‘Everyday Enhancement’: Parents and Professionals Making Decisions about Drug Treatment of Minors for Problems with Learning and Behaviour

Abstract

The use of pharmaceuticals to support learning and behaviour in children has been a controversial topic since the 1990s. Concerns have been raised about overmedicating children, thwarting their moral develop with drugs, as well as providing an unfair advantage. Everyday enhancement can be understood as the grey area between unambiguously therapeutic and unambiguously non‐therapeutic uses of medication to improve cognitive performance in children. Attention‐deficit hyperactivity (ADHD) disorder and psychostimulant medication use offer a good case study to reflect on the questions raised by everyday enhancement. Over the past years several frameworks have been developed to guide medical professionals' decision‐making. These are rooted in different ethical commitments and include a pragmatic managerial approach to reducing or preventing the harms of enhancement in children; a framework centered on the physician's fiduciary responsibility; and a framework starting from the notion of children's best interests. Key Concepts Enhancement is a controversial subject that rose to prominence from the late 1990s. Evidence suggests that psychostimulant medication is being used to enhance normal performance in children and adolescents. Current evidence is inconclusive about the prevalence of the practice and the efficacy of stimulants in improving normal cognitive performance. Several ethical, societal and neurodevelopmental concerns have been raised about the use of psychostimulants for nonmedical purposes, although the boundaries between therapeutic and enhancing interventions may sometimes be very difficult to define. Various frameworks for professional decision‐making have been formulated, which allocate different weight to a shared set of ethical and societal considerations, such as harm reduction, children's best interests and the fiduciary responsibility of physicians.