Who Put the 'H' in AD/HD? Trivia Quiz

Answer: The Story of Fidgety Philip

Heinrich Hoffman (not to be confused with Heinrich Hoffmann, friend and photographer to Adolf Hitler) was a Frankfurt general practitioner who wrote several books on psychiatry and medicine. The poems he wrote for his 3-year-old son (later collected as 'Der Struwwelpeter') were intended as bed-time stories, but it's doubtful they would find a place next to the beds of contemporary children.

'The Story of Fidgety Philip' (also variously rendered as Phillip and Phillipp) begins:

""Let me see if Philip can
Be a little gentleman;
Let me see if he is able
To sit still for once at table":
Thus Papa bade Phil behave;
And Mamma looked very grave.
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,
Just like any rocking horse--
"Philip! I am getting cross!""

Philip's wild behaviour increases until he ends up on the floor with everything from the dinner table on top of him. His parents look on in despair, wondering how they will possibly eat their supper now.

Fidgety Phil is one of the more fortunate children in Hoffman's tales. In 'Little Johnny Head-in-Air' (which has also been suggested as descriptive of AD/HD) Johnny's vagueness sees him end up losing his writing-book after he falls into the river. But at least Johnny survives; not so fortunate are the title characters in 'The Story of Augustus Who Would Not Have Any Soup' (who starves to death) and 'The Dreadful Story of Harriet and the Matches', the latter telling us:

"So she was burnt, with all her clothes,
And arms, and hands, and eyes, and nose;
Till she had nothing more to lose
Except her little scarlet shoes;
And nothing else but these was found
Among her ashes on the ground."

Answer: Brain injury

Sir George is best known for his work in identifying the form of childhood arthritis which bears his name (Still's Disease). He was the first Professor of Paediatrics at King's College, Oxford, and was instrumental in the formation of the British Paediatric Association in 1928.

Sir George was the first to suggest that the series of symptoms now known as AD/HD had a physiological rather than purely psychological basis. Even so, it has taken many years for the medical profession and society as a whole to realise that AD/HD is not simply 'bad behaviour' which can be blamed on inept parenting or the individual's lack of self-control.

Answer: Encephalitis

'Post-encephalitic behaviour disorder' included symptoms of hyperactivity, anti-social behaviour, and sometimes violence. It was ultimately determined that the brain damage sustained by encephalitis survivors was more severe than in AD/HD, with such conditions as epilepsy and paralysis often eventuating.

While there are some types of brain injury which will cause similar symptoms, AD/HD more typically occurs 'spontaneously'. That is, it occurs in the absence of injury or other disease.

Answer: Stimulants

While other drug therapies are sometimes used, stimulants have been the drug of choice for treating AD/HD for many years. American paediatrician Charles Bradley (1902-1979) was the first to experiment with the use of stimulant medication in the treatment of children with AD/HD. Like so many medical breakthroughs, his discovery of the efficacy of the stimulants was accidental, as he was actually trying to treat the children for headaches.

As a thorough diagnostician, Bradley ran a full battery of tests on his young patients, including lumbar punctures (extraction and testing of spinal fluid).

Many of the children experienced headaches after these tests, and Bradley assumed the cause to be loss of spinal fluid. He reasoned that the stimulant benzedrine would spark production of spinal fluid, and thus cure the headaches.

It didn't. However, the children's teachers noticed that some of their pupils' schoolwork was markedly improved after taking the stimulant. The children also noticed the improvement, and dubbed the drug 'arithmetic pills'.

Answer: False

While there is little doubt that AD/HD has a physiological basis, a definitive cause is yet to be found. Current (as of May 2005) research is progressing under four general categories: Genetic, Chemical, Anatomical and Functional. An overview is available at http://www.dummies.com/WileyCDA/DummiesArticle/id-2755,subcat-MIND.html

Answer: Impulsivity

The 'bible' of psychiatry and psychology is published by the American Psychiatric Association (APA). The "Diagnostic and Statistical Manual of Mental Disorders" (DSM) is regularly updated; the latest version being the fourth (DSM-IV), released in 1994. (The DSM-V is due for publication in 2011, at the earliest).

The DSM-IV lists nine types of 'Inattention', and nine of 'Hyperactivity-Impulsivity' (six of 'Hyperactivity' and three of 'Impulsivity'). A diagnosis of AD/HD requires (among other things) persistence for six or more types in at least one category to be present for at "least 6 months to a degree that is maladaptive and inconsistent with developmental level". The full text is at http://www.psychologynet.org/dsm.html

Answer: 3

The DSM-IV defines three types of AD/HD:

Combined Type (elements of Inattention, Hyperactivity and Impulsivity)
Predominantly Inattentive Type
Predominantly Hyperactive-Impulsive Type

This shows that not all people with AD/HD are necessarily hyperactive, which may surprise some people. Also somewhat surprisingly, the term 'hyperactivity' was only added to the name relatively recently. In the DSM-III (1980), the disorder was known as ADD, and was later changed to ADHD in the 1987 revised addition (DSM-III-R). ADD is still used by many people to describe the condition.

While the addition of 'hyperactivity' might make the name more accurate, it removes the possibility of a whole range of terrible puns. Lost are such appropriate and descriptive terms as ADDled, member of the ADDams Family, value ADDed, and full of twADDle. If anyone can come up with an English word which includes 'adhd' in order and without other letters in between, please let me know!

Answer: Dopamine

Neurotransmitters are the chemicals which pass messages around the brain. The basic idea is that norepinephrine affects attention and distractibility, while dopamine relates to impulsivity and other behavioural problems.

There's some interesting stuff on this at http://www.enotalone.com/article/4121.html

There is masses of information available on AD/HD, but I am yet to find an organisation which has taken on the obvious poster-girl. One day I might even draw Nora Drenaline...

Answer: False

While symptoms of AD/HD do abate in some people as they grow older, for most it is with them for life. One of the aspects of the disorder which is often overlooked is indicated in the DSM-IV requirement that symptoms exist "to a degree that is maladaptive and inconsistent with developmental level".

The problem areas of AD/HD are aspects of 'normal' human behaviour, but are lacking or exaggerated to a degree which impacts negatively on everyday life.

Answer: Queen Victoria

The list of those who show signs of AD/HD, but may not necessarily have been formally diagnosed, makes interesting reading. The most comprehensive list I've found is at http://www.adhdrelief.com/famous.html

I was particularly pleased to see my favourite author, John Irving, on the list. There are plenty of other creative types, also athletes, entrepreneurs, politicians and scientists. The lists are generally designed to point out to people with AD/HD - children, in particular - that it needn't hold you back. This is admirable, but it is also important to remember that most people dealing with this and other mental or neurological impairments are everyday schlubs who just want to live as 'normal' a life as possible.

I hope this quiz has shed a little light on a subject which is obviously close to my heart. Oh, and if you weren't paying attention, the answer to the question posed in the title is 'The APA put the 'H' in AD/HD'. The jury is still out on who stole the cookies from the coo-coo-cookie jar, and I am personally resigned to never finding out who put the bomp in the bomp bah bomp bah bomp. But there's nothing wrong with a little mystery in life!