Shirah Vollmer MD

The Musings of Dr. Vollmer

Shame: ‘Foster Kids Given Psychiatric Drugs At Higher Rates’

Posted by Dr. Vollmer on December 1, 2011

Foster care children are much more likely to be prescribed psychotropic drugs, a federal report finds.

 

http://www.npr.org/blogs/health/2011/12/01/143017520/foster-kids-even-infants-more-likely-to-be-given-psychotropic-drugs?ft=1&f=1001

I am assuming that child psychiatrists are prescribing these drugs to these foster kids. To quote from the article:

“I think putting me on all of these stupid meds was the most idiotic thing I experienced in foster care, and the worst thing someone could do to foster kids,” Cook said. “I was upset about my situation, not bipolar or ADHD.”

As a fellow child psychiatrist, I feel shame for my field. Why are we not standing up and saying that we will not prescribe to these kids who need better social services, and not necessarily psychotropic medication? We, as a field of professionals, are complicit in this problem. Something has to change!

9 Responses to “Shame: ‘Foster Kids Given Psychiatric Drugs At Higher Rates’”

  1. Jon said

    Right on!

  2. wendy said

    As a child clinician and foster parent, I feel this article imeans well, but the study is flawed. Children are in the foster care system because they have experienced substantiated abuse and/or neglect as well as at least one disrupted attachment from their primary caregiver. This disruption often happens multiple times. These children present with numerous physical and behavior symptoms due to trauma. Often, these children DO need medication in order to help them be socially appropriate and function in their lives. Children who have developed maladaptive coping skills will experience more negative consequences that will then be internalized by the child.

    This study is flawed because it is not using comparable populations. A child in foster care cannot be compared to a child who is not. It is comparing apples to oranges. By default, 100% of children in foster care has experienced at least one trauma (being removed from primary caregiver) whereas in the general population, the % is unknown.

    However, medication cannot be substituted for parenting – even foster parenting – or for the chronic failures of the child welfare systems. Child psychiatrists and clinicians should be educated in child development, symptoms of trauma and appropriate treatment. A new diagnosis is proposed for the DSM V called “Developmental Trauma”. This diagnosis better describes the psychiatric needs of a child in foster care.

    • Hi Wendy,
      Thank you for your comments and thank you for sharing your experience. I do agree that foster kids, in all likelihood, have a greater need for psychotropic medications than the general population. Having said that, it seems to me that clinicians have gotten sloppy by overprescribing these medications and thereby giving both the child and the caretakers the message that inappropriate behaviors warrant medications and not psychosocial interventions. It is my clinical impression that the pendulum has swung way too far in the direction of medication and away from more intuitive interventions such as more social supports. Thank you again.

      • Wendy said

        I observe more over-prescribing not by the child psychiatrists, but rather by a child’s primary care doctor. Child psychiatrists, at least in my geographic area, are in very short supply and it often takes months for a child to get an appointment. In lieu of this, PCP’s are prescribing medications without the same level of expertise. Also, in my experience, medication decisions are often made primarily by parent report of behaviors – not necessarily what the doc observes in the child or with any collateral input. Depending on the psychosocial issues the child and family are facing, this can be a dangerous combination.

        • Hi Wendy,
          Thank you again for chiming into this discussion. One of my wishes is for PCPs to feel comfortable consulting psychiatry, in this case child psychiatry, when there is a short supply of psychiatrists. This is another area where there is large room for improvement. I completely agree that collateral information is crucial and it is sloppy not to pursue getting that information before prescribing psychotropic medication to kids. Our business relies on thorough history taking, and this means from multiple sources. That is a basic tenet of our work, and it is a large shame that that is not more highly valued. Thank you again.

  3. Shelly said

    I agree with almost everything Wendy said….until the last paragraph where she said, “However, medication cannot be substituted for parenting – even foster parenting…” Wendy, the psychotropic medications we give our children is a last resort and it’s not a substitute for parenting. Some children are simply toxic to families, wild and uncontrollable; their behaviors destroy the rest of us. How judgmental to assume that medications are used to make our lives easier!

    • Hi Shelly,
      Thank you for your comments. The world of children in mental pain can become a blame game, where the blame is thrown from parents to doctors to systems of care. It is my hope that we can work together because we all know how tough it is to see what a child can do to himself, his family and to our society as a result of trauma and/or organic disorders. As we all know, medicating a child is a last resort. Yet, with the explosion of psychotropic drugs, and the loss of funding for social services, medicating children has become a less costly intervention, and so the fear is that medications are now overused in socially needy children. Some parents, certainly not most, when faced with difficulties in their family are drawn to the idea that medication for their child makes sense since it implies that poor parenting is not to “blame” for their child’s behavior. Once again, we have to get away from this either/or approach to mental illness and be more comprehensive in our approach.

    • Wendy said

      Shelly, I guess I didn’t make my last statement clear. I absolutely agree there are times children need psychotropic medication (re-read my first paragraph). However, there are parents (biological, foster or adoptive) who look to medicate behaviors vs examining and changing their own parenting practices. This isn’t a judgement, it is a fact. I see it first hand. I did not say ALL parents who give their children medication do this, but it does happen.

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