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.
Image Credit: fotobydave