By Dr. Anthony Policastro
Recently Dr. Ben Carson paid a visit to Seaford. One of the things he pointed out was that when he went to school there were no such things as ADHD and Autism. That is correct. He was born in 1951 and would have graduated high school in 1969. ADHD and Autism did not yet exist as diagnoses.
When I taught the Family Practice residents at Andrews AFB, I insisted that they include a developmental assessment on each patient admitted to the hospital. I had developmental criteria for them to use at all ages.
Sometimes they would come and tell me that they did a developmental assessment on a middle school child. It showed that the child was only performing at the second grade level. It was not that unusual. It was also not that surprising.
Those middle school students had started elementary school in the late 1960’s In those days if a child had a developmental disability, the approach was the same. It did not matter what the disability was. The child started first grade like every other child.
However, some of those children were not where they should have been at the end of the first year. For that reason, they repeated first grade. Between the repetition and the child maturing, they were close to where they needed to be the second time around.
They were then promoted to second grade. Again by the end of second grade, they had fallen behind where they should be. It was true for reading, writing and math.
They could not be retained a second time. For that reason, they received what was called a social promotion. The problem was that they did not understand anything that was taught past the second grade level. The result was that by middle school, they were years behind.
That did not happen until 1975. In that year Congress passed what was called the Education for All Handicapped Children Act (Public Law 94-142). It simply stated that if a school wanted Federal funds they had to identify and address special needs learners.
It went into effect on October 1, 1977. That was the birth date of diagnosing learning disorders. They had always been there. It was just that no one recognized them with a formal name.
When physicians treat patients, each diagnosis has a code associated with it. The code is the code they use for billing. For mental health disorders the codes are contained in something called the Diagnosis and Statistical Manual (DSM).
In 1980 DSM-III (third edition) was published. For the first time, it contained codes for both ADHD and autism. That meant that both diagnoses were now formally acceptable.
Sometimes, we use terms for such a long period of time that we take them for granted. We think that things like ADHD and autism have been around forever. While the disorders themselves have been, they were not officially recognized until PL94-142 and DSM-III.