Federal health officials are failing to monitor how state agencies are doling out powerful psychotropic drugs to foster children, according to a comprehensive investigation released Thursday showing that foster kids are being prescribed the drugs at rates 2.7 to 4.5 higher than nonfoster children and often at much higher doses.
Hundreds of foster children are being prescribed five or more of the medications at once, which can have severe side effects, including diabetes and suicidal behavior.
In some regions, foster children as young as 1 were twice as likely to be prescribed the medications, according to a two-year investigation by the Government Accountability Office. The investigation looks at 2008 data from more than 100,000 foster children in Florida, Massachusetts, Michigan, Oregon and Texas.
Sen. Tom Carper, D-Del,, requested the investigation's release after media reports of high prescribing rates and anecdotes from former foster children who said they were on multiple medications at the same time. The report was released ahead of a hearing Thursday by his congressional subcommittee that deals with federal services.
Some of the drugs have a "black box" label warning for children's safety and are not approved for use by young children. But doctors often prescribe them off-label. The drugs affect the central nervous system and can change behavior or perception. They are prescribed for depression, anxiety, schizophrenia and other psychiatric conditions. Examples are Ritalin, Xanax and Risperdal. Little is known about the long-term side effects of the drugs, experts said.
"We're kind of flying blind as far as knowing the safety and efficacy of long-term risks (for children)," said Dr. Christopher Bellonci, a child psychiatrist and assistant professor at Tufts University.
The report offered several explanations for the high prescription rates, noting the children had greater exposure to trauma before entering foster care and that state agencies were lax in overseeing the prescriptions. Critics say the drugs are overused as a chemical restraint for unruly children.
"I do believe that medications are being used almost in default, and my concern is that it's being used in lieu of psycho-therapeutic interventions," Bellonci said.
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Six-year-old Brooke was on two psychiatric medications for attention deficit hyperactivity disorder when Todd and Lisa Ward adopted her out of Florida foster care in 2010.
Over the next two years, doctors put her on an array of powerful drugs as her parents watched her behavior become more aggressive, erratic and agitated. She twice tried to kill the family dog, pulled skin off her nose, wiped blood on the walls and threw tantrums as doctors plied her with more than a dozen medications over the years, her mother said.
"Her hands would just shake insanely and they would tell us, 'Oh, that's just her.' But it wasn't her. It stopped once she went off the medication," her mother said.
The Wards tried desperately to get her into a psychiatrist but waiting lists were typically nine months long, so she ended up going back to the same mental health center that Lisa Ward said constantly overmedicated her.
This past summer Brooke tried to burn the house in an attempt to kill her sister, said Mrs. Ward, a 39-year-old accountant who adopted Brooke and her two siblings in 2010.
The Wards placed her in a residential facility where she got intensive therapy for the first time, including yoga and play therapy. Three months later, Brooke is home and down to one medication.
Mrs. Ward, who started a nonprofit group to link other foster parents to doctors and therapists, says the medication was just a Band-Aid and notes the girls no longer have the ADHD they were diagnosed with when the Wards adopted them from foster care.
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Attempts have been made in Florida to provide greater regulation of psychotropic medications. In 2009, Florida health officials began requiring doctors to get approval before giving these drugs to children under 6 on the Medicaid program.
That same year, Gabriel Myers, a 7-year-old boy heavily medicated on powerful psychiatric drugs, hanged himself in his Margate foster home.
The state Department of Children and Families reported that 26 percent of children in group homes or other institutional settings were being given mental health drugs, compared with 21 percent of children in foster homes and 4 percent of children living with relatives in 2009.
Gabriel's death led to a proposal in 2010 that would have required DCF to assign volunteer guardians to oversee each child's mental health care. The bill would have raised the age at which children are allowed to take these drugs from 6 to 11 in many cases. The bill died in committee.
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The report released Thursday found that foster children in some areas were twice as likely as nonfoster children to be prescribed five or more of those drugs at the same time. Texas foster children were prescribed five or more medications most often.
"No evidence supports the use of five or more psychotropic drugs in adults or children, and only limited evidence supports the use of even two drugs," according to the report.
Eleven-year-old Ke'onte Cook, who entered Texas foster care at age 4, testified that he was on 20 drugs during his time in foster care, sometimes five at once. He didn't know why he was taking them and was never told of possible side effects.
"It was the worst thing someone could do to foster kids. I was upset about my situation and not because I was bipolar or had ADHD," said Ke'onte, who has since been adopted and stopped taking all medications. "Meds aren't going to help a child with their problems. It's just going to sedate them for a little while until it comes back again."
Times staff writer Ron Brackett contributed to this report.