From “Dancing on Desks” to Diagnostic Clarity
by William A. Knorr // October 30, 2025
Published in the Brattleboro Reformer on October 28, 2025.
October marks ADHD Awareness Month, aimed at increasing understanding and reducing stigma surrounding Attention-Deficit/Hyperactivity Disorder (ADHD), a problem that affects both adults and children but is often first encountered in children. My first encounter with a child who would meet criteria for this diagnosis, called at the time a “Hyperactive Child,” was as a Pediatric Resident in 1974, and the evaluation was almost absurdly simple. In the University of Iowa’s Diagnostic Clinic, a doctor sat a referred child down and simply requested they remain seated quietly for five minutes. Naturally, the child failed, and the diagnosis was handed down: Hyperactive Child.
Three years later, in 1977, the diagnosis showed its wilder side. A distraught parent came to my office—her six-year-old son had been suspended from first grade. Suspended? In first grade? I was stunned. “He was dancing on his desk,” she explained.
It was a wake-up call. I was utterly unprepared. I immediately dove into the published literature and quickly learned the focus had already shifted from simple hyperactivity to inattention and impulsivity. Crucially, I discovered that low-dose stimulant medications offered significant improvements. I prescribed Ritalin, and my patient returned to school, transforming a frustrated parent into a much happier one.
The Shift: Attention Takes Center Stage
It wasn’t until the mid-eighties, during a Child and Adolescent Psychiatry Fellowship, that I fully grasped the revolution in this diagnosis. The key was the work of Canadian psychologist Virginia Douglas. Her seminal 1972 paper, “Stop, Look, and Listen,” re-centered the discussion on the cognitive difficulties encountered by these children.
Douglas’s research propelled the shift to what we now know as ADHD. We moved past the single “hyperactive” label to a nuanced understanding of three types: predominantly inattentive, predominantly impulsive/hyperactive, or the combined type. Today, we also recognize the diverse underlying causes, from prenatal exposure to alcohol or opioids, to brain injuries and occasionally genetic factors. Our evaluation methods have also become far superior. We no longer rely only on subjective observations; modern diagnosis incorporates reliable rating scales completed by parents and teachers, standardized testing, and a thorough review of behavioral history. ADHD, despite much misunderstanding about it in the public sphere, is nuanced, very real, and complex.
Building a Better Plan: Structure and Support
Children with ADHD thrive best when treatment is a two-pronged effort, supporting them both at school and at home. In school, behavior plans developed as part of an
Individualized Education Plan (IEP) are vital. At home, the typical “just parent harder” approach often leads to frustrating cycles. Success comes from rewarding task completion and establishing predictable routines. Parent Management Training (PMT) can teach caregivers supportive, effective strategies.
Finally, medication remains a powerful tool. Stimulants are highly effective for improving attention and reducing impulsivity. Newer options, like alpha-2 agonists (clonidine and guanfacine), further help to reduce restlessness. Side effects are typically minimal, and for many children, the benefits of improved focus far outweigh the risks.
Fortunately, most primary care providers are well-versed in ADHD and can initiate this critical support. If you have questions about ADHD for yourself or a child, don’t wait. See your primary care provider today to discuss treatment options, develop a comprehensive plan, or secure a referral for a specialized consultation.
William A. Knorr, MD, FAAP Staff Psychiatrist, Brattleboro Retreat
