ADHD - An Illustrated historical overview

"Brain damage" and behaviour disorder B etween 1917 and the late 1920s, encephalitis lethargica was an epi- demic and often lethal neurologic dis- ease. In adults, it typically elicited se- vere somatic effects, and in particular, various forms of cranial nerve and mo- tor dysfunction. In children, the psychi- atric effects were often as severe as the physical consequenc- es. Approximately one third of affected children underwent a rapid transformation from normal behav- iour to impulsiveness, emotional lability, precocious sexuality, self-mutilation, a ten- dency to wander, and delinquency, often to a degree requir- ing confinement in psychiatric or penal institutions. The on- set of the final and largest epidemic in 1924 caused a great deal of public and political concern caused by “a disease which makes criminals” ( The Times , London, August 20, 1924). Encephali- tis lethargica was cited in the defence of youths arraigned for various crimes during the 1920s, and its effect on adolescents was the subject of parlia- mentary debate and government en- quiries. Special institutes for the care of such children, with varying success, were established in various countries, including Germany, France, the United Kingdom and the United States. Many neurological and psychological theo- ries were advanced to explain these severe behavioural changes, and the therapeu- tic approaches em- ployed ranged from training in dedicated schools to frontal leu- cotomy. Neither intel- ligence nor memory were consistently im- paired in the disorder, but concentration and sleep were commonly affected: the children tend to be overactive through the night but slept through most of the day. Doctors also noted that although children suffering post- encephalitic psychiatric disturbances could exhibit the cruellest behaviour – for example, removing their own eyes or killing a sibling – they exhib- ited genuine remorse after the fact,