Attention deficit hyperactivity disorder has been around and known by different names since the early 1900’s when in the Boston area, the first child behavioral (psychiatric) established by the then family/child court system of Boston started to have to deal with behaviorally out of control, hyperactive [thought that term came into use later] children in sudden new higher numbers after World War I. Most medical historians feel that ADHD has always been with us but the time after WWI saw an increase in children who had unfortunately suffered mild brain damage from what was known then as “Von Economo’s Encephalitis.” This was the CNS manifestation of the “Spanish flu pandemic” that swept the world shortly before the end of WWI and through somewhere around 1920-1921. This was the first great known documented influenza pandemic and many books in the last 20 years have documented beautiful this pandemic as the modern scientific and public world began to become interested in infectious diseases, emerging diseases, largely set off the AIDS epidemic that rose to public awareness in the late 1970’s and especially the 1980’s.[ For the very best book on the start of the AIDS epidemic, the reader is referred exclusively to the now dated book AND THE BAND PLAYED ON by the late San Francisco newspaper reporter Randy Shilts.]
To explain what happened in the Spanish Flu pandemic, the influenza virus is capable in anyone of producing an “encephalitis,” a viral infection of the brain. Nowadays we are acquainted unfortunately with annual “equine encephalitis” outbreaks in various parts of the country. Any of these viral infections of the brain can cause real brain damage, paralysis, loss of virtually any brain function or capacity. Strikingly though, this viral outbreak that was part and part of the Spanish Flu pandemic produced as it were, “artificial,” causes of Parkinsonism by the thousands as an aftermath residual symptom of having the influenza brain viral infection. Patients young and old had the visible and even in those days nearly 100 years ago now, the tremors, halting gait, imbalance and slow gait of the adult Parkinsonism patient. But in the young people they seemed more likely to develop sudden hyperactivity, wild difficulties with impulse control, poor or absent concentration and focus. Sound familiar? They got into all kinds of behavioral, legal and delinquent behaviors and turned by the dozens, then hundreds, in the Judge Baker juvenile court, one of, if not the first of its kind in the country. The court and this jurist were wise and recognized that these were not criminal youth, but that something had altered them self-control and resulting behavioral styles drastically for the worse. It was a tough time as there was really NO treatment for this new avalanche of a patient cohort with a new condition not seen before. But that is likely the historical start of the recognition of ADHD. It came to be then appreciated in the school systems that there were other youths who had much the same behaviors, but who had NOT had the influenza nor Von Economo’s encephalitis. Thus, the concept of the “hyperkinetic” child started in the decades after World War I.