Children in foster care are taking psychotropic drugs at a rate much higher than non-foster children in Medicaid. According to a new report by the Government Accountability Office (GAO,) children in foster care in five US states are taking powerful mind-altering drugs at a rate two to almost five times higher than non-foster children. Overmedicating children with powerful drugs may alter their quality of life and psychological development.
The investigation by the GAO was prompted by a request from both Republican and Democratic United States senators, led by Senator Tom Carper (D-DE), concerned by numerous reports of waste and abuse in treating foster children with psychiatric medications.
Although all children can be affected by overmedication, foster children are particularly vulnerable, since they lack the family and social support that other children usually have.
In addition, they tend to have more serious medical and mental health conditions than children in different situations.
The GAO report analyzed the situation of 609 foster children and 1,100 non-foster children in Oregon, Florida, Massachusetts, Michigan and Texas, and found that at least one-third of foster children were prescribed one or more psychiatric drugs. The cost of this policy is staggering: the five states in the study spent $375 million for psychotropic prescriptions for children covered by Medicaid, $200 million of which was spent in Texas alone.
As indicated in the report, although hundreds of children -both foster and non-foster- were given five and in some cases even more medications, there is no evidence that such a medication regime can really benefit the children but can, instead, give rise to serious side effects. In addition, thousands of infants under one year old were given psychotropic drugs which could have serious adverse effects such as metabolic and cardiovascular problems.
Even though the actual percentages of children receiving several psychiatric drugs at the same time were relatively low in the five states analyzed, the chances of this happening among foster children are a cause for concern. In Texas, for example, foster children were 53 times more likely to be given five –and sometimes more- psychiatric medications at the same time than non-foster children.
The GAO report also found that almost 4,000 foster and non-foster care infants under a year old who were on Medicaid were taking those drugs. In addition, foster children were nine times more likely than non-foster children to be given medications for which there was no FDA-recommended dose for their age, according to an investigation carried out by Rutgers University among 300,000 children in 16 states.
Among the so-called psychotropic drugs are medications such as anti-depressants, anti-anxiety, antipsychotics and mood stabilizers that act by altering chemical levels in the brain, and as a result provoke altered mood and behavior. Among those medications, antipsychotics are the most prescribed psychiatric medications, particularly among foster children on whom they are used as chemical restraints.
Although psychotropic drugs have proven to be effective in treating a variety of mental disorders and have been approved for use in adults by the Food and Drug Administration, they have not necessarily been approved for use in children of all ages. The report found that thousands of foster and non-foster children were given high doses of medications with potentially serious side effects.
Antipsychotic medications may cause tremors, muscle spasms, restlessness and tardive dyskinesia, a serious condition in which patients have involuntary movements of the tongue, lips, and arms and legs. According to the National Institute of Mental Health, each year five percent of people on antipsychotics will develop tardive dyskinesia.
Elizabeth J. Roberts, a psychiatrist in California wrote, “Using such diagnostics as bipolar disorder, attention-deficit hyperactivity disorder (ADHD) and Asperger’s, doctors are justifying the sedation of difficult kids with powerful psychiatric drugs that may have serious, permanent or even lethal side effects.”
A critical recommendation of the GAO report is that HHS considers endorsing guidance for states on best practices for overseeing the prescription of these drugs to all, but particularly to foster children. Unless stricter procedures are followed, the quality of life and health of thousands of children will continue to be negatively affected.
Dr. Cesar Chelala is an international public health consultant.