Hyperactive

It was published in London by Reaktion Books in 2012: Hyperactive: The Controversial History of ADHD. A short book of nearly two hundred and fifty pages.

Matthew Smith is a historian of medicine; today he is a professor of the history of health at the University of Strathclyde in Scotland. Before this book he had written an academic book on the history of the Feingold diet and the food additives hypothesis. The first told a side road of the history of ADHD; Hyperactive tells the main road.

The book is built around four questions: why this diagnosis was first given to children, why biological explanations became dominant, why stimulant medications became the preferred treatment, and why alternative explanations failed to gain legitimacy.

I could not find a verified Turkish edition; I write it under its English title.

What I measure a history book by

Reading this book like an ADHD guide would be unfair. What I expect from a history book is different: fidelity to sources, not judging the past by today's concepts, not turning the people of the period described into caricatures.

I also look at how visible the historian makes their own thesis. There is hardly any neutral historiography. A good historian is one who does not hide their side.

Smith is good on this last measure. Some readers have complained that, while trying to look neutral, the author's views leak into the narrative. I did not read it as leakage; Smith writes his thesis openly. Whether to agree or not is left to the reader.

The path of the book

An introduction, six chapters and a closing.

The introduction opens with a title that plays on the word "hype" and sets up the book's question. The first chapter looks at the period before the concept of hyperactivity emerged. The second takes up the first hyperactive children, the third the debates that broke out around hyperactivity.

The fourth chapter is given to Ritalin; its title asks whether the drug is a magic bullet or black magic. The fifth chapter takes up alternative approaches, the sixth hyperactivity in the rest of the world. The closing chapter asks whether it is possible to be a happy hyperactive.

The chapters are short, the bibliography extensive. The language is plain and not closed to the general reader.

Is Fidgety Philipp that child

This is the idea of the book that first made me object and then made me think most.

When the history of ADHD is told, the same chain is usually built. Fidgety Philipp in the illustrated children's book that Heinrich Hoffmann wrote in the middle of the nineteenth century. The children the British physician George Still described in 1902. In 1937 Charles Bradley's observation that a stimulant drug improved the behavior of some children. Then the diagnostic manuals, then today.

Smith questions this chain. According to him, hyperactivity emerged as a picture specific to the second half of the twentieth century. Mapping figures from the past one to one onto today's hyperactive child means reading history backwards. The frame of the children Still described, the expectations and language of that period, are very different from those of the typical child diagnosed today.

There is a place where he is right as a historian. Pasting today's diagnosis onto the past is an academic relative of the habit of "retroactive diagnosis of famous people" that I criticized in the article why most ADHD books don't help. Smith refuses to do this, and that is an honest stance.

But as someone with ADHD I have an objection too. A concept being historical does not show that the pattern it describes is historical. Differences in attention and impulse control may have existed in every period; what changes may be when it is counted as a problem and how it is named. Smith does not ignore this possibility entirely, but the weight of the book is on the history of the concept.

1957 and Sputnik

According to Smith, hyperactivity entered the serious field of interest of pediatricians and psychiatrists in the US in the 1950s. In 1957, child psychiatrists working at the Emma Pendleton Bradley Home in Rhode Island coined the name "hyperkinetic impulse disorder."

The book's most original argument concerns the timing of this. In the same year the Soviet Union launched Sputnik, and education in the US turned into a national security matter. Cold War politics demanded more science, more discipline, more achievement from schools. Smith argues that the child-centered understanding of education of the previous period retreated under this pressure, and that the child who could not sit still in class became visible as a problem in exactly this environment.

Reading this part I thought of Hinshaw and Scheffler's finding about school accountability laws in The ADHD Explosion. Different periods, different methods, a similar question: when school asks more of a child, does that child's difference turn into a diagnosis?

The difference in method between the two books is instructive too. Hinshaw and Scheffler try to build this relationship with data and stress that the finding is a correlation. Smith builds it through the documents and discourse of the period, with a historian's method. The first is narrower but sturdier; the second is broader but more open to interpretation.

Ritalin and the rejected alternatives

The Ritalin chapter tells how stimulant medications became the standard treatment. Smith reads the rise of the biological explanation alongside scientific developments, together with professional dynamics, the influence of the pharmaceutical industry and psychiatry's general turn to biology.

In the alternative approaches chapter he looks at why explanations like the Feingold diet were pushed aside. This is the subject of his earlier book. There he had argued that in the fate of the Feingold hypothesis non-scientific factors played a role as much as scientific evidence: Feingold's personality and the way he presented his idea, the interests of the food, chemical and pharmaceutical industries.

This is the place where I am most careful with the book. Writing the history of why an idea was rejected and arguing whether that idea is true are different jobs. Later controlled studies and meta-analyses found the effect of food additives and diets on ADHD to be limited; I covered this in the article does diet work for ADHD. Smith does not ignore this evidence. But the narrative can easily leave the reader with the feeling that the rejected alternative was wronged.

The two sides of the Atlantic

The world chapter is for me one of the most valuable parts of the book. Smith compares the US's early and eager approach to the diagnosis of hyperactivity and stimulant treatment with the long-standing skepticism, especially in Britain. That similar children were met so differently in two countries is a strong example showing that diagnostic practice has a cultural dimension.

Reading this chapter I wondered how Turkey's own history of ADHD would be written. I have no reliable historical study to apply Smith's comparison here; I note this as an open question the book left me with.

The aged part: biology

The book came out in 2012; DSM-5 was published a year later. Since then the field has changed significantly.

The review by Faraone and Larsson (2019), based on twin studies, gives heritability as about 74 percent. The World Federation of ADHD consensus statement (Faraone et al., 2021) lays out, with a broad evidence base, the validity of the diagnosis and the presence of similar patterns in different countries. Prevalence research in community samples also shows that most of the differences between countries come from differences in method.

These do not refute Smith's thesis. Smith also accepts that hyperactivity is a product of both neurological and environmental factors. But if the book were written today, the share of the biological side would probably be broader. When and how the diagnosis became a problem is still a historical question. As to whether the pattern itself exists, there is a much stronger answer today.

The book's last question

Smith ends the book with a call for a more humane, child-centered education for children; a kind of return to the understanding he says retreated under post-Sputnik pressure.

I agree with this call emotionally. It would be good for every child, with ADHD or without, if the classroom did not turn a child into a "problem" so easily.

But as an adult with ADHD I also know this: however flexible school is, the difficulties with working memory, sense of time and impulse control do not end when you leave school. Work, money, relationships, traffic. Because the book's subject is childhood and school, adult life stays outside this frame. Changing the environment gains a great deal, but not all of the cost of ADHD comes from the environment.

How the field received it

Historians received the book largely favorably. David Herzberg wrote that Smith convincingly shows how tied our ideas about hyperactivity are to historical conditions. Erika Dyck assessed it as a narrative that invites us to think critically about modern culture's share in disruptive behavior. The review in the Journal of the History of Medicine and Allied Sciences also found the book fluent and appreciated that it moves beyond the polarized debate to look at the social, economic and professional roots of the diagnosis.

What caught my attention is that the praise came mainly from historians. I did not come across a similar assessment showing how those who do clinical or genetic research look at this book. That too shows which question the book answers: a history question.

What history gives a person with ADHD

When I finished the book, the question that stayed with me was: as someone who got their diagnosis in adulthood, what did knowing this history give me?

First, understanding where the doubt directed at the diagnosis comes from. I have heard the sentence "there was no such thing before" many times. Smith's book gives this sentence its due in one place and complicates it in another. The concept is recent, yes. But a concept being new does not show that the difficulties it describes were made up. Knowing the history strengthened my hand when arguing with this sentence.

Second, understanding the tension around medication. Seeing that stimulant medications have stood inside a moral debate for decades shows that the odd shame felt when ADHD medication is discussed is not personal. That shame has a past. Some of the things I described in the article stigma in ADHD have their roots here.

Third, humility. Some of the things we are sure of today will also become a historical curiosity in fifty years. Smith's book reminds us that knowledge is always produced from inside a period. This reminder does not devalue knowledge; it teaches you to be a little more careful while holding it.

For whom

For someone who wants to understand how ADHD in its present form came about. Especially for someone curious about the historical roots of why this diagnosis is so contested.

A very good starting point for students interested in the history of psychology, psychiatry, education or medicine. Its bibliography is extensive and opens doors to other reading.

I would not recommend it to someone newly diagnosed who already doubts the legitimacy of their own diagnosis. When the book's thesis is misread, it can be understood as "so it's something made up," and that is not what Smith is saying. At that stage, first a source that explains what ADHD is on the basis of evidence, this book after.

How to read it: open two columns on the side. Write "the history of this concept" in one and "the existence of this pattern" in the other. Look at which column each of Smith's arguments falls in. This distinction is what I got most from the book.