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Reply to Rothman

  • William D. Graf, Child Neurologist, Yale School of Medicinewilliam.graf@yale.edu
  • William D. Graf, New Haven, CT; Saskia K. Nagel, Osnabr?ck Germany; Leon G. Epstein, Chicago, IL; Geoffrey Miller, New Haven, CT; Dan Larriviere, New Orleans, LA
Submitted April 16, 2013

In our recent ethics position paper, we defined neuroenhancement as “the use of prescription medication by healthy persons for the purpose of augmenting normal cognitive or affective function.” [1] Thus, neuroenhancement should not be confused with the potential beneficial effects of medication in neurological disorders such as attention deficit hyperactivity disorder (ADHD). Dr. Rothman's comments relate to the indiscriminate use of prescription stimulants for children with other neurodevelopmental disorders such as specific learning disabilities (e.g. dyslexia) and vaguely defined conditions such as central auditory processing disorder, in which signs of ADHD (inattentiveness, impulsivity, and hyperkinesis) may coexist. [2] Stimulants may show some benefit in these multidimensional disorders. [3, 4] Separate questions relate to diagnostic accuracy and whether any neurological disorder exists at all. We agree with Dr. Rothman about the common misperception that "Ritalin-responsiveness" justifies an ADHD diagnosis. We are also generally concerned about the significant increase in the use of prescription stimulants and the possible overdiagnosis of ADHD. Nonmedical use of methylphenidate and amphetamines and the illicit diversion of these drugs to healthy students for neuroenhancement may account for some of the recent rise in ADHD diagnoses. Public dissemination of information about the misuse and abuse of prescription stimulants is necessary.[5]

1. Graf WD, Nagel SK, Epstein LG, G. M, Nass R, Larriviere D. Pediatric neuroenhancement: ethical, legal, social, and neurodevelopmental implications. Neurology 2013;80:1251-60. Epub 2013 Mar 13.

2. Pastor PN, Reuben CA. Diagnosed attention deficit hyperactivity disorder and learning disability: United States, 2004-2006. National Center for Health Statistics Vital Health Stat 2008;10:(237).

3. Shafritz KM, Marchione KE, Gore JC, Shaywitz SE, Shaywitz BA. The effects of methylphenidate on neural systems of attention in attention deficit hyperactivity disorder. Am J Psychiatry 2004;161:1990-1997.

4. Tillery KL, Katz J, Keller WD. Effects of methylphenidate (Ritalin) on auditory performance in children with attention and auditory processing disorders. J Speech Lang Hear Res 2000;43:893-901.

5. International Narcotics Control Board (INCB). Report of the International Narcotics Control Board for 2012. Vienna, Austria: United Nations, 2013 ISBN: 978-92-1-148270-6.

For disclosures, contact the editorial office at journal@neurology.org.

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