Are Foster Children Taking Too Many Antipsychotic Medications?

Findings from a groundbreaking study indicate that children in foster care are just as likely to be prescribed more than one psychotropic medication as were disabled youths.

A team of researchers led by Susan dosReis, PhD, of the University of Maryland School of Pharmacy’s Department of Pharmaceutical Health Services Research, examined Medicaid records of 637,924 children aged 19 years and younger who were either in foster care, receiving disability benefits, or on a family assistance plan. The goal of the study, which was published ahead of print on November 21 in Pediatrics, was to examine the concomitant use of more than one antipsychotic medication among youth in foster care.

They found that overall, 2.7% of the children received an antipsychotic medication, with the breakdown being 11% for disabled youths, to 10% for youths in foster care, and to 0.7% for youths in the family assistance program. However, among those who received at least one antipsychotic medication, 9.2% of the foster children were prescribed more than one antipsychotic simultaneously, while only 6.8% of the children on disability benefits, and 2.5% in the family assistance program were prescribed more than concomitantly.

The authors also found that more than a third of the children in foster care without disabilities were taking multiple antipsychotic prescriptions for longer than 90 days. Of the children who were not adopted, 38% were taking multiple medications, compared with 26% of children on public assistance but not in foster care.

These high rates raised flags among the researchers. “When we see a subsample of kids getting more than one antipsychotic for an extended period of time, that is concerning because we’re moving toward a practice that isn’t supported by evidence showing that’s effective,” Dr. DosReis told Reuters Health.

The authors hope that the results of the study will lead to better oversight of psychotropic medication treatment for youths in foster care and lead to less antipsychotic use and better quality of mental health care.

“Children in foster care often have very complex emotional and behavioral problems for which antipsychotic medications are often prescribed,” she said in a statement. “There is no scientific evidence for efficacy or safety of treatment with more than one antipsychotic medication simultaneously.”

The findings, the authors concluded, “highlight the need to put systems into place that can not only monitor and provide oversight of utilization but also evaluate the quality of care and outcomes.”