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Adderall for All: A Defense of Pediatric Neuroenhancement

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Abstract

I argue that young patients should be able to access neuroenhancing drugs without a diagnosis of ADHD. The current framework of consent for pediatric patients can be adapted to accommodate neuroenhancement. After a brief overview of pediatric neuroenhancement, I develop three arguments in favor of greater acceptance of neuroenhancement for young patients. First, ADHD is not relevantly different from other disadvantages that could be treated with stimulant medication. Second, establishing a legitimate framework for pediatric neuroenhancement would mitigate the bad effects of diversion and improve research on neuroenhancement and ADHD. Third, some pediatric patients have rights to access neuroenhancements. I then consider several objections to pediatric neuroenhancement. I address concerns about addiction, advertising, authentic development, the parent–child relationship and equal opportunity and conclude that these concerns may inform a framework for prescribing neuroenhancement but they do not justify limits on prescribing.

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Notes

  1. Children in the US consume three times more ADHD medication than the rest of the world combined (Mayes et al. 2008). As many as 66.3 % of American children with an ADHD diagnosis receive medication for the disorder (CDC—ADHD, Data and Statistics 2013). Still, the global market for ADHD drugs has quickly expanded in the last decade, which indicates that the rising prevalence of ADHD diagnosis and medication is a global phenomenon (Scheffler et al. 2007).

  2. Studies indicate that 35 % of college students have used ADHD medications without a prescription, usually as a study aid (Low and Gendaszek 2002).

  3. Greeley et al’s commentary set off a wave of letters to the journal, some in enthusiastic support of pharmaceutical means of enhancement and some urging greater caution and questioning the benefits (Anonymous 2009a, b; Chatterjee 2009; Williams and Martin 2009; Young and Colpaert 2009).

  4. The lack of good evidence about neuroenhancement is especially problematic because healthy brains may be different than brains of people with ADHD, and the standard course of treatment and dosage levels may vary as well (Singh and Kelleher 2010). On this point, I leave it as an open question whether healthy pediatric patients should be enrolled in clinical trials. I suspect that it is permissible to enroll healthy children in clinical trials that could provide them with nonmedical benefits, for the reasons I develop in this essay. Here I only mean to highlight the basis of a common objection to neuroenhancement, which is the lack of evidence.

  5. While there may be some reason to think that the effects of stimulants on a child without ADHD will be more dangerous because of biological differences, this hypothesis also has not been well established and some parents and patients may be willing to tolerate higher risks than those associated with ADHD treatment to attain the benefits of neuroenhancement.

  6. Or possibly, if the patient experiences relief of her symptoms after using the drug while similarly situated patients did not experience relief while using a placebo. On the other hand, perhaps placebos may be reasonably classified as effective treatments by this standard.

  7. Dr. William Graf, a pediatrician at the Yale School of Medicine affirms this recommendation in a report about ADHD in the New York Times. Graf suggest that pediatricians ought to be permitted to prescribe stimulants to non-ADHD children as long as they closely monitor the side effects (Schwarz 2012). On the other hand, Graf is also an author of the position paper for the Ethics, Law, and Humanities Committee endorsed by the American Academy of Neurology that recommends against pediatric neuroenhancement, so Graf’s all-things-considered judgment remains unclear (Graf et al. 2013).

  8. One might question whether the current framework is justified. For example, an anonymous reviewer suggested that parents, not pediatricians, should be empowered as gatekeepers to treatment. My aim in this essay is not to question the current system of pediatric decision making but rather to show broadly recognized standards for children’s medical treatment can and should be adapted to accommodate neuroenhancement as well.

  9. This reply may assume that the child remains essentially the same person whether she is enhanced or not. For neuroenhancements that go beyond stimulant medication, one may worry that encouraging a child to take drugs that will significantly transform her identity are incompatible with an attitude of accepting the child’s existing identity. If this objection succeeds then a defense of transformative pediatric neuroenhancement must show that other considerations can take priority over unconditional acceptance of a child’s identity or that parents’ unconditional acceptance of a child’s identity is not very morally significant.

  10. Some critics are skeptical that pediatricians will be well placed to screen parents for vulnerability to advertisements and social pressure or to assess whether a parent is acting coercively (MacDonald and Poirier 2010). If pediatricians are not well placed to make these assessments, social workers or interdisciplinary gatekeepers may be appropriately involved in the case (Gini et al. 2010). The solution to parental ignorance is not that all parents and patents, however informed, ought to be prohibited from pursuing pediatric neuroenhancement because some parents will be uninformed any more than the solution to the fact that some patients are ignorant is not to prohibit all patients from making treatment decisions.

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Acknowledgments

I am grateful to Javier Hidalgo for helpful comments and to Tammy Tripp for proofreading assistance.

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  1. Leadership Studies, and Philosophy, Politics, Economics, and Law, University of Richmond, 28 Westhampton Way, Richmond, VA, 23173, USA

    Jessica Flanigan

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Flanigan, J. Adderall for All: A Defense of Pediatric Neuroenhancement. HEC Forum 25, 325–344 (2013). https://doi.org/10.1007/s10730-013-9222-4

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