I hope most readers may find Lesson 301 to be by far the most entertaining essay in this series.  However, unfortunately, ADHD has often been treated for at least two centuries by well-meaning educators, physicians, and parents who used physical implements, "potions," and ultra-drastic presumed remedies which we would universally consider cruel as well as ineffective now.  I cannot possibly attempt to describe all of these  "treatment" interventions, but hopefully this Lesson will serve as a starting sample.

Restraining devices:  Prussia, the largest and most powerful German state before and after the Napoleonic wars, appears to be the first nation or state to selectively place some hyperactive and/or disobedient children in special wooden chairs equipped with leather straps.  The straps were applied at a variety of points on the head (usually the forehead), then around the shoulders and chest, then the waist, and also around the arms and legs.  This had the desired effect of essentially immobilizing the child, although his hands were free to hold a paper tablet and write.  A standard holding a book was placed in front of him (I have not seen any record of girls being restrained in this way) in effect like a standard holding a score for a musician.

In the 1820's and 1830's Prussia became the first state or nation to demand all children attend publicly-funded schools (exceptions were made for children of the nobility, but they were already being educated in manor houses and castles of the upper crust).  So now, for the first time in history, ALL children were required to attend schools, and now educators were confronted with ALL local children in their classrooms, a few of whom were hyperactive and/or disobedient.  So now the restraining chairs and straps which had been applied selectively to the relatively few boys educators were trying to cope with in the past 10-20 years were in effect used for unruly boys all over the state.

Eventually, even the typically stubborn Prussians gave up using these devices and decided some boys were not suitable for school, and should be trained in the manual arts instead of confinement in special chairs and in classrooms.  I am not sure when this practice was abandoned; i believe it went on for at least 15-20 years.  Hopefully one of our German readers who knows this history far better than I do will advise me and all of us more about the history of this practice.

To the best of my knowledge restraint chairs were never employed in schools in America or elsewhere, in part no doubt due to universally-dictated public schooling for all children not being attempted until early in the 20th century here and elsewhere.

Potions:  There were essentially no "Pharmacies" as we know them now in the U.S. in the 1870's - 1920's.  There were "Chemists" in most of our larger cities and a few towns here and there; was also true in Great Britain and elsewhere in Europe.  A huge majority of North Americans awaited the monthly delivery of the Sears & Roebuck catalog and ordered almost everything they need form this source, including a wide variety of so-called remedies for almost everything they felt they needed.  These catalogs always had multiple pages devoted to tonics, elixirs, mixtures, special drops, and all manner of potions dramatically advertised to calm overactive children, to make them sit still (even during church services), obey their parents, and even to get up and do their chores cheerfully.  Almost all North Americans (I am including Canadians here, of course) lived on farms or in very small towns until WW I, so the Sears & Roebuck catalogs were the only source of presumably helpful substances for concerned parents.  Most of the substances advertised and ordered contained robust doses of alcohol, so it is probably no wonder many children seemed calmer after being "treated" with these potions.

Electroshock therapy (ECT):  This is a truly sordid, hideous episode in our history of treating children and adolescents for ADHD symptoms.  It may shock and even stun most well-trained clinical psychologists and child/adolescent psychiatrists now in the year 2011, but from the mid-30's through the early 70's some of the leading authorities in our fields advocated using ECT to treat kids for ADHD.  I am not kidding.  I know many of the names of these eminent professors, many of whom were also psychoanalysts!, but I am not going to reveal their names here.

They did not advocate or employ a few ECT "treatments" back then.  It was by no means unusual in the 60's and early 70's to see newly-referred adolescents in consultation who had received 50, 60, or even 70 bilateral ECT "treatments," in many cases there had been no use of anesthesia or muscle relaxants, and in my first year in private practice, I wound up trying to treat a 14 y/o boy recently discharged form one of the worst-offending psychiatric hospitals in the U.S.  He was then also treated with incredible doses of the old major tranquilizers (Thorazine) and the old antidepressants (Elavil and Trazodone), as well as a preposterous regimen of vitamins.  Needless to say, I failed to help him.

Megavitamin therapy:  This became a huge, very widely hyped fad in the 60's, 70's and even for a while in the 80's.  Although the physicians who advocated and used these interventions primarily focused on a theory Niacin deficiency was the main problem, they infused (usually IV) all manner of other vitamins and exotic substances as well - completely without ANY scientific basis for their theories or treatments.  Nonetheless, for as many as 10 or more years megavitamin infusions were very widely employed even by some "mainstream" psychiatrists.

Worse yet, the fervent advocates of megavitamin treatment often embraced ECT as another useful parameter of intervention.  They had a large number of former patients consistently serving to provide "testimonials" about their amazing cures.

Feingold Diet:  See Lesson 201

Colloidal silver:  This preposterous idea and resulting widely-hyped potion soon followed the waning enthusiasm of the Feingold Diet.  Infusions of various metals has a long history in medicine dating back to ancient Greek physicians; Alexander the Great was supposedly treated with small amount of mercury when he was dying.  Gold, Mercury, and Silver were all used in various forms by the medieval alchemists who ultimately became predecessors of physicians and pharmacists.  In the 80's yet another totally unproven fad developed to treat ADHD, a tiny amount of silver suspended in a liquid or "colloidal" solution.  For a while, an amazing number of amazingly naive parents truly believed it was helpful, in part because of a new gimmick in the deception of promoting measures like this.  People who ordered and used a lot of Collodial Silver could become distributors, thus making about 20+% profit by selling stuff to friends, relatives, etc.  It was one of the earliest Pyramidal schemes to emerge in our field.  Others would soon follow.

Pycnogenal:  I am not sure I a even spelling this detestable substance properly, and I don't care.  It is pronounce 'Pik-nog-enal.'  It is a concentrated extract of grape seed, like Laetrile was purported to be a wonderful anti-cancer extract of apricot seeds.  How and why this substance might ever be helpful for anyone who had ADHD was never truly explained scientifically, but the hype was tremendous, and even some seemingly rational physicians jumped on the bandwagon...for a cut of the profits, of course.  This was an even more successful Pyramid scheme than Colloidal Silver.  Pycnogenal was quite popular in the late 80's and early 90's.  I was amazed during that time how many parents of ADHD kids tried it, and how convinced many of them were it worked wonders (especially those who were distributing it and receiving a share of the profits).

Magnets:  These were very popular and widely-hyped in the late 80's.  I have kind of a "story" to tell about magnets.  Many years ago I was widely known nationwide as a real expert in diagnosis and treatment of ADHD, especially during the years when Compuserve was an important communication modality (mid 80's - mid 90's.  I received and read lots of C-mail back then and one message I found especially intriguing was authored by a "psychologist" describing the astounding benefits of magnets placed into their inner soles and under mattress pads of ADHD children's shoes and beds!  This person insisted these magnets had essentially cured ADHD in all children who had faithfully used them for 3 or more months.  I ignored his many messages for a few weeks, then decided:  "OK, let's have some fun."

So I C-mailed him back an agreement to try using the magnets, hoping they would be of great help.  He wanted me to be a "distributor," in the same sense described for use of Pynogenal and Colllodial Silver.  He insisted I would make $$$$$ and retire early.  I responded by stating this sounded great, but I had serious academic and professional reputation requiring caution in my offer to collaborate with him.

I insisted he send me 10 sets of shoe inserts and mattress pad inserts, and also 10 matched sets of shoe inserts and mattress pads with identical metal forms which were not magnetic.  Then I explained I would have an associate mark them with a code he would keep secret from me, and I would perform a double-blind experiment with 20 subjects to make sure results achieved statistical significance.

He balked at sending me the metalized sole and mattress devises free of charge!  Can you imagine?  And then he said he had no way of sending me non-magnetized metal forms.  We went on and on from there.  The whole scheme was of course yet another ludicrous Pyramid fraud bilking consumers, and I later checked further on his credentials and discovered he was a shoe salesman.

EEG and other Biofeedback schemes:  This seemingly somewhat logical treatment program has been around for more than 30 years.  The idea is to train the subject to achieve a steady alpha rythym detected by EEG leads attached to the scalp while playing a video game like PacMan.  Claims of dramatic benefits for kids who have ADHD date back to the late 70's, and this and a few much less elaborate interventions have been widely endorsed and applied ever since by some mental health professionals, usually psychologists.  There have been hundreds of "testimonials" over these years written and mentioned by pleased parents, accompanied in some cases by claims a child has been "cured" of having ADHD after 15, 20, or 30 or more sessions.  Proponents of EEG Biofeedback have even published studies documenting significant increase in the child's IQ, including amazing data improvements up to 20 points or more.

These studies have never been replicated or confirmed in truly independent academic settings, nor have the people promoting this form of intervention ever employed "control groups."  Further, since no standard, mainstream professional journals have ever accepted and published the seemingly professional-looking papers submitted by proponents of Biofeedback, the studies which have published and promoted the benefits of Biofeedback are all to be found in self-published journals and their own proprietary websites. 

Most serious academic child psychiatrists and child psychologists I have known in the past and converse with in the present shy away from using a term an pejorative as "Quackery" for EEG and other forms of Biofeedback, but i believe it would be accurate to state there are very few, if any, sophisticated specialists in our field who endorse this intervention.  It is also, usually, very expensive and time-consuming.  I have never seen a patient any age who received substantial benefit from this form of "treatment."

Optometric or Special Lens Training:  This treatment protocol advocated and employed by a few Optometrists who are convinced providing children with a variety of different forms and colors of lenses in special eyeglasses can help them read more efficiently, and also - somehow - help treat them for ADHD.  One presumption is by being able to track and read more effectively these children will exhibit fewer ADHD symptoms.  There is no sound scientific evidence this intervention has any merit.

Chiropractic Treatment:  Some chiropractors have claimed various forms of neck and spinal manipulation can effectively treat ADHD.  This is blatantly ridiculous.

"Ergotherapie":  this perfectly preposterous form of treatment for ADHD children seems to be based on an absurd assumption to the effect that achieving better motor coordination and balance will help these children.  It has a history of being commonly used in Europe until recently.  This is also scientifically preposterous.

Over-the Counter "calming" supplements of all sorts are widely used by parents who basically :believe in folk medicine."  Some parents and grandparents combine these supplements with "veggie" diets.  There is no scientific basis for using any of these supplements or diets.

Please advise if I have overlooked some other mythological remedies.

Corydon G. Clark, M.D.