# Ethical Considerations in Requests for Stimulant Medication from Patients Without an ADHD Diagnosis - URL: https://alisanburak.com/en/wcp-2026-posterler/so442 - Language: en - Last updated: not specified - Page title: Ethical Considerations in Requests for Stimulant Medication from Patients Without an ADHD Diagnosis | WCP 2026 Summary > Neither reflexive refusal nor uncritical acceptance is defensible when patients who do not meet diagnostic criteria request stimulants; individualized assessme… This page was translated automatically from Turkish. [Read the original](https://alisanburak.com/wcp-2026-posterler/so442) This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it. SO442 Brief Oral Poster PresentationEducation and EthicsClinical vignette-based ethical analysis and review # Ethical Considerations in Requests for Stimulant Medication from Patients Without an ADHD Diagnosis ETHICAL FACTORS IN NAVIGATING PATIENT REQUESTS FOR STIMULANTS WITHOUT ADHD DIAGNOSIS Presenter: Omar Kawam Country: United States of America Institution: Rutgers Robert Wood Johnson Medical School Session: 4530 - PARALLEL SHORT ORAL POSTER SESSIONS: ETHICS & HUMAN RIGHTS Date: Sat, 26.09.2026 Neither reflexive refusal nor uncritical acceptance is defensible when patients who do not meet diagnostic criteria request stimulants; individualized assessment, shared decision-making, and, when appropriate, a time-limited, monitored trial offer an ethically defensible approach. The aim of this paper was to examine the ethical tensions arising in encounters with patients who request stimulant medication despite not meeting the diagnostic criteria for adult attention-deficit/hyperactivity disorder (ADHD), and to propose practical frameworks for managing these tensions. The method involved applying the principles of autonomy, beneficence, nonmaleficence, justice, and professional integrity to a representative clinical vignette describing a patient with bipolar disorder, substance use disorder in remission, and hypertension who requested continuation of stimulant treatment initiated through telepsychiatry; the literature on ADHD diagnosis, stimulant prescribing, cognitive enhancement, and shared decision-making was reviewed and synthesized. The vignette states that the patient met only 3 inattention criteria, compared with the minimum of 5 out of 9 required by DSM-5 for adult ADHD, that attention and inhibitory control were average on an objective continuous performance test (CPT), and that working memory and processing speed were unimpaired. The analysis reveals substantial tensions among patient autonomy, diagnostic accuracy, avoidance of harm, and equitable allocation of resources, indicating that both rigid refusal and uncritical acquiescence carry ethical risks. It notes that genuine functional impairment may be present despite subthreshold symptoms, and that time-limited, monitored stimulant trials alongside evidence-based adjunctive interventions may be justified in high-risk life circumstances; explicit discontinuation criteria, limited prescribing, long-acting formulations, urine drug screening, state prescription monitoring programs, and a signed treatment agreement are described as safeguards for such a trial. Alternative approaches include prioritizing the management of comorbid conditions and related concerns (mood stabilization, hypertension, sleep disorders, and active substance use), nonstimulant options such as atomoxetine, bupropion, and guanfacine, cognitive behavioral therapy targeting attention and executive functioning, and workplace accommodations. In conclusion, the authors recommend simultaneously considering the patient’s genuine functional difficulties and the societal consequences of prescribing for subthreshold symptoms, and call for professional organizations to develop clearer regulatory guidance beyond the level of the individual clinician. [View the original poster](https://cslide.ctimeetingtech.com/wcp26/attendee/eposter/file/25) How to cite this study APA 7: Kawam, O., et al. (2026, September 26). Ethical factors in navigating patient requests for stimulants without adhd diagnosis [Poster presentation]. 26th WPA World Congress of Psychiatry (WCP 2026), Stockholm, Sweden. https://cslide.ctimeetingtech.com/wcp26/attendee/eposter/file/25 Vancouver: Kawam O, et al. Ethical factors in navigating patient requests for stimulants without adhd diagnosis [poster]. 26th WPA World Congress of Psychiatry (WCP 2026); 2026 Sep 23-26; Stockholm, Sweden. 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