The American Academy of Neurology took a formal stance Wednesday on the use of attention-altering drugs by children who do not have a formal diagnosis. In a position paper, the academy outlined the ethical issues for treating healthy children with such drugs, a concept known as neuroenhancement.
“Neuroenhancement is using a medication of any kind — a drug, a medication, to, in some way, improve, or at least have the perception of improving cognitive function, thinking, memory, performance in some way, in someone who does not have a diagnosable condition,” said Dr. Leon Epstein, who worked on the paper.
The position comes on the heels of a similar paper done for adult patients released in 2009. According to Epstein, the issue is that children cannot make the same decisions as adults, and doctors are supposed to make decisions that are in the best interest of a child’s health.
If a condition is diagnosed, the use of the medicine is a treatment for that condition. Neuroenhancement is common among college students who take stimulants such as Adderall to help them study for exams. The drugs could have been obtained secondhand from someone who was originally prescribed the medication.
Dr. William Graf, of Yale University, who also worked on the paper, said that the ADHD diagnoses have increased 12-fold over a 20-year period and some of those could be attributed to over-diagnosis or over-treatment.
“I think that we have a problem with a large pharmaceutical industry in this country that is growing, with the number of tablets and pills that people take is growing,” Graf said. “We have to stop at some point and assess how this should be practiced, especially with children and adolescents.”
Much of the skepticism occurs at the intersection of consumerism and medicine. Pharmaceutical companies are allowed to advertise their products to the public and critics say this is influencing what the public perceives as proper medical treatment.
“The neuroenhancement issue is really the ethical issue about whether or not it would be all right for a physician to prescribe a medication,” said Epstein, head of the neurology division at Lurie Children’s Hospital in Chicago. “In this case we’re talking about stimulants, but it could apply to other medications, to prescribe a medication to somebody, who is an adolescent or a child, who does not have a diagnosable condition.
“The position of this paper, of this committee, ultimately was that no, that is not ethically permissible.”