Renaming ADHD - What's in a Name?

ADHD has a long history of not quite fitting in with the cool kids of psychology like depression, delusional parasitosis, and the Oedipus complex. The problem has been that no one has been certain what its criteria were. Now there's talk of a new name. What does it all mean?

In 1798, Dr Alexander Crichton, royal physician to the tsar of Russia and famous collector of foreign minerals as well as books with very long names, wrote of children who were "incapable of attending with constancy to any one object of attention." He labeled this Mental Restlessness Disorder.

One hundred and four years later, Sir George Still identified cases of impulsive children in England and labeled them with a disorder known as Defect of Moral Control. There may have been cases identified prior to this time, but the physicians likely had Mental Restlessness Disorder and never got around to transcribing their notes off of napkins and the backs of tavern receipts.

In the Roaring 20s, fidgety kids who couldn't sit still long enough to transcribe Huckleberry Finn into cursive were labeled with Post-Encephalitic Behavior Disorder, apparently because they behaved poorly after their brain stems were inflamed. Instead of cold compresses, however, psychiatrists soon began administering amphetamines to the rowdy kids with some degree of success. By the late 1930s, the term "hyperkinesis" had crept into the vernacular to describe the condition - which was then defined as hyperkinetic impulse disorder.

Minimal Brain Dysfunction became all the rage in the 1960s to describe the condition, but Hyperkinesis won out, most likely because it was already in use, described the condition more accurately, and parents threatened to give the the psychiatrists a wedgie if MBD was ever used in their presence again.

Modern Day Definition of ADHD

In 1980, the American Psychiatric Association coined a term in the Diagnostic and Statistical Manual of Mental Disorders we are familiar with today: Attention Deficit Disorder. This addressed the crux of the problem in that children with ADD had a hard time concentrating on things that didn't interest them, but the label also described most children who had a hard time concentrating on things that didn't interest them.

Several revisions later, we have the DSM-IV, published in 1994, which states a patient must have demonstrated at least six out of nine symptoms of inattention, hyperactivity, and/or impulsivity prior to age seven in order to be diagnosed with attention deficit and hyperactivity disorder (AD/HD). Or is it Attention Deficit Hyperactive Disorder (ADHD)?

There is some degree of confusion over whether to include the slash or not. Battle lines have been drawn across the Internet and on couches around America. I, myself, have had a Twitter rumble over the subject. There was blood drawn. I was even blocked. I know. It was serious. Most people leave off the slash because it's easier to type, but is it the correct thing to do? Thankfully, there will be a DSM-V in 2013 which will part the contentious sea of confusion and lead us all to a promised land of unified labeling.

Then I read about the DSM-V, that the label ADHD or ADD may even go away, or at the very least, change meaning." Now what will we fight over?

Fears of a new version of Minimal Brain Disorder aside, there will be some benefits to clarifying the criteria, especially since hyperactivity is not found in all children with ADHD. Still, concerns of the age of onset or reducing the amount of criteria to qualify for the ADHD diagnosis don't address some major flaws with the existing criteria—namely that attention deficit isn't exactly the problem. Or the fact that there is no mention of impulsivity or hyper focus in the description.

It seems that the name they use will once again fail to explain what the disorder is all about, leaving the field open for critics to condemn the disorder by its vague label as they've been doing for decades. With that in mind, may I make a few name suggestions?

Perhaps Variable Attention Disorder might be more descriptive. Or maybe Attention inconsistency disorder? Focus impulse disorder? Attention disaster disorder with wiggles? This is harder than it looks. It's a good thing they've got another three years to work it all out.