ABC news had a special yesterday on the use of psychiatric drugs for US foster children. Their report was based in part on a Government Accounting Office (GAO) report which found foster children were prescribed psychotropic drugs at rates up to nearly five times higher than non-foster children. Foster children were also more than nine times more likely than non-foster children to be prescribed drugs for which there was no FDA-recommended dose for their age. Perhaps most disturbing, foster children younger than 1 year old were nearly twice as likely to be prescribed a psychiatric drug compared to non-foster children. One of the concerns is that these incredibly powerful drugs are being used to subdue and “restrain” children with problematic behaviors.
Why are the numbers so high for foster kids?
“The general consensus is that when you’re treating young children, you always try behavioral intervention before you go to medication,” said Dr. Charles Zeanah, director of child and adolescent psychiatry at Tulane University. Dr. Jeffrey Thompson, chief medical officer for Medicaid in the state of Washington, said, “Nobody gets up in the morning to overdose kids. It just happens that it’s a momentum in the system. Kids get aggressively diagnosed and sometimes we look for the easy solution, which is a pill over psychotherapy or better parenting.”
While in no way trying to justify over-medication or inappropriate use of medication, it seems to me that the most relevant statistical comparison would be comparing the use of psychiatric drugs by foster children to the use by other children diagnosed with conditions such as Post Traumatic Stress Disorder, Attachment Disorders, or other mental disorders that might be caused by abuse or neglect. The truth is that children who come into state care come from hard places, and sometimes come with the baggage of abuse and neglect which often manifest in difficult behaviors and mental illness. Behavior modification and counseling take time, a stable home, and a great deal of commitment by parents—often this level of time, stability, and commitment is beyond the average foster parent.
How do the numbers compare to non-foster care kids in similar situations?
While not discussed in this report, it is an unfortunate fact that treatment of mental health issues requires money and in our country requires good insurance. Children in foster care have decent health coverage (Medicaid) which will pay for these drugs. Many many many other children do not have coverage for mental illness. In this case, it’s hard to know whether this coverage is a blessing or a curse since it looks like it has led to over-medication, but I talk with many parents who would like to explore the cautious use of medication with their children who are stymied by the cost.
I am thrilled that ABC News is bringing attention to this problem. I am also pleased that the coverage I saw talked about the importance of adoption. Kids need committed parents with the time and emotional investment to fight for the most appropriate treatment available.
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I view this from many angles. Are meds over used in foster care and in our nation in general, yes. Do behavior modification techniques work, yes. Problem is you have foster care with real issues, big issues, and severe behavior. When trying to treat these issues a kid can be moved from home to home over and over again. How can you implement a behavior plan when the kids always are moving? Sometimes you need to medicate a child in order for them to find a stable home and then begin behavior modification techniques. None of our adopted kids are medicated, not even the ones we fostered to adopted and adopted stright from foster care. We currently do respite care for kids transition between foster homes. Everyone we have done that for has been very medicated and have been through a lot of homes. I am not sure there is a good solution. These kids need stable homes whether it be long term foster care or adoption. Without medication many of these kids wouldn’t be able to find those homes.
We’ve worked real hard at providing a safe home and a significant change in diet(that mainly consisted of sugar) and there was no need for the meds any longer.
No diagnosis but all kinds of medications. He came to us on 4 different meds. Mainly for bed wetting and behavior, and than they weren’t sure what the other one was for. He’s never had any incidents of bed wetting or any sort of behavior issues to speak of since he’s been in our home.
great article. We’ve experience this to a T with our son after adopting him through foster care.
Honestly though,I myself was in Foster Care and i think the problem is that quite a bit of Foster Parents are not qualified enough to care for these children that try to withstand everyday life. I strongly believe that not a lot of foster or regular parents care what the the child is thinking about everything that’s going on.Some people just think that us foster children don’t know what is good for us and what is not because we are younger than the parents. i think if the parents listened to us,they would not have to drug us to supposedly make us feel better.
Good point. Clearly more training and support for foster parents would help. I know plenty of foster parents who would add that it would help if “the system” would listen to them more too.
What about REAL parents? You only mention foster parents…my child wad NOT medicated until the state became involved…she was a straight A student active in extra curricular activities…maybe the states should STOP medicating our children to keep them compliant!
Tammy, how did the state become involved with making medication decisions for your child?
Thank you for understanding these kids! We have 3 siblings we just adopted from foster care who have lived with us for 15 months. We had to make the agonizing decision to medicate one of our kids. Her PTSD is so severe that her anxiety prevented her being able to be parented. Our other two are not without their issues, but are not at the same level and are not taking medication.
No parent “wants” to give their child medication. No parent wants for their child to need medication. I have no doubt foster kids are often over-medicated, but I don’t want parents to feel guilty if after trying other options, they conclude that judicious use of medications is in their child’s best interest.
I view this from many angles. Are meds over used in foster care and in our nation in general, yes. Do behavior modification techniques work, yes. Problem is you have foster care with real issues, big issues, and severe behavior. When trying to treat these issues a kid can be moved from home to home over and over again. How can you implement a behavior plan when the kids always are moving? Sometimes you need to medicate a child in order for them to find a stable home and then begin behavior modification techniques. None of our adopted kids are medicated, not even the ones we fostered to adopted and adopted stright from foster care. We currently do respite care for kids transition between foster homes. Everyone we have done that for has been very medicated and have been through a lot of homes. I am not sure there is a good solution. These kids need stable homes whether it be long term foster care or adoption. Without medication many of these kids wouldn’t be able to find those homes.
Maureen, thank you so much for this thoughtful response. I agree with you completely that it’s a complicated situation, and one of the reasons I post about it is because I think the ABC report did a poor job of looking at all the different issues. As with you, I think we over-medicate everything and everyone in this country, but I also think what you said has some merit. What kids need are parents to help figure out what’s in their ultimate best interest.
Which is proof that what most kids need are caring stable PARENTS!
What exactly did you experience. Over medication? Inappropriate diagnosis?