Cognitive Enhancement and Education: Perspectives from a Low-and Middle-Income Context

By Jayashree Dasgupta and Georgia Lockwood Estrin

This piece is part of a series of featured posts from the 2020 International Neuroethics Society Meeting. It is based on an abstract titled “How Do Parents View Cognitive Enhancers for their Children? Evidence from India” that won the award for the “Best Oral Presentation.”

Image courtesy of Wim Klerkx

The term “cognitive enhancement” generally refers to improvements made above or beyond the “typical” or “normal” in areas of cognitive functioning like attention, memory, and speed of processing. Strategies for cognitive enhancement include a variety of approaches such as exogenous agents, e.g., pro-cognitive drugs and nutritional supplements, behavioral interventions, and neuromodulation techniques like transcranial magnetic stimulation (Keshavan, Vinogradov, Rumsey, Sherrill, & Wagner, 2014). However, as “normal” depends upon the context, the scope of cognitive enhancement has been a hot topic of debate, particularly when it comes to use with children.  

Traditionally, pro-cognitive drugs, such as methylphenidate, have been used for treatment purposes in neurodevelopmental disorders, like Attention Deficit Hyperactivity Disorder (ADHD). From a clinical deficit perspective, there is a clear understanding that children fall below the norm due to an underlying condition, and therefore the use of cognitive enhancement to help a child achieve their full potential is largely acceptable to parents and society. However, the concept of “normal” cognitive development is complex, and research has demonstrated poverty and adversity to be among the several factors which influence brain development (Lipina & Evers, 2017). Would children from disadvantaged backgrounds who fail to reach their true cognitive potential be considered to fall below the norm and be a potential target for cognitive enhancement? Whilst there has not been much research in this area, a series of studies conducted by Farah and colleagues has shown strong associations between poverty and adverse development of children’s cognitive abilities (e.g. Farah et al., 2006). For some, this suggests that children from disadvantaged backgrounds, who are at high-risk of not achieving their full cognitive potential, should be offered cognitive enhancers as a way to potentially equalise the playing field and optimize brain development for those most in need. However, the use of cognitive enhancement raises many neuroethical concerns, including those related to opportunity, medical safety, coercion, and fairness (Schelle et al, 2014). 

These questions may be particularly pertinent in Low and Middle Income Countries (LMICs), where there are over 200 million children at risk of sub-optimal development, a majority of whom live in India (Lu, Black, & Richter, 2016). Theoretically, cognitive enhancers like pro-cognitive drugs, nutritional supplements, and stimulants could be widely distributed to help such children overcome the limitations of living in adverse circumstances. An advantage of such cognitive enhancers, compared to e.g. providing more broad-based social changes, is its potential to be scaled up at comparatively low cost, thereby benefitting more children (Butcher, 2003). This debate argues that cognitive enhancement could help disadvantaged children attain their true cognitive potential, and benefit from advantages like improvements in academic performance, thereby opening avenues for upward social mobility. This has been a focus of academic deliberations, and neuroethicists have questioned whether it is our moral and social responsibility to provide children growing up in sub-optimal environments cognitive enhancement. However, cognitive enhancement research in children has almost exclusively been carried out in High Income Countries (HICs), and we know little about how this idea is viewed in LMIC contexts where parents and children could be potential end users and beneficiaries.  

Image courtesy of Anders Sandberg on Flickr

Our ongoing work through the NeuroGenE project aims to throw light on these questions, and for the first time tries to understand how parents across different socioeconomic strata in India view cognitive enhancement. Through discussions about vignettes on cognitive enhancement techniques, we have been exploring parental attitudes and are trying to understand which techniques are most acceptable. Our initial findings indicate that in general, parents are skeptical about non-traditional approaches, e.g., ingestion of pro-cognitive drugs or other supplements. Issues parents raised included concerns about safety and side effects as well as challenges of accessibility and affordability. Instead, parents across socioeconomic strata emphasized the importance of more traditional approaches, such as education and good nutrition (not in the form of supplements). Parents highlighted the need for effective implementation of good quality education to help children attain their true cognitive potential and succeed in later life.  

So what about other types of “cognitive enhancing” tools? 

Unfortunately, the most significant event of 2020 was the COVID pandemic, which has impacted education systems globally. Schools across the world have been struggling with disruptions to the academic year and India has been one of the countries to institute nation-wide school closures in an attempt to reduce the spread of COVID. It is estimated that this has impacted 320 million learners across the country. To help children continue with their schooling, there has been a sudden and unprecedented shift to online education. The government has launched several e-platforms to assist students and teachers until schools reopen, and at an institutional level, schools have developed and are delivering curriculum online.  

Image courtesy of Pixabay

One can see that online education has the potential to reach children from disadvantaged backgrounds who may not otherwise have access to good schools and resources to optimize their cognitive development. From within their homes, these children could access education on par with children from far more privileged backgrounds, thereby bridging this critical gap in access to quality education. One could even go as far as to say the forced shift to online education as a result of the COVID pandemic is actually a silver lining. However, this would be oversimplifying the solution for such a complex challenge. Societal disparities in access to the internet and affordability of technology remain a major barrier in several parts of the country that cannot be ignored. Further, even if technology is made more accessible and affordable, how do parents of children from disadvantaged backgrounds, who themselves may not be educated or comfortable with technology, help their children navigate online education? We also know that educational context and the school environment play a critical role in identity formation and interrelatedness of individuals with society (Verhoeven, Poorthuis, & Volman, 2019). The long term social and ethical implications of a shift to online education are not clearly known. Therefore, although online education may have the potential to reach children from disadvantaged backgrounds, it remains to be seen whether online education would actually reduce or widen the gaps of cognitive, social, and emotional development that education strives to fill.  

Despite these questions, our research in India has so far suggested that parents across socioeconomic strata appear to be reticent for quick fix solutions involving pharmacological approaches and supplements for cognitive enhancement that come with concerns about safety and potential side effects. Our research instead points towards the need to invest in traditional and acceptable approaches, such as improving access to quality education in LMIC contexts. Ironically, the current pandemic may be providing us with a unique impetus to improve the quality and universal access to online education - an opportunity that should not be missed. 

References

1. Butcher, J. (2003). Cognitive enhancement raises ethical concerns. Academics urge pre-emptive debate on  neurotechnologies. Lancet, 362(9378), 132-3. 
2. Farah, M. J., Shera, D. M., Savage, J. H., Betancourt, L., Giannetta, J. M., Brodsky, N. L., Malmud, E. K., and Hurt, H. (2006). Childhood poverty: Specific associations with neurocognitive development. Brain Research, 1110(1), 166-174. 
3. Keshavan, M. S., Vinogradov, S., Rumsey, J., Sherrill, J., & Wagner, A. (2014). Cognitive training in mental disorders: Update and future directions. American Journal of Psychiatry, 171(5), 510–522. https://doi.org/10.1176/appi.ajp.2013.13081075 
4. Lipina, S. J., & Evers, K. (2017). Neuroscience of childhood poverty: Evidence of impacts and mechanisms as vehicles of dialog with ethics. Frontiers in Psychology, 8(JAN), 1–13. https://doi.org/10.3389/fpsyg.2017.00061 
5. Lu, C., Black, M. M., & Richter, L. M. (2016). Risk of poor development in young children in low-income and middle-income countries: an estimation and analysis at the global, regional, and country level. The Lancet Global Health, 4(12), e916–e922. https://doi.org/10.1016/S2214-109X(16)30266-2 
6. Schelle, K.J., Faulmüller, N., Caviola, L. and Hewstone, M., 2014. Attitudes toward pharmacological cognitive enhancement—a review. Frontiers in Systems Neuroscience, 8, 53. 
7. Verhoeven, M., Poorthuis, A. M. G., & Volman, M. (2019). The Role of School in Adolescents’ Identity Development. A Literature Review. Educational Psychology Review, 31(1), 35–63. https://doi.org/10.1007/s10648-018-9457-3 

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Jayashree Dasgupta is a clinical psychologist and co-lead of a project at Sangath, India, supported by the Global Initiative in Neuropsychiatric GenEthics (NeuroGenE). She is also the Co-Founder and Project director of Samvedna Senior Care, India. Her work focuses on ethical issues of cognitive enhancement, dementia care, caregiving experiences and access to mental health interventions in low resource settings. 

Georgia Lockwood Estrin is the co-lead of this project. Her work focuses on ethical issues surrounding neurodevelopmental research in low-resource settings, and she is currently a Sir Henry Wellcome Post-doctoral Research Fellow at Birkbeck, University of London. 

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Dasgupta, J. & Lockwood Estrin, G. (2021). Cognitive Enhancement and Education: Perspectives from a Low-and Middle-Income Context. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2021/03/cognitive-enhancement-and-education.html