As early as 1932, German physicians Pollnow and Kramer noted a characteristic motor activity increase in children not accountable by current medical conditions of the day

German physicians Pollnow and Kramer noted a characteristic motor activity increase in children not accountable by current medical conditions of the day

As early as 1932, German physicians Pollnow and Kramer noted a characteristic motor activity increase in children not accountable by current medical conditions of the day (Lange, Reichl and Tucha, 2010). Also noted by the duo was that the behavior exhibited served no immediate purpose; it appeared the children were distracted by random stimuli and unable to focus (Lange et al. 2010). Though concentration on any activity was limited, these same children had the ability to immerse themselves for long periods of time if they were interested and engaged. They exhibited mood swings and frequent aggressiveness and disruption of their immediate environment; these factors cumulatively correspond to the Diagnostic and Statistical Manual of Mental Disorders (DSM) requirements for a diagnosis of ADHD: hyperactivity, inattention, and impulsiveness (Lange et al. 2010).      Through all its manifestations, in 1968 the disorder was incorporated into the DSM-II as “hyperkinetic reaction of childhood” with behavioral traits characterized by restlessness and attentional deficits (Lange et al. 2010). The DSM-III renamed it to Attention Deficit Disorder (ADD) with the addition or exclusion of hyperactivity and in its fourth incantation, the DSM-III-R, the hyperactivity subtypes were eliminated and the disorder was renamed Attention Deficit Hyperactivity Disorder (ADHD); if the hyperactivity was absent the diagnosis was “undifferentiated ADD”(Lange et al. 2010).      There exists no definable boundaries of what constitutes a disorder in the current DSM-IV (Stein, Phillips, Bolton, Fulford, Sadler and Kendler, 2010). Context plays a crucial factor when defining a “disorder”. Situational variables can and do contribute as to the validity of the diagnosis. Symptoms are presented on a continuum; there is no preset designation of “dysfunction”. Additionally, evaluation of symptoms is highly subjective; impulsive behavior exhibited on the playground can go unnoticed but might be construed as disruptive in the classroom. Thirdly, perceived dysfunction can be viewed differently according to the biological age of the child; at age two it can be viewed as “the terrible twos” (a developmentally accepted label in our US culture) but at age eight that same behavior can be regarded as impulsive and hyperactive and diagnosed as ADHD.      It is imperative that labeled disorders such as ADHD not be misclassified as separate distinct conditions when they may be nothing more than a range of symptoms on another disorder’s continuum, ie.bipolar or conduct disorder. Antisocial personality disorder and narcissism correlate highly with the hyperactivity exhibited in ADHD and borderline personality disorder has the greatest concurrence with all three symptoms associated with ADHD; hyperactivity, impulsiveness and inattention (Matthies and Philipsen, 2016).  There is a significant heritability factor between autism and ADHD; central nervous system development is believed to be affected; symptoms begin in early childhood and continue into adulthood (Matthies and Philipsen, 2016). Externalized disorders such as oppositional defiant disorder or conduct disorder  are found in approximately 50-70% of children diagnosed with ADHD (Armstrong, Lycett, Hiscock, Care and Sciberras, 2014). The same studies have confirmed roughly 64% of ADHD diagnoses suffered from internalized disorders including anxiety and depression (Armstrong et al. 2014). If externalized and internalized disorders are combined, it resulted in comorbidity rates of more than 22% (Armstrong et al. 2014). Clearly more research is needed to reevaluate and possibly reclassify the multitude of psychological “disorders” currently listed in the DSM. ADHD and its associated symptoms may meet the criteria as a subset of one or more of the diagnostic conditions mentioned above and not a “real” disorder classification on its own

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