Will the “Real Boy” Please Behave: Dosing Dilemmas for Parents of Boys with ADHD

The use of Ritalin and other stimulant drug treatments for attention-deficit hyperactivity disorder (ADHD) raises distinctive moral dilemmas for parents; these moral dilemmas have not been adequately addressed in the bioethics literature. This paper draws upon data from a qualitative empirical study to investigate parents' use of the moral ideal of authenticity as part of their narrative justifications for dosing decisions and actions. I show that therapeutic decisions and actions are embedded in valued cultural ideals about masculinity, self-actualization and success, as well as in moral conceptions of authenticity and personal freedom. I argue that this investigation of parents' moral justifications and dosing dilemmas raises questions about the validity of authenticity as a transcendent moral principle. Moreover, this study demonstrates that in order to be relevant, bioethical analysis of neurocognitive enhancement must engage with ground-up studies of moral principles and decision-making in context.

Keywords:

• attention-deficit hyperactivity disorder (ADHD)
• Ritalin
• neuroethics
• enhancement
• authenticity
• boys' psychology

Notes

1. I use Ritalin representatively here, as there are other stimulant drug treatments on the market for ADHD. These are discussed later in the paper.

2. This listing is far from comprehensive and is meant to give just a sense of the variety of approaches and arguments on the general topic of mental illness, identity and selfhood. In anthropology see Low's (1994) work on the self/body relationship in the experience of “nerves”; also Estroff's (1985) work on selfhood among schizophrenic patients. In psychology see work on self-concept in children by Harter (1999), and work on self as a construct by Gergen (1991). In sociology see the classic work on labelling and stigma by Goffman (1961) and by Scheff (1966). Cognitive neuroscientist Steven Pinker (2002) has argued that there is no neurological evidence for the self, calling the self a “ghost in the machine”; Varella et al. (1991) have applied Buddhist principles to a neurological analysis of the self and have arrived at a similar conclusion.

3. Methylphenidate is not generally used to treat conditions other than ADHD; however it is also indicated for the treatment of narcolepsy.

4. All names have been changed and individual narratives are composites.

5. Three boys were on medication consistently over weekends and holidays. However their mothers also questioned the wisdom of such continuous dosing and experimented with drug holidays.

6. Thanks to Tim Lewens for this insight.