Clinical implications of ethical concepts: moral self-understandings in children taking methylphenidate for ADHD

Stimulant drug treatments for Attention Deficit/Hyperactivity Disorder (ADHD) have been a particular target of ethical controversy and debate. Bioethicists have raised concerns about the implications of stimulant drug treatment for child authenticity, individuality, and enhancement. There is at present little empirical evidence to support or deny these concerns. This article presents data from a pilot interview study that investigated children's moral self-understandings in relation to ADHD diagnosis and stimulant drug treatment, with a focus on children's understandings of their authentic selves. Stimulant drug treatment does not appear to undermine a child's sense of personal authenticity: In this study, children reported that they believed a core dimension of their 'real' selves was persistently 'bad', despite medication. This finding complicates two bioethical assumptions: That the authentic person is inherently good, and that there is inherent value in the experience of having access to a core, authentic dimension of oneself. Some important preliminary clinical implications of these findings are discussed.