Psychotropic Medications

The use of psychotropic medications for children has risen over the past 10-15 years, although there is currently no definitive, comprehensive information that shows the prevalence of psychotropic medication use among children in the child welfare system.  However, published studies do indicate that there are higher rates of psychotropic medication use among children involved in child welfare than in the general population; older children, males, and children in residential or group settings are the most likely to have psychotropic medications prescribed.

Unfortunately, the full effect of these medications on a child's growth, development, and maturing neurological system remains unknown.  What is known is that psychotropic medications can have a variety of side effects, including lethargy, withdrawal, weight gain, poor appetite, irritability, and sleep disturbances.  They can also cause hallucinations, intrusive thoughts, and paranoia.

There are growing concerns that some children in foster care are prescribed too many psychotropic medications, that their dosages exceed approved recommendations, and that they are being prescribed psychotropic medication at too young an age.  There has, in fact, been a dramatic rise over the past 20 years in the use of antipsychotic medications with foster children.  A seven-state study found that the rate of antipsychotic medication use among foster children was almost nine times that of other Medicaid-covered children, even though foster children made up only three percent of the population of children on Medicaid.  An additional concern is that because there is no clear diagnostic label for complex trauma, a default to a mental health diagnosis is resulting in the inappropriate over-use of psychotropic medication for traumatized children.

Despite these concerns, the high rates of psychotropic medication use among children in foster care may indicate, at least in part, the high level of emotional and behavioral needs of this population.  Psychotropic medication may be necessary to effectively treat children or adolescents struggling with a mental illness, and can be helpful when children are so overwhelmed by their own behavior that their symptoms cannot be managed in other ways.  However, if untreated emotional trauma underlies the presenting symptoms, use of medication as a primary treatment may be ineffective or even exacerbate existing problems, and the stabilization needed to effectively support growth and healing will not occur.

Pending Developments in Psychotropic Medication

Some States have made attempts to regulate, at least to some extent, the use of psychotropic medication for behavior and mood management among foster children, encouraging caregivers to become more skilled in dealing with children’s challenging behaviors. Agencies are promoting more effective, evidence-based treatments for these children, coupled with trauma-focused training and education for staff and foster parents about caring for and managing behaviors of children with significant emotional and behavioral needs. The issues surrounding psychotropic medication use for children in foster care are being addressed through several Federal initiatives outlined in the ACYF Information Memorandum, Promoting the Safe, Appropriate, and Effective Use of Psychotropic Medication for Children in Foster Case (ACYF-IM-12-03).