Why Parents Misuse Prescription Drugs to Enhance the Cognitive Performance of Healthy Children: The Influence of Peers and Social Media

• Date: 01 July 2021
• Published date: 01 July 2021
• Author: Guido Mehlkop,Cornelia Betsch,Sebastian Sattler,Vanessa Bahr
• DOI: 10.1177/0022042621994547
• Subject Matter: Articles

https://doi.org/10.1177/0022042621994547

Journal of Drug Issues

2021, Vol. 51(3) 461 –482

© The Author(s) 2021

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DOI: 10.1177/0022042621994547

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Article

Why Parents Misuse Prescription

Drugs to Enhance the Cognitive

Performance of Healthy Children:

The Influence of Peers and

Social Media

Sebastian Sattler1,2 , Guido Mehlkop3, Vanessa Bahr3,

and Cornelia Betsch3

Abstract

The mechanisms affecting parents’ misuse of prescription stimulant drugs to boost healthy

children’s school performance are hardly unknown. Using four web-based factorial vignette

surveys (2×2 between-subjects design experiment), we investigated the willingness of U.S.

parents with school-aged children to medicate a fictitious 13-year-old child whose grades had

declined. We examined mechanisms of informational and normative social influence on their

decision-making: others’ behavior (NExperiment 1 = 359), others’ definitions (NExperiment 2 = 326),

social control (NExperiment 3 = 325), and others’ experience (NExperiment 4 = 313). In addition, we

explored the moderating role of influential sources (close friends vs. social media). Parents

were more willing to engage in said behavior when others reported engagement in this behavior

or positive drug experiences, especially if both influences were transmitted via social media.

Others’ definitions and social control had no effect. Thus, social media might be a channel for

the prevention of pharmacological cognitive enhancement.

Keywords

cognitive enhancement, substance misuse, descriptive norm, injunctive norm, social influence

Introduction

If other children at school were hypothetically taking prescription drugs to increase cognitive

functions such as concentration or memory without medical necessity, approximately every third

respondent in a nonrepresentative survey (conducted by the magazine Nature among their

[potential] readers) would feel pressure to give such drugs to their child (Maher, 2008). Such

nonmedical use of prescription drugs has gained growing academic interest in recent years

(d’Angelo et al., 2017; Heyes & Boardley, 2019; O’Connor & Nagel, 2017; Teter et al., 2020).

Candidate drugs for this so-called “cognitive enhancement” (CE) include methylphenidate,

1University of Cologne, Köln, Germany

2Institut de recherches cliniques de Montréal, Quebec, Canada

3University of Erfurt, Germany

Corresponding Author:

Sebastian Sattler, Institute of Sociology and Social Psychology, University of Cologne, Universitaetsstrasse 24, 50931

Köln, Germany.

Email: sattler@wiso.uni-koeln.de

994547JODXXX10.1177/0022042621994547Journal of Drug IssuesSattler et al.

research-article2021

462 Journal of Drug Issues 51(3)

modafinil, and amphetamines. These drugs are usually prescribed to treat attention-deficit hyper-

activity disorder (ADHD), sleep disorders, or narcolepsy.

A recent study among U.S. high school students found that 2.5% self-reported CE for study

purposes (Teter et al., 2020). Among the several hundred thousand adolescents (aged 12–17) in

the United States who misused prescription stimulants (Substance Abuse and Mental Health

Services Administration, 2019), cognitive performance enhancement is one key motive (Schepis

et al., 2020). The prevalence rates of CE that have been assessed in different populations (e.g.,

students or employed people) vary greatly (Maier & Schaub, 2015; Sattler, 2016; Smith & Farah,

2011). Recent research, however, found indications for increasing prevalence rates in several

countries (Maier et al., 2018). Currently, little is known about parents’ administration of drugs to

enhance the cognitive performance of their children (Sattler, 2020a). According to a survey with

parents from the United States, 1% of parents of children aged 13 to 17 (who had not been pre-

scribed stimulants to treat ADHD) assumed that their children use “study aids,” and another 4%

were not sure (C.S. Mott Children’s Hospital National Poll on Children’s Health, 2013).

Most research investigating the etiology of CE has involved college and university students,

that is, persons using the drugs for themselves (reviews: Caviola & Faber, 2015; Ragan et al.,

2013; Schelle et al., 2014). We aim to explore the decision-making process of parents to give

these drugs to their children (here defined as 18 years and below) without medical necessity

because it can be assumed that at least for younger children, parents may contribute to children’s

CE. Parents are important stakeholders in decisions regarding whether a child will engage in CE

(Sattler & Wörn, 2019) because children depend on their parents’ stewardship (Coleman, 1994).

A certain proportion of parents seem to have high expectations toward their children’s school

performance, driven by the aim of improving their children’s prospects or own status motives,

often together with competitive thinking (Doepke et al., 2019; Nadesan, 2002; Rasmussen &

Troilo, 2016). This might make some parents tempted to administer CE. Moreover, parents are

also the gatekeepers of drugs, and as they are often role models, their attitudes may impact their

children’s attitudes and potential substance use subsequently in life (Epstein et al., 2007). While

researchers forecasted a rise of CE in children (Colaneri et al., 2018), also “because parents want

the best for their child” (O’Connor & Nagel, 2017, p. 5), parents fear such a rise (Forlini &

Racine, 2009; Hiltrop & Sattler, under review).

Factors that may facilitate an increase or prevent a decrease in CE include a high availability

of drugs due to more (invalid) diagnoses, competitive admission criteria and grading, increased

performance and peer pressure in schools, parents who may convince physicians that their chil-

dren have ADHD when they are not satisfied with their child’s grades or behavior, or the spread

of information through online sources (Conrad & Bergey, 2014; ExpressScripts, 2014; Forlini &

Racine, 2009; King et al., 2014; McCabe et al., 2005; Singh et al., 2013). Given this, parents

might be susceptible to rationalizing CE as an instrument to achieve their goals (Arria & DuPont,

2010), similar to engagement in other intensive parenting practices such as private tutoring

(Wells et al., 2016).

Such developments should also consider the serious criticisms that CE in children raised due

to its individual and social consequences (Colaneri et al., 2018; Graf et al., 2013; Nagel, 2019;

Sattler & Singh, 2016). These criticisms include concerns about fairness, side effects, social dis-

advantages, and peer pressure. Thus, gaining insight into how parents decide for or against such

drugs is crucial for prevention and regulation policies and to protect children from harm.

However, limited research has investigated parents’ motivations and goals regarding CE (Ball &

Wolbring, 2014; Forlini & Racine, 2009; Sattler, 2020b; Sattler & Wörn, 2019; Smith & Farah,

2011). The initial, mainly qualitative research, however, indicates that parents would administer

CE to children under certain conditions (Ball & Wolbring, 2014; Cutler, 2014). They would

surprisingly do so, despite no clinical research on the effectiveness of CE drugs in children

(Sattler & Singh, 2016). Reviews for research in healthy adults, however, indicated moderate