One in nine children in foster care in the U.S. are medicated with antipsychotics, despite efforts to curb the use of these potentially dangerous drugs, a new study found.
Moreover, the analysis in Health Affairs showed that more than one-third of foster children given antipsychotic drugs failed to receive counseling or other psychosocial interventions, such as anger-management training, which doctors and policymakers believe should have been the first line of treatment.
"It's just easier to write a prescription than it is to provide a more systematic approach to the underlying behavioral problems," said lead author Stephen Crystal, who directs the Center for Health Services Research at Rutgers University in New Brunswick, New Jersey.
The study also found that nearly three-quarters of foster children prescribed antipsychotics were never tested to gauge their elevated diabetes risk, although public health officials say patients on antipsychotics should have their glucose and lipid levels regularly monitored.
Prior research has shown that youths taking antipsychotics gain weight rapidly and are three times more likely to develop diabetes than those taking other psychotropic drugs.
Lawmakers and physicians have voiced concern about the use of antipsychotics, designed to quell hallucinations and delusions, in foster care.
Government-financed foster-care programs provide temporary housing for more than 400,000 children whose parents are considered unable to care for them. State efforts to oversee the use of antipsychotics in children have focused on the need to first try behavioral interventions, to monitor children prescribed antipsychotics for diabetes risk and to curb the use of prescribing more than one antipsychotic at a time, the study authors write.
Antipsychotic drugs - such as Risperdal, Zyprexa and Seroquel - were developed to treat schizophrenia, which is a rare condition in children.
In addition to schizophrenia, the Food and Drug Administration has approved their use in children for irritability associated with autism, Tourette's and bipolar disorder.
But clinicians frequently prescribe the drugs for attention deficit hyperactivity disorder, or ADHD, and to manage disruptive youngsters.
Nearly 40 percent of foster kids ages 17 and younger who were diagnosed with both disruptive behavior and ADHD were prescribed antipsychotics, the study found. More than 19 percent of those diagnosed with disruptive behavior without ADHD and about 20 percent of those with ADHD were prescribed antipsychotics. The numbers changed little between 2005 and 2010.
On the positive side, the study did find that rates of prescribing antipsychotic medication for children in foster care and other low-income children insured by Medicaid had leveled off after rising rapidly in the past decade.
Still, antipsychotic use remained substantially higher among foster children than other Medicaid-insured and privately insured children from 2005 to 2010, the research shows. In 2005, 8.73 percent of foster children were prescribed antipsychotics. The number rose to 9.26 percent in 2008 and dropped to 8.92 percent in 2010.
In comparison, the prescription rate for privately insured youngsters remained below 1 percent throughout the study period, and the rate for Medicaid-insured children outside of foster care peaked in 2008 at 1.86 percent and declined to 1.73 percent by 2010, the study found.
"I'm not somebody who believes the appropriate rate is zero, but somebody who believes the appropriate rate should be a lot lower than it is," Crystal said in a phone interview.
Susan dosReis, a professor at the University of Maryland School of Pharmacy in Baltimore who was not involved in the study, told Reuters Health by phone, "We're moving in the right direction. There's still room to grow."
She was pleased to see in the report that the number of foster children simultaneously prescribed two or more antipsychotics dropped from nearly 4 percent to 2.76 percent between 2009 and 2011.
She said she knew of no good reason to prescribe more than one antipsychotic at a time.
She also was happy to see that the number of foster kids who had their blood sugar and cholesterol levels monitored rose from 58 percent of those prescribed antipsychotics in 2009 to more than 65 percent in 2011.
"We need to have programs in place to ensure that when individuals need these medications that other things are in place so they're not a detriment to their health," she said.