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Children who enter foster care face many changes and challenges that can lead to mental health disorders treated with psychotropic medications.
Many have experienced abuse and neglect. Some have witnessed violence and trauma. Others have parents who suffer profound mental health issues. Regardless of what led to their involvement in the child welfare system, all face separation, broken relationships, and confusion. Increasing their vulnerabilities are risk factors such as poverty, neighborhood
violence, exposure to parental mental illness, racial discrimination, lack of food, and homelessness.
The paths to a mental health diagnosis are numerous and complex. Genetically some of these children are already prone to disruptions in their mental health. Mental health disorders such as attention deficit disorder or bipolar disorder, even borderline personality disorder, are thought to have genetic components that place children at risk for developing the same disorders as their parents. Environmental experiences are also linked to mental health issues such as conduct disorder, depression, and anxiety disorder.
Exposure to violence is directly linked to post traumatic stress disorder and depression.
The Role of Medication in Healing
For children and teens in foster care who struggle with mental health disorders, the goal is to help them heal and function optimally. Among their needs are to:
• understand what is happening to them, why they are not living with
their parents, and their options.
• be able to feel their emotions and work through them, but know how
to manage them in age-appropriate ways so they do not interfere with
their success, growth, and development.
• be able to communicate with those who advocate for them and
make decisions on their behalf.
• feel stable or organized in their thinking so they can reclaim
age-appropriate power and take charge of their lives.
The paths to a mental health diagnosis are numerous and complex.
Medications can help children and teens in foster care, but they can also further impair them, derail them, and sabotage them. Without a clear understanding of their mental health issues, misdiagnoses can be made and incorrect medications can be prescribed. If there is no reliable caregiver who can describe the child’s struggles, information collected can be biased and incomplete. If emotional trauma underlies the presenting symptoms and is not addressed, medications can have no effect or increase problems. If medications are prescribed but other therapies are not provided and supervision of the medication is
inadequate, healing and stabilization supporting healthy growth will not occur. Finally, if caregivers are not adequately trained and educated in caring for a child with significant
emotional and psychological needs, medications can often be given to the child to “manage their behaviors” rather than to truly treat the child’s illness.
To adequately and successfully represent and speak for a child or teen in foster care, the child’s advocate must be able to communicate with the child and discuss the child’s experiences.
Does the child manage his or her acting-out behaviors and emotions, use positive social skills, think clearly, and track the ongoing events in their lives? Children and teens also need to be safe. Depression or suicidal thinking must be addressed. Self-abusive behaviors must be contained and risk-taking behaviors reduced. Medications can be part of a successful intervention and treatment plan. Working with children and teens in foster care requires a solid understanding of the positive and negative aspects of medication use in this population.
Common Child and Adolescent Diagnoses
Statistics on the presence of psychiatric diagnoses in children in foster care vary from a low of 29% to a high of 96%.
1. Diagnoses in school-age children and adolescents fall into several
groups, including mood disorders, thought disorders, and behavioral disorders. The most common diagnoses can be found in Table 1.
Children and adolescents can also experience mental retardation, fetal alcohol syndrome, learning disorders, communication disorders, pervasive developmental disorders (including autism), feeding/eating disorders, adjustment disorders, and dissociative disorders.
Adolescents aged 14 and older can be diagnosed with borderline personality disorder. At age 18, other personality diagnoses can be applied, although features of these disorders can begin to emerge earlier during childhood and adolescence.
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