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Historical Influence of ADHD in School Psychology Shawna Sjoquist University of Calgary

HISTORICAL INFLUENCE OF ADHD IN SCHOOL PSYCHOLOGY There have been many historical developments that have inspired, shaped and reformed the research, practice and profession of school psychology. Presenting symptoms of inattention, hyperactivity and impulsivity have been described and included in the development of school psychology since the early eighteenth century. Symptoms consistent with that of Attention Deficit Hyperactivity Disorder (ADHD) are documented to have caused difficulty in homes and

schools throughout history (Mash & Barkley, 2003). The history of conceptualization for what is now known as ADHD has been pertinent to the development of modern day school psychology and will be used to inform the body of this paper. Literature documenting the presence and existence of ADHD has been found to date back to the eighteenth century (Lange, Reichl, Lange, L. Tucha & O. Tucha, 2010). One of the first examples of the disorder may be found in the works of Sir Alexander Crichton published in 1798 (Lange, et al. 2010). Crichtons work, 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, consisted of three books accounting clinical cases of mental illness (Palmer & Finger, 2001). Crichtons work is of historical note in 1798 literature addressing mental illness from a physiological or medical perspective was relatively rare (Palmer & Finger, 2001). Of particular relevance to ADHD, chapter two of Crichtons work titled On Attention and its Diseases presents an eighteenth century account of attention, the presence of abnormal inattention and distractibility (Crichton, 1798) that in many ways reflects the modern conceptualization of ADHD in school psychology today. Crichton considers attention to be the mental process that occur 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

HISTORICAL INFLUENCE OF ADHD IN SCHOOL PSYCHOLOGY attend to it (Crichton, 1798, p. 200). For all intents and purposes Crichtons conceptualization of attention corresponds to the modern understanding of attention used both in practice and research of school psychologists today and very well may have been the foundation from which the modern conceptualization were formed. Crichtons acknowledgement of attention included

recognition that an individuals normal ability to attend is best represented as a range rather than a fixed ability itself (Crichton, 1798). Recognition that an individuals ability to attend represents a range of attending possibilities can be found in educational practice and school psychology today. For instance, the practice of a school psychologist may often include providing recommendations to teachers designed to increase an individuals ability to attend within what is possible for the individual. School psychologists are routinely employed to support parents, teachers and children to reach their individual attending potential. Inherent to the school psychologists role is also the ability to identify, diagnose and understand the presentation of inattention. In his book, Crichton offers two possible influences that relate to the presentation of abnormal inattention (Crichton, 1978). Crichton states the incapacity of attending with a necessary degree of constancy to any one object (Crichton, 1978, p. 203) and a total suspension of its effects on the brain (Crichton, 1978, p. 203) define individual manifestations of abnormal inattention (Crichton, 1978). Crichtons representation of inattention, established in the eighteenth century, mirrors one of the criteria for inattention presented by the American Psychiatric Association (APA); difficulty sustaining attention in tasks or play activities (APA, 2000, p.85) which have now been used by school psychologists the world over. Crichton suggested that the incapacity to attend almost always arises from an unnatural or morbid sensibility of the nerves, by which means this faculty is incessantly withdrawn from

HISTORICAL INFLUENCE OF ADHD IN SCHOOL PSYCHOLOGY one impression to another (Crichton, 1978, p. 203). Crichton discussion of what he calls a morbid sensibility of the nerves can be seen as an important precursor for current research and practice in school psychology seeking to address sensory overstimulation and distractibility in children. Moreover, Crichtons statement, incessantly withdrawn from one impression to another (Crichton, 1978, p. 203) parallel the second symptom of inattention presented in the DSM-IV-TR which states is often easily distracted by irrelevant stimuli (APA, 2000, p.86). Additionally, information pertinent to the age of onset presented by the American Psychiatric Association with regard to ADHD is also reflected by Crichton when he states born with a

person (Crichton, 1978, p. 203) and when born with a person it becomes evident at a very early period of life (Crichton, 1978, p. 203). Although portions of Crichtons eighteenth century work may be found and used in todays literature and practice not all of Crichtons theories correlate with those presently held by modern school psychology today. Crichton states that 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 (Crichtion, 1978, p. 203). When considering this statement it is important to note the clear historical example of the presence of psychology observed, used and applied to the educational domain. Crichton uses the individuals ability to attend to instruction, which may be considered as formerly provided education or informal familial learning, to gauge amount of abnormal inattention. It must also be recognized that Crichtons suggestion that ADHD generally diminished with age (Crichton, 1978, p. 203) may be synonomous with views previously held in school psychology. Research now indicates that ADHD persists into adulthood in approximately 50 percent of diagnoses (Okie, 2006). Overall, Crichtons work is an important historical development that has influenced the research and practice in the field of modern day

HISTORICAL INFLUENCE OF ADHD IN SCHOOL PSYCHOLOGY school psychology. Review of this early account of ADHD reveals that ADHD related symptomology was been documented as early as the eighteenth century (Palmer & Finger, 2001). Information pursuant to the identification and understanding of ADHD has, where correlated, perhaps provided the foundation from which current conceptualizations of ADHD were built upon and, where dissociated, provided a foundation from which current conceptualizations were brought fourth. Just as Alexander Crichtons work offered an early account of ADHD associated

symptomology, Heinrich Hoffmann is also considered to have been a contributor to the historical development and modern day conceptualization of ADHD referenced in both the research and practice of modern day school psychologists (Lange, Reichl, Lange, L. Tucha & O. Tucha, 2010). This historical development came at a time in history when stories designed and used as educational warnings had become very popular (Herzog et al., 1995 as cited in Lange et al, 2010). In a time when formal school psychology did not yet exist Hoffmanns work marked another important link between psychological practice and the educational domain. Heinrich Hoffmann is the author of an1844 illustrated childrens series that included the work titled Fidgety Phil that is now considered to be a widely held parable for children diagnosed with ADHD (Lange et al., 2010). The accounts contained within the story Fidgety Phil have been considered to parallel the familiar characterization of ADHD (Thome & Jacobs, 2004) that is encountered today throughout psychological practice. Given that this work was presented during a time in history when attention and hyperactivity were not associated with a psychological diagnosis the parable offers accounts of childhood behavior that may parallel current conceptualizations of ADHD (Lange et al., 2010). Hoffmanns work states wriggled and giggled, and then, I declare, swung backward and forward and titled his chair (Hoffmann, 1846,

HISTORICAL INFLUENCE OF ADHD IN SCHOOL PSYCHOLOGY as cited in Thome & Jacobs, 2004) and has been considered by some authors to be an

exemplification of the motoric overactivity associated with ADHD and acknowledged in current research (Lange et al., 2010). The American Psychiatric Association offers through the DSMIV-TR yet another parallel to Hoffmanns work when it states often fidgets with hands or feet or squirms in seat (American Psychiatric Association, 2000, p. 86). While links between the works of Hoffmann and ADHD may be present this supposition is not without its criticisms. For instance, critics claim Hoffmans Fidgety Phil may simply depict a typically developing child demonstrating an instance of misbehavior (Lange et al., 2010). Up until this point, the historical representation of ADHD had been limited to the supposed characterization of ADHD and therefore highly susceptible to critics and lacking in unanimity. The conceptualization of ADHD received its first scientific foothold in 1902 with the lectures of Sir George Frederic Still (Barkley, 2006). Sir George Frederic Still offered a series of three lectures known as the Goulstonian Lectures that emphasized abnormal psychical conditions in children with specific regard to the abnormal defect of moral control (Still, 1902, p. 127). Still considers moral control to be the control of action in conformity with the idea of the good of all (Still, 1902, p. 127) and states that it is dependent upon three psychical factors, a cognitive relation to the environment, moral consciousness and volition (Still, 1902, p. 127). Cognitive relation to the environment is said to pertain to the capacity for reasoning comparison, moral consciousness to intellectual capacities and volition the willful decision (Still, 1902). Children meeting these requirements were in some cases deemed mentally retarded (Still, 1902). Moreover the Still lectures provided a historical moment in time that was instrumental for increases of attention to children, presenting with abnormalities, but not meeting all of Stills criteria (Lange, Reichl, Lange, L. Tucha & O. Tucha, 2010). Specifically, children presenting

HISTORICAL INFLUENCE OF ADHD IN SCHOOL PSYCHOLOGY with what Still described as a defect of moral control and intact intellectual capacities therefore not deemed mental retarded are believed to be those cases constituting yet another historical representation of ADHD (Lange et al., 2010). These children seemingly meet criteria that are

consistent with the modern-day conceptualization of ADHD and thereby constitute an important historical development to the conceptualizations of ADHD in the field of school psychology. Still completed scientific observation of children that demonstrated a defect of moral control, without general impairment of intellect and without physical disease (Still, 1902, p. 1079). Through these observations several equivalencies were noted between the documented behaviors and what is now considered common behavior of children diagnosed with ADHD. Although past literature and theory had identified behaviors consistent with the characterization of ADHD, until now there had been little if any scientific proof. Consistent with current literature, in 1902, Stills observations of the differentiated group of children he had identified revealed a inordinate amount of seemingly affected boys than affected girls (Palmer & Finger, 2001). Consistent with current knowledge of ADHD, On average, male children are more likely than female children to be diagnosed as having ADHD within epidemiological samples, with the average being roughly 3:1 (Mash & Barkley, 2003, p. 95). Still also made observations that are consistent with the current understanding of age of onset. For instance, Still was noted to observe that, in the majority of his observed cases behaviors were noted to have surfaced prior to the age of 7 (Lange, Reichl, Lange, L. Tucha & O. Tucha, 2010). It is also important to note that in order for there to be a morbid manifestation of moral control Still suggested that the manifestation must have been deemed to be exhibited outside of what was recognized as normal (Still, 1902). This may be considered to be a historical expression of what the American Psychiatric Association considers to be pertinent to the


diagnosis of ADHD. Currently, in order for a school psychologist to assign a diagnosis of ADHD symptoms must present to a degree that is maladaptive and inconsistent with developmental level (American Psychiatric Association, 2000, p.92). Still suggested that in order for a lack of moral control to be rendered a number of symptoms Still felt were associated with the description such as passionateness; spitefulness cruelty; jealousy; lawlessness; dishonesty; wanton mischievousness destructiveness; shamelessness immodesty; sexual immorality; and viciousness (Still, 1902, p. 1009) must be present. It is true that while many of these symptoms are not directly associated with the symptomology considered by modern-day representation of ADHD it has been argued that the theme of the symptoms presented by Still may be indirectly linked to what is now consider to be delay of gratification (Barkley, 2006). Additionally, as is now common in modern-day understanding of ADHD in many instances the symptomology of children diagnosed with ADHD is largely impulsive by nature. It may also be argued that many of the symptoms presented by Still may also be closely associated with impulsivity (Lange et al., 2010). Further, Still also documented instances whereby there was an abnormal degree of passionateness (Still, 1902, p. 1009) which may considered to be aligned with what Mash and Barkley describe as greater emotional expression in their reactions to events;diminished social perspective taking, as these children do not delay their initial emotional reaction long enough to take the view of others and their own needs into account (Mash & Barkley, 2003, p. 86). Still also described a quite abnormal incapacity for sustained attention (Still, 1902, p. 133) which correlates with modern day criteria outlined in the DSM-IV-TR: has difficulty sustaining attention in task or play activities (American Psychiatric Association, 2000, p. 85).

HISTORICAL INFLUENCE OF ADHD IN SCHOOL PSYCHOLOGY Stills work presents the first scientific account of symptomology that has been considered to be associated with the conceptualization of ADHD within the field of modern-day school psychology. While many of the symptoms identified and catalogued by Still either correspond to or suggest the characterization of modern day ADHD Stills work nonetheless provides another historical account of ADHD, although not explicitly defined as such. Critics

have argued that Stills work regarding his defect of moral control is not simply an early account of a narrow diagnosis of ADHD in particular but more so an account of a wide range of externalizing behavior disorders (Conners, 2000). While it is likely that some of the cases that Still documented and used to inform his lectures likely had a diagnosis of ADHD, it is not to say that other diagnoses may have also been present (Lange, Reichl, Lange, L. Tucha & O. Tucha, 2010). The work presented by Still provides an important point in the historical development of ADHD as used in the research and practice of school psychologists today. The differentiation Still offered in his works presented an important connection between brain damage and deviant behavior (Lange et al, 2010). Stills differentiation that incorporated diagnostic criteria associated to presenting physical disease such as cerebral tumor, head injury, typhoid fever or the like served as a historical marker for the origination of later concepts of minimal brain damage, minimal cerebral dysfunction and hyperactivity that have been considered in the literature to be historical precursors to ADHD (Lange et al., 2010). Moreover, Stills lectures represented a break from the more general medical discussion of morality (Rafalovich, 2001) and a change in conceptualization principal to the development of ADHD present in modern day school psychology. The historical account of ADHD relevant to research and practice in present-day school psychology, has also included several other associations to diagnoses associated with their



respective points in history. As the correlation between brain damage and behavioral diagnoses continued it was furthered through the encephalitis lethargica epidemic experienced world-wide in 1917 and continuing on into the 1920s (Rafalovich, 2001). Survivors of the epidemic were noted to demonstrate markedly abnormal behavior that came to be known as postencephalitic behavior disorder (Mash & Barkley, 2003). Aspects of the symptomology associated with postencephalitic behavior disorder mirrored that which has now come to be associated with ADHD in modern day school psychology (Lange, Reichl, Lange, L. Tucha & O. Tucha, 2010). For example, children were noted to be highly hyperactive, distractible, irritable, antisocial, destructive, unruly, and unmanageable in school (Ross & Ross, 1976, p. 15). While not all symptoms associated with postencephalitic behavior disorder characterize ADHD per se, the rise in disruptive cases experienced in schools at the time sparked a wide ranging and fervent interest in hyperactivity in children (Lange et al., 2010). Similarly, in 1932 Franz Kramer and Hans Pollnow offered a lecture describing hyperkinetic disease in children (Neumarker, 2005). The authors sought out to distinguish hyperkinetic disease from other disorders and diseases that demonstrated similar symptoms ( Lange, Reichl, Lange, L. Tucha & O. Tucha, 2010). Analysis of the symptoms described through Kramer and Pollnows rendition of the disease reveal historical correlations to the current conceptualizations of modern day ADHD. For instance, Kramer and Pollnow suggested that children diagnosed with hyperkinetic disease demonstrated significant motoric activity that was urgent in nature (Kramer & Pollnow, 1932 as cited in Lange et al., 2010). Current literature has demonstrated that there is substantial evidence already available for problems in motor development and motor execution in those with ADHD (Mash & Barkley, 2003, p. 87) and as depicted in the DSM-IV-TR children appear as if driven by a motor (American

HISTORICAL INFLUENCE OF ADHD IN SCHOOL PSYCHOLOGY Psychiatric Association, 2000, p. 86). Kramer and Pollnow identified that children with


hyperkinetic disease experienced extreme educational difficulties that often stemmed from lack of concentration, insufficient goal orientation, increased distractibility, walking around aimlessly, touching chairs, boards . . . everything that comes in their way (Neumarker, 2005, p. 438). As is well known by school psychologists today, children diagnosed with ADHD are also often known to demonstrate difficulty remaining seated and refraining from moving about the room when asked to be still (American Psychiatric Association, 2000). Moreover, the DSM-IVTR expresses that children diagnosed with ADHD often appear as if their mind is elsewhere or as if they are not listening (American Psychiatric Association, 2000, p. 85), often have difficulties organizing tasks and activities (American Psychiatric Association, 2000, p. 85) and may be manifested by fidgetiness or squirming in ones seat (American Psychiatric Association, 2000, p. 86). Especially pertinent to the field of school psychology, Kramer and Pollnow went on record as making specific associations between noted symptomology and their effects regarding education and learning potential stating directly that identified symptoms lead to poor learning abilities [and] . . . impairments in later years (Neumaker, 2005, p. 438). The link between symptomology and educational experiences reflect the current necessity for symptoms to cause significant impairment in social, academic, or occupational functioning (American Psychiatric Association, 2000, p. 85) in order to warrant diagnosis of ADHD. Kramer and Pollnow identified that children diagnosed with hyperkinetic disease at that time were often disobedient, caused distinct educational difficulties, caused disturbances in the classroom and generally demonstrated difficulty playing with other children (Neumaker, 2005).

HISTORICAL INFLUENCE OF ADHD IN SCHOOL PSYCHOLOGY In addition to the many similarities between what was known in 1932 as hyperkinetic disease and what is now known as ADHD, Kramer and Pollnow offered yet another important distinction relevant to the development of ADHDs conceptualization in modern day school


psychology. Kramer and Pollnows rendition of hyperkinetic disease offered the recognition that the disorder may not simply disintegrate with age but, in fact, still have implications for adulthood (Neumaker, 2005). It is important to note that while Kramer and Pollnow may have acknowledged that the disease held implications for adulthood, for their purposes the primary symptom considered was the demonstration of abnormal motor activity. Therefore, where individuals presenting with the disease aged and were better able to regulate control over this symptom the presentation of the disease was seen to decline (Lange, Reichl, Lange, L. Tucha & O. Tucha, 2010). With the emphasis on symptomology and their effects on the educational experience and learning potential research in the early 1900s began to look toward methods that might be beneficial to circumventing the educational and behavioral effects of noted symptoms. In 1937, Charles Bradley demonstrated some of the first positive effects of medicinal therapy for use with, what are now considered to be ADHD related behaviors (Strohl, 2011). Charles Bradley attempted to use Benzedrine as a treatment for headaches (Strohl, 2011). While improvements with regard to headaches were not found Bradley did inadvertently discover that the Benzedrine resulted in prominent improvements in school performances in children (Strohl, 2011). Use of the drug reportedly resulted in children demonstrating increased interest in their work and an increased ability to complete school tasks more quickly and accurately (Strohl, 2011). Use of Benzedrine was also reported to result in the decreased motor activity and the placation of emotional outbursts (Strohl, 2011). It is reported that children most likely to benefit from the

HISTORICAL INFLUENCE OF ADHD IN SCHOOL PSYCHOLOGY effects of Benzedrine were those children demonstrating a short attention span, dyscalculia,


mood variability, hyperactivity, impulsivity, and poor memory (Lange, Reichl, Lange, L. Tucha & O. Tucha, 2010) which are included in the modern day characterization of ADHD. Bradleys findings marked the beginning of a revolutionary change in the treatment approaches available to support children exhibiting ADHD related behaviors (Lange et al., 2010) which has affected the treatment approaches and practices of school psychologists today. While Benzedrine is no longer in use, Bradleys findings ignited a branch of research that had not been previously present transforming the research and practice of todays school psychologists. Without Bradleys findings the practices of school psychologists may not reflect the incorporation of medicinal therapy and the field of school psychology may not have had the opportunity to experience the benefits of incorporating pharmacological practices with behavioral and cognitive techniques. Interestingly, as prominent as this finding was and as relevant as it is today, popularity of the psychoanalysis approach of the time appeared to trump Bradleys pharmacological findings (Conners, 2000). Thus while Bradleys finding have no doubt inspired and influenced the research and practice of the field of school psychology today when published the findings produced little to no influence on the research and practice of the time (Conners, 2000). Where Benzedrine was the first stimulant medication used in the treatment of hyperactive children (Lange et al., 2010). Methylphenidate is now the most commonly prescribed drug in children for the treatment of ADHD (Grizenko, Bhat, Schwartz, TerStepanian & Joober (2006). Recent literature has demonstrated that medication alone or medication associated with intensive behavioral therapy were equally effective in reducing the core symptoms of ADHD (MTA Cooperative Group as cited in Grizenko, Bhat, Schwartz, TerStepanian & Joober, 2006, p. 47).

HISTORICAL INFLUENCE OF ADHD IN SCHOOL PSYCHOLOGY With the increased attention prescribed to the presence of hyperactivity in children and the relatively recent encephalitis epidemic numerous historical accounts began to surface that spoke of further associations between brain damage and symptoms of hyperactivity (Mash &


Barkley, 2003). As links between supposed brain lesions and behavioral disorders became more and more numerous, research and practice in the 1930s and 1940s began to focus on the concept of minimal brain damage (Mash & Barkley, 2003). Minimal brain damage has been said to be regarded as a historical antecedent to ADHD (Lange, Reichl, Lange, L. Tucha & O. Tucha, 2010, p. 250). The concept of minimal brain damage proposed three considerations: the presence of undiagnosed mild forms of brain damage during infancy could lead bring about behavioral difficulties identified and exacerbated when children are of school age; degree, location and type of lesion; as well as placement on a continuum of damage ranging from severe abnormality to minimal damage (Ross & Ross, 1976). According to Ross and Ross (1976) the concept of minimal brain damage was assigned to children demonstrating hyperactivity regardless of confirmed presence of brain damage. At the time, where children demonstrated symptoms of hyperactivity the presence of brain damage, where not confirmed, was deemed to be present (Ross & Ross, 1976). The concept of minimal brain damage marks a poignant historical event that has influenced psychological practice thus forward. At this time it became general practice to infer brain damage without evidence of explicit neurological damage citing observed behavioral signs as proof of brain damage (Strauss & Lehtinen, 1950). The concept of minimal brain damage continued and by the 1960s was widely recognized however the concept was not without its critics (Lange et al., 2010). The main criticism of the concept of minimal brain damage centered on the fact that professionals required no evidence of neurological damage, just behavioral evidence, in order to

HISTORICAL INFLUENCE OF ADHD IN SCHOOL PSYCHOLOGY discern the presence of minimal brain damage (Neumarker, 2005). As a result, the Oxford International Study Group of Child Neurology began to campaign for a change from the term minimal brain damage to minimal brain dysfunction (Ross & Ross, 1976). The change in


terminology was to start a shift in the categorization of children into smaller more homogenous groupings (Ross & Ross, 1976). In 1963 the National Institute of Neurological Diseases and Blindness answered the call and designated a team of professionals to reclassify both the terminology and procedures used to identify children with what was now to be called minimal brain dysfunction (Rie, 1980). Minimal brain dysfunction was considered to be applicable for children of near average, average or above average general intelligence with certain learning or behavioral disabilities ranging from mild to severe, which are associated with deviations of function of the central nervous system (Clements 1966 as cited in Lange, Reichl, Lange, L. Tucha & O. Tucha, 2010, p. 251). Minimal brain dysfunction was deemed to be characterized by various combinations in impairment in perception, conceptualization, language, memory and control of attention, impulse or motor function (Clements 1966 as cited in Lange et al., 2010, p. 251). The classification of minimal brain dysfunction utilized the presence of neurological damage rather than a reliance on behavioral symptomology as had been done with regard to minimal brain damage (Barkley, 2003). Moreover, minimal brain dysfunction differentiated children demonstrating normal ranges of intelligence from those that were more heavily involved which was instrumental for the development of the conceptualization of ADHD utilized in the field of school psychology (Lange, Reichl, Lange, Tucha & Tucha, 2010). The criticisms that led to the development of the term minimal brain dysfunction did not end with the abolition of the term minimal brain damage. Critics continued to argue that the presence of neurodevelopmental abnormalities [were] argued to be non-specific and also



common in other psychiatric disorders (Schaffe et al, 1985 as cited in Lange, Reichl, Lange, L. Tucha & O. Tucha, 2010). Overall, minimal brain dysfunction was criticized as too general and heterogenous, and was later to be replaced by multiple more specific and descriptive labels such as hyperactivity, learning disability, dyslexia, or language disorders (Conners, 2000 as cited in Lange et al., 2010). This differentiation in coordination with influence from Kramer and Pollnow hyperkinetic disease, now referred to as hyperkinetic impulse disorder eventually lead to the development of a formal definition of hyperactivity itself (Mash & Barkley, 2003) which, in 1968, was incorporated into DSM-II (Volkmar, 2003). Of historical note, this inclusion into the DSM-II was not without influence from the lingering psychoanalytic thought of the time. Though many researchers in the field had begun to acknowledge the potential presence of a neurological origin, differing opinion stemming from the psychoanalytic view lead to all childhood disorders in the DSM-II being referred to as reactions as is seen with the term hyperkinetic reaction of childhood (Mash & Barkley, 2003). The unwavering interest in hyperactivity continued into the 1970s without contest until the publication of a work offering that sustained attention and impulse control were more significant features of the disorder (Mash & Barkley, 2003) was published by Douglas (1972). Douglas (1972) presented his view that the major deficits involved in hyperkinetic reaction of childhood reflected major deficits in the investment, organization and maintenance or attention and effort; the ability to inhibit impulsive behavior and the ability to modulate arousal levels to meet situational demands (Mash & Barkley, 2003, p. 77). The influence of Douglass work led to the reconceptualization of hyperkinetic reaction of childhood giving way to the diagnostic label, Attention Deficit Disorder, used fervently by school psychologists in their research and practice of the time. This classification, used in the DSM-III, identified three symptom lists for



inattention, impulsivity and hyperactivity (Mash & Barkley, 2003) and differentiated ADD with and without hyperactivity as associated subtypes (Barkley, 2006). As empirical research supporting the differentiation of Attention Deficit Disorder with and without hyperactivity was limited, at the time of publishing it was decided that the DSM-III-R would remove the differentiation and rename the disorder Attention Deficit-Hyperactivity Disorder (Lange, Reichl, Lange, L. Tucha & O. Tucha, 2010) which has now been fervently used, the world over, by school psychologists today. The new category would then be divided into subtypes that include inattentive type, hyperactive-impulsive type and combined type subclasses (American Psychiatric Association, 2004). Today the DSM-IV-TR has benefited from continued research fostered by the early work of those that had gone before and is now considered to have the most empirically based conceptualization of ADHD to date (Mash & Barkley, 2003?). Early descriptions and theories relevant to the diagnosis of ADHD have proven to be, in many ways, similar to the conceptualizations of the disorder today. Crichtons descriptions have provided evidence for the existence of ADHD documented as early as the late eighteenth century (Lange, Reichl, Lange, L. Tucha & O. Tucha, 2010) and correspond to the accounts of Fidgety Phil (Thomes & Jacobs, 2004). Many of the historical descriptions of ADHD related symptoms are consistent with the modern diagnostic criteria used by school psychologists to identify ADHD. Stills demonstration of a connection between brain damage and deviant behavior in children influenced the further conceptualization of ADHD, research and practice relevant to the field of school psychology (Lange et al., 2010). Stills work, in many ways, initiated the formation of concepts such as minimal brain damage, minimal brain dysfunction and hyperactivity which have come to be known as historical precursors for our modern day conceptualization of ADHD (Lange et al., 2010). Kramer and Pollnows work regarding

HISTORICAL INFLUENCE OF ADHD IN SCHOOL PSYCHOLOGY hyperkinetic disease lead to the inspiration, configuration and reformation of a diagnosis that


encompasses much of work completed in the field of school psychology. It has become clear that symptoms of hyperactivity, inattention and impulsivity have been present in the literature and influence the social, occupational and educational experiences of children since the nineteenth century (Lange et al., 2010) and as such have revolutionized both the research and practice of modern day school psychology.




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