“I just wanted to talk to someone.” We hear this time and again from young people in the foster care system. These children and adolescents have a lot on their minds. For whatever reason, their parents were unable to care for them. That fact alone contributes to the unusually high levels of depression and anxiety in this population. Add to that the frequent changes among those charged with their care. Change and uncertainty are a way of life for foster children as caseworkers come and go and they move from one foster home to another — often without warning or explanation. They want to make connections — to have someone to hear about what is making them so unhappy that it is difficult for them to think and learn, to make friends, and to enjoy life. However, as the New York Times reports, when these children want someone to lend an ear, they are often given pills instead. And the drugs they are given, even at a very young age, are powerful psychotropic drugs, formulated to treat the most serious of mental illnesses.
Researchers from the University of Maryland, Johns Hopkins University, and the University of Pennsylvania analyzed the distribution of psychotropic medication among nearly 17,000 Medicaid-enrolled youth in one mid-Atlantic state. Among three groups — youth in foster care, disabled youth receiving Supplemental Security Income (SSI), and those receiving Temporary Assistance for Needy Families (TANF) — foster youth were more likely to be prescribed more than one psychiatric medication and to be maintained on those medications for longer than youth in the other two groups.
The findings of this study are extremely disturbing.
First and foremost, as the authors note, “concomitant antipsychotic use is not empirically supported.” While the evidence does not suggest that youth will benefit from a regime that includes two or more of these powerful drugs, the evidence does demonstrate that even one of these “atypical antipsychotics” can produce dangerous and lasting side effects. For example, metabolic changes induced by these drugs can lead to obesity, high cholesterol levels, and diabetes and patients taking these medications should be carefully monitored.
The need for ongoing medical supervision points another concern arising from this study. Life in foster care is notoriously unstable. When children move from one foster family to another, there is no guarantee that they will remain in the same community or that there will be continuity in their medical care. Indeed, “Medical Passports” were created to address the need for foster children to carry their records with them because of the great likelihood that they would receive medical care in different places and from different people. In attempting to understand the results of their study, the authors posit a number of possible clinical explanations and suggest that some “might lack a reasonable clinical rationale.” These explanations might be directly related to larger systemic issues. For example, it may be that as a result of multiple changes and the lack of a consistent adult, foster youth remain on medications longer than other children because they simply didn’t have consistent follow-up appointments.
No doubt, there are many possible clinical, systemic, and other ways of explaining the outcomes of this study. One issue that must be kept in mind is role of the parent or caregiver throughout the medication process. Parents are called on to describe the child’s symptoms, participate in the decision making-process, administer medications, monitor effects and side effects, and maintain communication with physicians and other professionals involved in the child’s care. This is a complex and lengthy process that depends on the parent or parent substitute knowing a child well enough to detect behavioral and affective changes over time and in different context. Most parents can offer this to their children. When they can’t, we owe children long-lasting relationships with other adults who can.
By Toni Heineman