'Machiavellian' parents seem more willing to give kids unnecessary ADHD medication

April 25, 2021
Parents might be willing to give their kids medications normally prescribed for ADHD in hopes of improving their school performance. (Unsplash/James Paul)

Parents might be willing to give their kids medications normally prescribed for ADHD in hopes of improving their school performance. (Unsplash/James Paul)

Incentives such as money and success, along with certain personality traits such as Machiavellianism, could make parents hypothetically more willing to give their children medication for attention deficit hyperactivity disorder when they don't need it. 

In a paper published April 9 in Social Science Research, a duo of sociologists from Germany investigated the extent to which parents will go to enable their children to succeed in competitive settings. One of their findings was that parents who scored high in having a Machiavellian personality, with traits like manipulativeness, callousness and indifference to morality, were more likely to be open to the idea of giving healthy kids medication in order to boost their focus and performance.

The global manufacturing, trade and consumption of prescription stimulant drugs has been rising in the past two decades, particularly of medications that are intended to treat ADHD. Those medications are regularly misused to improve cognitive performance. This new study suggests parents often play a role in this problem.

Sebastian Sattler, a lecturer at the University of Cologne in Germany and lead author of the paper, told The Academic Times that he has been studying the nonmedical use of prescription drugs among university students for several years. He eventually realized that adolescents and their parents have been understudied when it comes to cognitive enhancement with prescription medications.

Cognitive enhancement is the use of drugs for nonmedical reasons with the intention of improving cognitive performance in areas like concentration, wakefulness, memory and learning. Medications such as methylphenidate, amphetamine and modafinil are usually prescribed for conditions like ADHD and narcolepsy, and they are commonly misused for cognitive enhancement.

"I found this topic especially interesting because investigating parents' underlying decision-making does not refer to their own prescription drug use, as [I researched] in my previous studies, but [to the fact that] they make decisions for other individuals—their children," Sattler said. "It brings in their potentially egoistic motivations and hopes for themselves, but also for their children, while at the same time one would expect that they [should] prevent harm [to] their children."

In their paper, which was based on an online survey of American adults who had at least one child in elementary, middle or high school, Sattler and his co-author Philipp Linden found that a small portion of the participants were willing to medicate a healthy child with prescription stimulants if it meant the child had a better chance at success, as defined by winning a fictional spelling bee and prize money. "A minority of parents seem to increasingly engage in intense parenting, accompanied by a competitive mindset and driven by the desire to optimize their children's future chances and to exceed the norm of their developmental achievements," Sattler and Linden said in that paper.

Intense parenting could be expressed in actions linked to educational achievement for the child, including homework support, standardized test preparation or other private tutoring, the authors said. But it is also seen in illegal practices, such as what was revealed in "Operation Varsity Blues," a large criminal conspiracy in the U.S. uncovered in 2019 that involved wealthy parents bribing admissions consultants and athletic coaches in order to get their children into elite universities. 

The authors cited previous research that found in parents of children recently diagnosed with ADHD, the parents were more likely to start their children on medication if the parents had strong academic goals for the children. In a study by a different pair of researchers, parents reported that they would accept side effects to reap academic benefits for their diagnosed children. But Sattler and Linden said that no prior study had researched how a parents' decision-making may be influenced by the situation, their personality and the interaction between the two, which they feel has left parental interventions and education initiatives uninformed.

Through their study, the authors wanted to examine how parents with certain personality traits would act in competitive settings, and how those personalities would interact with clear incentives and disincentives within the setting to affect their decision-making. "We argue that tangible incentives increase parents' willingness to administer such drugs," the authors said in the paper. "To test this assumption, we investigated to what degree the attractiveness of the stakes in a competitive situation motivates parents to administer [cognitive enhancement] drugs."

They surveyed 1,360 participants online, asking them to read different versions of a vignette in which a 12-year-old child hopes to win a national spelling bee. In the vignettes, the fictional single parent of the child listens to a radio broadcast in which a researcher talks about cognitive enhancement drugs and their side effects. The story mentions that the parent has access to such drugs via an acquaintance, that the competition would award prize money and that the parent does not have information about other competitors in the spelling bee. 

Several further details of the story were manipulated to create the different versions, such as how much money the child could win, how happy that victory would make the child, how high the child ranked in past spelling competitions, the level of enhancement the medication would give them, the probability and severity of any side effects and how expensive the medication would be. Each study participant evaluated four versions of the story for a total 5,440 responses.

Because the situation featured in the vignettes had to do with prize money in a contest, the researchers hypothesized that the higher the amount that could be won, the more willing parents would be to administer cognitive enhancement drugs. They also expected that the parents would be more willing to give their child medication if the child had already done well in similar prior contests.

After reading each scenario, the participants indicated their willingness to give a cognitive enhancement drug to the child on a 100-point scale ranging from "definitely not" to "definitely yes." The participants' personalities were evaluated using the Machiavellian subscale of the Short Dark Triad in which they indicated their level of agreement with nine statements. They were also asked whether their child had ever been diagnosed with ADHD and whether the child had been medicated. Additionally, they were asked about their family's history with cognitive enhancement drugs

About 15.5% of the participants reported personally using drugs for cognitive enhancement during their lifetime, and 6.8% said they had administered them to their children for the same reason at least once, which Sattler noted was higher than he and Linden had expected. In 58.2% of the vignette evaluations, the participants reported zero willingness to medicate the healthy child in the story; while 41.8% chose any number other than zero, indicating at least some willingness. But Sattler said the number of evaluations that showed a strong willingness to favor drug use was less than 5%.

Analysis of the results showed that both the higher prize money and the child's higher ranking in a prior competition increased the participants' willingness to administer drugs.

On the other hand, the severity and the probability of side effects as well as the medication price diminished participants' willingness to administer drugs. Perhaps unsurprisingly, the participants who had a history of consuming or having their children consume cognitive enhancement drugs were also more willing to administer the drugs compared to participants without that history.

Parents who scored high in Machiavellianism were more likely to say they would give cognitive enhancement drugs to the child, and the higher their Machiavellianism score, the greater the effect the prize money had on their responses. Sattler theorized that parents with a Machiavellian personality type may see the medication option as a manipulative way to gain control of the situation, as well as to fulfill their own extrinsic desires.

"From our findings, we can conclude that parents' decisions do not depend only on certain incentives, like money to be won, and disincentives, like risks of drug use, but also the parent's personality. Furthermore, such situational circumstances can be processed differently depending on a person's personality traits," the authors said in the paper.

Sattler and Linden emphasized that their study was not large enough to be considered representative, and future research should replicate their findings with a large-scale, nationally representative sample. They also recommended that related studies should examine more personality traits of parents in the context of other competitive parenting situations, such as standardized tests.

"Practically, we can conclude that children as a vulnerable group, who often cannot protect themselves from harm, might be at risk if parents with certain personalities find themselves in tempting situations," Sattler said. "Public health authorities should not only consider ways to increase parents' understanding of the ethical problems associated with cognitive enhancement, [but also] promote children's growing up in a protective, diverse and creative environment."

The study, "Unhealthy parenting strategies: Situational (Dis-)Incentives, Machiavellian personality, and their interaction on misuse of ADHD medication for healthy children," published April 9 in Social Science Research, was authored by Sebastian Sattler, the University of Cologne and the Montreal Clinical Research Institute; and Philipp Linden, the University of Cologne and the University of Siegen.

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