How Medicating ADHD Has Changed Over Time (2024)

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that is most often diagnosed during childhood, although it can affect adults as well. While ADHD is the most common mental health condition diagnosed in children today, it was not always as well recognized or understood.

Although ADHD hasn't always been identified, diagnosed, or treated as much as it is now, doctors have actually known about it for some time. It has been referred to by different names throughout history, which is why you may still hear it referred to as ADD from time to time.

Previous Names for ADHD

Doctors and scientists once used terms including these to describe the condition we call ADHD today.

• Attention deficit disorder (ADD)
• Brain-injured
• Brain-damaged
• Clumsy child syndrome
• Hyperactive child syndrome
• Hyperexcitability syndrome
• Hyperkinetic impulse disorder
• Hyperkinetic reaction of childhood
• Minimal brain dysfunction
• Nervous (a "nervous child")
• Organic brain disease
  

Since 1987, this condition has been known as ADHD and is further divided into three subtypes: inattentive type, hyperactive/impulsive type, and combined type.

History of ADHD

The earliest references to an ADHD-like disorder date back to the late 18th century and appear in textbooks published by Melchior Adam Weikard and Sir Alexander Crichton. Though, work on ADHD is more often thought to begin in the early 20th century.

Here's what the history of ADHD looks like when placed on a timeline:

• 1902: Sir George Frederick Still first describes children with ADHD symptoms. At this time, these children were thought to have an "abnormal defect of moral control."
• 1908: Alfred F. Tredgold describes "high-grade feeble-minded" children who likely had a form of mild brain damage that caused them to have ADHD-like behavior.
• 1937: Charles Bradley publishes a study describing the use of Benzedrine (racemic amphetamine) in children with behavior problems. He accidentally learned about the benefits of Benzedrine when giving the medication to help kids with severe headaches and noticed that it instead helped their behavior and school performance.
• 1952: The first edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) is published by the American Psychiatric Association (APA) but includes no mention of an ADHD-like disorder.
• 1956: Herbert Freed and Charles Peifer study the use of Thorazine (chlorpromazine) on "hyperkinetic emotionally disturbed children."
• 1957: The term "hyperkinetic impulse disorder" is first used to describe children with ADHD symptoms.
• 1963: C. Keith Conners publishes a study on the effects of Ritalin (methylphenidate) in "emotionally disturbed children."
• 1966: "Minimal brain dysfunction syndrome" becomes a popular term to describe kids with "various combinations of impairment in perception, conceptualization, language, memory, and control of attention, impulse, or motor function."
• 1967 and 1968: The National Institute of Mental Health (NIMH) awards a number of grants to researchers to study the effectiveness of stimulants for children with ADHD symptoms.
• 1968: The second edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-II) includes the disorders of hyperkinetic reaction of childhood or adolescence and organic brain syndrome.
• 1969: C. Keith Conners publishes the first Conners' Rating Scale, an assessment tool used to diagnose ADHD-like conditions.
• 1970: The Washington Post publishes a story reporting that 5% to 10% of school children in Omaha, Nebraska were receiving Ritalin or Dexedrine to control their behavior. The story creates controversy around the diagnosis of ADHD and the use of stimulants, especially since it implies that many parents are coerced into medicating their kids. However, the statistics only referred to kids in special-ed programs.
• 1970-1971: The Comprehensive Drug Abuse Prevention and Control Act of 1970 makes stimulants such as Ritalin (methylphenidate) Schedule III medications, then making them Schedule II medications in 1971.
• 1973: Section 504 of the Rehabilitation Act of 1973 allows students with ADHD (who qualify) to get additional assistance and services at school to help them succeed.
• 1975: An anti-Ritalin movement greatly expands as several new books reinforce the belief that ADHD isn't a real diagnosis, was created by drug companies to make money, or that hyperactivity is caused by food allergies and food additives.
• 1975: The American Academy of Pediatrics (AAP) publishes its first statement about ADHD, "Medication for Hyperkinetic Children," which says that in addition to "consideration of non-drug therapy in situations where such an approach is appropriate," that "there is a place for stimulant drugs in the treatment of hyperkinetic children."
• 1980: The third edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-III) includes attention deficit disorder for the first time, including the subtypes of ADD with hyperactivity, ADD without hyperactivity, and ADD residual type.
• 1981: Russell A. Barkley, PhD, writes his first of 17 books about ADHD: "Hyperactive Children: A Handbook for Diagnosis and Treatment."
• 1987: The DSM-III-R (revised edition) again changes the name of this condition, this time to Attention Deficit Hyperactivity Disorder (ADHD), but doesn't include any subtypes.
• 1987: The AAP publishes a report, "Medication for children with an attention deficit disorder," offering "indications for drug therapy in the treatment of attention deficit disorder." Drugs mentioned include Ritalin, Dexedrine, Cylert, and "other potentially useful drugs," including tricyclic antidepressants.
• 1993: Dr. Barkley begins publishing "The ADHD Report" newsletter.
• 1994: The fourth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-IV-TR) describes three types of attention deficit hyperactivity disorder (ADHD), including ADHD, combined type; ADHD, predominantly inattentive type; and ADHD, predominantly hyperactive-impulsive type.
• 1995: Joseph Biederman, MD, publishes one of the first of hundreds of medical studies about children with ADHD.
• 1996: An updated AAP report, "Medication for Children With Attention Disorders," stresses that drug therapy should be combined "with appropriate management of the child's environment and curriculum."
• 2000: The AAP publishes its first "Clinical Practice Guideline: Diagnosis and Evaluation of the Child With Attention-Deficit/Hyperactivity Disorder," offering clear guidance for pediatricians and parents on the assessment and treatment of kids with ADHD.
• 2002: Strattera, the first non-stimulant treatment for ADHD, is approved.
• 2007: Warning labels on ADHD medications are updated to include warnings about the possibility of cardiovascular risks (sudden death in children and adolescents with structural cardiac abnormalities or other serious heart problems) and risks of adverse psychiatric symptoms (hallucinations, delusional thinking, or mania).
• 2013: The publication of the "Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition" (DSM-5) changes the age of ADHD onset criterion by raising the age of the onset of symptoms and eliminating the requirement that the symptoms cause impairment.

ADHD Medication Timeline

Benzedrine was once thought of as heralding the modern era of ADHD treatment, but that role has likely now passed to the newer, once-a-day ADHD medications that most kids take.

Although it seems like a lot of differentADHD medicationshave been developed over the years, especially in the last ten years, most of them use the same basic active ingredients: methylphenidate and amphetamine/dextroamphetamine. These are ingredients that have been used since the earliest days of ADHD research.

Here is the history timeline that includes some of today's most common ADHD medications, like Adderall and Ritalin, as well as less common or older drug treatment options.

• 1937: Benzedrine (racemic amphetamine)
• 1943: Desoxyn (methamphetamine hydrochloride)
• 1955: Ritalin (methylphenidate)
• 1955-1983: Biphetamine (mixed amphetamine/dextroamphetamine resin)
• 1960: Adderall (mixed amphetamine/dextroamphetamine salts)
• 1975-2003: Cylert (pemoline)
• 1976: Dextrostat (dextroamphetamine)
• 1976: Dexedrine (dextroamphetamine)
• 1982: Ritalin SR
• 1999: Metadate ER (methylphenidate)
• 2000:Concerta(methylphenidate)
• 2000: Methylin ER (methylphenidate)
• 2001: Metadate CD (methylphenidate)
• 2001: Focalin (dexmethylphenidate)
• 2001:Adderall XR(mixed amphetamine salts)
• 2002: Ritalin LA
• 2002: Methylin (methylphenidate) oral solution and chewable tablet
• 2002: Strattera (atomoxetine)
• 2005:Focalin XR(dexmethylphenidate)
• 2006:Daytrana(methylphenidate patch)
• 2007:Vyvanse(lisdexamfetaminedimesylate)
• 2008: Procentra (liquid dextroamphetamine)
• 2009:Intuniv(guanfacine hydrochloride)
• 2010: Kapvay (clonidinehydrochloride)
• 2012: Quillivant XR (liquid methylphenidate)
• 2015: Dyanavel XR (amphetamine extended-release oral suspension)
• 2016:AdzenysXR-ODT (amphetamine oral disintegrating tablet)
• 2016: Quillichew ER (chewable methylphenidate)
• 2017: Mydayis (Triple-Bead MixedAmphetamine Salts)
• 2017:Cotempla XR-ODT (methylphenidate extended-releaseorally disintegrating tablets)
• 2019: Jornay PM (methylphenidate)
• 2019: Adhansia XR (methylphenidate)
• 2021: Azstarys (serdexmethylphenidate and dexmethylphenidate)
• 2021: Qelbree (viloxazine)
• 2021: Dyanavel XR (amphetamine extended-release oral tablets)
• 2022: Qelbree (viloxazine extended-release capsules)

Many of these ADHD medications, even the extended-release versions, are now available asgenerics. Generic ADHD medications are often available at a reduced cost.

Summary

While we have come a long way in our understanding of ADHD, researchers continue to explore the causes of the condition, seek additional treatments, and strive to understand how it affects people in different ways. As we learn more, additional treatments may emerge that can help both children and adults with ADHD.

By Vincent Iannelli, MD
Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.