Monday, December 10, 2007

More foster kids getting drugged.

From a much longer article in the Rochester Democrat and Chronicle. There are also a number of heart wrenching letters in the comments section following the original story, indicating the horrific need for political reform in the foster care system.

When Laticia Anderson's son entered foster care in 2005, a social worker described the 4-year-old as "an extremely smart little boy who loves school."

But over the next six months, as he was shuttled from an emergency foster-care placement to two foster homes, his personality changed.

The boy would explode in tantrums, gouge his own flesh, even consider killing himself. Social workers and pediatricians could not quell his outbursts.

Frustrated, they resorted to Depakote, an anti-seizure medication intended for adults but occasionally given to children to alter their moods.

And then her son's personality really changed, Anderson said. The boy she knew as playful and exuberant was, when she visited him, distant and withdrawn - "almost like a zombie."

Like Anderson's child, hundreds of foster children in Monroe County each year are placed on psychotropic, or mood-altering, drugs. Though questioned in some medical and psychiatric quarters because of long-term health risks, the use of the psychotropic medications on foster care children in Monroe County is on the rise, a Democrat and Chronicle investigation shows.

The investigation included analyzing data from county, state and federal agencies; interviewing experts locally and nationwide; interviewing families of some local foster children on medications; and reviewing public records of Monroe County Family Court cases in which the prescription of the drugs has been an issue.

The investigation reveals that:
  • In 2002, about a third of the county's foster care population, 327 children, were prescribed one or more common psychotropic drugs. By the end of 2006, the number had increased about 40 percent to 457 foster children, or almost half of the county foster care population.
  • In the five years from 2002 through 2006, according to state data, Medicaid expenditures for common psychotropic medications for Monroe County foster children nearly doubled - an increase almost four times the statewide rate.
  • Psychotropic medications are also more commonly used at residential foster care treatment centers than in the past, according to medical and psychiatric staff. At the nonprofit Hillside Children's Center, for instance, 55 percent of the foster children are prescribed one or more psychotropic drugs.
  • 2006 records show that more than one of every eight foster children in Monroe County is on some kind of drug to combat psychosis, a severe form of mental illness characterized by lost contact with reality.
  • Very young children are also prescribed the psychotropic medications, according to county data.
Last year, a 1-year-old foster child was prescribed the antipsychotic drug Risperdal, and two 4-year-old foster children were prescribed Depakote. Pediatricians say Risperdal and Depakote, if properly monitored, can be safely prescribed for young children, but some medical experts worry about possible health effects. Risperdal has been associated with heart disease in older adults; Depakote has been linked to liver failure in children younger than 2.

Drugs a straitjacket?


Foster care advocates say children are a particularly vulnerable population, often invisible to the public and beset with higher rates of mental and emotional illness in large part because of the disruptive - and sometimes abusive - lives they've led.

This leads to a conundrum: Are foster children legitimately prescribed psychotropic drugs more commonly because they have so many needs? Or are the drugs used more as a convenient way to straitjacket troublesome behavior?


The use of such drugs "definitely has gone up, and I say that with much reluctance because I don't think these medications are necessarily safe medications," said Dr. Mohsen Emami, a staff psychiatrist at St. Joseph's Villa in Greece, a nonprofit residential facility for troubled youths.

Across the country, while the use of psychotropic medications for all children has increased, the rate of use for those in foster care has grown even faster. By some estimates, foster children receive psychotropic drugs at a rate two to three times that of other children.

"I have no doubt that many, many kids are overmedicated," said Dr. Martin Irwin, a Syracuse-area psychiatrist who has been contracted by counties and treatment centers around the state to help decrease the use of psychotropic drugs for foster children.

"It's out of control in general, but the worst problems are in foster care because there's basically nobody advocating for the kid."
There is also much more in this follow up article
A Democrat and Chronicle investigation shows an escalating use of psychotropic medications for foster children in Monroe County — reflecting a national trend. Some experts say that's because foster children have far greater rates of mental illness and emotional disturbance than other kids.

Yet physicians and lawmakers nationwide now fear that the increasing prescription of the drugs, without ironclad assurance of their safety, could be sentencing foster children to physical or mental ailments later in life. Two trends are especially worrisome:
  • Many psychotropic drugs prescribed to children and teens have not been tested for effectiveness or safety in youths.
  • The prescription of multiple psychotropic medications for individual children, such as Jessie Sayyeau, has become more common.
[...]

Eight years ago, between 75 percent and 80 percent of the drugs prescribed for children had not been studied for pediatric use, said FDA's Murphy. In 2002, Congress passed laws providing financial incentives to companies that conducted pediatric testing on medications. Under the law, the companies were granted exclusivity, meaning the time was extended before competing generic brands could be approved and reach the market.

Murphy said regulators are seeing results, but many drugs already commonly prescribed off-label probably won't be tested for pediatric use. A March study by the U.S. Government Accountability Office estimated that about two-thirds of drugs prescribed for children are used off-label, which, the report said, "places children at risk of being exposed to ineffective treatment or incorrect dosing."

Many critics say that, despite the congressional action, far more needs to be done.

"If the United States does not build a more adequate system for studying and monitoring drug safety, then it's reasonable to think, down the road, we're going to see (side effects) in children that are going to surprise us," Zito said.

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