Pediatric neuroenhancement

Abstract

The use of prescription medication to augment cognitive or affective function in healthy persons-or neuroenhancement-is increasing in adult and pediatric populations. In children and adolescents, neuroenhancement appears to be increasing in parallel to the rising rates of attention-deficit disorder diagnoses and stimulant medication prescriptions, and the opportunities for medication diversion. Pediatric neuroenhancement remains a particularly unsettled and value-laden practice, often without appropriate goals or justification. Pediatric neuroenhancement presents its own ethical, social, legal, and developmental issues, including the fiduciary responsibility of physicians caring for children, the special integrity of the doctor-child-parent relationship, the vulnerability of children to various forms of coercion, distributive justice in school settings, and the moral obligation of physicians to prevent misuse of medication. Neurodevelopmental issues include the importance of evolving personal authenticity during childhood and adolescence, the emergence of individual decision-making capacities, and the process of developing autonomy. This Ethics, Law, and Humanities Committee position paper, endorsed by the American Academy of Neurology, Child Neurology Society, and American Neurological Association, focuses on various implications of pediatric neuroenhancement and outlines discussion points in responding to neuroenhancement requests from parents or adolescents. Based on currently available data and the balance of ethics issues reviewed in this position paper, neuroenhancement in legally and developmentally nonautonomous children and adolescents without a diagnosis of a neurologic disorder is not justifiable. In nearly autonomous adolescents, the fiduciary obligation of the physician may be weaker, but the prescription of neuroenhancements is inadvisable because of numerous social, developmental, and professional integrity issues.

Assessment and Treatment of Attention-Deficit/Hyperactivity Disorder: Part 2

“…[31][32][33] Other alternative interventions such as neurofeedback, use of megavitamins, and chelation therapy currently have insufficient evidence to support their use, and in the case of megavitamins and chelation therapy, may cause adverse health consequences and therefore are contraindicated. 34 …”

Pediatric neuroenhancement: Ethical, legal, social, and neurodevelopmental implications

“…1 The benefits are clear: history, preexisting problems, current medications, and other physicians' plans are accessible and evident in the electronic file. There are problems, however.…”

“…I would add one more solution: EHR software should be compatible to allow transmission of information among physicians using different EHR systems without compromising patient confidentiality. 1 However, the authors may be off point. Most children initially receive stimulant medications from general pediatricians and family physicians who believe that they are treating attention deficit disorder (ADD).…”

Neuro-Enhancement Practices across the Lifecourse: Exploring the Roles of Relationality and Individualism

“…The ethical questions neuroenhancement raises may vary according to the developmental stage of the population at which it is targeted (Forlini and Racine, 2011). This is reflected, for instance, in the American Academy of Neurology's differing guidelines for use of neuroenhancement for children and adults, which recommend more conservative practice for children (Graf et al, 2013) than for adults (Larriviere et al, 2009). Children are frequently positioned as vulnerable consumers (Graf et al, 2013).…”

“…This is reflected, for instance, in the American Academy of Neurology's differing guidelines for use of neuroenhancement for children and adults, which recommend more conservative practice for children (Graf et al, 2013) than for adults (Larriviere et al, 2009). Children are frequently positioned as vulnerable consumers (Graf et al, 2013). While enhancement in adolescents is often justified with reference to the principle of personal autonomy, enhancement for young children is more difficult to evaluate because their underdeveloped cognitive and legal competence establishes a special vulnerability to any risks Neuro-Enhancement, Relationality, and Individualism Frontiers in Sociology | www.frontiersin.org March 2017 | Volume 2 | Article 1 neuro-enhancement technologies might incur (Graf et al, 2013).…”