Foster Kids: Over-Medicated or Under-Treated?

On December 1st 2011 Diane Sawyer reported on foster children and how many are on psychiatric medications.  She showed them tracking down doctor’s in parking lots as if it were “To Catch a Predator” and asking the doctor about his treatment of a foster child.

The story was very sad, but the spin on the story was even worse.

It speaks of a child and says “Both his father and mother had ended up in Jail.”

It then asks “What would drive a 7 year old to kill himself?”

While no one really knows the answer, they certainly seemed to imply that it had nothing to do with a horrific childhood, rather it was due to medications.

Let’s examine the evidence concerning foster kids and psychiatric treatment.

According to a GAO report in 2011: Foster kids are prescribed psychiatric medications 2.7 to 4.5 times more than non-foster children and often at much higher doses.

That is alarming.  Are we over-medicating these kids?  Are they being given medicines with serious side effects to "calm them down" so they're easier to deal with?

Another study published in 2010 gave us statistics on mental health disorders among adults who were once in foster care.  It turns out that kids in foster care are more likely to have mental illnesses as adults.

PTSD: 3.9 times more likely (30% in foster kids v. 7.6% in the general population)

Major Depression: 1.95 times more likely (41.1% v. 21% in general population)

Panic Disorder: 4.39 times more (21.2% v. 4.8%)

Generalized Anxiety: 2.7 times more (19.1% v. 7%)

Drug Dependence: 4.6 times more  (21% v. 4.5%)

So if we look at these two studies - it looks like kids in foster care are between 1.9 and 4.4 times more likely to have a mental illness, and they are prescribed medications for these conditions 2.7 to 4.5 times more often.

Those seem to correlate pretty well.

But still - isn't it possible that because foster kids automatically have health insurance from the government, that they are seen more and thus prescribed more medication that other kids?

Another 2010 study addressed this:  They found that 96% of all foster kids on psych meds were on them before they entered foster care.  Only 4% were started on psychotropic medications AFTER entering foster care.  And that's the number receiving medications.  The study also showed that 85% of foster kids who saw a psychiatrist ended up with limited or no medication use over time. 
The lesson I learn from this - there is a reason these kids are in Foster care, and it's usually the same reason they end up with a mental illness.  Something about their life before foster care was VERY VERY WRONG.

There was another scary part to this story - the real concern and what Diane Sawyer saw.  The problem is not necessarily how many foster kids are being prescribed medications, but rather how these medications are prescribed.  Some studies showed infants under the age of one receiving medication - in my opinion this should NEVER happen.  There were also small number of kids taking 4 or 5 medications at once.  This should be the RARE exception, and even when needed should still cause the prescribing doctor to worry.

In my estimation - that is where our focus should lie.  There should be more standardized guidelines for the diagnosis and treatment of foster kids.  They are a high risk group, we need to at least be aware that they are more likely to need help than other kids, and it should be available.  But we should also be aware of possible polypharmacy - over medicating of our foster kids.

One last parting thought:  Texas has more foster kids on more medications than any other state.  Minnesota has the least.  Which state do you think is scarier for foster kids?