Steven M.Rothman, Pediatric Neurologist, Mercy Clinic St Louissrothman62@gmail.com
Submitted April 16, 2013
The recent article on pediatric neuroenhancement is an excellent review of the ethical aspects of stimulant drug use. [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 (ADD). These physicians do not believe that they are prescribing drugs for neuroenhancement. It is rare for children taking these drugs to have received psychometric testing. These drugs are frequently started in elementary school with initial success. Because a large segment of the medical establishment still believes that a positive response to stimulants is diagnostic of ADD, this success is viewed as a validation of the diagnosis. After several years, when the drugs begin to fail, children are referred for a dose adjustment—or new drug. At that point, a previously ignored learning disability is often identified. In pediatric neurology, we would do better educating our colleagues in primary care that stimulant medications initially help almost every child do better in school, at the price of neglecting many important learning disabilities that merit early attention. If Graf et al. provoke us to do this, they will have provided an invaluable service to hundreds of thousands of children.
1. Graf WD, Nagel SK, Epstein LG, Miller G, Nass R, Larriviere D.
Pediatric Neuroenhancement. Neurology 2013;80:1251-1260.
For disclosures, please contact the editorial office at journal@neurology.org.
The recent article on pediatric neuroenhancement is an excellent review of the ethical aspects of stimulant drug use. [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 (ADD). These physicians do not believe that they are prescribing drugs for neuroenhancement. It is rare for children taking these drugs to have received psychometric testing. These drugs are frequently started in elementary school with initial success. Because a large segment of the medical establishment still believes that a positive response to stimulants is diagnostic of ADD, this success is viewed as a validation of the diagnosis. After several years, when the drugs begin to fail, children are referred for a dose adjustment—or new drug. At that point, a previously ignored learning disability is often identified. In pediatric neurology, we would do better educating our colleagues in primary care that stimulant medications initially help almost every child do better in school, at the price of neglecting many important learning disabilities that merit early attention. If Graf et al. provoke us to do this, they will have provided an invaluable service to hundreds of thousands of children.
1. Graf WD, Nagel SK, Epstein LG, Miller G, Nass R, Larriviere D. Pediatric Neuroenhancement. Neurology 2013;80:1251-1260.
For disclosures, please contact the editorial office at journal@neurology.org.