ADHD and its medications: An Illustrated History Over Timeby Eric Konofal MD, PhD.Foreword by Dr. Thomas E. Brown.Book available to be sold in February 2019.This book is the English translation of the book initially published in French*.

It is the first book totally devoted to the historyof ADHD, encompassing the literary, philoso-phical, medical, neuropsychological and thera-peutical aspects of attention, hyperactivity andADHD, with more than 400 illustrations and500 bibliographic references.

THE FOUR DOMAINS ANALYZED IN THE BOOK ARE:

Philosophy and Theoric PsychologyFrom the first definitions of attention from philosophers tothe modern concept of ADHD centered on attention deficit.

The ClinicAn extensive children's literature describe mischievious,

fidgetty, absent-minded, agitated children from the beginning of 19th century. Later, with generalization of school,pediatrician, psychiatrists, and educators try to find the causes of education failure: They recognize the crucial roleof attention in education and define better educational methods and conditions to improve it. They identify childrenwith cognitive impairment separately from those who show «unstable» behavior. Attention deficit was finally reco-gnized as the central problem of «agitated children», leading only a few decades ago to the concept of ADHD. Howeverdescription of typical ADHD cases can be found in the medical literature from the beginning of 19th.

TreatmentsFrom very long time, some medicines have been prescribed for their «stimulant» effect. The principe of activatingthe body or the mental strength as whole can be found in every pharmacopoeia in the history. Nowadays, methyl-phenidate, the most popular treatment against attention deficit, has over 70 years of use. Future treatments will pro-bably be found in relation with sleep disorders.

Physiology of the AttentionThat was a main domainof the experimental psy-chology at its beginning.

Cli

nic

lll TABLE OF CONTENTS lll

1110

lll TABLE OF CONTENTS lll

PHILOSOPHYAND THEORICPSYCHOLOGY

CLINIC PHYSIOLOGY

Contemporary issues about Attention Deficit Hyperactivity Disorder

Evolution of diagnostic criteriaand the birth of

psychiatric classifications

The use of stimulantsfor attentional and behavioral

illnesses

Evolution of the concept of attention disorder and child hyperactivity

CPsychomotor agitation in turbulent children

llForms of instability and inattention

and their treatments

Psycho-physiologyof attention

First experimentalresearches on attention

Hygienism and poisoningin children’s nervous diseases

iccAttentional pathologies and nervousness:causes and cures

Psychology of attention and childhood education

Tonics and stimulants used for illnesses of the mind

Inattentive and agitated children

14

Psychology of attention Psychology of attention and childhood educationPsychology of attention Psychology of attention and childhood educationand childhood educationand childhood education

4

8

psychiatric classificationspsychiatric classificationspsychiatric classificationspsychiatric classificationspsychiatric classificationspsychiatric classificationspsychiatric classificationspsychiatric classifications13

Tonics and stimulants used Tonics and stimulants used 3

in children’s nervous diseasesin children’s nervous diseases

6

7

Attentional pathologies Attentional pathologies Attentional pathologies 5

9

2

10

Evolution of the concept

and child hyperactivityand child hyperactivity

Evolution of the concept

and child hyperactivityand child hyperactivity

12for attentional and behavioralfor attentional and behavioralfor attentional and behavioralfor attentional and behavioralfor attentional and behavioralfor attentional and behavioral

innilForms of instability lForms of instability lForms of instability Forms of instability

iiPsycho-physiologyof attention

Psycho-physiologyof attention

Psycho-physiologyPsycho-physiologyPsycho-physiologyPsycho-physiologyof attentionof attentionof attention

Attention during the times of philosophers and alienistsAttention during the times of philosophers and alienistsAttention during the times Attention during the times Attention during the times Attention during the times of philosophers and alienistsof philosophers and alienistsof philosophers and alienistsof philosophers and alienists

1

Psychology of attention Psychology of attention

of philosophers and alienistsof philosophers and alienistsof philosophers and alienistsof philosophers and alienists

TREATMENTS, MOLECULES

for attentional and behavioralfor attentional and behavioralfor attentional and behavioral

11

*ReferenceEric Konofal

Histoire illustrée de l'hyperactivité. Le TDAH et ses traitements

au fil du temps. Impulsion Naturelle, Vauhallan,

sept. 2017. 240 p.ISBN: 978-2-9544013-2-4

Eric Konofal ADHD and its medications:

An Illustrated History Over Time. Foreword by T.E. Brown.

Trans. D. Dolitski. Impulsion Naturelle, Vauhallan,

feb. 2019. 240 p.ISBN: 978-2-9544013-3-1

39 euros - 44,5 USD

An Illustrated HistoryOver Time

Éric Konofal, MD, PHD

unruly pupil, who never manages to do whatshe is told (Brun, 1856).

Idiot and unstable childrenBelhomme’s observations concerning idiocyare considered to be the first in the history ofchild psychiatry (Belhomme, 1842). When inthe idiocy ward, under Esquirol’s supervision,Jacques-Étienne Belhomme wrote the veryfirst book on child idiocy, not only a book but a thesis he defended that very year.Belhomme, by working on education for the“mentally retarded” and a way to improve the intellectual capacities of idiot children,entered history as the father of child psycho-pathology.

35

These illustrations, referred to as Épinal prints,often ironic and slightly naïve, were used to teach children the consequences of their mistakes and acts of disobedience and havegreatly contributed to moral education(Catelin, 1874).

Attention.

To listen is to hear,Either words, or a soundSpreading in the air;To prove that you are sound.

To be Attentive is to understand;It’s to take in with a strong mind,To compare, to judge, to learn where you standWhen your will decides to bind.

Adrien Linden, who might have been in-spired by Georges Sand, or maybe as a simpletribute, introduced Mademoiselle Lucie, a littlegirl just as curious and turbulent as herbrother Georges le distrait (Georges theabsent-minded; Linden, 1869) to French lite-rature. Les grands défauts de nos petites filles(The big faults of our little girls) is a book pu-blished in 1880 aimed at children. Its authortells the story of the young Jeannette whoalways makes a mess of everything: “Shegoes, she runs, she rummages about, shehurries.” (Guillotin, 1880) The most importantpoint here is that girls are not forgotten. Therewere also Suzanne the reckless or even Rose,a reckless, disobedient and agitated little girl,yet another touche-à-tout child presented byAlice Cruppi in the book Touche-à-Tout, sestragiques mésaventures (Touche-à-Tout’stragic stories; Cruppi, 1928).

Some of these girls are also dirty such asMademoiselle Sans-Soin (Macé, 1867),Sidonie la petite Sans Soin (an Épinal print in1885), Juliette Sans Soin (anonymous, 1904),and Mademoiselle Marie Sans-Soin (Bertall,1867). All of them are charming little girls, butthey are also incredibly messy and do not take

lll INATTENTIVE AND AGITATED CHILDREN lll lll INATTENTIVE AND AGITATED CHILDREN lll

34

care of their belongings. Such is the case forSidonie who would lose her gloves, her para-sol, her hat and anything else she uses.

Juliette on the other hand is “a kind girl, niceand lovely, whom everyone liked because ofher bright personality. But sadly, she was com-pletely disorganized. If one would open herlocker, they would find such an incrediblemess comprised of books and notebooks thatthey would believe that it had been used by adozen little puppies.” (anonymous, 1904)

After discussing touche-à-tout and messychildren, those who fumble should also bementioned”, such as Lili the fumbler: “Seelittle Lili, she has once again disregarded therules; She spilled a pitcher of milk on herbeautiful dress, what a naughty little girl; shelistens to no one and touches everything.”(Gilbert and Morel, 1876). Chatterboxes canalso be mentioned (Bertall, 1873; Stahl,1869); they are often reckless, badly behavedor unruly such as Jeanne, also known as the

Using Frédéric Dubois d’Amiens’s classifi-cation, Belhomme presented a category ofchildren which he separated from idiots who,according to Dubois d’Amiens, suffer from amental affliction. The children presented by

other quinquina-based preparations, such asgeneral stimulants (Orillard, 1862).

Child medical science first appeared duringthe 19th century. Jacques-Joseph Grancherbeing one of the most important doctors atthe “Hôpital des Enfans Malades” during theend of the 1800’s.

At that time, child health had become a majorsocial issue. The Napoleonic wars had destro-yed the men most likely to have children andit had become important to preserve the livesof the few children there were. Cures againstchild weakness or simply to prevent domesticaccidents thus abounded. In the thesis hepresented for the agrégation (the exam tobecome a professor in French medicalschools), Grancher declared that it was impor-tant to strengthen sick children by givingthem tonics or nutrition modifying agentswhich could have invigorating physiolo-

g ica l act ions( G r a n c h e r ,1 8 7 5 ) . Thus,thanks to hima s w e l l a sothers, analep-tics and tonicsbecame widelyu s e d , w h i l eduring the pre-vious century,their usage was

rather modera-te and they were only usedfor moronic and asthenic cases (Sydenham,1733).

47

can be used with any patient. More thanany other, iron was considered as “thespecial analeptic tonic that works wherequinquina and al l the others do not.”(Grancher, 1875)

Ferrous preparations come in many kinds andsometimes, even very improbable combina-tions like iron hydrocyanate which can beused against epilepsy, certain kinds of neuro-sis or states of agitation (Fabre, 1853).

Blaud’s pills, Vallet’s pills, Gélis et Conté sugarpills (iron lactate), and Colmet-d’Aage’s fer-rous chocolate have many therapeutic usesfor children (Vanier, 1841). They were used for

instabilities and weak states seen in mentallyretarded people who do not seem languid orwith any lymphatic symptoms, but, on theother hand, do act nervously (Guersant, 1864).

The use of natural tonics, strychnine sulfate-based syrups, or even quinine sulfate wasaccepted by the medical community. It seems

46

lll TONICS AND STIMULANTS USED FOR ILLNESSES OF THE MIND llllll TONICS AND STIMULANTS USED FOR ILLNESSES OF THE MIND lll

rather modera-te and they were only usedrather modera-te and they were only used

Hôpital des Enfans Malades.

there was less of a distinction between tonicsand stimulants; but nonetheless, where men-tal illnesses are concerned, tonic infusionswere more often used to stimulate the child’sorganic forces and stimulant infusions wereused to help with chronic choreic agitation orinstabilities in the child (Trousseau and Reveil,1951; Reveil,1863).

Reveil believes it necessary to reanalyze Trea-tise on Therapeutics written by Trousseauand Pidoux (1839) which categorizes toge-ther all tonics that affect a single organ or canbe used as special stimulants as well as thoseused for defervescent purposes and nervouspurposes, including nevrosthenical and all

written by Trousseauidoux (1839) which categorizes toge-

ther all tonics that affect a single organ or can

as well. Piorry had a

lready mentioned this clo-

se relationship betw

een breathing and m

ental

development, sayin

g that “thoughts ar

e not

quite as clear and

cerebral developm

ent is

more difficult when the n

ostrils are not emp-

ty.” (Piorry, 1841) Ern

est Monin mentioned so-

me similar observations w

hen looking for

“adenoid tumors prese

nt within apathetic, la-

zy or inattentive ch

ildren whose intellectual

depression had no

other cause.” In tho

se ca-

ses, their memory and, e

ven more so their at-

tention, were apath

etic: “The child bec

omes

retarded, a poor,

inert being insensi

tive to

stimulation, a stupid an

d stubborn dunce

.”

(Monin, 1905)

This concept of chi

ldren who are “inattentive

because of breath

ing problems” has be

en

used in all treatise

s on infantile patho

logies.

Picot treats it importantly

in his work Traité

des maladies de l’enfan

ce (D’Espine and

Picot, 1899).

Aprosexia is often n

oticed in ozenous c

hild-

ren. Rhinoscopic exa

ms among those presen-

ting an attention de

ficit or showing signs

of

intellectual laziness

often show lesions in

the

pharyngeal mucous membrane with effects

on the inferior nasa

l concha.

Their atrophic rhini

tis is such that it lea

ds to

blocking the nasal d

ucts. Maurice Boulay gave

such an example in his

work Traité des mala-

dies de l’enfance (1897).

Aprosexia can also

originate from a disorde

r

in the auditory syste

m, as Titeff had noted,

in subjects showing signs o

f “very thick” pha-

ryngeal adenoid (T

iteff, 1896). Titeff

later

added that many othe

r authors (Tröltsch

,

Ruprecht, Michel, Hac

k, Elsberg) had alre

ady

mentioned psycho-in

tellectual disorders

link-

ed to the auditory s

ystem. On the subject of

child surdity Titeff sa

ys, “Even lesser dea

fness,

when present since c

hildhood, will have so

me

influence during on

e’s whole life. Not only is

it difficult to give th

ese children the ha

bit of

focusing their atten

tion but the lack of p

sychic

stimulation, generally c

reated through hea

r-

ing, make it often quite di

fficult to have well

organized thoughts

.” (Tröltsch, 1862)

The term “aprosexia” was also us

ed to des-

cribe attention diso

rders or attention d

eficit

due to neurosis befo

re a broader term, neura-

sthenia, appeared a

nd replaced it.

This term is defined

by Charles Robert R

ichet

(1895) thusly, “Atten

tion is slow, hard to fo

cus,

and is accompanied by

all kinds of pain; It o

nly

lasts a short amount of ti

me and only yields

incomplete and insufficie

nt results. These

characteristics are e

specially noticeable

when

the person is readi

ng. The patient is a

ble to

read out loud, which means he d

oes not lack

sensations. He can

even sometimes recite

what he read more or le

ss perfectly, this

means he does not la

ck memory. And even

then, he does not u

nderstand the meaning of

the paragraphs he

just read. He reads

French

in the same way as he w

ould read a foreign

language. He und

erstands each ind

ividual

77

According to Guye,

aprosexias were cause

d

by “circulatory pro

blems which prevent the

blood from flowing into th

e areas of the brain

where the individual’

s special faculties a

re lo-

cated.” That definiti

on was used in the Nou-

veau dictionnaire e

ncyclopédique univ

ersel

illustré published by Jules

Trousset, a very

popular encycloped

ia at that time (Trousse

t,

1885-1891). This le

ads to the deductio

n that

any nasal obstruct

ion can bring abou

t inat-

tention and by elim

inating that obstru

ction,

it is often possible

to eliminate the aprosexia

76

lll ATTENTIONAL PATHOLOGIES AND NERVOUSNESS: CAUSES AND CURES lll

lll ATTENTIONAL PATHOLOGIES AND NERVOUSNESS: CAUSES AND CURES lll

(Monin,

cept of children who are inini a

blems” has been Ruprecht,Mic

tioned ps

unruly pupil, who never manages to do whatcare of their belongings. Such is the case for

lll HYGIENISM AND POISONING IN CHILDREN’S NERVOUS DISEASES lll

95

For Contet, good hygiene started during preg-nancy, which would be logically followed byefficient breast-feeding, and then late andprogressive weaning while preventing thenursemaid from any alcoholic poisoning.Children were to be protected from any kindof poisoning that could affect their nervoussystem.

Among the most common poisoning causing“hyperactivity” and moronity, let us mentionlead. Lead was, indeed, one of the most com-mon causes of poisoning among children.“Tonic medication” (based on meat, iron, andquinquina) was recommended to fight leadpoisoning, which was very common amongunstable idiots (Chevalier-Lavaure, 1890).

In order to treat those “unstable idiots” orthose who became alienated through “poiso-ning”, various therapeutic options seemedviable. Among the different medical treat-ments for nervous diseases of that time,Contet distinguished “tonic and energy-restoring medications (restoring medicine andanaleptics)” which mainly included iron,arsenic, phosphorus, bitters and alcohols(Contet, 1903). Thanks to him, the regulatorsof nervous action appeared in therapeutic for-mularies. Among the most important wereiron salts, quinine, quininics (cinchona, quin-quina) for which the main objective was stillto treat agitation (due to poisoning) and ner-vousness (Virès, 1902).

It was then commonly accepted to use iron salts, be it to treatnervous afflictions or anemicstates (chlorotic neuralgias,puberty-related nervous trou-bles). Iron salts were also of interest as theyhe l p ed to trea-ting lead p o i s o -ning.

94

lll HYGIENISM AND POISONING IN CHILDREN’S NERVOUS DISEASES lll

4

It was then commonly accepted It was then commonly accepted to use iron salts, be it to treatnervous afflictions or anemicstates (chlorotic neuralgias,puberty-related nervous trou-bles). Iron salts were also of interest as theyhe l p ed to trea-ting lead p o i s o -ning.

It was then commonly accepted o use iron salts, be it to treatto use iron salts, be it to treatnervous afflictions or anemicstates (chlorotic neuralgias,uberty-related nervous trou-puberty-related nervous trou-bles). Iron salts were also of bles). Iron salts were also of bles). Iron salts were also of interest as theyhe l p ed to trea-he l p ed to trea-he l p ed to trea-ing lead p o i s o -ing lead p o i s o -ing lead p o i s o -ting lead p o i s o -ning.ning.

4

Thus the mid-19th century wasmarked by hygienists, thosepioneers of public health, as well as societal and medical in-fluences. Gélineau, Monin andBrissaud were some of the greatnames in neurology who focusedon nervous hygiene and foundthat nervous disorders appearwherever there is a lack ofmental hygiene.

Alcohol and lead were known tobe the causes of those mental di-seases, and ferrous tonics to curethem. The work carried out bySéglas, Mabille and Becquerel allpointed toward a new aspect; theexcess of urea in the blood.

These hygienists have in com-mon the notion that eliminatingureic acid can help treat somemental disorders. The era ofchemical medication was born.Piperazine and the first varia-tions of piperidine had been dis-covered.

he l p ed to trea-interest as they

uberty-related nervous trou-states (chlorotic neuralgias,nervous afflictions or anemico use iron salts, be it to treatIt was then commonly accepted o use iron salts, be it to treatnervous afflictions or anemicstates (chlorotic neuralgias,uberty-related nervous trou-bles). Iron salts were also of interest as theyhe l p ed to trea-ing lead p o i s o -

It was then commonly accepted

bles). Iron salts were also of

ing lead p o i s o -

It was then commonly accepted o use iron salts, be it to treatnervous afflictions or anemicnervous afflictions or anemicstates (chlorotic neuralgias,states (chlorotic neuralgias,states (chlorotic neuralgias,uberty-related nervous trou-uberty-related nervous trou-bles). Iron salts were also of interest as theyinterest as theyhe l p ed to trea-he l p ed to trea-ing lead p o i s o -

interest as theyhe l p ed to trea-ing lead p o i s o -he l p ed to trea-ing lead p o i s o -

The AuthorDr. Eric Konofal(MD, PhD) is a French physicianand researcher, specialist ofsleep and ADHD. He practices inRobert-Debré pediatric hospitalin Paris. He published numerousstudies on sleep and ADHD es-pecially about the role of irondeficiency in ADHD, and the cli-nical efficacy of awakening me-dications. He filed patents fortreatments in ADHD.

other quinquina-based preparations, such asgeneral stimulants

Child medical science first appeared duringentury. Jacques-Joseph Grancher

eing one of the most important doctors atthe “Hôpital des Enfans Malades” during theend of the 1800’s.

At that time, child health had become a majorocial issue. The Napoleonic wars had destro-yed the men most likely to have children andt had become important to preserve the livesf the few children there were. Cures against

child weakness or simply to prevent domesticccidents thus abounded. In the thesis heresented for the ecome a professor in French medicalchools), Grancher declared that it was impor-tant to strengthen sick children by givingthem tonics or nutrition modifying agentshich could have invigorating physiolo-

rather modera-te and they were only usedfor moronic and asthenic cases (Sydenham,

lll

rather modera-te and they were only usedrather modera-te and they were only usedrather modera-te and they were only used

Hôpital des Enfans Malades.

ticed

ms am

ficit

often

s me

l con

itis i

duct

in hi

(189

lso o

syst

wing

oid (

many

chel,csych

lll HYGIENISM AND POISONING IN CHILDREN’S NERVOUS DISEASES lllYGIENISM AND POISONING IN CHILDREN’S NERVOUS DISEASES lll

other quinquina-based preparations, such asgeneral stimulants (Orillard, 1862).

Child medical science first appeared duringentury. Jacques-Joseph Grancher

eing one of the most important doctors atthe “Hôpital des Enfans Malades” during theend of the 1800’s.

At that time, child health had become a majorocial issue. The Napoleonic wars had destro-yed the men most likely to have children andt had become important to preserve the livesf the few children there were. Cures against

child weakness or simply to prevent domesticccidents thus abounded. In the thesis heresented for the agrégation (the exam toecome a professor in French medicalchools), Grancher declared that it was impor-tant to strengthen sick children by givingthem tonics or nutrition modifying agentshich could have invigorating physiolo-

g ica l act ionsG r a n c h e r ,1 8 7 5 ) . Thus,thanks to hima s w e l l a sothers, analep-ics and tonicsbecame widelyu s e d , w h i l eduring the pre-vious century,heir usage was

rather modera-te and they were only usedfor moronic and asthenic cases (Sydenham,

otbu s e d , w h i l edvious century,t

rather modera-te and they were only used

o

b

d

gg(1 8 7 5 ) . Thus,thanks to hima

g(1 8 7 5 ) . Thus,thanks to himaotbu s e d , w h i l edvious century,t

rather modera-te and they were only usedrather modera-te and they were only usedrather modera-te and they were only used

Hôpital des Enfans Malades.

7d in ozenous child-

mong thosepresen-

or showing signs of

n show lesions inthe

embrane with effects

ncha.

is such that it leads to

ts.Maurice Boulay gave

is work TrTrT arar itétét des malalal -

97).

originatefrom a disorder

tem, as Titefffff had noted,

g signs of“very thic

k” pha-

(Titeff,f,f 1896). Titeff later

y other authors (Tröltsch

,

Hack, Elsberg) had already

ll ctual disorders lin

k-fo-intellect

ual diso

On the subject of

f the few children there were. Cures againstchild weakness or simply to prevent domesticccidents thus abounded. In the thesis he

(the exam toecome a professor in French medicalchools), Grancher declared that it was impor-tant to strengthen sick children by givingthem tonics or nutrition modifying agentshich could have invigorating physiolo-

ica l act ionsG r a n c h e r ,

An Illustrated HistoryOver Time

Éric Konofal, MD, PHD

w w w . i m p u l s i o n - n a t u r e l l e . c o m