How Did Early 20th Century Psychiatrists Describe Adult ADHD?

What you need to know

• Early 20th century psychiatrists Gustav Specht and Hermann Paul Nitsche described patients with symptoms matching modern adult ADHD criteria, though they did not use that term.

• They categorized these patients under labels like “chronic mania” but recognized them as a distinct group that didn’t fit neatly into existing diagnostic categories.

• Their observations provide historical evidence that adult ADHD is not a newly invented disorder, but has likely existed for a long time.

Early Descriptions of Adult ADHD Symptoms

While attention-deficit/hyperactivity disorder (ADHD) in adults was not officially recognized as a diagnosis until 1980, psychiatrists from much earlier were observing and describing patients with symptoms that match our modern understanding of adult ADHD. This article examines the work of two early 20th century German psychiatrists, Gustav Specht and Hermann Paul Nitsche, who wrote about patients that likely had what we would now call adult ADHD.

Gustav Specht’s Observations on “Chronic Mania”

Gustav Specht was a prominent German psychiatrist in the early 1900s. In 1905, he published a paper describing what he called “chronic mania.” Many of the symptoms he described align closely with what we now recognize as adult ADHD.

Specht noted that patients with this “chronic mania” often showed:

• Restlessness and jumpiness in their thinking
• A milder form of typical manic symptoms
• An expansive mood
• Poor judgment stemming from impulsivity

Importantly, Specht observed that these symptoms typically began as the person’s personality was developing in youth - matching the childhood onset we now know is characteristic of ADHD. He also noted that many of these patients came from families with a history of mental health issues, hinting at the genetic component of ADHD that modern research has confirmed.

Specht believed this group of patients represented a distinct disorder that was being overlooked or misdiagnosed by other psychiatrists. He argued it should be considered “a completely independent mental illness” rather than just a milder form of other known conditions.

Hermann Paul Nitsche’s “Chronic Manic States”

A few years later in 1910, another German psychiatrist named Hermann Paul Nitsche published a nearly 100-page paper on what he called “chronic manic states.” Like Specht, many of Nitsche’s observations align closely with modern adult ADHD criteria.

Nitsche described patients with symptoms including:

• Poor concentration and inconsistent performance
• Getting easily sidetracked in conversation
• Difficulty completing tasks
• Constant slight agitation and fidgeting
• Impulsivity and irritability

He noted these symptoms often began in childhood, with patients showing signs of being “distracted” in school. Nitsche also observed that these patients often struggled in their careers and relationships as adults due to their symptoms.

Interestingly, Nitsche recognized that this group of patients didn’t fit neatly into existing diagnostic categories. While he classified them under the broad umbrella of “manic-depressive illness,” he speculated that in the future, this group might be further subdivided into more specific diagnoses.

Case Study: The Distracted Student

One of the case studies Nitsche described was a student named Karl Dörfler, who showed many classic signs of ADHD:

• In school, he was described as scattered, with inconsistent effort and performance
• He was disorganized and had trouble finishing tasks
• His thoughts were described as restless
• He showed constant slight physical agitation, fidgeting in his seat
• He spoke in a rushed, hurried manner
• He had conflicts with classmates and authority figures
• As a young adult, he impulsively left the military (going AWOL)
• He started and quickly abandoned multiple career paths and areas of study

This description paints a clear picture of someone struggling with attention, hyperactivity, and impulsivity from childhood into adulthood - the hallmarks of ADHD.

The Significance of These Early Observations

While Specht and Nitsche did not use the term ADHD, their detailed descriptions provide strong evidence that they were observing the same condition we now recognize as adult ADHD. This is significant for several reasons:

1. It counters the notion that adult ADHD is a recently invented disorder. These accounts show that the symptoms were being observed and documented over 100 years ago.

2. It demonstrates that adult ADHD symptoms have been impairing people’s lives for generations, regardless of the societal context. The patients described by Specht and Nitsche struggled in school, work, and relationships in ways very similar to modern ADHD patients.

3. It highlights how long it can take for the medical community to fully recognize and classify a disorder. Despite these early observations, it took many more decades for adult ADHD to be officially recognized.

4. It shows the value of revisiting historical medical literature. While our diagnostic labels and understanding have evolved, there is much to be learned from the careful observations of earlier clinicians.

Evolving Understanding of Adult ADHD

The work of Specht and Nitsche represents an important step in the evolving understanding of adult ADHD. However, it’s worth noting how our conception of the disorder has changed over time:

• Terminology: While they used terms like “chronic mania,” we now recognize these symptoms as part of ADHD.

• Diagnostic criteria: Modern ADHD diagnosis requires more specific criteria and considers how symptoms impair functioning across multiple areas of life.

• Treatment: Specht and Nitsche did not have access to modern ADHD treatments like stimulant medications or cognitive behavioral therapy.

• Prevalence: We now recognize ADHD as relatively common, affecting an estimated 2.8% of adults globally.

• Lifespan perspective: We now understand ADHD as a lifelong neurodevelopmental disorder, rather than a condition that begins in adulthood.

Conclusions

• Early 20th century psychiatrists were observing and documenting adult ADHD symptoms, even though they didn’t have that diagnostic label.

• Their descriptions closely match modern ADHD criteria, providing historical evidence that adult ADHD is not a newly invented disorder.

• These early observations highlight how long it can take for the medical community to fully recognize and classify a disorder, even when its symptoms are being clearly documented.