The Use of Stimulant Medication in Healthy Children and Adults

The use of prescription stimulants or psychotropic medication to improve cognition or overall functioning in a healthy individual who does not have an underlying medical condition is called neuroenhancement.  The prevalence of such treatment is increasing for children and adults.

The premise behind the use of stimulant medication or anxiolytic medication is to improve overall functioning and achievement in an otherwise normal individual.  A parent or child’s willingness and interest to pursue neuroenhancement are dependent on numerous cultural, social, religious, psychological, personal and ethical considerations.

The use of stimulant medication has been increasing and so has the diagnosis of ADHD.  Recent reports estimate an increase in the diagnosis of ADHD by over 40% for teens.  At least part of this increase is due to a “softening” in the diagnostic criteria to allow stimulant medication to be prescribed.  In these situations the stimulant is prescribed for social or psycho-educational motivations rather than medical. With such prescriptive treatment the benefits of treatment often do not justify the risk for side effects and the potential misuse of the stimulant medication.

The most common side effects include nervousness, tachycardia, hypertension, motor or vocal tics, appetite suppression and insomnia.  Potential neurodevelopmental effects are unknown as are the effects on the development of individual autonomy and the sense of internal control of one’s own decision making.

Parents and doctors play a vital role in both providing information and decision-making. The use of these medications to provide a competitive academic edge is becoming increasingly common in our era where academic achievement and success are increasingly important for long term economic success and job or academic advancement.  This is not a new question.  Caffeine has been used for productivity enhancement for many decades. The risk to drift in this direction with stimulant medications has already begun.

In the end the decision to use stimulant medication comes down to what is and what is not appropriate. What price is a parent or child willing to pay to excel?  Honest two way communication and evidence based advice are critical. This decision needs to be discussed in an open and honest forum with appropriate documentation of the criteria that justify treatment rather than allowing the decision to be based solely on a consumer-provider relationship where the parent or student wants and the physician provides the medication.