June 3, 2011
This week on our investigative series The Watch List: An update to our story on the use and potential over-use of powerful antipsychotic drugs on children in the nation’s foster care systems.
Nearly one in every 10 American children is diagnosed with a mental health disorder. Often the treatment prescribed is medication. Children in foster care are prescribed drugs at a much higher rate than that of other kids. And concern over their well-being — not to mention the amount it costs to treat them — has prompted the government accountability office to investigate potentially abusive prescribing practices in state foster care systems. The GAO findings are expected to come out later this year. Need to Know correspondent Shoshana Guy provides an update on a story we first aired in January.
Foster kids get more antipsychotics: study
By Kerry Grens | Reuters – Tue, Nov 22, 2011
NEW YORK (Reuters Health) - Kids in foster care are more likely to have long-term prescriptions for more than one type of antipsychotic medication than kids who are also on government assistance, but not in foster care, a new study finds.
The results, published in the journal Pediatrics, point to prescribing practices that have known risks, but uncertain benefits, researchers say.
"We have very little evidence for antipsychotic use in kids, and no evidence to support two medications," lead author Susan dosReis, a professor at the University of Maryland School of Pharmacy, told Reuters Health.
DosReis and her colleagues examined antipsychotic prescriptions given to nearly 17,000 children on Medicaid in 2003.
Medicaid is the state and federal health insurance for the poor.
Most of the children in the study were in foster care, some also had a disability, others were adopted out of foster care during the study period. For comparison, the researchers also looked at kids on Medicaid who had disabilities or were receiving aid for needy families, but were not in foster care.
More than a third of the kids in foster care without disabilities had multiple antipsychotic prescriptions for longer than 90 days. Those who were not adopted had the highest rates of all -- 38 out of every 100 children.
In comparison, 26 out of every 100 children who were on public assistance but not in foster care had more than one prescription for an antipsychotic.
The medications are used to treat schizophrenia and bipolar disorder, and go by brand names such as Zyprexa, Risperdal and Seroquel.
Doctors also prescribe them for other psychiatric disorders.
Dr. Michael Naylor, a professor at the University of Illinois at Chicago, said he was not surprised by the results.
"You can't imagine a more perfect storm for severe emotional and behavioral psychiatric disturbance" than someone who ends up in foster care, said Naylor, who was not involved in the study.
Children are often born into unstable, neglectful and abusive situations, in addition to having a psychiatric illness, Naylor told Reuters Health.
Though such kids present challenges in treating their mental or behavioral illnesses, the high rates of multiple prescriptions for antipsychotics raises red flags.
"When we see a subsample of kids getting more than one antipsychotic for an extended period of time, that is concerning because we're moving toward a practice that isn't supported by evidence showing that's effective," DosReis said.
In addition, antipsychotics can have some serious side effects.
"It's putting some kids at risk for some more medical problems with the weight gain (and) the possibility of type 2 diabetes" associated with antipsychotic medications, Naylor said.
Some previous research, including a study published Monday in the same issue of Pediatrics, links modern antipsychotics to increased risk of developing diabetes.
A pediatric advisory panel recently urged the Food and Drug Administration to determine whether the benefits of antipsychotics outweigh the risks (see Reuters Health story of September 23, 2011).
Naylor's concern is that the children are being prescribed one drug to help with a conduct or psychiatric disorder, and a second drug to help with sleep.
"I don't think that's good medicine," he said.
DosReis and her colleagues did not determine why the medications were being prescribed.
"I would advocate for better monitoring for efficacy, symptoms, and side effects," she said. "We don't have that system to monitor how well these treatments are working for kids."
SOURCE: http://bit.ly/tssjl5 Pediatrics, online November 21, 2011.