New Study Raises Concerns Over Foster Children on Antipsychotic Meds

The study published in Pediatrics is the first to examine the concomitant use of more than one antipsychotic medication among youth in foster care.

By Steve Berberich
November 28, 2011

The authors of a unique and revealing study of children in foster care receiving antipsychotic medication are calling for better oversight of such medications for youths.

A main finding from this research is that children in foster care were just as likely to be prescribed more than one psychotropic medication as were disabled youths says Susan dosReis, PhD, an associate professor in the University of Maryland School of Pharmacy’s Department of Pharmaceutical Health Services Research and the study’s lead author.

In the study, researchers examined Medicaid records of 637,924 children less than 20 years old who were either in foster care, receiving disability benefits, or on a family assistance plan.

Overall, 2.7 percent of the children received an antipsychotic medication, ranging from 11 percent for disabled youths, to10 percent for youths in foster care, and to 0.7 percent for youths in the family assistance program. However, among youth who received at least one antipsychotic medication, 9.2 percent of the foster children were prescribed more than one antipsychotic simultaneously, while only 6.8 percent of the children on disability benefits, and 2.5 percent in the family assistance program were prescribed more than one at a time.

The study published in the journal Pediatrics by researchers at the University of Maryland, Johns Hopkins University, and the University of Pennsylvania, is the first of its kind, say the authors, to examine the concomitant use of more than one antipsychotic medication among youth in foster care.

“The mounting evidence of the increased risk associated with these agents has heightened public concern about antipsychotic prescribing in pediatrics, and specifically adverse metabolic effects and the adequacy of monitoring and oversight,” the authors noted.

Amid growing national interest in providing better oversight of psychotropic medication treatment for youths in foster care, dosReis says she hopes the study will 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. There is no scientific evidence for efficacy or safety of treatment with more than one antipsychotic medication simultaneously,” says dosReis.

The authors conclude, “The findings 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.”

The study team consisted of dosReis; Yesel Yoon, and Mark Riddle, MD, with the Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine; David Rubin, MD, Department of Pediatrics, University of Pennsylvania School of Medicine; and Elizabeth Noll, PhD, MA, and Aileen Rothbard, ScD, with the Center for Mental Health Policy and Services Research, University of Pennsylvania.