More than 1 in 4 kids in U.S. child welfare system prescribed psychotropic medication, study finds

A recent study is shedding more light on a known medical anomaly within the U.S. child welfare system.

What the study says

According to a research letter published in August, children in the U.S. child welfare system — which includes youths with adoption assistance, foster care or guardianship care — are more likely than other children with Medicaid to receive psychotropic medication (i.e., a drug to help with behavior or mood disorders like anxiety, depression or bipolar disorder) without also getting psychotherapy or behavioral intervention.

Key findings

The study, which was conducted from July 7 to Sept. 29, 2022, used 2019 data from a national database that included all Medicaid Children’s Health Insurance Program (CHIP) beneficiaries ages 3 to 17 years old who were enrolled for at least six consecutive months that year.

It found that 26.25% of children and adolescents in the child welfare system had a psychotropic medication prescription, and 13.27% had two or more psychotropic medication prescriptions — compared with 9.06% and 3.11%, respectively, of other Medicaid-enrolled youths.

Stimulants (which are used to treat disorders such as attention deficit hyperactivity disorder) were the most common medication in the child welfare group (15.95%), followed by antidepressants (9.88%) and antipsychotics (7.87%).

Further, 42.85% of children and adolescents in child welfare had a diagnosed mental health condition, “with trauma or stressor-related disorder (22.93%), attention-deficit/hyperactivity disorder (21.49%), and behavior or conduct disorder (11.67%) being the most prevalent diagnoses.”

What experts think

Dr. Louis Kraus, division director of child and adolescent psychiatry at Rush University Medical Center in Chicago, who was not involved in the study, tells Yahoo Life that he isn’t at all surprised by the study’s findings.

“Children in foster care have a higher risk for developmental and psychiatric disorders, [and] as a result, they are more likely than the general population to be on psychotropic medication,” Kraus says. “And because of the process of foster care — multiple foster home placements, inconsistency with medical follow up, and difficulty in obtaining child psychiatrists — these kids will be at higher risk for being on multiple medications.”

Dr. Rachael J. Keefe, a pediatrician on the executive committee for the American Academy of Pediatrics Council on Foster Care, Adoption, and Kinship Care, who was not involved in the study, says she also wasn’t surprised. Her own research in 2021 looking at psychotropic medication usage among kids in foster care in southeast Texas corroborated this study’s results — and revealed “alarming statistics.”

“Across six drug classes, the prevalence of psychotropic medication use was 2 to 27 times higher among children in foster care compared to non-foster children covered by Medicaid, and these differences persisted across all age groups,” she tells Yahoo Life of her research. “The overprescription of psychotropic medications to children in foster care is a daily concern in my clinical practice, but it becomes even more poignant when seeing it on paper.”

Why it matters

Keefe points out that while it’s common for children in foster care to be on two or more psychotropic medications, there’s limited data on whether it’s safe and effective. Prescription monitoring guidelines and oversight rules for children in foster care also aren’t uniform between states, and often not well monitored.

Kraus says this recent study highlights the importance of young people in the child welfare system visiting a specialist when needed. Often, Kraus says, children in foster care are treated by multiple general practitioners and physicians instead of by a child psychiatrist — which can lead to multiple diagnoses and prescriptions.

“If you have a problem with your eye, you're probably not going to have it looked at by your pediatrician; you're going to go to an ophthalmologist," he says. "It shouldn't be any different when a child is having struggles; they should be going to see a child psychiatrist.”

After being prescribed medication, many youths in foster care may not have a followup appointment for months, but Kraus says regular visits are crucial to make sure treatment is working. He adds that while medication can play an important role, it shouldn’t be an automatic solution and can’t replace other psychiatric services.

“If a child is having trouble behaviorally, is the best answer another medication? Or is it helpful to try to figure out programming to help them to try to get extra services through their school system,” he asks. “Psychotropic medications are very important for kids that need them, but you have to watch it carefully and monitor these kids. If you start a medication and it's not helpful, you take them off of it. You don't add another one.”