Revisiting History of Treatment of Attention Deficit Hyperactivity Disorder : Pharmacologic Approach

주의력결핍 과잉행동장애 치료의 역사적 재조명 : 약물치료적 접근

Besides from medical data, the patients who were previously called as attention disorder, mental instability, moral imbeciles, or moral defectives, can also be identified by exploring literatures and historical figures. In the past, as we can notice from the titles, they were recognized as a 'moral defect group'. And rather than treating them, separation from the society was the main solution. After the endemic encephalitis from 1917 to late 1920s, however, many survivors suffered from behavioral problems similar to those of the previous 'moral defect group' and studies on the relationship between brain damage and behavior problems were started henceforth. After being known as the 'minimal brain dysfunction', it was developed into the current attention-deficit/hyperactivity disorder. While the disease concept changed and developed over time, after numerous trials and errors, treatment medication starting from central nervous system stimulants such as amphetamine and methylphenidate is used for treatment in children and adult patients with ADHD, and most recently non-stimulants such as atomoxetine has become the one of the first line treatment options. Although we went through a thorough verification process of the safety and efficacy of the medication by contemplating the historical development process, we believe that adjustment is needed for remaining concerns on medication abuse and slight differences in disease paradigm and therapeutic philosophy depending on cultures.