A new study from Children's Hospital of Philadelphia found that one in six adolescents in foster care nationwide in 2007 took antipsychotic medications. David Rubin, a study author and director of the hospital's PolicyLab, thinks that's a sign that too few treatment options are available.
Foster children often have a history of abuse and, as a result, emotional problems. While they represent less than 3 percent of children on Medicaid, they account for 25 to 41 percent of all mental health expenditures for children.
The Children's study, which analyzed Medicaid data, found that antipsychotic use in foster children of all ages increased from 8.9 percent in 2002 to 11.8 percent in 2007.
Most states saw an increase during that time. In Pennsylvania, seven of every hundred foster kids were given antipsychotics, an increase of 17.1 percent. Antipsychotic use among New Jersey foster children rose from 9.8 percent to 10.6 percent.
During the same period, there was a much smaller increase in kids who were taking three or more psychotropic drugs at once, known as polypharmacy. That number rose just 0.1 percentage point. Polypharmacy increased in some states and fell in others, including Pennsylvania and New Jersey.
The issue of putting kids on psychotropic drugs has drawn increasing attention, and there are national and state efforts to reduce use of these powerful medicines in children. Rubin said doctors are particularly concerned about the side effects of newer antipsychotic drugs, which can cause rapid weight gain, making kids vulnerable to diabetes. Too little is known, he said, about their long-term effects on the brain and learning. There's no evidence that giving multiple drugs is helpful, he said, and the drug combinations have caused some deaths.
Many of the children receiving the antipsychotics were diagnosed with attention-deficit or conduct disorders and had disruptive or aggressive behavior, Rubin said. "Their behavior problems are really a manifestation of untreated trauma," he said.
He doesn't fault doctors for prescribing a drug when the only other option might be letting a child be kicked out of school, again. "They have no other treatment programs available for them and the family's in crisis," Rubin said.