Table 14Timeline of identification of ADHD and development of treatment—derived from Eisenberg3 and Mayes2

YearCountryNosology/DiagnosisSocial and Economic Factors
1876U.K.The Educational Act passed, mandating elementary education for all children, and thus, a structured environment against which childhood ADHD is often identified
1902U.K.Sir G.F. Still1 describes distinctive constellation of behaviors in children who cannot focus and fail school despite intelligence. He describes their behavior under various conditions, occurring more often among boys than girls, frequently apparent by early school years, generally showing little relationship to child training and home environment, and commonly sharing a poor prognosis
1922U.KTredgold observes agitated behaviors among Spanish Influenza Epidemic (1919) survivors and hypothesizes relationship to encephalitic lethargica, referring to the condition as “minimal brain damage”
1932U.S.Bradley identifies d, l-amphetamine and observes its “paradoxical” calming and focusing effect on children who were psychiatric inpatients
1952U.S.DSM-1 released; no mention of hyperkinetic syndrome
“minimal brain damage”
“hyperkinetic reaction of childhood” (DSM-II)
Research studies on children using antipsychotic drugs such as chlorpromazine (i.e., Largactil, Thorazine)
1955SwitzerlandGeigy develops MPH (i.e., “Ritalin”)

Dextroamphetamine included in pharmacotherapy as the only effective treatment for ADHD/ADD, although no evidence about efficacy is available since no clinical trials are performed

Geigy releases “Ritalin” to the market; and states that their experience with it is too limited to make a valid statement as to its usefulness
1958U.S.NIMH Pharmacological branch sponsor first ever conference on use of psychoactive drugs in treatment of children
1961U.S.“Ritalin” approved for use in children
Mid 60sU.S.Questions about link between brain ‘damage’ and hyperactivity; new phrase coined “Minimal Brain Dysfunction” hedging between old terminology and new discoveries
1965WHOICD-8 309 – Behavior disorders in childhood
1967WHOInclusion of hyperkinesis as syndrome in WHO Seminar on Diagnosis and Classification in Child Psychiatry
1968U.S.DSM-II released, includes “hyperkinetic reaction of childhood”NIMH requests longer term studies (i.e., >8 weeks) on effects of stimulant drugs on children
End 60sU.S.Estimated 150,000 to 200,000 children treated with stimulants (0.002% of child population at that time)
1970U.K.Rutter’s Isle of Wight study; first well designed epidemiological ascertainment of prevalence of hyperkinesis which found 2 cases among 2199 children between ages 10 and 11 (i.e., 0.9%)
1971U.N. and U.S.U.N. Convention on Psychotropic Substances: Substances in Schedule IICongressional hearing which changed classification of stimulant drugs to controlled substances and making data collection mandatory

Wender’s book released which notes familial nature of ADHD, pointing way to genetic studies

Eisenberg and Conners receive NIMH grants to study MPH
1975U.S.Popular Feingold diet published

Characterisation in the media of medication for hyperactive children as ‘chemical straitjacket’, as reflection of the social period
1977WHOICD-9 314 - Hyperkinetic syndrome of childhood
314 Hyperkinetic syndrome of childhood
Excludes: hyperkinesis as symptom of underlying disorder? code the underlying disorder

314.0 Attention deficit disorder (ADD)
314.00 Without mention of hyperactivity
 Predominantly inattentive type
314.01 With hyperactivity
 Combined type
 Overactivity NOS
 Predominantly hyperactive/impulsive type
 Simple disturbance of attention with overactivity

314.1 Hyperkinesis with developmental delay
 Developmental disorder of hyperkinesis
 Use additional code to identify any associated neurological disorder

314.2 Hyperkinetic Conduct Disorder
 Hyperkinetic Conduct Disorder without developmental delay
Excludes hyperkinesis with significant delays in specific skills (314.1)

314.8 Other specified manifestations of hyperkinetic syndrome

314.9 Unspecified hyperkinetic syndrome
 Hyperkinetic reaction of childhood or adolescence NOS
 Hyperkinetic syndrome NOS
1978U.S.Therapeutic response to drugs taken as confirmation of Dx

Rapoport observes that both normal children and ADHD children respond to stimulant medications with greater focus; age may be the operative factor in its effectiveness, not ‘disorder’
1980U.S.DSM-III released; includes “Attention Deficit/Hyperactivity (ADHD) Disorder”
1987U.S.MPH use (“defined daily doses”) = ~60 million
1991U.S.MPH prescriptions = 4 million
Amphetamine prescriptions = 1.3 million
1992WHOICD-10 Mental and behavioral disorders (F00-F99)
Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
F90 – Hyperkinetic disorders
 Excludesanxiety disorders ( F41.- )
mood [affective] disorders ( F30-F39 )
pervasive developmental disorders ( F84.- )
schizophrenia ( F20.- )
F90.0 Disturbance of activity and attention
Attention deficit:
  • disorder with hyperactivity
  • hyperactivity disorder
  • syndrome with hyperactivity
  Excludes: hyperkinetic disorder associated with Conduct Disorder ( F90.1 )
F90.1 Hyperkinetic Conduct Disorder
   Hyperkinetic disorder associated with Conduct Disorder
F90.8 Other hyperkinetic disorders
F90.9 Hyperkinetic disorder, unspecified
 Hyperkinetic reaction of childhood or adolescence NOS
 Hyperkinetic syndrome NOS
F91 Conduct disorders
Excludes:mood [affective] ( F30-F39 )
pervasive developmental disorders ( F84.- )
schizophrenia ( F20.- )
when associated with:
  • emotional disorders ( F92.- )
  • hyperkinetic disorders ( F90.1 )
F91.0 Conduct disorder confined to the family context
F91.1 Unsocialized Conduct Disorder
   Conduct disorder, solitary aggressive type
   Unsocialized aggressive disorder
F91.2 Socialized Conduct Disorder
   Conduct disorder, group type
   Group delinquency
   Offences in the context of gang membership
   Stealing in company with others
   Truancy from school
F91.3 Oppositional defiant disorder
F91.8 Other Conduct Disorders
F91.9 Conduct disorder, unspecified
  • behavioral disorder NOS
  • Conduct Disorder NOS
1993U.K.Methylphenidate released to general availability in the U.K.189
1994U.S.DSM-IV released with amplified ADHD subtypes

Attention-deficit and Disruptive Behavior Disorders
Attention-Deficit Hyperactivity Disorder
  314.01 Combined subtype
  314.01 Predominantly hyperactive-impulsive subtype
  314.00 Predominantly inattentive subtype
  314.9 Attention-Deficit Hyperactivity Disorder NOS
Conduct disorder
  312.81 Childhood onset
  312.82 Adolescent onset
  312.89 Unspecified onset
 313.81 Oppositional Defiant Disorder
312.9 Disruptive Behavior Disorder NOS
1999U.S.MPH use (“defined daily doses”) = ~360million
MPH prescriptions =~11 million/amphetamine =~6 million
2000/2003U.S.Great Smoky Mountain studies113,114 report unequivocal prevalence of 0.9% among children between 9 and 16 (2.2% at age 9 declining to 0.3% at age 16) but rate of stimulant treatment more than twice rate of unequivocal diagnosis, and majority of children treated did not meet ADHD criteria; serious mismatch between need and provision; others115,116 do not find the potential for mismatch so clear cut.
2003U.S.NSCH4 survey of children 4 to 17:
Diagnosed (see below): 4.4 million
Medication for ADHD: 2.5 million (56%)

Estimated prevalence based on parent report of response to the NSCH survey question “Has a doctor or health professional ever told you that [child name] has ….ADD or ADHD?”

Prevalence reports average 7.8% with variability from 5.0% in Colorado to 11.1% in Alabama
Lexchin147 among others identifies company sponsored studies more than four times likely to have outcomes that favor sponsor than neutrally sponsored research
2005U.S.Child Medication Safety Act (H.R.1790) to protect children and parents from being coerced into administering a controlled substance or psychotropic drug in order to attend school, and for other purposes, as amended

Abbreviations: ADD = Attention-Deficit Disorder; ADHD = Attention-Deficit Hyperactivity Disorder; CM = Clinical Modification; DSM = Diagnostic and Statistical manual; Dx = diagnosis; F = subsection of ICD codes; H.R. = House of Representatives; ICD = International Classification of Disease; MPH = methylphenidate; NIMH = National Institutes of Mental Health; NOS = not otherwise specified; NSCH = National Survey of Child Health; U.K. = United Kingdom; U.N. = United Nations; U.S. = United States; WHO = World Health Organization

From: Results

Cover of Attention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment [Internet].
Comparative Effectiveness Reviews, No. 44.
Charach A, Dashti B, Carson P, et al.

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