Antipsychotic Use in Foster Children

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Those that have followed the foster care system in the last decades are likely well aware that a substantial portion of youth are prescribed antipsychotics. In a study on antipsychotic use among Medicaid-Insured Children and Adolescents Burcu, Zito, Ibe, and Safer (2014) found that this use is often off label and for a longer duration than children not Medicaid-insured. As children in foster care are eligible for and more times than not Medicaid-Insured this information is applicable to this population.
Burcu et al. (2014) found that the reasons for antipsychotic use among Medicaid- Insured youth was often for non FDA approved uses (approved uses: schizophrenia, bipolar disorder, and irritability associated with autism) such as behavior issues, ADHD, and other disruptive behaviors/ disorders. A quick survey of those children in foster care would likely show that many of these children have one or more of the issues listed above. Burcu et al. also found that Medicaid-Insured youth with externalizing behavior issues were the largest set of youth prescribed antipsychotics medication (2014).

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The clinical significance of this is the potential risks for long term use. Those risks include: weight gain, risk of diabetes, heart disease, and stroke also referred to as cardiometabolic risk (Burch et al., 2014). Children and youth receiving antipsychotic medications require regular monitoring of the potential risks. It is also of importance to note that long term use in those using this medication for off label use has not been studied.
Those who have experienced trauma and abuse often may experience behavioral symptoms of emotional pain. This is noted because this could be a cause for concern for relatives or foster parents caring for these children who then relay these concerns to primary care physicians. Children in foster care also receive more psychological testing and evaluation that children not in care which can again result in a higher likelihood of psychotropic prescription.

References

Burcu, M., Zito, M.Z., Ibe, A., Safer, D.J. (2014). Atypical antipsychotic use among Medicaid-insured children and adolescents: Duration, safety, and monitoring implications. Journal of Child and Adolescent Psychopharmacology, 24 (3), pp. 1-8. doi: 10.1089/cap/2013.0094