Hyperactivity





The pinpointing and treatment of hyperactivity in children forms a fascinating link between medical research and popular attitudes about and settings for the child. Scattered indications of new concern about hyperactive behavior began to accumulate in the second half of the nineteenth century. Hyperactivity formed part of a new interest in identifying and segregating "backward" children in the early twentieth century, particularly in western Europe. Medical research on brain dysfunctions accelerated in the 1920s and 1930s, but there was continued dispute about whether some special condition of hyperactivity existed. Drug treatment, first introduced in 1937, became more common after 1957. But it was only after 1970 that identification of hyperactive children, under the designation attention deficit disorder (ADD), became widely accepted. Amid controversy, treatment programs gained ground steadily through the 1990s.

Historical Background

Children's hyperactivity, to the extent it existed, was simply a question of DISCIPLINE until modern times and received no specific attention. Protestant clergymen and parents in the eighteenth and nineteenth centuries often resorted to physical discipline against children who could not sit still in long church services, but since this was seen as an expression of children's original sin and natural unruliness it did not come in for specific comment. We have no systematic indications of how what we would now call hyperactivity affected children's work performance.

A German children's book in the 1850s offered a character, "Fidgety Phil," who was the characteristic hyperactive child, unable to sit still. By this point stricter MANNERS for children included explicit injunctions about body control, which would implicitly single out children who had difficulties in this area. More regular schooling also created problems for hyperactive children. Still, a truly troubled child could still be pulled out of school and either sent directly to work or (in wealthy families) given private tutoring.

More extensive school requirements plus new medical research capabilities opened a new chapter in the identification of hyperactive children around 1900, particularly in England and Germany. Generally such children fell into a larger category of backward or mentally deficient children who could not perform well on standardized tests and/or who caused persistent behavior problems in school. Some of these children were placed in special schools or classes, where different kinds of instruction, focusing on specific tasks, could lead to improvements in learning capacity. By the 1920s experts began to realize that hyperactive children were often quite intelligent, and inclusion into a generic backward category began to diminish.

Research continued on brain dysfunction of children with hyperactive behavior problems, with increasing interest in the United States. A study by Charles Bradley in 1937 introduced the first possibility of medication, using Benzedrine. Widespread identification of a hyperactivity problem was still limited by a belief that a certain amount of unruliness in children was natural, that schools themselves were part of the problem, and that it was up to parents to figure out how to keep their children in hand.

Research, Diagnosis, and Treatment since 1957

Several developments, including the introduction of new psychostimulant medication, particularly the drug Ritalin in 1957, began to accelerate attention to and concern about hyperactivity. Fewer children were now encouraged to drop out before completing secondary school. With more mothers working, parental availability to help with hyperactive children declined; indeed parental interest in finding assistance intensified. With more children in day care facilities by the 1960s, opportunities to identify problems of hyperactivity at a younger age expanded. Increasing school integration in the United States exposed teachers to categories of children they might more readily define as behavior problems. Finally, teachers themselves faced new constraints in physically disciplining children, which put aggressive restlessness in a new light.

These various developments, along with effective medication, prompted a steady growth in the numbers of behaviors that were regarded as symptoms of attention deficit disorder–behaviors that in earlier decades might often have been regarded as normal. There were cautions: some observers worried about unduly frequent use of medicines that could have adverse side effects or induce dependency; some studies suggested that minority children were particularly likely to be cited as needing medication, with teachers using this option as a means of facilitating classroom control.

But acceptance of hyperactivity as a disease category gained ground steadily, and some schools required drug treatments for certain children as a condition of entry. Estimates in 1980 that 3 percent of all children suffered from ADD grew to 5 percent a decade later. Production of Ritalin soared 500 percent between 1990 and 1996. Popularizations of the ADD concept bolstered many parents, who could now point to a problem of brain function for behaviors that used to be blamed on poor home discipline. Supplementary measures, including therapy, special diets, and adult support groups, were deployed against hyperactivity, but medication continued to command the greatest attention.

BIBLIOGRAPHY

Armstrong, Thomas. 1996. "ADD: Does it Really Exist?" Phi Delta Kappan (February): 424–428.

Charles, Alan F. 1971. "The Case of Ritalin." New Republic (October): 17–19.

Fowler, Mary. 1994. NICHCY Briefing Paper: Attention Deficit/Hyperactivity Disorder. Washington, DC: Government Printing Office, 1-S.

Smelter, Richard W., et al. 1996. "Is Attention Deficit Disorder Becoming a Desired Diagnosis?" Phi Delta Kappan (February): 29–32.

Swanson, James. 1995. "More Frequent Diagnosis of Attention Deficit-Hyperactivity Disorder." New England Journal of Medicine 33: 944.

PETER N. STEARNS