The case for prescribing Adderall to kids who don’t have ADD

What’s good for you isn’t always good for me.
What’s good for you isn’t always good for me.
Image: Reuters/Srdjan Zivulovic
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At her core, University of Richmond philosopher Jessica Flanigan is a fierce libertarian. She believes doctors should treat patients based on their own value system and circumstantial needs. As such, she thinks cognitive enhancers that help students focus shouldn’t only be given to those with learning disabilities, but rather any student facing disruption—including loud and distracting classrooms.

How did you start thinking about when children should be prescribed cognitive-enhancing drugs like Ritalin and Adderall?

Something that was pretty influential in my thinking was an article by Nick Bostrom and Toby Ord called The Reversal Test (pdf) where they argue that a lot of people’s opposition to cognitive enhancement is based on status quo bias. People think further cognitive enhancements would be really bad. But they don’t see all of the cognitive enhancements that we’ve already achieved: better education, prenatal care, early childhood nutrition, and rising resources due to development. We wouldn’t think that it was a mistake to cognitively enhance people in those ways.

Do you think all children should have access to neuroenhancements?

A risk-benefit calculus for prescribing stimulants shouldn’t be limited to only children who have a clinical diagnosis of ADHD. It should be broadened to think about whenever the benefits would outweigh the risks, and we shouldn’t limit ourselves to these narrow, medicalized criteria.

There are other kinds of impairments that aren’t ADHD. For example, having an open classroom or a very loud school. That’s not a learning disability or cognitive impairment, but in some ways that’s an environmental impairment that could merit prescribing stimulants to help kids focus.

Obviously, the thing that should be done is education reform. But failing any kind of policy solution, I think that it would be a mistake to say ‘Well we can’t achieve equality of education’ and ‘I guess there’s nothing we can do!’ We know that in some cases, academic outcomes can be achieved in just prescribing stimulants in limited cases.

How do you determine who has access?

There are a lot of kids in schools that have tons of resources, but are nevertheless prescribed stimulants because they have ADHD. The pediatricians, parents, and patients judge that stimulants would be in their best interest. People don’t seem to have a problem with the prescription of stimulants in those cases. So if it’s possible to judge that, on balance, it’s a benefit to take stimulants in those cases, it seems conceivable that the risk-benefit calculus could come out in favor of stimulus for students who face other kinds of cognitive impairments.

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This interview is an extended version of a piece featured in Quartz’s new book The Objects that Power the Global Economy.