 1). The authors point out that the symptoms of this “hyperkinetic disease” had previously been observed and described by several authors, but the disorder had not been distinguished from other diseases with similar symptoms, such as the residual effects of the encephalitis lethargica epidemic. In their cases, the authors observed no bodily symptoms, sleep disturbances, or nocturnal agitation, which were specific to the postencephalitic behavior disorder (Kramer and Pollnow 1932 , p. 39). In contrast to the postencephalitic motor drive, the restlessness observed in the cases of Kramer and Pollnow could be observed only by day (Kramer and Pollnow 1932 , p. 39). The main symptoms of the “hyperkinetic disease” as described by Kramer and Pollnow are very similar to the current concept of ADHD.

According to Kramer and Pollnow, the most obvious symptom of children with hyperkinetic disease is a remarkable motor activity, which appears to be very urgent (Kramer and Pollnow 1932 , p. 7). These children cannot stay still for a second, run up and down the room (Kramer and Pollnow 1932 , p. 7), climb about preferring high furniture in particular (Kramer and Pollnow 1932 , p. 10) and are displeased when deterred from acting out their motor impulses (Kramer and Pollnow 1932 , p. 7). This description is very similar to the current characterization of hyperactivity, one of the main symptoms of ADHD. The American Psychiatric Association ( 2000 ) describes children with ADHD to leave their seats when “remaining seated is expected”, to “run (…) about” and to be often “on the go” (American Psychiatric Association 2000 ). Excessive climbing is also an explicit hyperactive symptom of ADHD mentioned by the American Psychiatric Association ( 2000 ). The urgent character of the children’s motor activity is reflected in the depiction of children with ADHD as being “driven by a motor” (American Psychiatric Association 2000 ). Kramer and Pollnow furthermore consider the observed motor activity as being characterized by a conspicuous lack of purposefulness (Kramer and Pollnow 1932 , p. 8). Children with hyperkinetic disease indiscriminately touch or move everything available without pursuing a goal (Kramer and Pollnow 1932 , p. 7, p. 9). They often do not use objects according to their function, but regard them as stimuli inducing activity (Kramer and Pollnow 1932 , p. 9). These children switch the light on and off, move chairs around the room, climb the table, the cupboard or the windowsill, jump around in their beds, turn keys in the keyhole, rip paper, go round in circles, throw objects out of the window, or beat their toys rhythmically on the floor without any purpose (Kramer and Pollnow 1932 , p. 8 f.). This aimlessness of action exemplified by quickly changing activities is possibly due to a distinct distractibility by new and intensive stimuli, which is another symptom mentioned by Kramer and Pollnow. The children described by Kramer and Pollnow often cannot complete a set task or do not answer to questions (Kramer and Pollnow 1932 , p. 13). They are unable to concentrate on difficult tasks (Kramer and Pollnow 1932 , p. 17), which may cause learning deficits (Kramer and Pollnow 1932 , p. 23) and make it difficult to assess their intellectual abilities (Kramer and Pollnow 1932 , p. 18). These descriptions comply with the second main symptom of ADHD, i.e. inattention. The DSM-IV-TR depicts children with ADHD as being “easily distracted by extraneous stimuli” and as having “difficulty sustaining attention in tasks or play activities” (American Psychiatric Association 2000 ). Together with the fact that children with ADHD are known to have difficulties in planning and “organizing (…) activities” (American Psychiatric Association 2000 ), their playing can suggest a lack of purposefulness as described by Kramer and Pollnow. In addition, Kramer and Pollnow’s observation of unresponsiveness in children with ADHD is reflected in the notion that a child with ADHD “often does not seem to listen when spoken to directly” (American Psychiatric Association 2000 ). Patients with ADHD typically have problems to concentrate and “to give close attention to details” (American Psychiatric Association 2000 ). It is also common for patients with inattention to leave work or activities uncompleted and to “fail (…) to finish (…) chores” (American Psychiatric Association 2000 ). This symptom is also described by Kramer and Pollnow as a further characteristic of the hyperkinetic child. According to these authors, hyperkinetic children show no perseverance in their activities, e.g. they play no game for more than a few minutes (Kramer and Pollnow 1932 , p. 10). However, Kramer and Pollnow also noticed that the children were able to persevere at some activities of their interest for hours (Kramer and Pollnow 1932 , p. 14). Both a lack of perseverance and the ability to concentrate on certain tasks can be observed in children with ADHD. Kramer and Pollnow describe furthermore that the children are unstable in their mood (Kramer and Pollnow 1932 , p. 11). They observed an increased excitability, frequent fits of rage, and a tendency to become aggressive or to burst into tears for marginal reasons (Kramer and Pollnow 1932 , p. 11). These are characteristic signs of impulsivity, and all main symptoms of ADHD are therefore present in the record of Kramer and Pollnow.

The description of the hyperkinetic disease also meets another criterion of ADHD. The American Psychiatric Association ( 2000 ) states that for a diagnosis of ADHD to be made, symptoms must cause “significant impairment in social, academic, or occupational functioning”. Kramer and Pollnow describe that hyperkinetic children are often disobedient (Kramer and Pollnow 1932 , p. 13) and cause severe educational problems (Kramer and Pollnow 1932 , p. 14). At school, they may cause confusion or disturb the class (Kramer and Pollnow 1932 , p. 14). They often have difficulty playing harmoniously with other children and are generally unpopular among peers (Kramer and Pollnow 1932 , p. 11). As mentioned previously, the presence of symptoms before the age of seven is an additional important diagnostic criterion in the DSM-IV-TR (American Psychiatric Association 2000 ). This criterion is also met by the cases of Kramer and Pollnow, since they reported an age of onset of the hyperkinetic disease as early as three or 4 years and a peak at the age of six. In many cases of Kramer and Pollnow, the abnormal behavior occurred following a feverish disease or epileptic convulsion (Kramer and Pollnow 1932 , p. 23), which suggests an organic cause (Kramer and Pollnow 1932 , p. 35). Kramer and Pollnow describe that the characteristics of the disorder, especially the motor restlessness, decline in intensity by the age of seven, and in most cases, the children recover in the subsequent years (Kramer and Pollnow 1932 , p. 23), so that Kramer and Pollnow considered the disorder a “hyperkinesis of childhood” (Kramer and Pollnow 1932 , p. 4). Although more than 50% of children with ADHD retain symptoms into adulthood (Barkley et al. 2002 ), the signs of hyperactivity decline with age in most cases of ADHD (Davidson 2008 ). Since Kramer and Pollnow considered abnormal motor activity as the most characteristic symptom of the disorder, they possibly regarded affected children as recovered when, regardless of other symptoms, this sign receded. However, Kramer and Pollnow recognized that the disorder can have implications into adulthood (Rothenberger and Neumärker 2005 , p. 167).

In summary, the descriptions of Kramer and Pollnow “on a hyperkinetic disease of infancy” meet all three main symptoms of ADHD and two additional DSM-IV-TR criteria. In particular, their description of motor symptoms is highly consistent with the current classification systems (Rothenberger and Neumärker 2005 ). The introductory remark of Kramer and Pollnow that the pathological manifestation of the disorder had been known previously, but had not been recognized as a distinct disorder which had to be differentiated from other disorders with similar symptoms, is consistent with the historical literature. In summary, Kramer and Pollnow established a concept of the hyperkinetic disease that closely resembles the current concept of ADHD.

The first treatment of hyperactivity (Charles Bradley 1902–1979)

In 1937, Charles Bradley reported a positive effect of stimulant medication in children with various behavior disorders (Bradley 1937 ). Bradley was medical director of the Emma Pendleton Bradley Home, today called Bradley Hospital, in East Providence, Rhode Island, which was founded by his great-uncle George Bradley (Brown 1998 ) to treat neurologically impaired children (Conners 2000 ). Apart from children with definite neurological disorders or residual effects of encephalitis (Conners 2000 ), there where children hospitalized with “emotional problems” and major difficulties in learning and behavior. Some of these children would possibly be diagnosed with ADHD today (Gross 1995 ). Bradley’s discovery of the improvement by stimulants of the behavior of children was based on a chance finding during his neurological examinations (Gross 1995 ). Bradley performed pneumoencephalograms in order to examine structural brain abnormalities (Rothenberger and Neumärker 2005 ). This usually caused severe headaches, which were supposed to be the result of a significant loss of spinal fluid. Bradley attempted to treat the headaches by stimulating the choroid plexus with benzedrine which was “the most potent stimulant available at the time” (Gross 1995 ). However, benzedrine had a negligible effect on the headaches, but caused a striking improvement in behavior and school performance in some of the children (Brown 1998 ; Gross 1995 ). Bradley subsequently started a systematic trial in 30 children of his hospital and observed remarkable alterations in behavior. “The most spectacular change in behavior brought about by the use of benzedrine was the remarkably improved school performance of approximately half the children” (Bradley 1937 , p. 582). The children “were more interested in their work and performed it more quickly and accurately” (Gross 1995 ). In addition, some decrease in motor activity was usually noted in the children who also “became emotionally subdued without, however, losing interest in their surroundings” (Bradley 1937 , p. 580). Bradley was surprised at this effect. “It appears paradoxical that a drug known to be a stimulant should produce subdued behavior in half of the children. It should be borne in mind, however, that portions of the higher levels of the central nervous system have inhibition as their function, and that stimulation of these portions might indeed produce the clinical picture of reduced activity through increased voluntary control” (Bradley 1937 , p. 582). He later identified children who were most likely to benefit from benzedrine treatment as “characterized by short attention span, dyscalculia, mood lability, hyperactivity, impulsiveness, and poor memory” (Conners 2000 ). These features are nowadays associated with ADHD. Bradley’s observations of stimulant effects in hyperactive children were revolutionary (Gross 1995 ) and are considered important discoveries in psychiatric treatment (Brown 1998 ).

Methylphenidate (Leandro Panizzon)

Although Bradley and his colleagues published their pioneering discovery in prominent journals (Brown 1998 ), their reports had almost no influence on research and practice for at least 25 years (Brown 1998 ; Conners 2000 ). This was possibly due to the wide influence of psychoanalysis at that time (Rothenberger and Neumärker 2005 ) and the assumption that behavioral disorders have no biological basis and require psychological interventions (Brown 1998 ). However, further investigations into this issue, for example by Laufer et al. ( 1957 ), produced growing interest in stimulant treatment of hyperkinetic children (Rothenberger and Neumärker 2005 ). At present, stimulant medication is the most frequently used treatment of children with ADHD (Wender 2000/ 2002 ). Benzedrine was the first stimulant drug administered to hyperactive children and is no longer in use. Methylphenidate is nowadays considered as drug of first choice (Leonard et al. 2004 ; Morton and Stockton 2000 ). The compound was first synthesized in 1944 by Leandro Panizzon and marketed as “Ritalin” by Ciba-Geigy Pharmaceutical Company in 1954 (Morton and Stockton 2000 ; Rothenberger and Neumärker 2005 ). The name “Ritalin” derives from the first name of Panizzon’s wife, i.e. Marguerite or “Rita” (Rothenberger and Neumärker 2005 ). Methylphenidate is “a piperazine—substituted phenylisopropylamine that is traditionally related to amphetamine” (Leonard et al. 2004 , p. 151) and was initially used in the treatment of “a number of indications such as chronic fatigue, lethargy, depressive states, disturbed senile behavior, psychosis associated with depression and narcolepsy” (Leonard et al. 2004 , p. 151). “However, its most impressive effect has been the reduction of symptoms seen in ADHD” (Morton and Stockton 2000 , p. 159). Methylphenidate is regarded by now as the most effective psychostimulant and is the most frequently prescribed drug in the treatment of ADHD (Döpfner et al. 2000 ).

Minimal brain damage

The scientific history of hyperactivity was characterized by reports of brain damage in children presenting with abnormal behavior (Ross and Ross 1976 ). Following the lectures of Sir George Frederic Still in 1902, the assumptions of Tredgold in 1908, and the reports of the epidemic encephalitis from 1917 to 1928, several cases of children with behavior disorders were depicted who suffered from “gross lesions of the brain and a variety of acute diseases, conditions, and injuries that presumably had resulted in brain damage” (Ross and Ross 1976 , p. 15). This indicated the growing notion that brain damage was the cause of hyperactive behavior (Ross and Ross 1976 ). Further research in the 1930s and 1940s supported the idea of a causal connection between brain damage and deviant behavior (Ross and Ross 1976 ). Children with a history of head injury were found to develop behavior disorders similar to the postencephalitic behavior disorder, while studies of birth trauma discovered a causative link between birth injury and mental retardation in children (Kessler 1980 ). Infections, lead toxicity, and epilepsy were also found to be associated with various cognitive and behavioral problems (Barkley 2006a ). In the 1930s, several researchers found a striking similarity in behavior between hyperactive children and monkeys with a frontal lobe ablation (Barkley 2006a ; Rothenberger and Neumärker 2005 ) and “experiences with brain-injured soldiers in particular have taught us that many a symptom considered psychogenic may be due to an organic cause” (Goldstein 1942 , cited by Kessler 1980 , p. 22). Rosenfeld and Bradley ( 1948 ) gave an account of typical behavior sequelae in children who suffered asphyxiant illness in infancy. They reported,

a fairly uniform overt behavior pattern in maladjusted children who have experienced asphyxiant illness in infancy. Six cardinal behavior characteristics make up this syndrome and may be listed as follows: 1. Unpredictable variability in mood; 2. Hypermotility; 3. Impulsiveness; 4. Short attention span; 5. Fluctuant ability to recall material previously learned; and 6. Conspicuous difficulty with arithmetic in school. (p. 74)

The notion of a physiological explanation of behavior disorders was remarkable (Rothenberger and Neumärker 2005 ). This led to the concept of “brain damage” (Kessler 1980 ) and the idea that hyperactivity in children may be caused by damage to the brain (Barkley 2006a ). The new concept of “minimal brain damage” (Kessler 1980 ) was based on several considerations. First, Tredgold had stated that mild forms of brain damage in infancy, although unnoticed at the time, could lead to behavioral sequelae, which became first apparent at school (Ross and Ross 1976 ). Second, possible variations of brain damage in extent, locus, or type of lesion were discussed (Kessler 1976). Third, the concept of “a continuum of cerebral damage ranging from severe abnormalities, such as cerebral palsy and mental deficiency, to minimal damage” was introduced by Knobloch and Pasamanick ( 1959 , p. 1384).

This new concept was characterized by the assumption that minimal damage to the brain, even when it cannot be demonstrated objectively, causes hyperactive behavior (Barkley 2006a ; Ross and Ross 1976 ) and, in turn, “that even when brain damage could not be demonstrated it could be presumed to be present” (Ross and Ross 1976 , p. 16). Under the influence of the work of Strauss and Lehtinen ( 1947 ) and Strauss and Kephart ( 1955 ), it became general practice to infer brain damage solely from behavioral signs without any neurological evidence of damage (Barkley 2006a ; Ross and Ross 1976 ). In brain-injured and non-brain-injured mentally retarded children, Strauss and his colleagues identified a number of behavior patterns, on the basis of which they could distinguish these two groups (Ross and Ross 1976 ). In particular, they considered the symptom of hyperactivity as a sufficient diagnostic sign of underlying brain damage (Ross and Ross 1976 ). Minimal brain damage was therefore supposed to be clearly associated with a specific syndrome (Conners 2000 ). Most symptoms described in this context meet the current DSM-IV-TR criteria, and the concept of minimal brain damage can be regarded as historical antecedent to ADHD. Laufer et al. ( 1957 ) describe the following characteristics of the syndrome:

It has long been recognized and accepted that a persistent disturbance of behavior of a characteristic kind may be noted after severe head injury, epidemic encephalitis and communicable disease encephalopathies, such as measles, in children. It has often been observed that a behavior pattern of a similar nature may be found in children who present no clear-cut history of any of the classical causes mentioned. This pattern will henceforth be referred to as hyperkinetic impulse disorder. In brief summary, hyperactivity is the most striking item. This may be noted from early infancy on or not become prominent until five or six years of age. There are also a short attention span and poor powers of concentration, which are particularly noticeable under school conditions. Variability also is frequent, with the child being described as quite unpredictable and with wide fluctuations in performance. The child is impulsive and does things “on the spur of the moment,” without apparent premeditation. Outstandingly also these children seem unable to tolerate any delay in gratification of their needs and demands. They are irritable and explosive, with low frustration tolerance. (Laufer et al. 1957 )

Minimal brain dysfunction

The hypothesis that minimal brain damage may lead to behavior disorders became well established. In the 1960s, however, many critics emerged who criticized the tests commonly used in the assessment of brain damage (Herbert 1964 ) and challenged the argument that every child presenting with abnormal behavior was to have minimal brain damage, even if this could neurologically not be demonstrated (Birch 1964 ; Rapin 1964 , cited by Rothenberger and Neumärker 2005 ). Laufer et al. ( 1957 ) regarded it as a problem that there were “children who present the hyperkinetic impulse disorder without having any of the classic etiologic traumatic or infectious factors in their historical backgrounds” (Laufer et al. 1957 ). In their study, they found that “children with the hyperkinetic impulse disorder, regardless of whether or not their history contains clear-cut evidence of any agent causing injury to the central nervous system” (Laufer et al. 1957 , p. 42) had a lower threshold for clinical responses in EEG to the administration of metrazol than children without the hyperkinetic syndrome. Following the administration of amphetamines, however, the threshold was similar to that of children without evidence of the syndrome (Laufer et al. 1957 ). Laufer and his colleagues supposed a dysfunction of the diencephalon to be the cause of the hyperkinetic syndrome (Laufer et al. 1957 ). Their results suggested a functional disturbance rather than damage to the brain as the cause of the characteristic syndrome (Conners 2000 ). In 1963, the Oxford International Study Group of Child Neurology (Bax and MacKeith 1963 ) held a conference and stated that brain damage should not be inferred from problematic behavior signs alone.

It became clear that this term has, for most people, the anatomical and aetiological implications that there has been an episode of injury and that this has produced anatomical change. Yet closer examination makes it clear that evidence of anatomical damage is usually absent, that evidence or history of an injuring process is often absent, and that disorder of function is the evidence used for applying the diagnostic label of “minimal brain damage” (Bax and MacKeith, 1963 , unpaginated foreword, cited by Conners, 2000 ).

The Oxford International Study Group of Child Neurology therefore advocated a shift in terminology by replacing the term “minimal brain damage” by “minimal brain dysfunction” (Ross and Ross 1976 ; Rothenberger and Neumärker 2005 ). They furthermore recommended that any effort should be undertaken to classify the heterogeneous group of children subsumed under the concept of minimal brain dysfunction into smaller and more homogenous subgroups (Ross and Ross 1976 ). Another conference held in 1963 by the National Institute of Neurological Diseases and Blindness (Conners 2000 ; Kessler 1980 ) assigned a national task force to work on terminology and identification of minimal brain dysfunction (Rie 1980 ). The national task force formulated the following official definition (Clements 1966 ):

The term minimal brain dysfunction refers to children of near average, average or above average general intelligence with certain learning or behavioural disabilities ranging from mild to severe, which are associated with deviations of function of the central nervous system. These deviations may manifest themselves by various combinations of impairment in perception, conceptualisation, language, memory and control of attention, impulse or motor function. (pp. 9 f.)

With regard to the etiology of the disorder, the concept of minimal brain dysfunction emphasized neurological factors including prenatal or perinatal “cerebral hypoxic lesions” (Towbin 1971 ) rather than environmental or social factors, such as parents and family, which were proposed by psychoanalysts (Barkley 2006a , Clements and Peters 1962 ). Since the definition of minimal brain dysfunction by Clements ( 1966 ) separates the symptoms “[impairment in] control of attention, impulse and motor function” (Clements 1966 , p. 10) by the conjunction “and” from other “various combinations of impairment” (Clements 1966 , pp. 9 f.), these three symptoms can be seen as “the central or defining criterion for MBD [minimal brain dysfunction]” (Conners 2000 , p. 182). The concept of the three main symptoms of inattention, impulsivity, and hyperactivity characterizing ADHD was therefore established with the definition of minimal brain dysfunction. The assignment of children with minimal brain dysfunction to the normal range of intelligence and therefore the differentiation from “the brain-damaged mentally subnormal groups” (Clements 1966 , p. 9) were important regarding the further conceptualization of ADHD.

Hyperkinetic reaction of childhood (1968, second edition of the diagnostic and statistical manual of mental disorders: DSM-II)

“The original concept of MBD (…) was not intended as a final statement on the subject” (Clements and Peters 1973 cited by Rie 1980 ). Although this concept persisted until the 1980s (Barkley 2006a ), its decline already began in the 1960s when severe critiques arose (Rothenberger and Neumärker 2005 ). The presence of neurodevelopmental abnormalities was argued to be non-specific and also common in other psychiatric disorders (Schaffe et al. et al. 1985, cited by Conners 2000 ). It was found that many cases of known brain damage or dysfunction did not show hyperactivity or other symptoms postulated by the concept of minimal brain damage or dysfunction (Birch 1964 , cited by Conners 2000 ). Minimal brain dysfunction was criticized as too general and heterogeneous and was later to be replaced by multiple more specific and descriptive labels such as “hyperactivity”, “learning disability”, “dyslexia” or “language disorders” (Barkley 2006a ; Rothenberger and Neumärker 2005 ). Rie ( 1980 ) argued that the definition of minimal brain dysfunction was “more speculative than definitive”, had no solid empirical basis, and lacked evidence. Further efforts to define the disorder were therefore based on objective observations of children’s deficits, “rather than on some underlying unobservable etiological mechanism in the brain” (Barkley 2006a , p. 8). In this context, “hyperactivity [was] the most striking item” as was already stated in 1957 by Laufer, Denhoff and Solomons. Their idea of a “hyperkinetic impulse disorder” (Laufer et al. 1957 ) was continued in the 1960s, and the concept of a hyperactivity syndrome was generated (Barkley 2006a ). Hyperactivity was recognized to be “a behavioral syndrome that could arise from organic pathology, but could also occur in its absence. Even so, it would continue to be viewed as the result of some biological difficulty, rather than due solely to environmental causes” (Barkley 2006a , p. 8). In 1968, a definition of the concept of hyperactivity was incorporated in the official diagnostic nomenclature, i.e. the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II) (Barkley 2006a ; Volkmar 2003 ). This concept was labeled “Hyperkinetic Reaction of Childhood” and defined with two sentences: “The disorder is characterized by overactivity, restlessness, distractibility, and short attention span, especially in young children; the behavior usually diminishes by adolescence” (American Psychiatric Association 1968 , p. 50, cited by Barkley 2006a , p. 9).

Attention deficit disorder: with and without hyperactivity (1980, third edition of the diagnostic and statistical manual of mental disorders: DSM-III)

In the 1970s, the predominant focus on hyperactivity was shifted toward an emphasis on the attention deficit in affected children (Rothenberger and Neumärker 2005 ). In a paper addressed to the Canadian Psychological Association, Douglas ( 1972 ) argued that deficits in sustained attention and impulse control were more significant features of the disorder than hyperactivity (cited by Barkley 2006a ; Douglas 1984 ; Rothenberger and Neumärker 2005 ). In addition, these symptoms were the ones showing the best response to stimulant treatment (Douglas 1972 , cited by Rothenberger and Neumärker 2005 ). Douglas’ paper was very influential at the time and provoked further research on this issue and finally initiated a complete change in the conceptualization of the Hyperkinetic Reaction of Childhood (Barkley 2006a ). “In 1980, the importance of attentional problems in the syndrome was recognized—and perhaps exaggerated—by the adoption of a new diagnostic label” (Douglas 1984 ). With the publication of DSM-III in 1980 , the American Psychiatric Association renamed the disorder “Attention Deficit Disorder (ADD) (with or without hyperactivity)” (Barkley 2006a ; Rothenberger and Neumärker 2005 ). DSM-III took the position that hyperactivity was no longer an essential diagnostic criterion for the disorder and that the syndrome occurred in two types “with or without hyperactivity” (Conners 2000 ). Deficits in attention and impulse control were, however, considered significant symptoms in establishing a diagnosis (Barkley 2006a ). In this respect, DSM-III departed from the “International Classification of Diseases (ICD-9)” by the World Health Organization, which continued to focus on hyperactivity as indicator of the disorder. DSM-III developed three separate symptom lists for inattention, impulsivity, and hyperactivity, which were far more specific than previous ones (Barkley 2006a ). In addition, DSM-III introduced “an explicit numerical cutoff score for symptoms, specific guidelines for age of onset and duration of symptoms, and the requirement of exclusion of other childhood psychiatric conditions” (Barkley 2006a , pp. 19 f.)

Attention deficit hyperactivity disorder (1987, revision of the third edition of the diagnostic and statistical manual of mental disorders: DSM-III-R)

The discussion regarding the importance of certain symptoms continued, and the creation of subtypes of ADD on the basis of the presence or absence of hyperactivity was discussed controversially (Barkley 2006a ). When the concept of ADD was formulated, “little, if any empirical research on this issue existed” (Barkley 2006a ). At that time, it was not evident if the attention deficit of the subtype of ADD without hyperactivity was qualitatively similar to that of the subtype with hyperactivity, or if the two types had to be considered as two separate psychiatric disorders (Barkley 2006a ). In order to further improve the criteria, in particular with respect to empirical validation, the revision of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) in 1987 removed the concept of two subtypes and renamed the disorder “Attention deficit-Hyperactivity Disorder (ADHD)”. The symptoms of inattention, impulsivity, and hyperactivity were combined into a single list of symptoms with a single cutoff score. The symptoms were empirically derived by rating scales and a field trial (Barkley 2006a ; Conners 2000 ). The subtype “ADD without hyperactivity” was removed and assigned to a residual category named “undifferentiated ADD” (Rothenberger and Neumärker 2005 ).

Attention deficit hyperactivity disorder (1994, fourth edition of the diagnostic and statistical manual of mental disorders: DSM-IV)

In addition to the reorganization of the concept of ADD, several studies examined the existence of subtypes of ADD at the end of the 1980s (Barkley 2006a ). It was found that children with ADD without hyperactivity differed from children with ADD with hyperactivity in that they were “more daydreamy, hypoactive, lethargic, and disabled in academic achievement, but as substantially less aggressive and less rejected by their peers” (Barkley 2006a , p. 21). In addition, some doubts arose as to the central role of a deficit in attention in so-called ADHD. The view emerged that motivational factors and deficits in reinforcement mechanisms were of major importance (Barkley 2006a ). Historical interpretations of brain damage or dysfunction were supported by the evidence of structural abnormalities in the brain of children with ADHD as shown with new neuroimaging techniques. Up until the end of the 1990s, most studies “have implicated the prefrontal-striatal network as being smaller in children with ADHD” (Barkley 2006a ). Further research found a genetic component of the disorder (Biederman et al. 1990 , cited by Barkley 2006a ). It was finally recognized in the 1990s that ADHD was not exclusively a childhood disorder, which disappeared with age as was previously thought (Barkley 2006a ), but rather a chronic, persistent disorder remaining into adulthood in many cases (Döpfner et al. 2000 ). Before the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was outlined in 1994, another large field trial was conducted (Lahey et al. 1994 ). Three subtypes of ADHD were identified on the basis of structured diagnostic interviews of multiple informants and of validation diagnoses. The previously heterogeneous category of ADHD according to DSM-III-R was consequently subdivided into three subtypes (Lahey et al. 1994 ), i.e. a predominantly inattentive type, a predominantly hyperactive-impulsive type, and a combined type with symptoms of both dimensions (American Psychiatric Association 1994 ). By using this categorization, the concept of the two separate dimensions of attention deficit and hyperactivity-impulsivity was reverted (Conners 2000 ) and the possibility of a diagnosis of a purely inattentive form of the disorder was reintroduced (Barkley 2006a ). The American Psychiatric Association accredited the diagnosis of ADHD in adulthood by including examples of workplace difficulties in the depiction of symptoms. “Based on a much larger field trial than any of their predecessors, the DSM-IV criteria for ADHD are the most empirically based in the history of this disorder” (Barkley 2006a ).

Attention deficit hyperactivity disorder (2000, text revision of the fourth edition of the diagnostic and statistical manual of mental disorders: DSM-IV-TR)

In order to bridge the span between DSM-IV and DSM-V, a text revision of the fourth edition of the DSM was undertaken in 2000 (American Psychiatric Association 2000 ). The main goals were to “maintain the currency of the DSM-IV text” (American Psychiatric Association 2009 ) and to correct any errors identified in the DSM-IV text. “Thus, most of the major changes in DSM-IV-TR were confined to the descriptive text” (American Psychiatric Association 2009 ). The definition of ADHD has therefore not been changed. A new edition of the DSM is in progress. Critics have called for a validation of ADHD in adults (Fischer and Barkley 2007 ; McGough and Barkley 2004 ). Since the DSM-IV field trials for ADHD included only children and adolescents up to the age of 17 (Lahey et al. 1994 ), the utility of the DSM-IV criteria in the diagnosis of adults with ADHD has been challenged (Fischer and Barkley 2007 ). The publication of the fifth edition of the DSM is not scheduled until 2012.

DSM-IV and ICD-10 have adopted almost identical criteria for the identification of inattentive, hyperactive, and impulsive symptoms. However, significant differences are still evident in the number of criteria in each domain required for a diagnosis, the importance of inattention and the handling of comorbidity. In comparison with DSM-IV, ICD-10 is more demanding about cross-situational pervasiveness and requires that all necessary criteria be present, both at home and at school or other situations.

Future directions

The development of the international classification systems appears to reflect a growing consensus regarding the clinical entity of ADHD. Evidence has been presented (Faraone 2005 ) to show that ADHD meets the criteria established by Robins and Guze ( 1970 ) for the validation of psychiatric diagnoses. Patients with ADHD show a characteristic pattern of hyperactivity, inattention, and impulsivity that lead to adverse outcomes. ADHD can be distinguished from other psychiatric disorders including those with which it is frequently comorbid. Longitudinal studies have demonstrated that ADHD is invariably chronic and not an episodic disorder. Twin studies show that ADHD is a highly heritable disorder. Molecular genetic studies have found genes that explain some of the disorder’s genetic transmission. Neuroimaging studies show that ADHD patients have abnormalities in frontal-subcortical-cerebellar systems involved in the regulation of attention, motor behavior, and inhibition. Many individuals with ADHD show a therapeutic response to medications that block the dopamine or noradrenaline transporter. This evidence as reviewed by Faraone ( 2005 ) supports the hypothesis of ADHD being a clinical entity and fulfilling the Robins and Guze ( 1970 ) validity criteria.

However, there has been considerable debate about this issue. Critics have described ADHD as a diagnosis used to label difficult children who are not ill but whose behavior is at the extreme end of the normal range. Concerns have been raised that “ADHD is not a disease per se but rather a group of symptoms representing a final common behavioral pathway for a gamut of emotional, psychological, and/or learning problems” (Furman 2005 ). Most of the research studies available rely on clinically referred cases, i.e. severely ill or narrowly diagnosed patients. The generalization of the research findings to non-referred cases in the community is therefore not necessarily valid.

In summary, the cardinal ADHD symptoms of inattention, hyperactivity, and impulsivity are not unique to ADHD. In addition, there is a remarkable overlap of these ADHD symptoms with those of comorbid mental health conditions or learning problems. A consistent genetic marker has not been found, and neuroimaging studies have been unable to identify a distinctive etiology for ADHD. The lack of evidence of a unique genetic, biological, or neurological pathology hinders the general acceptance of ADHD as a neurobehavioral disease entity. In addition, the ratings of school children with ADHD by parents and teachers are frequently discrepant and do not appear to provide an objective diagnostic basis. The issue of the clinical entity of ADHD remains therefore an open question and requires further investigation.

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6 Books for Adults Living With A.D.H.D.

Psychiatrists, counselors and researchers shared their recommendations.

By Hope Reese

Staying focused in a world of distractions can be incredibly challenging. But for people living with attention deficit hyperactivity disorder — a neurodevelopmental disorder often marked by difficulty maintaining attention, disorganization, hyperactivity and impulsivity — it can be even harder. Adults are diagnosed less often than children , but A.D.H.D. can still create problems at work and in friendships and romantic relationships .

Books can be “the entree into understanding whether you should consider getting a diagnosis and evaluation for A.D.H.D.,” said Melissa Orlov, the founder of A.D.H.D. and Marriage, a website and consulting company that provides resources for couples living with the condition.

Sharon Saline, author of “What Your A.D.H.D. Child Wishes You Knew: Working Together to Empower Kids for Success in School and Life,” says the right book can combat misinformation. It can also help people close to someone with A.D.H.D. by providing a “toolbox for engaging with them, supporting them and loving them,” she said.

To demystify the subject, we asked experts — psychiatrists, counselors and researchers — to recommend books on A.D.H.D., focused on adults.

1. Taking Charge of Adult A.D.H.D. , by Russell A. Barkley with Christine M. Benton

This book, first published in 2010, is full of information and practical tools from Dr. Barkley, “one of the leading, if not the leading expert on A.D.H.D. in the world,” Dr. Saline said. It’s a “combo workbook/info book, which is great for people to get a better sense of who they are,” she said.

“No one knows more about A.D.H.D. or does a better job of integrating all the research on it,” said Ari Tuckman, a psychologist in West Chester, Pa., who specializes in A.D.H.D.

2. Your Brain’s Not Broken , by Tamara Rosier

If you want a book that’s both current and personal, this 2021 title might fit the bill. Dr. Rosier is “in touch with modern A.D.H.D.,” said Margaret H. Sibley, a professor of psychiatry and behavioral sciences at the University of Washington.

Dr. Rosier and some of her family members have A.D.H.D., and she shares her story with “a lot of warmth, a lot of humor,” Dr. Saline said.

She also offers a “really positive” perspective and provides tips for people with A.D.H.D. to assess and organize information, Ms. Orlov explained, “which is a huge part of being a successful adult.”

3. A Radical Guide for Women With A.D.H.D. , by Sari Solden and Michelle Frank

“A.D.H.D. manifests differently in women,” Dr. Saline said, “and young women are often not diagnosed or diagnosed later on.” That’s because symptoms like “dreaminess or low self-esteem or anxiety” are often incorrectly diagnosed as anxiety or depression, she said.

This 2019 workbook addresses those issues, tackling the specific ways that women experience A.D.H.D. and the ways they can learn to live with the condition.

“It’s a very relatable and practical guide,” Dr. Tuckman said.

4. The Couple’s Guide to Thriving With A.D.H.D. , by Melissa Orlov and Nancie Kohlenberger

A.D.H.D. can pose unique roadblocks for couples. For example, distracted behavior might be misinterpreted by a partner as lack of care. This 2014 title, which Dr. Saline calls “a classic,” was written by Ms. Orlov and Ms. Kohlenberger, a licensed marriage and family therapist. (Ms. Orlov was one of the sources for this piece, but several experts also said hers is the top book for couples.)

It includes useful information to help partners understand the signs and symptoms of A.D.H.D. and how to work together to resolve issues that arise. Dr. Tuckman, who works with couples, said his clients have “found it eye-opening.”

“A.D.H.D. can have a big impact on one’s relationship that can leave both partners unhappy and feeling powerless,” he said. “This book explains that impact and normalizes the struggles that couples fall into and the common dynamics that result.”

5. A.D.H.D. 2.0 , by Dr. Edward M. Hallowell and Dr. John J. Ratey

This 2021 title is a follow-up to “Driven to Distraction,” by the same authors, published in 1992. It offers “important updates about recent research on A.D.H.D.,” Dr. Saline said, along with advice that people with A.D.H.D. can use to “alter their environments to serve them better and reduce negativity.”

Ms. Orlov noted that this book illustrates “how a person with A.D.H.D. can really focus a lot on things like a phone or a video game or even their work, and not be able to focus on things that are less interesting.”

6. Outside the Box , by Thomas E. Brown

This 2017 title “hits the sweet spot,” Dr. Tuckman said. “It’s definitely driven by the research, and sophisticated, but it’s accessible. It helps illustrate what A.D.H.D. looks like at various stages of development, which can be helpful for those with A.D.H.D., family members of people with the condition and educators.”

“Brown’s approach to A.D.H.D. and executive functioning is very helpful,” Dr. Saline said. She likes “Outside the Box” because, in contrast with other workbooks, it offers “an informational narrative” without exercises. “He has a lot of research,” she said, “but this is also a book you can just sit back and read.”

Understanding A.D.H.D.

The challenges faced by those with attention deficit hyperactivity disorder can be daunting. but people who are diagnosed with it can still thrive..

Millions of children in the United States have received a diagnosis of A.D.H.D . Here is how their families can support them .

The condition is also being recognized more in adults . These are some of the behaviors  that might be associated with adult A.D.H.D.

Since a nationwide Adderall shortage started, some people with A.D.H.D. have said their medication no longer helps with their symptoms. But there could be other factors at play .

Everyone has bouts of distraction and forgetfulness. Here is when psychiatrists diagnose it as something clinical .

The disorder can put a strain on relationships. But there are ways to cope .

Though meditation can be beneficial to those with A.D.H.D., sitting still and focusing on breathing can be hard for them. These tips can help .