The Problem
August 1st, 2020
On the surface, ADHD drugs provide positive results to those in need. It is a culture of misuse paired with a disparity in socioeconomic availability of these drugs that proves unethical for their current method of distribution.
A Case for Benefits of the Medication
Similar type ADHD drugs including Vyvanse, Adderall, and Ritalin, help reduce ADHD and ADD symptoms of trouble focusing, paying attention, etc. However, in recent years, there has been an uptick in usage of ADHD drugs. Part of this increase is due to the fact that many individuals, especially students who do not have ADHD/ADD, use ADHD drugs to help improve their test scores. The drugs help improve their focus and alertness which can help on their exams and with studying.
A recent Nature article argued the possibility of allowing any individual to use ADHD drugs because it can benefit their learning and educational progress. The article also mentions the side effects of using ADHD drugs as "not severe", similar to other drugs like ibuprofen.
Current Screening Methods
The current CDC guidelines and current screening procedures include a testimony of five to six symptoms of the DSM-5 Criteria. These symptoms include behaviors that are difficult to diagnose, such as inability to listen, focus, or organize work.
Data and Statistics About ADHD. (2019, October 15). Retrieved from https://www.cdc.gov/ncbddd/adhd/data.html
Misdiagnosis
There currently exists data surrounding the culture of misdiagnosis for ADHD due to the disease's lack of a pathogenic indicator.
Due to this difficulty of diagnoses, research has indicated several subjective manners by which ADHD has arisen in individuals. For example, "it was found that boys born in December were 30% more likely to be diagnosed and 41% more likely to be treated for ADHD than those born in January, and that girls born in December were 70% more likely to be diagnosed and 77% more likely to be treated for ADHD than those born in January" (Jones). These numbers are statistically significant, meaning that there is a basis in environment and bring up that may lead to symptoms of ADHD that may not be the same as an individual born with the condition. This does not mean that all individuals in the high percentages of December births do not need the medication. The statistic solely exists to indicate a reason needed for a more specific screening procedure.
It is also important to note that individuals have often reportedly outgrown symptoms, showing that early diagnosis of ADHD may be mistaken for child development. The literature says: "there is a significant challenge in distinguishing between the majority of preschoolers whose symptoms will pass and the 5% to 10% who will develop persistent ADHD; this has significant implications for the decision to medicate" (Jones).
Ford-Jones P. C. (2015). Misdiagnosis of attention deficit hyperactivity disorder: 'Normal behaviour' and relative maturity. Paediatrics & child health, 20(4), 200–202. https://doi.org/10.1093/pch/20.4.200
The Socioeconomic Disparity
In large part due to the lower class inability to pay for trips to the doctor, or their having less access to medical centers, there is a disparity among socioeconomic classes and minority groups in access to ADHD drug prescription.
In fact, “several studies raise additional concerns about access to ADHD treatment for girls, blacks, and poorer individuals. Barriers may occur at multiple levels, including identification and referral by school personnel, parents' help-seeking behavior, diagnosis by the medical provider, treatment decisions, and acceptance of treatment. Such findings confirm the importance of establishing appropriate mechanisms to ensure that children of both genders and all socioeconomic, racial, and ethnic groups receive appropriate assessment and treatment.”
This block quote from J.M Foy & MF Earls research demonstrates a problem that is paired with a culture of a difficult to diagnose disease. With a difficulty of diagnosis, there will always be a greater access to those with the means to visit these doctors and receive the diagnosis.
When it comes to cognitive enhancement, this is especially important because mental ability plays a part in an individual's ability to grow and gain an education. Thus, when only those who are able to get these prescriptions properly receive the needs for their education, the gap between socioeconomic classes may increase.
Foy, J. M., & Earls, M. F. (2005). A process for developing community consensus regarding the diagnosis and management of attention-deficit/hyperactivity disorder. Pediatrics, 115(1), e97–e104. https://doi.org/10.1542/peds.2004-0953
The Ethical Dilemma
Those who believe that “cognitive liberty" is a fundamental right argue that an important element of the autonomy at stake in cognitive liberty is the liberty to determine for ourselves what to do with and to our minds, including cognitive enhancements, if we so choose (Boire 2001; Bostrom and Roache 2010). Many argue the idea anyone - even those who do not have ADHD - should have access to ADHD drugs.
However, ADHD drugs can be expensive, and only those with the financial means to afford it would be have access to ADHD drugs in order to improve their learning (individuals who intend to use it for test-taking, instead of treating ADHD). The socioeconomic gap, which already makes learning and education more difficult for those financially struggling, will increase if any individual can obtain/use ADHD drugs.
In order to create an ethically equitable environment and still provide ADHD drug access to those who require it, we propose an extensive screening procedure (RFM-123) for individuals seeking treatment.