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The United States has in many ways been the epicenter of attention deficit–­ hyperactivity disorder (ADHD). The diagnosis of ADHD was developed and institutionalized in the United States in the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of ­Mental Disorders (DSM), and the United States is where the most frequently used treatments (psychostimulants) ­ were first promoted to treat ADHD and hyperactivity more generally. ­ Until the 1990s, the United States was the country with the highest estimated prevalence of ADHD in the world and this country continues to have some of the highest estimated rates of both diagnosis and treatment (Conrad and Bergey 2014). As of 2011, 11% of American school-­ age ­ children had been diagnosed with ADHD (6.4 million ­children and adolescents between the ages of 4 and 17) and 8.8% (5.1 million ) currently had ADHD (Visser et al. 2014). Of ­ those ­ children who had a current diagnosis, 69% (3.5 million ­ children) ­ were taking ADHD medi­ cations (Visser et al. 2014). In this chapter we discuss the rise and transformation of ADHD in the United States. We begin by briefly reviewing related historical antecedents of the diagnosis before describing the development of diagnostic and treatment changes in this country. Next we discuss patterns in diagnosis and treatment, along with American ADHD advocacy groups, and some controversies and challenges that 2 The Rise and Transformation of ADHD in the United States Meredith R. Bergey Peter Conrad 10   Global Perspectives on ADHD have emerged in the United States with re­ spect to ADHD. We close the chapter with some reflections on ADHD in the twenty-­ first ­ century. The Emergence of ADHD Be­ hav­ iors that might ­ today be consistent with a diagnosis of ADHD—­ hyperactivity, inattention, and impulsivity—­ have not always been associated with a medical disorder. ­ There have been claims that evidence of ADHD can be traced back as early as 1845 in the characterization of Zappelphilipp (Fidgety Philip) in Heinrich Hoffmann’s popu­ lar German ­ children’s book Der Struwwelpeter (Hoffmann 1845). ­Others point to Sir George Frederic Still’s (1902) Goulstonian Lectures at the Royal College of Physicians of London in which he described conditions related to hyperactivity and impulsivity in ­ children. In yet another example, the German physicians Franz Kramer and Hans Pollnow produced a report in 1932 “Über eine hyperkinetische Erkrankung im Kindesalter” (“On a Hyperkinetic Disease of Infancy”). They described a neurological disorder, called Kramer-­ Pollnow syndrome, which was characterized by hyperactivity and­ mental retardation. Examples like ­ these suggest that certain be­ hav­ iors that are now associated with ADHD have been considered problematic at dif­fer­ent points in history (see Lange et al. 2010). None of ­these cases, however, seemed to prompt widespread diagnosis and/or treatment at the time. That did not occur ­ until the 1960s in the United States. The Establishment of ADHD in the United States The medicalization of ­ children’s be­ hav­ iors related to hyperactivity, impulsivity , and inattention (the core symptoms of ADHD) in the United States has historical roots in the early twentieth-­ century work of the American physician Charles Bradley. Bradley was the medical director of the Bradley Home, a fa­cil­i­ty in Rhode Island for ­ children with vari­ ous emotional, behavioral, and neurological impairments. Bradley’s neurological evaluations of the ­ children ­ there­ involved pneumoencephalography, which can lead to intense headaches (Brown 1998). Bradley tried to treat the headaches with the stimulant drug benzedrine and observed something unexpected: although the drug had ­ little effect on the headaches, it appeared to have a positive effect on be­ hav­ ior and school per­ for­ mance (Brown 1998). Bradley conducted a controlled trial afterward and reported similar effects (Brown 1998). “It appears paradoxical that a drug known to be a stimulant should produce subdued be­ hav­ ior in half of the ­ children,” he noted (Bradley The Rise of ADHD in the United States   11 1937: 582). ­ There ­ were a scattering of reports about this effect over the next two de­ cades, mostly by Bradley and his colleagues. ­ Others did not pick up on this finding, however, ­ until roughly 20 years ­ later (Conrad 1975; Lange et al. 2010)— at least in part ­ because it was a treatment without a clear diagnosis. Another contributing ­ factor might have been the wide popularity of psychoanalytical approaches at the time for ­addressing mental health issues (Brown 1998; Rothenberger and Neumarker 2005). Two de­cades ­later, a group of researchers from the same Bradley Home picked up their...


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