Abstract
ObjectivesThe purpose of this study is to examine the use of prescribed psychoactive medications in a prospective cohort of children shortly after they entered foster homes; and to identify demographics, maltreatment history, psychiatric diagnoses including ADHD comorbidity, and level of aggression that contribute to prescribed use of stimulant and atypical antipsychotic medication over time.MethodsThe sample included N = 252 children (nested in 95 sibling groups) followed for three years up to 4 yearly waves.ResultsNearly all (89%) met criteria for at least one of eight psychiatric diagnoses and 31% (75/252) used one or more prescribed psychoactive medications. Over half (55%) were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD); of these 38% used stimulants and 36% used atypical antipsychotics. Of the 75 medicated children, 19% received ≥3 different classes of drugs over the course of the study. Stimulants (69%) and atypical antipsychotics (65%) were the most frequently used drugs among medicated children. Adjusted odds ratios (AOR) showed that male gender (AOR = 3.2; 95% CI = 1.5–9.3), African American vs Latino ethnicity (AOR = 5.4; 95% CI = 2.1–14.2), ADHD regardless of Oppositional Defiant (ODD) or Conduct (CD) comorbidity (AOR = 6.0, 95% CI = 1.3–27.5), ODD or CD (AOR = 11.1, 95% CI = 2.1–58.6), and Separation Anxiety (AOR = 2.0, 95% CI = 1.0–4.0) psychiatric disorders were associated with the use of prescribed stimulants; while male gender (AOR = 3.8, 95% CI = 1.5–9.3), African American vs Latino (AOR = 5.1, 95% CI = 1.2–9.2) or Mixed/Other ethnicity (AOR = 3.3, 95% CI = 1.9–13.7), ADHD regardless of ODD or CD comorbidity (AOR = 5.8, 95% CI = 1.2–28.7), ODD or CD (AOR = 13.9, 95% CI = 3.3–58.5), Major Depression/Dysthymia (AOR = 2.8, 95% CI = 1.1–6.7) psychiatric disorders, and history of sexual abuse (AOR = 4.6, 95% CI = 1.3–18.4) were associated with the use of prescribed atypical antipsychotics.ConclusionThe aggressive use of atypical antipsychotics, which has unknown metabolic risks, suggests that the efficacy and safety of such treatment strategies for psychiatrically ill children in foster care should be monitored.
Highlights
There were 415,000 children in the United States in foster care in 2010 [1]
The purpose of this study is to examine the cross-sectional use of prescribed psychoactive medications among children shortly after they entered foster homes and followed up to 4 yearly waves; and to identify demographic, maltreatment history, psychiatric diagnoses including Attention Deficit Hyperactivity Disorder (ADHD) comorbidity, and level of aggression that are associated to prescribed use of stimulant and atypical antipsychotic medication classes, in particular
We focused on the use of these psychoactive medication for ADHD and comorbidity with other disruptive behavior disorders (ODD and Conduct Disorders (CD)) because they are the most salient disorders among youth in foster care [19,20]; and because of the increasing concerns about the potential metabolic adverse effects of antipsychotic medications [17]
Summary
There were 415,000 children in the United States in foster care in 2010 [1]. Children in foster care experience environmental, social, biological and psychological risks factors prior to and during their stay in care that make them vulnerable to problems of over-activity and inattention [2], high aggression, and high rates of disruptive behavior disorders including Attention Deficit Hyperactivity (ADHD), Oppositional Defiant (ODD), and Conduct Disorders (CD) requiring multilevel treatments including psychiatric interventions [3,4,5]. Children in foster care use both inpatient and outpatient mental health services at a rate 15 to 20 times higher than the general pediatric population. Zito et al [15] examined a sample of 472 children and adolescents in the Texas foster care system that were randomly selected from the 12,189 youth (38% of 32,135 enrollees) who had been dispensed a psychiatric medication according to Medicaid records in the preceding year. They found that 41% of medicated children in foster care were being treated with three of more classes of psychotropic medications. Given recent concerns regarding the metabolic adverse effects of treatment with atypical antipsychotics [16,17,18], it is important to understand factors associated with elevated risk for prescriptions for antipsychotics use in this high risk child population
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