The woeful history of ADHD, the condition that once got you branded as "defective"

Having ADHD once got you branded as being "immoral" or "defective." Even today, that stigma is hard to overwrite

By Matthew Rozsa

Staff Writer

Published April 21, 2023 1:05PM (EDT)

Distracted child (Getty Images/AHMET YARALI)
Distracted child (Getty Images/AHMET YARALI)

Speaking from experience, having ADHD is a bit like reading a book outside during a windy day. Despite your best attempts to concentrate, an elemental force beyond your control keeps flipping the pages. Instead of focusing on what you want to read, you struggle just to get back to the "right" page — and stay there long enough to absorb it. In this way, those with ADHD are forever distracted by the impulses of their own minds.

"ADHD has always been an under-diagnosed and under-treated condition. Children were considered lazy, misbehaved, spoiled or simply bad."

ADHD can be life-ruining. Unless they have the resources of a one percenter, some people with ADHD may struggle to hold down jobs, succeed in school, maintain relationships and in general function on par with people who do not deal with the same unpredictable tempests inside their skulls. Thankfully, today scientists at least recognize ADHD as a disability, one that can be diagnosed and treated. Yet that hasn't always been true. For a long chunk of history, people with ADHD were treated as if they were just bad human beings.

"Medical doctors first began documenting/writing about what we today call ADHD [two] centuries ago — not coincidentally, around the time that compulsory education was becoming policy in the UK and then the US," explained Dr. Stephen P. Hinshaw, a Distinguished Professor of Psychology at the University of California, Berkeley, in an email to Salon. 

As children struggled to keep up with the strict requirements of Western education systems, British physicians like George Still in the early 20th century lamented the supposed "'moral defect' in some children — mostly boys (as has been the stereotype 'forever' of normal intelligence) who somehow lacked the ability to concentrate and act according to classroom and 'moral' standards' (hence, his designation)," Hinshaw told Salon.

Still, incidentally, is nicknamed "the father of British pediatrics," and is widely recognized as one of the first doctors to identify ADHD as a condition. After the World War I-era influenza epidemic led to a number of survivors claiming to demonstrate ADHD-like traits, more diagnoses followed, with patients complaining of problems like impulsivity and poor concentration. Yet this increase in recognition came with an unfortunate catch: The erroneous belief, as Hinshaw put it, that there was "a biological 'cause' — which then became overstated to the claim that any child with such symptoms had brain damage, later softened to minimal brain damage or minimal brain dysfunction (MBD)."

It was not until the mid-20th century that specialists began focusing on patients who displayed overactivity and impulsivity, and coined the term "hyperactivity" (or its synonym, hyperkinesis). But even then the "scales developed hardly included any items related to executive dysfunction, inattention, etc." Additionally, they were "biased toward boys often with aggressive behavior patterns." Only in the 1980s were Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) coined; and in that decade outdated assumptions like disregarding girls or assuming ADHD ends with childhood began to fade.

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"At long last, we're beginning to move from 'either/or' to 'both/and' conceptualizations."

Yet even though ADHD has only been formally recognized for the last few decades, it has always existed. Dr. Jose Martinez Raga of the University of València, who co-authored a 2015 paper about the early history of ADHD, elaborated on this for Salon.

"We can find some vague clinical descriptions done by the ancient Greeks, and in modern times we can find clear clinical descriptions of individuals with what we nowadays name ADHD in textbooks since the mid-1700s," Raga told Salon by email. Yet even though ADHD patients in classical Athens or Georgian England were observed, this did not mean they were understood.

"ADHD has always been an under-diagnosed and under-treated condition," Raga explained. "Children were considered lazy, misbehaved, spoiled or simply bad." Even today Raga argued that the situation "is far from ideal, especially with regards to adult individuals with ADHD, but certainly things have improved."

Hinshaw echoed Raga in recalling how people with ADHD used to regarded as "lazy, not well motivated, truly 'immoral' or 'defective' (like people with learning disorders) — and as burdens on classrooms and social order more generally." Nor were the ADHD patients alone in being blamed for their medical conditions. "As were nearly all psychological/psychiatric conditions in the 20th century, the automatic attribution was to 'faulty parenting' (lasting legacy of psychodynamic theories)," Hinshaw told Salon.

Today, of course, scientists understand that "genetic vulnerability to ADHD is extremely strong — but at the same time that parenting, school climate, etc., also have a large amount to do with ultimate outcome. At long last, we're beginning to move from 'either/or' to 'both/and' conceptualizations." Hinshaw is also encouraged by a shift away from treating ADHD solely with medication and instead seeing medication merely as a way to alleviate short-term symptoms.

"Unless combined with family behavioral therapy, school consultation, organizational skills, etc. etc. it's typically not sufficient," Hinshaw told Salon.

At the very least, though, the stigma surrounding ADHD is not as bad as it once was.

"Public conceptions now getting better — despite the anti-ADHDers out there who claim that it's solely a social construction, or lousy public education, or permissive parenting, etc," Hinshaw mused.

By Matthew Rozsa

Matthew Rozsa is a staff writer at Salon. He received a Master's Degree in History from Rutgers-Newark in 2012 and was awarded a science journalism fellowship from the Metcalf Institute in 2022.

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Adhd Attention Deficit Disorder Disability Health Hyperactivity Mental Health Neurodiversity