The increasing use of cognitive enhancing drugs by those with ADHD and neurotypical individuals: Societal demands, lifestyle preferences, and ethical issues.

Abstract

Attention deficit hyperactivity disorder (ADHD) is a highly heritable neurodevelopmental condition characterised by impairments in sustained attention, executive functioning, and emotional regulation, with significant lifelong consequences if untreated. Recent years have seen substantial increases in ADHD diagnoses and stimulant prescriptions across children, adolescents, and adults, alongside a parallel rise in the non-medical use of cognitive-enhancing drugs by neurotypical individuals. This review examines five key issues: factors driving rising ADHD diagnoses and prescriptions; the cognitive profile of ADHD and mechanisms of pharmacological treatments; reasons for increasing cognitive enhancer use in neurotypical populations; evidence for their efficacy in neurotypical individuals; and associated ethical implications. We review evidence implicating digital technology, parenting styles, educational incentives, and diagnostic practices in rising ADHD prevalence. Cognitive studies demonstrate that ADHD is associated with deficits in sustained attention, working memory, inhibitory control, and emotional regulation, underpinned by fronto-striatal dysfunction. Stimulant medications such as methylphenidate and lisdexamfetamine effectively improve 'cold' cognitive functions and change dysfuntional neural circuitry to a more typically developing pattern, though emotional dysregulation may persist. In neurotypical individuals, drugs such as methylphenidate and modafinil produce small-to-moderate improvements in cognition, particularly by increasing cognitive effort and motivation, with greatest benefits in those operating below optimal levels. However, their growing use raises ethical concerns regarding safety, fairness, coercion, and regulation. We argue that careful risk-benefit evaluation, long-term research studies, and informed policy are urgently needed to guide responsible use.