Psychotropic Medications and Children in Foster Care

A Dangerous Combination

We have seen how psychotropics harm children in various foster care systems when not carefully administered.  

For example, in Missouri, we got to know KC.  She was 12 years old and placed in a large congregate care facility.  She was prescribed five psychotropics.

Our adult client, Kris, when visiting KC once found her involuntarily shaking.  When Kris brought this to the attention of the staff, they ignored her.  When Kris insisted that something be done, the staff, including the director, told her that the child was not shaking (even though she plainly was).  Kris had to communicate directly with the doctor before a prescription was changed.  Thankfully, the shaking stopped after a particular medication was stopped.  We later learned that involuntary movements are a common side effect of this medication.

At one point, KC could not get out of bed in the mornings.  This led to rough handling by the staff which resorted at times to yanking her out of bed.  This in turn resulted in altercations between KC and staff members.  “Holds” were part of their reaction.  One such hold lasted 1 ½ hours.  KC was injured seriously enough to be taken to the infirmary on several occasions.  Once again, Kris had to figure out why KC was suddenly so aggressive.  And once again, it turned out that she was being prescribed a medication which has drowsiness and aggression as common side effects.  When Kris got the medication stopped, KC’s aggression resolved.  She also started getting out of bed in the morning on her own.

KC gained an enormous amount of weight while on a medication infamous for causing weight gain in young teens.  As a result, she developed diabetes and a cardiac condition that has prevented her from being involved in athletics at school.  These are all risks that medical researchers have identified as consequences of children being on psychotropic medications.

In looking at KC’s child welfare agency file, we found ignored warnings issued by the Medicaid agency that she be seen by a cardiologist due to one of her psychotropic medications.  That never happened until Children’s Rights insisted after discovering the warnings in the file.

What is painfully clear is that no one except Kris was trying to oversee the administration of the psychotropic medications.  This was the department’s job and they failed to do it. (Kris was only a volunteer visiting resource.)  As a result of this failure, KC has had a much more difficult, painful life. 

Psychotropic medications are powerful agents, drugs, which can be helpful to some people when properly administered.  In fact, for some, it allows to them live much fuller, happier lives.

The key point is that they must be carefully and appropriately prescribed.  This requires that the prescribing doctor knows the relevant medical and behavioral history of the person, that there is informed consent, and that careful monitoring of the person follows.  Having a second independent opinion is useful in many cases.  Especially when an outlier prescription is involved.

While helpful for many people, negative side effects, and even the usual effects of these medications, may make a particular prescription inappropriate for some people.

Developmental issues (including effects on brain development), physical issues such as heightened risk for diabetes and cardiac conditions, irreversible movement disorders, aggression, unhealthy levels of weight gain, and organ damage are all concerns of serious medical researchers, and of course, of patients and their families.   

The list of concerns also includes the normal or expected effects of these medications:  loss of normal emotions, all-day drowsiness, loss of sleep, and so on.  These can make life intolerable for some people, especially developing children.

Several features of foster care make the administration of psychotropics more difficult than in a regular family situation.

The instability of placements often results in children having caretakers who lack knowledge of a particular child’s medical, emotional, and behavioral history.

Large impersonal congregate facilities often mean children are not carefully observed for side effects.  The direct caretakers at these facilities are rarely involved in the informed consent process or in giving histories to doctors.

Also, in foster care, there is sometimes the temptation to use the medications to control behaviors and make children more manageable. This temptation is amplified in crowded or overwhelmed group facilities (which unfortunately many facilities are).  

The improper use of these medications can divert children from more healing therapies; therapies more appropriate for children suffering primarily from PTSD.  Talk therapies and those relying upon educating patients on techniques to tackle daily life without medications are overlooked.

Thinking back to our time in Missouri, I remember Joshua, who we met in St. Louis.  He had aged out of foster care after 15 years.  He told us that as long as he could remember he was on psychotropic medications, as many as seven or eight at a time.  He eventually ran away from foster care to avoid the sense that he was a “zombie” with little or no feelings.  He had no friends and had accomplished little in school for years.  Now his life is going from barroom to barroom performing cage fights for a living—in order to survive.  The last I heard he had hit the West Coast; he had no direction—no idea what he would do next.  He attributes all of this to the years and years of living in the fog of a large cocktail of psychotropic medications.  He was very clear about this.  His account is convincing.

The federal judgment we achieved in Missouri in concert with our courageous next friend clients can fix this.  For children like KC and that four-year-old little girl, we can stop the reckless and harmful administration of psychotropic medications.  In Missouri, we are ensuring that:

  1. All children go to the doctor with an up-to-date medical and behavioral health record,
  2. All children get the benefit of a true informed consent process, and 
  3. All children and their caregivers have access to an independent second opinion when an outlier prescription has been flagged.

Now, our immediate hope is to bring this important solution to other foster care systems.  Eventually, we hope to build momentum so that these protections for foster children will become the national standard.