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Academy of Neurology Warns Against 'Smart Drugs'

Last fall I wrote about a surge in the research and interest in so-called "smart drugs" or "study drugs," to improve students' attention and cognition. This afternoon the American Academy of Neurology officially weighed in against prescribing these drugs to healthy children.

Pediatric neurologists at the Yale School of Medicine in New Haven, Conn., wrote in a position statement in the journal Neurology that off-label prescriptions, particularly of stimulants such as Adderall and Ritalin, have risen in parallel with increasing diagnoses of attention-deficit disorders, suggesting that "boundaries between therapy in sickness and enhancement in wellness are often imprecise in practice. ... The concepts of 'normal' and 'typical' are relative to family and community expectations." The researchers found a nearly 22 percent increase in ADHD diagnoses in the last 20 years, including a gobsmacking 53 percent increase among Hispanic children.

This increase raises troubling ethical and scientific problems, the researchers argue. The long-term health and safety of these drugs, known technically as nootropics. have by and large not been studied in children and adolescents, and the drugs may have very different effects on children, whose cognitive abilities are still in flux. Moreover, children and teenagers may be more susceptible to pressure from parents or peers to take the drugs in order to achieve academically, the researchers warned.

"Doctors caring for children and teens have a professional obligation to always protect the best interests of the child, to protect vulnerable populations, and to prevent the misuse of medication," said lead author of the position, Dr. William Graf, a professor of pediatrics and neurology at Yale. "The practice of prescribing these drugs ... for healthy students is not justifiable," he said, adding that such requests from students "may reflect other medical, social, or psychological motivations such as anxiety, depression, or insomnia."

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