Antipsychotic drug prescriptions high for Oklahoma foster children

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Antipsychotic drug prescriptions high for Oklahoma foster children

Nearly 15 percent of Oklahoma foster children were on antipsychotic prescription drugs in 2007 — an increase of more than 48 percent in just five years.


Nearly 15 percent of Oklahoma foster children were on second-generation antipsychotic prescription drugs in 2007 — an increase of more than 48 percent in five years, according to a study released by PolicyLab at The Children’s Hospital of Philadelphia.

Antipsychotic drugs are often prescribed to address disruptive behaviors in children.

Nationally, children in child welfare systems have been prescribed such drugs at two to three times the rate of other children in the community, the study says.

Excessive prescribing of antipsychotic drugs to foster children is a matter of national concern, because the drugs have significant side effects, said Dr. David Rubin, one of the study’s authors.

“The biggest issue with antipsychotics has been significant metabolic side effects — significant weight gain within a couple of months on kids who started on those medications,” he said. “It looks like some of those metabolic side effects are worse in children than they are in adults. Now there are concerns about developing some of the complications of obesity in terms of diabetes and hypertension and some of those types of complications.”

The drugs “really dull them,” he said. “We don’t have good data on the impact on learning.”

Data shows 14.8 percent of Oklahoma foster children were on antipsychotic prescription drugs in 2007, a rate significantly higher than the national average of 11.8 percent.

The study also revealed 6.2 percent of Oklahoma foster children were on three or more psychotropic medications at once in 2007, a rate higher than the national average of 5.3 percent.

Rubin said 2007 information was the most recent contained in the study because of the slowness with which some states have reported and the federal government has assembled data. Researchers hope to update the report with 2008 and 2009 data soon, he said.

Rubin cautioned against drawing too many conclusions from state-to-state comparisons.

If one state has a higher prescription rate than another, it might be because drugs are being overprescribed in the higher state in situations where many children would be better served by counseling therapy, he said.

On the other hand, the rate in the other state might just be low because officials aren’t getting children mental health treatment when they should, he said.

“I think the high rates that we’re seeing is really a symptom or the fact we’re not providing some of the other therapies, like evidence-based counseling therapies that are really rooted around trauma treatment,” he said. “At the end of the day, we label these kids with a lot of diagnoses, but what they share in common is a significant trauma history and significant relational failures. ... The best treatments we have for those are harder to fund in public systems.”

It’s sometimes easier and cheaper in the short term to prescribe antipsychotic medications in situations where intensive counseling might be of far greater assistance to the child, he said.

Focusing on Oklahoma data, Rubin said the high use of antipsychotic drugs indicates to him that the state “has a real problem.”

“I don’t see a lot of evidence here that they’ve been able to really get their hands around the problem,” he said.

On a more positive note, he said Oklahoma children seem to have access to mental health professionals.

Sheree Powell, spokeswoman for the Oklahoma Department of Human Services, said state officials are aware of the issue and have been working to address it.

Three state agencies — the Oklahoma Health Care Authority, DHS and the Oklahoma Department of Mental Health and Substance Abuse Services — joined forces earlier this year to submit a grant application to the Center for Health Care Strategies.

One goal they stated was to “increase communication and data sharing between the agencies responsible for the care and oversight” of children using psychotropic medications.

“This will help isolate the highest utilizers as well as the providers that are prescribing these medications,” the grant application said.

They said another goal was to provide intensive education on therapeutic non-drug alternatives and the risks of medications.

The application also discussed creating “health homes” for children with serious emotional disturbances, where children would have ready access to psychiatrists and pediatricians and where prescribing patterns could be carefully monitored.

Oklahoma’s grant application was rejected March 30, but the Center for Health Care Strategies said it still would try to provide Oklahoma and other rejected states with additional resources.