Our society may be highly competitive, but prescribing brain-enhancing medication to healthy children is unethical and doctors must act to protect the most vulnerable.

That’s the crux of the argument put forth in guidelines for doctors released Wednesday by the American Academy of Neurology (AAN). The paper discusses the misuse of stimulant medications normally prescribed to treat attention-deficit hyperactivity disorder (ADHD), such as Ritalin and Adderall.

Dr. Michael Goldstein, a pediatric neurologist at Western Neurological Associates in Salt Lake City and former vice president of the AAN, said the article isn’t intended to stop doctors from medicating children with diagnosable learning disorders. It is, however, directed at adolescents who take ADHD and other stimulant medications to boost their brain power or get better grades.

“Taking some child with As and Bs and making it so they get all As, that’s different than a child who’s struggling. If society sees that as acceptable, that’s one issue. If physicians see it as acceptable, that’s another,” he said in an interview with Healthline. “If your child is doing well and you want him to be a star, that troubles me personally and those who wrote this paper.”

Athletes, Celebrities, and Social Pressure to Perform

Children in success-driven environments are often under pressure to not only meet requirements, but to excel beyond them. This includes performing well in elementary school, junior high, and high school in order to get into a top-tier college, doing well there, and then striving for a successful career.

The AAN paper states that the practice of using stimulant medications solely to improve performance is rising, but the evidence is mostly anecdotal. Still, experts say the use of neuroenhancers is adding to the $10 billion annual revenue for makers of ADHD medications.

When professional athletes—from Barry Bonds to Lance Armstrong—use performance-enhancing drugs it’s not much of a stretch for kids to believe that taking pills to excel is acceptable. 

Goldstein argues that teens using neuroenhancers to do better in the classroom is just the same as athletes using steroids or celebrities having plastic surgery: once one starts doing it, the rest have to follow suit to stay competitive. Though no one bats an eyelash when a movie star gets breast implants, we’d be appalled to see them on a six-year-old girl for the purpose of making her a star, Goldstein said.

Taking medication to increase brainpower is more ethically complicated for adults, as they’re less vulnerable than children, but the AAN's standards for doctors are quite straightforward.

“There are some things you do with adults that you shouldn’t do with children,” Goldstein said. 

The AAN paper explains the ethical, legal, social, and neurodevelopmental implications of allowing this prescribing practice to continue. In sum, the AAN says doctors should stop prescribing stimulants to healthy kids for numerous reasons, especially the fact that experts don't know what the drugs can do to a developing brain.

Praise for High Achievers

Praising children who use stimulants for their good grades is a major factor in the continuing abuse of these drugs. In fact, experts say that serious dilemmas may arise because using drugs to boost academic performance is sometimes applauded by parents and teachers.

This is why the responsibility to protect children rests not only with parents, but with doctors as well.

“Doctors caring for children and teens have a professional obligation to always protect the best interests of the child, to protect vulnerable populations, and to prevent the misuse of medication,” study author Dr. William Graf of Yale University said in a press release. “The practice of prescribing these drugs, called neuroenhancements, for healthy students is not justifiable.”

Studies have shown that many college students experience high levels of stress due to academic pressure and self-imposed expectations. Some report an increased workload and lower grades than they expected. Many students are turning to neuroenhancers to combat these problems through late-night cram sessions.

Neuroenhancing drugs seem like a student's savior: they’re cheap (and covered by insurance), easy to obtain, and effective at helping students study. The New York Times recently featured op-eds from people who have abused stimulants in order to excel. These anecdotes highlight the drugs’ ability to enhance performance, but also to cause crippling addiction and withdrawal.

A Doctor’s Duty

Previous AAN guidelines for doctors state that it’s neither illegal nor unethical for doctors to prescribe adults neuroenhancing drugs. For children, however, it’s a different ballgame.

The implications of prescribing performance-enhancing drugs cast as far out as experts can see. The new paper states that a doctor’s concern should be protecting society’s children, as well as maintaining the integrity of the medical profession. 

“The physician should talk to the child about the request, as it may reflect other medical, social, or psychological motivations such as anxiety, depression, or insomnia,” Graf said. “There are alternatives to neuroenhancements available, including maintaining good sleep, nutrition, study habits, and exercise regimens.”

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