Skip to main content

Advertisement

Log in

Personal Autonomy and Authenticity: Adolescents’ Discretionary Use of Methylphenidate

  • Original Paper
  • Published:
Neuroethics Aims and scope Submit manuscript

Abstract

Minors with attention-deficit-hyperactivity disorders (ADHD) are liable to use pharmacological treatment against their will and may find their authentic “I” modified. Thus, their use is widely criticized. In this study, the effect of ADHD drugs on adolescents’ personal experience is examined. The goal is to understand how psychological changes that young people experience when they take these medications interrelate with their attitude toward being medicated. Methylphenidate is the most common pharmacological treatment for ADHD. We look into the change that Israeli adolescents undergo when they use it; their experience in controlling the change, and their assessment of the meaning of the change for their lives. Thirty-eight adolescents participated in semi-structured interviews. The findings, analyzed using grounded theory, show that methylphenidate affects the participants’ demeanor, mood, and even preferences. The participants, aware of these effects, apply discretion in taking methylphenidate and thus influence their traits and their willingness to engage in various activities. When needing to prepare for a matriculation exam, for example, they take methylphenidate; when they need to be creative or sociable, they avoid it and enjoy what they consider the advantages of ADHD, such as creativity and spontaneity. As discretionary users, they shape their life stories in a way that makes them more meaningful and diverse, better tailored to their social surroundings, and more useful in maintaining personal autonomy in the course of pharmacological treatment of ADHD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders, APA. 5th ed. Arlington: American Psychiatric Publishing.

    Book  Google Scholar 

  2. Wolraich, M.L., and G.J. DuPaul. 2010. ADHD diagnosis and management: A practical guide for the clinic and the classroom. Baltimore: Paul H. Brookes.

    Google Scholar 

  3. Comstock, A.J. 2011. The end of drugging children: toward the genealogy of the ADHD subject. Journal of the History of the Behavioral Sciences 47: 44–69. doi:10.1002/jhbs.20471/.

    Article  Google Scholar 

  4. Shaw, D. 2014. Neuroenhancing public health. Journal of Medical Ethics 40: 389–391. doi:10.1136/medethics-2012-101300.

    Article  Google Scholar 

  5. Singh, I. 2005. Will the “real boy” please behave: Dosing dilemmas for parents of boys with ADHD. The American Journal of Bioethics 5: 34–47. doi:10.1080/15265160590945129.

    Article  Google Scholar 

  6. McCarthy, S. 2014. Pharmacological interventions for ADHD: How do adolescent and adult patient beliefs and attitudes impact treatment adherence? Patient Prefer Adherence 8: 1317–1327. doi:10.2147/PPA.S42145.

    Article  Google Scholar 

  7. Newson, A.J., and R.E. Ashcroft. 2005. Whither Authenticity? American Journal of Bioethics 5: 53–55. doi:10.1080/15265160591002863.

    Article  Google Scholar 

  8. Childress, A.C., and S.A. Berry. 2012. Pharmacotherapy of attention-deficit hyperactivity disorder in adolescents. Drugs 72: 309–325. doi:10.2165/11599580-000000000-00000.

    Article  Google Scholar 

  9. Charach, A., and R. Fernandez. 2013. Enhancing ADHD medication adherence: challenges and opportunities. Current Psychiatry Reports 15: 371. doi:10.1007/s11920-013-0371-6.

    Article  Google Scholar 

  10. Bussing, R., M. Koro-Ljungberg, K. Noguchi, D. Mason, G. Mayerson, and C.W. Garvan. 2012. Willingness to use ADHD treatments: A mixed-methods study of perceptions by adolescents, parents, health professionals and teachers. Social Science & Medicine 74: 92–100. doi:10.1016/j.socscimed.2011.10.009.

    Article  Google Scholar 

  11. Walker-Noack, L., P. Corkum, N. Elik, and I. Fearon. 2013. Youth perceptions of attention-deficit/hyperactivity disorder and barriers to treatment. Canadian Journal of School Psychology 28: 193–218. doi:10.1177/0829573513491232.

    Article  Google Scholar 

  12. Prasad, V., E. Brogan, C. Mulvaney, M. Grainge, W. Stanton, and K. Sayal. 2013. How effective are drug treatments for children with ADHD at improving on-task behaviour and academic achievement in the school classroom? A systematic review and meta-analysis. European Child and Adolescent Psychiatry 22 (4): 203–216. doi:10.1007/s00787-012-0346-x.

    Article  Google Scholar 

  13. Charach, A., E. Yeung, T. Volpe, and T. Goodale. 2014. Exploring stimulant treatment in ADHD: Narratives of young adolescents and their parents. BMC Psychiatry 14: 110. doi:10.1186/1471-244X-14-110.

    Article  Google Scholar 

  14. Knipp, D.K. 2006. Teens’ perceptions about attention deficit/hyperactivity disorder and medications. Journal of School Nursing 22: 120–125. doi:10.1177/105984050602200210.

    Article  Google Scholar 

  15. Singh, I. 2013. Not robots: Children's perspectives on authenticity, moral agency and stimulant drug treatments. Journal of Medical Ethics 39: 359–366. doi:10.1136/medethics-2011-100224.

    Article  Google Scholar 

  16. Cortese, S., M. Holtmann, T. Banaschewski, J. Buitelaar, D. Coghill, M. Danckaerts, R.W. Dittmann, J. Graham, E. Yayler, and J. Sergeant. 2013. Practitioner review: Current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents. Journal of Child Psychology & Psychiatry 54: 227–246. doi:10.1111/jcpp.12036.

    Article  Google Scholar 

  17. Avisar, A., and M. Lavie-Ajayi. 2014. The burden of treatment: Listening to stories of adolescents with ADHD about stimulant medication use. Ethical Human Psychology & Psychiatry 16: 37–50.

    Article  Google Scholar 

  18. Golomb, J. 1995. In search of authenticity: From Kierkegaard to Camus. London and New York: Routledge ISBN 0-415-11946-4.

    Google Scholar 

  19. Varga, S., and C. Guignon. 2016. “Authenticity,” The Stanford Encyclopedia of Philosophy (Summer 2016 Edition), ed. Edward N. Zalta, http://plato.stanford.edu/archives/sum2016/entries/authenticity/.

  20. Erler, A., and T. Hope. 2014. Mental disorder and the concept of authenticity. Philosophy, Psychiatry, & Psychology 21: 219–232. doi:10.1353/ppp.2014.0032.

    Article  Google Scholar 

  21. Dees, R.H. 2007. Better brains, better selves? The ethics of neuroenhancements. Kennedy Institute of Ethics Journal 17: 371–395. doi:10.1353/ken.2008.0001.

    Article  Google Scholar 

  22. Fukuyama, F. 2003. Our posthuman future: Consequences of the biotechnology revolution. New York: Picador.

    Google Scholar 

  23. Singh, I. 2014. Authenticity, values, and context in mental disorder: The case of children with ADHD. Philosophy, Psychiatry & Psychology 21 (3): 237–240,274. doi:10.1353/ppp.2014.0038.

    Article  Google Scholar 

  24. Guignon, C. 2004. On being authentic. London and New York: Routledge.

    Google Scholar 

  25. Varga, S. 2011. Authenticity as an Ethical Ideal. New York: Routledge.

    Google Scholar 

  26. Levy, N. 2011. Enhancing authenticity. Journal of Applied Philosophy 28: 308–318. doi:10.1111/j.1468-5930.2011.00532.x.

    Article  Google Scholar 

  27. DeGrazia, D. 2000. Prozac, enhancement, and self-creation. The Hastings Center Report 30: 34–40. doi:10.2307/3528313.

    Article  Google Scholar 

  28. Glannon, W. 2012. Neuropsychological aspects of enhancing the will. The Monist 95: 378–398. doi:10.5840/monist201295320.

    Article  Google Scholar 

  29. Pugh, J. 2014. Enhancing autonomy by reducing impulsivity: the case of ADHD. Neuroethics 7: 373–375. doi:10.1007/s12152-014-9202-7.

    Article  Google Scholar 

  30. Thaler, D.S. 2009. Improving introspection to inform free will regarding the choice by healthy individuals to use or not use cognitive enhancing drugs. Harm Reduction Journal 6 (10). doi:10.1186/1477-7517-6-10.

  31. Chandler, J.A. 2013. Autonomy and the unintended legal consequences of emerging neurotherapies. Neuroethics 6: 249–263. doi:10.1007/s12152-011-9109-5.

    Article  Google Scholar 

  32. Foucault, M. 2006. Psychiatric power: lectures at the College de France 1973–1974, ed. J. Lagrange, tr. G. Burchell. New York: Palgrave Macmillan.

  33. Patton, M.Q. 1990. Qualitative evaluation and research methods. 2nd ed. Newbury Park, CA: Sage.

    Google Scholar 

  34. Corbin, J.M., and A.M. Strauss. 1990. Grounded theory research: Procedures, canons, and evaluative criteria. Qualitative Sociology 13: 3–21. doi:10.1007/BF0098859.

    Article  Google Scholar 

  35. Patton, M.Q. 1999. Enhancing the quality and credibility of qualitative analysis. Health Services Research 34 (5 Pt 2): 1189–1208 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1089059/.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Amos Fleishmann.

Ethics declarations

Conflict of interest

There are no conflicts of interest in relation to the submitted manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fleishmann, A., Kaliski, A. Personal Autonomy and Authenticity: Adolescents’ Discretionary Use of Methylphenidate. Neuroethics 10, 419–430 (2017). https://doi.org/10.1007/s12152-017-9338-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12152-017-9338-3

Keywords

Navigation