Welcome to our module on attention, the scientific history of what currently is called attention deficit disorder or attention deficit disorder with hyperactivity, ADD or ADHD. Difference in a couple of ways from the other psychiatric disorders we covered in this course. First, aberrations and attention, a function of thinking have long been documented, but the problems received a variety of classifications over the century from failures of volition or will to executive function disorders. Additionally, the cognitive deficits were until very recently, identified only in children and then mainly in boys. However, the disorder does resemble the scientific history of depression and narcissism in one noteworthy way, all three of these disorders, one time or another targeted mothers as a causal factor in the disorder itself. Let's proceed to examine the scientific history of attention deficits and review the changing classifications, along with the explanations they have been given, since children have been the main object of investigation. Let's start with them. 18th, 19th Century Representations in Art sharp, children's mostly perfectly composed, being stressed and acting much like adults. Yet children were not always represented as so beautiful, by the 19th century observers commentated on unruly children, the mischievous and the unmanageable. For example, misbehaving children are the main characters in stories told by a mid 19th century German physician. These amusingly illustrated stories depict a young child Fidgety Phil named after the doctors young son who's unruly actions disrupt and who seems unresponsive to discipline. Other stories feature the life of Johnny Look In The Air, who's wandering attention results in mishaps. These in related 19th century tales were read to children as moral lessons, misconduct was a moral shortcoming. The first scientific account of behaviorally challenging children was developed by a British pediatrician. Frederick Still, who in 1902 delivered a lecture on children who have normal intellectual abilities, but who suffered from what he called deficits of inhibitory volition, still describe these children's inability to stay calm and other problems they had, including lying, violence, spitefulness, and want a mischievousness and suggested the possibility of organic disease as causal. Yet he also drew upon then current theories of volition or will that held clear moral undertones for Still, and I quote, a notable feature of many of these cases of moral defect without general impairment of intellect is a quite abnormal incapacity for sustained attention. End quote, these children suffered a failure of will, a failure of moral self restraint. Such bad boys were coming to be considered a special social problem by the early 20th century, and on a few occasions they were submitted to purportedly to surgical corrections. One bad boy was made good with a tonsillectomy. Such dramatic measures were uncommon, but worries about children's behavior were becoming more common. However, at this time, cultural attitudes and science were changing. Among the changes were ideas that much of people's actions were not voluntarily. They were determined not free acts of will that shift in psychological ideas underscores several approaches to understanding children who exhibited attention problems, disobedience and moral rule breaking. In the early 20th century, one approach is evident in what might be called the child study movement, which was influenced by scientific ideas that children needed safe, socially and physically and psychologically healthy environments. This scientific approach guided creation of institutions for children's care, for instance, juvenile courts and residential hospitals, or reform schools for behaviorally challenging children. The scientific history of attention problems often overlooks to relevant contributions to the scientific study of children's problem behavior. The first overlooked contribution is the introduction of behaviorism, the science of how both good and bad behaviors are learned and unlearned, and underscored the environment as important as well as a growing belief in determinism. The psychologist John B Watson led the development of scientific behaviorism and his writings emphatically stressed the importance of appropriate rearing of children, including the damage that could be incurred without that appropriate rearing. However, Watson did write and speak extensively on how bad behaviors come into being and how they can be avoided or removed through conditioning, children raised with behaviors principles, conditioning correct behavior and habit training, he asserted, are free from fears and temper tantrums. They are happy children end quote. By contrast, a child growing up in a home environment that does not condition the child properly has inconsistent parenting advice or over affectionate coddling by the mother will develop bad habits, tantrums, outbursts and misbehaviors. Watson science and advice provided a recipe to avoid raising a troublesome child and lessons for reconditioning the problem child, are related yet often sidelined part of the history of attention disorders in children is the science based advice given to parents, especially to mothers. Alina sings content analysis of over 200 articles on child rearing found that the targeted mother's primary role in children's development and behavior, she reports and I quote, almost all early childhood articles focused on boys and almost all articles were about boys behavioral development and particularly aggressive behaviors such as fighting, talking back toughness and sports. End quote, in these articles, as well as in psychoanalytic theory and behaviorism, mothers, psychology and interactions were believed to be crucial to healthy growth and to the prevention of what were called emotional disturbances. In short, mothers were the cause or a cause of difficult children. Even with the advent of medicating these children, mother blamed did not disappear. A recent interview study of these mothers found that the brain blamed narrative, attached the use of stimulant medications does not replace the mother blamed narrative of the pre drug era. Rather, the author concludes, the author of the study and I quote, the brain blamed narrative contains supports and reconstitutes opportunities for mother blames end quote, the 1950s brought a new focus as psychiatrists took up the idea that these behavior problems of attention and hyperactivity were biological brain based. In other words, these problems constituted a neurological disease. The class batory term minimal brain damage, or MBD was introduced in 1957, at that time. Dr Maurice Laufer introduced the term hyperkinetic disorder of childhood or hyperkinetic syndrome and recommended use of amphetamines. The organic brain based thesis soon gained ascendancy as the predominant explanation for problems of children's attention and conduct. Between the late 1950s and 2000, researchers advanced a number of theories about what part of the brain was impaired. Research soon suggested that most of these children did not have brain damage, but rather abnormalities of functioning. This led to renaming MBD as minimal brain dysfunction, not disease. More controversies arose around questions of whether the condition was even caused by brain dysfunctions. However controversial in the early years, the turn to the brain as the central cause of the disorders doomed to the spotlight on mothers and mother blade. In addition to scientific deliberations over the role of the brain, arguments are also made that hyperactivity and attention problems might be two distinct pathologies. The scientific deliberations led to a series of classifications. The DSM 2 published in 1967 named hyperactivity problems as hyperkinetic reaction of childhood. Soon thereafter, researchers increased attention on a problems of attention and impulse control. As one psychologist described in 1974. These conditions were the inability to stop look and listen. In the DSM 3, the disorder was named attention deficit disorder. A classification change indicating that hyper activity is not always present in the disorder. The hyperactivity was one subtype. The revised DSM 3 published 7 years later, recombined these characteristics in a single disorder, attention deficit hyperactivity disorder or ADHD. The symptom criteria for the disorder combined those of impulsivity, hyperactivity and inattention into one list. The subsequent edition, DSM 4 published in 1994 reverted to using subtypes of ADHD. These subtypes were the predominantly inattentive type, the predominantly hyperactive, impulsive type and a type with symptoms of both inattention and hyperactivity. To summarize early 20th century took up problems of the troublesome child and that science generally emphasized the environment and determinism, displacing 19th century notions of free will and moral character. During the second half of the century, neurological studies thought to discover the precise abnormalities in brain structure and or function that would cause hyperactivity, poor impulse control and attention problems. Some researchers reported structural differences in the brain's prefrontal network, prompting the term executive functioning disorder. Many investigators remained hopeful that discoveries of relevant brain mechanisms lay ahead.
