Early Descriptions of Inattention and Hyperactivity

Some of the oldest-known accounts of individuals appearing to exhibit some ADHD-like symptoms were made in the 18th, 19th, and early 20th century, starting with Sir Alexander Crichton’s description of “mental restlessness” (Lange, Reichl, Lange, Tucha, & Tucha, 2010; Palmer & Finger, 2001). The observations and descriptions provided by Crichton, Heinrich Hoffmann, and Sir George Frederic Still did not provide diagnostic criteria for any named disorder, but they are important early mentions of inattentive and hyperactive behavior.

Sir Alexander Crichton and Inattention (18th Century)

According to Palmer and Finger (2001) and Lange et al. (2010), Sir Alexander Crichton was the first to describe features like those found in the primarily inattentive subtype of ADHD. Crichton was born in Scotland in 1763, in the city of Edinburgh (Lange et al., 2010; Palmer & Finger, 2001). His academic career would later take him to the Netherlands, where he studied medicine at the University of Leiden (Lange et al., 2010; Palmer & Finger, 2001). He earned his M.D. there in 1785, and afterwards he spent some time traveling through Europe on a medical tour of different hospitals (Lange et al., 2010; Palmer & Finger, 2001).

Sir Alexander Crichton (1763-1856) was among the first to describe abnormal distractibility and inattention in medical terms. / Image from “The Languages of Psyche,” from UC Press E-Books Collection.

Following his return to the U.K., Crichton practiced surgery and then medicine in London (Palmer & Finger, 2001). Eventually his interests turned to matters of mental health and mental illness, and he published his observations on these topics in his book, 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, which was published in 1798 (Palmer & Finger, 2001).

Crichton’s Inquiry includes a description of attention problems within a chapter of the book titled On Attention and its Diseases (Palmer & Finger, 2001). In this section, Crichton writes of individuals exhibiting “the incapacity of attending with a necessary degree of constancy to any one object” (1798, cited by Lange et al., 2010). Crichton also states that, for these people, “every impression seems to agitate the person, and gives him or her an unnatural degree of mental restlessness” (1798, p. 272, cited by Palmer & Finger, 2001).

While hyperactivity is not mentioned, the other factors Crichton describes seem to fall in line with some of the current criteria for ADHD relating to inattention, including distractibility and early onset of the symptoms (Lange et al., 2010). On top of that, the Inquiry also speculates on the potential causes of this inattentive behavior and the role it plays throughout the life span, as well as the effect it can have on children’s performance in school (Lange et al., 2010; Palmer & Finger, 2001). Crichton’s medicalization of abnormal distractibility and inattention and his recognition of its impact on the patient’s quality of life served as a crucial first step on the road to defining and diagnosing ADHD.

Heinrich Hoffmann and “Fidgety Phil” (19th Century)

Born in Germany in 1809, Heinrich Hoffmann was a physician who later moved into the realm of psychiatry (Lange et al., 2010). Throughout his adult life he worked as an obstetrician, worked in a mental hospital, became a psychiatrist, and eventually founded his own psychiatric hospital (Lange et al., 2010).

However, it is a children’s book that he wrote that makes him relevant to the history of ADHD (Lange et al., 2010). First published in German in 1845 with great success, “Struwwelpeter” was a collection of stories and pictures that Hoffmann originally created as entertainment for his own young son (Lange et al., 2010). One story in the book, “Zappelphilipp” (or “Fidgety Phil” in the English translation), describes a young boy that seems to exhibit ongoing symptoms of hyperactivity and restlessness (Hoffmann, 1848). He regularly has difficulties remaining still at the dinner table, much to the displeasure of his frustrated parents (Hoffmann, 1848).

fidgety phil

An illustration of “Fidgety Phil” from Heinrich Hoffmann’s story, which portrays a child with what appears to be symptoms of hyperactivity and inattention. / Image from Project Gutenberg.

In the following excerpt from the story, Hoffmann (1848) describes some of Phil’s behavior during supper:

But fidgety Phil,
He won’t sit still;
He wriggles,
And giggles,
And then, I declare,
Swings backwards and forwards,
And tilts up his chair.

Although the boy is never described as having a disorder, Lange et al. (2010) state that the symptoms exhibited by Phil in Hoffman’s story appear to match with some descriptions of criteria for ADHD as published in the DSM-IV-TR, including difficulties obeying instructions and paying attention when spoken to (Phil ignores his father’s order to behave) and a tendency to fidget and squirm while sitting. Of course, “Zappelphilipp” may simply be an amusing story about an unruly child, but it is still interesting to consider Phil’s behavior from a psychological perspective, especially considering Hoffmann’s experience as a psychiatrist.

Sir George Frederic Still and “Moral Deficiency” (Early 20th century)

Sir George Frederic Still’s contribution to ADHD history is his description of a “defect of moral control” in certain children, which he discussed in a series of lectures in 1902 (Lange et al., 2010; O’Brien, 2006). Still was born in a borough of London in 1868, and as an adult he worked as a professor and a pediatrician (Lange et al., 2010; O’Brien, 2006). He accomplished notable “firsts” in both areas: he was the first professor of pediatrics in England (Lange et al., 2010; O’Brien, 2006) and he was the first doctor specializing full-time in pediatrics to work at the Great Ormond Street Children’s Hospital in London (O’Brien, 2006). “Still’s Disease,” which he described as “a form of chronic joint disease in children” (Still, 1897, cited by O’Brien, 2006) was named for him (Lange et. al, 2010; O’Brien, 2006).

Still delivered his Goulstonian Lectures at the Royal College of Physicians in London, where he mentioned non-developmentally delayed, physically healthy children who exhibited difficulties in controlling “immoral” behavior (Lange et. al, 2010; O’Brien, 2006). The behavior of these children, according to Still, was characterized by the following factors: “(1) passionateness; (2) spitefulness—cruelty; (3) jealousy; (4) lawlessness; (5) dishonesty; (6) wanton mischievousness; (7) shamelessness—immodesty; (8) sexual immorality; (9) viciousness” (1902, p. 1009, cited by O’Brien, 2006). Perhaps the symptom most relevant to the ADHD diagnosis is “passionateness,” which O’Brien (2006) and Lange et al. (2010) clarify as a difficulty controlling emotional expression and impulsiveness; children with ADHD may be prone to emotional outbursts and impulsive behavior (Lange et al, 2010). Futhermore, according to Lange et al., Still went on to describe ADHD-like attention difficulties in some of the children he studied, which created problems for the child in school.

Sir George Frederic Still spoke about children exhibiting “moral deficiency” during a series of lectures at London’s Royal Academy of Physicians in 1902. / Image (c) ADHD Center on Flickr

While many of the criteria for Still’s lack of moral control in children do not match those needed for an ADHD diagnosis (and in fact seem to indicate personality disorders instead), his mention of impulsiveness and inattention do seem to be relevant to ADHD and therefore worth noting in our discussion of the disorder’s history.

Leave a Reply