Fidgety Philip and the history of ADHD

In the first of this series, we considered whether ADHD warrants inclusion among the ranks of medical conditions at all, or whether, as has been claimed by some, it is nothing other than the convenient invention of the pharmaceutical industry (and overworked school teachers), having discovered the cognitive benefits of the stimulant medications. To fully address this allegation, we have to consider not only the merits of ADHD as a bona fide medical condition – the topic of the previous post – but also the history of developments pertaining to the disorder and its treatment.

In fact, descriptions of what we now know as ADHD date back centuries, as far back as the time of Shakespeare. Here is Falstaff, in King Henry IV (Part 2), bemoaning his poor concentration span:

… it is the disease of not listening, the malady of not marking, that I am troubled withal.

 Not quite a medical treatise, I agree, but how about this description by the physician Sir Alexander Crichton, as long ago as 1798:

…it was obvious that they had a problem attending even how hard they did try. Every public teacher must have observed that there are many to whom the dryness and difficulties of the Latin and Greek grammars are so disgusting that neither the terrors of the rod, nor the indulgence of kind entreaty can cause them to give their attention to them.

Yes, I know, Latin and Greek are probably noxious enough to try the attention span of any modern child, but even so, other authors provided detailed descriptions of many salient aspects of the condition which transcend generations. In 1846, the German physician Heinrich Hoffman published a series of illustrated poems entitled The Struwwelpeter. It is a series of morality tales, written for children, involving characters who get their respective comeuppances for various forms of bad behaviour. Here is an excerpt, in which a boy named ‘Fidgety Philip,’ is described causing havoc at the dinner-table:

See the naughty restless childFidgety Philip

Growing still more rude and wild

Till 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, plates, knives, forks and all.

How mamma did fret and frown

When she saw them tumbling down!

And papa made such a face!

Philip is in sad disgrace.


Sound familiar? Now, we have to fast forward about a hundred years, to 1944, when the chemist Leandro Panizzon, in the employ of the Swiss pharmaceutical company Ciba Geigy, synthesized the molecule methylphenidate (which we know as Ritalin) in the laboratory. His wife had low blood pressure and would take the drug as a stimulant before playing tennis, bless her. Actually it wasn’t her backhand that inspired the synthesis of the molecule. It was in fact initially developed for use in chronic fatigue and mild depressive states. The wheel turned slowly, and it was only in 1963, after it was discovered that this medication was helpful for children with concentration difficulties, that methylphenidate was first marketed for ‘Hyperkinetic Reaction.’

‘Hyperkinetic Reaction,’ you ask? What Alexander Crichton originally termed a ‘disease of attention,’ has subsequently been known by a variety of other labels, including Moral Defect’ (how harsh is that!?), Minimal Brain Dysfunction (only marginally better), Hyperkinetic Reaction and Hyperkinetic Disorder (the British and Europeans still stubbornly refer to it as such). It was only as recently as 1987 that it received its current title, Attention Deficit Hyperactivity Disorder.

But whatever you call it, the clinical descriptions of the condition have been remarkably consistent over time. Furthermore, these descriptions predate the availability of stimulant medications by at least 150 years. Far from being an artificially contrived diagnosis, ADHD belongs with any other genuine medical condition, by any criterion you care to mention…

Except, perhaps, the absence of an objective diagnostic test. More on this next time…