The Ethics of Using Brain Stimulation to Enhance Learning in Children

By Peter Leistikow

This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris in Summer 2016.

Peter Leistikow is an undergraduate student at Emory University studying Neuroscience and Sociology. When he is not doing research in pharmacology, Peter works as a volunteer Advanced EMT in the student-run Emory Emergency Medical Service. 

Ever since the advent of electricity, people have tried to harness this power for therapeutic purposes. Nineteenth century posters touted the benefits of “self-applicable curatives for nervous, functional, chronic, and organic diseases” in the form of electric belts and harnesses (Browne 2014). Although these items are historical curiosities today, scientists are still trying to harness the potential benefits of electricity, especially in the treatment of psychiatric and learning disorders.

Transcranial direct current stimulation (TDCS) is a non-invasive experimental procedure that utilizes direct currents applied to two electrodes on the head with the goal of stimulating specific brain areas (John Hopkins Medicine 2016). Although there is evidence that this technology, and it’s closely related variant transcranial random-noise stimulation (TRNS), can increase attention and aid in treating cognitive impairments and depression, TDCS has caught the interest of companies and hobbyists assembling these devices for cognitive enhancement (Hogenboom 2014). This has worried some researchers, who have called for regulations regarding the sale and use of this technology which they fear can have detrimental effects if used incorrectly (Wexler 2015).

Meanwhile, researchers have continued to investigate TDCS, and the media has taken notice. In an article published just last year, neuroscientist Roi Cohen Kadosh explains his then-forthcoming study in which TRNS was administered to a group of twelve 8 to-10-year-old children with learning difficulties such as dyslexia or dyscalculia as the children played a game in which they guided a ball using gestures (Geddes 2015). In fact, they are a few of at least 1000 children estimated to have taken part in brain stimulation as part of clinical trials. As this research progresses, several issues must be addressed, namely costs and benefits of early life treatment, access to treatment, and future use as enhancement.

Because this technology can be used on a developing brain, there exists an opportunity to permanently change the structural organization of a child’s brain. Unfortunately, the promise of early treatment is tempered by the possibility of irreparable damage to the child’s brain. The thinner skulls of pediatric patients could have profound effects on everything from effects of treatment to dosing guidelines and side effects, and there is increasing skepticism regarding children as “small adults” for the purpose of utilizing TDCS data obtained from adults (Davis 2014). The allure of stopping or even reversing the effects of learning disabilities such as dyslexia is tempting, given that current clinical interventions are promising yet inconclusive; nevertheless, more studies are needed for parents of children with disabilities to make an informed choice regarding the therapeutic value of this technology (Cioni et al. 2016).

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Along these same lines, access to this technology must be such that parents will not resort to purchasing or constructing this technology without being trained in its applications and shortcomings. Some may argue that regulation of this technology and criminalization of its use outside of a clinical setting may deter parents until further data is available, but ultimately the success of needle exchange programs and other public health initiatives shows us that harm reduction is the most ethical path until an optimal end point can be reached (Kleinig 2009). In this case, the optimal end point would be proven therapeutic value of TDCS for pediatric patients, and an equitable dissemination of TDCS for those whom it is indicated. Although there is understandable skepticism regarding this technology among researchers, it may be possible to expand TDCS access to children of parents who would otherwise attempt home use of this technology. It should be a priority of researchers to advocate for parents of children with disabilities in order that they might have equitable access to TDCS and make informed decisions regarding their child’s treatment, especially given that risks and rewards of treatment may vary by disorder type and severity. At the same time, it is crucial that parents seeking a “last resort” option are not commodified and used for studies that have little interest in alleviating their child’s disability.

Central to the debate over TDCS is where treatment ends and enhancement begins. Maslen et al. (2014) argue that for a child experiencing significant neurological burden, brain stimulation may be permissible despite negative side-effects, while cognitive enhancement involves even more significant cognitive trade-offs and should not be permitted. However, enhancement is defined relative to the abilities of others, and direct marketing to consumers by pharmaceutical companies and other corporations as seen in the testosterone supplement industry could further obfuscate the already blurred line between treatment and enhancement (Purcell 2014). Already the ease of constructing or purchasing TDCS could conceivably lead to its ubiquity among competitive parents once the technology is optimized. Thus, there is a need for the adoption of standardized criteria to determine who is eligible for TDCS use. Researchers may be able to assist in the development of these criteria by acknowledging how their TCDS findings will be used by hobbyists for both treatment and enhancement in further investigations into the cognitive effects of TCDS (Wexler 2015).

It is crucial that we continue to advocate for responsible use of experimental technology whether within or outside of the laboratory. Unlike the dubious electricity-based endeavors of antiquity, our approach to both the science and ethics of transcranial direct stimulation must be appropriately rigorous.

References

1. Browne, A. 2014. It’s electrifying! Medical uses of electricity. New York Historical Society, October 1. Available at: http://blog.nyhistory.org/electric-medicine/ (accessed June 11, 2016).

2. Cioni, G., Inguaggiato, E. and Sgandurra, G. 2016. Early intervention in neurodevelopmental disorders: underlying neural mechanisms. Developmental Medicine & Child Neurology 58: 61–66. doi: 10.1111/dmcn.13050

3. Davis, N. J. 2014. Transcranial stimulation of the developing brain: a plea for extreme caution. Frontiers in Human Neuroscience 8: 600. DOI: 10.3389/fnhum.2014.00600

4. Geddes, L. 2015. Brain stimulation in children spurs hope — and concern. Nature, September 23. Available at: http://www.nature.com/news/brain-stimulation-in-children-spurs-hope-and-concern-1.18405 (accessed June 11, 2016).

5. Hogenboom, M. 2014. Warning over electrical brain stimulation. BBC News, August 24. Available at: http://www.bbc.com/news/health-27343047 (accessed June 11, 2016).

6. John Hopkins Medicine. 2016. Transcranial direct current stimulation. Available at: http://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/tdcs.html (accessed June 11, 2016).

7. Kleinig, J. 2009. Thinking ethically about needle and syringe programs. Substance Use & Misuse 41(6): 815-825. DOI: 10.1080/10826080600668670

8. Maslen, H., Earp, B. D., Kardosh, R. C., & Savulescu, J. (2014). Brain stimulation for treatment and enhancement in children: an ethical analysis. Frontiers in Human Neuroscience 8: 953.

9. Purcell, R. 2014. The new normal: how the definition of disease impacts enhancement. The Neuroethics Blog, July 24. Available at: http://www.theneuroethicsblog.com/2014/07/the-new-normal-how-definition-of.html (accessed June 11, 2016).

10. Wexler, A. (2015). A pragmatic analysis of the regulation of consumer transcranial direct current stimulation devices in the United States. Journal of Law and the Biosciences 2(3):669-696.

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Leistikow, Peter. (2016). The Ethics of Using Brain Stimulation to Enhance Learning in Children. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/08/the-ethics-of-using-brain-stimulation.html