Overmedication of Children in the Foster Care System

Sydney Matteson, Psychology, '20

Ever since I worked at Camp Ramapo this past summer I have wanted to learn more about children in foster care, as many of the children I worked with were from the system. As I researched this topic I learned a lot of valuable and concerning information that I feel is important for everyone to know. 

A 2010 study from the Tufts Clinical and Translational Science Institute estimated that about 13 to 52 percent of children in the foster care system are prescribed psychotropic drugs compared to 4 percent of children in the general population (https://www.childrensrights.org/our-campaigns/5605/). In addition, a 2011 study from the Government Accountability Office (GAO) reported that from 5 surveyed states the prescription of psychotropic drugs was 2.7 to 4.5 times higher for foster children than general children in Medicare (DeMarco, 2017). On any day about 438,000 children are in foster care in the US and the average age of a child entering foster care is 7 (childrensrights.org). In 2016 there were over 687,000 children in foster care and more than half of these children were young people of color. Why are so many foster care children prescribed psychotropic medication, especially at such a young age? 


One reason might be that 80 percent of children in foster care have a mental health issue compared to 18-22 percent of general children. In addition, foster care alumni experience PTSD at a rate approximately 5 times higher than the general population (http://www.ncsl.org/research/human-services/mental-health-and-foster-care.aspx). Due to past trauma children in foster care experience serious mental health problems and may need medication to assist in their recovery and treatment. The American Academy of Child and Adolescent Psychiatry (AACAP) created prescription guidelines for states with four categories: consent, oversight, consultation, and information. However, states reviewed by the GAO in 2014 all failed to reach these guidelines, meaning they were not prescribing drugs to foster children correctly (https://childsworldamerica.org/overuse-medication-foster-children/). Why are states not following these guidelines?

One reason is that states lack the ability to follow the medical history of children in foster care due to their different guidelines for the prescription of medication. In addition, a report by Health and Human Services found for ⅔ claims of drugs paid for by Medicaid children were receiving either too many drugs, the wrong dosage, poor monitoring of their prescription, and/or an incorrect prescription (https://www.npr.org/sections/health-shots/2015/09/02/436350334/california-moves-to-stop-misuse-of-psychiatric-meds-in-foster-care). This may be due to drugs being used by parents to control children's behavior, children's lack of opportunity to see a mental health professional, and a lack of consistency in the children's care. Children are also sometimes diagnosed during transition periods which could result in temporary symptoms that psychiatrists mistake for a mental illness. The stressful time of transitioning from one family to another will definitely cause some children to express behaviors that appear to be the result of a mental illness. Children should never be prescribed new medication during a transition period (https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Pages/Mental-and-Behavioral-Health.aspx). 

Some side effects of psychotropic drugs include fatigue, tremors, illusions, weight gain, and suicidal thoughts. These effects may result in behaviors that teachers and parents of the child do not know is related to the medication. If many children are being misdiagnosed, then they are experiencing side effects which may be harming them as a result. These drugs should not be prescribed lightly and children should be thoroughly examined by a mental health professional before they are prescribed. Optimally therapy should be the first treatment option for foster children, but unfortunately, it is not ideal that they will have access to this treatment (https://www.childrensrights.org/our-campaigns/5605/). 

Tisha Ortiz is an example of a foster child that was prescribed psychotropic drugs incorrectly. When she was entered into foster care she would lash out violently at her caretakers and resort to self-harm in her darkest moments. In an NPR interview, she stated "They [her foster family] considered the flashbacks as hearing voices, so I got put on psychotropic meds for that, when I wasn't hearing voices at all… I just felt sedated, and I wasn't really dealing with the problems.” Tisha was given medication because her foster parents believed she was hearing voices. As a result, she felt "sedated" but not much better. When she was older she was advised by a social worker to see a therapist. When she did, she learned that she had been experiencing PTSD as a child and had not been hearing voices but was experiencing flashbacks. Most of her childhood Tisha had been on an incorrect prescription due to a wrong diagnosis. This is an example of what can go wrong when children in foster care are not properly assessed (https://www.npr.org/sections/health-shots/2015/09/02/436350334/california-moves-to-stop-misuse-of-psychiatric-meds-in-foster-care). 

What can be done to fix this issue? Foster families should be given easier access to medical information and states should improve communication between the child's doctors (https://www.childrensrights.org/our-campaigns/5605/). Families should be monitored for the purpose of the child's prescription. Children should also be evaluated upon their entrance into foster care since so many of them have mental illnesses (http://www.ncsl.org/research/human-services/mental-health-and-foster-care.aspx). States should pass more laws that protect foster children and make the guidelines for their psychotropic medication prescription more strict. Until these problems are corrected children in foster care will continue to be improperly prescribed medication, which affects their life and education.