The drugged children of foster care

A February, 2014 Wall Street Journal article, “Drugged as Children, Foster Care Alumni Speak Out,” examines the upsurge in strong antipsychotic drugs prescribed for children in Medicaid and foster care in the past decade and a half.  It should be required reading for every parent, teacher, counselor, caseworker, and judge who has or may have contact with the child welfare system.

I have been a court-appointed attorney for indigent parents in the Chester County, Pennsylvania Juvenile Dependency Court for about a decade.  

“Dependency” is a legal term of art and encompasses truancy; aggression; ungovernability; parental neglect; and physical, sexual, or emotional abuse.

For me, the most disturbing thing about these most disturbing of cases is the widespread use of antipsychotic medication to treat behavioral problems in children.  Children, both in home and in foster care or other institutional settings, some as young as three and four, are routinely prescribed antipsychotic medication for a variety of disruptive behaviors, from hyperactivity and rebelliousness to mood swings and poor grades.  

From my observations, the majority of these kids are exhibiting normal childhood behaviors, albeit writ large, not because of mental illness, but because of the vacuum, and resultant absence of structure and discipline, caused by broken homes.  

In the Journal piece, David Crystal, a professor of health services research at Rutgers University, based on 2009 data from Medicaid and private insurers, estimates that 12% to 13% of kids in foster care take these medicines.  That compares with about 2% for children on Medicaid but not in foster care and about 1% for those with private insurance.

The largest diagnostic groups receiving the drugs in foster care in 2009 were those with disruptive-behavioral disorders and attention-deficit/hyperactive disorders.

“These diagnoses involve difficulty focusing attention or controlling behavior – but that is different from not being in touch with reality,” a key element of psychosis, he says.  I agree.

Chris Nobles, who became a ward of Pennsylvania at age 15, is the centerpiece of the article.  In three years of care, doctors treated his depression and bouts of uncontrollable anger with a steady diet of psychiatric drugs.

Now in his mid-twenties, Mr. Nobles lives on his own, works full-time, and refuses any medication, “not even Nyquil.”

Another foster-home alum, testifying in spring of 2013 before a Senate Finance Committee roundtable discussion on psychiatric drugs, cited a list of medications she was prescribed over the years: antipsychotics Abilify and Seroquel, three antidepressants, a drug for attention deficit disorder, and an anticonvulsant.  She was variously diagnosed with depression, attention deficit disorder, and bipolar disorder.

“How do you develop as a person and find out who you are when you have been given all these diagnoses?” she asks.

Their stories mirror that of a local 17-year-old on Concerta and Seroquel and a 13-year-old on Lithium, Risperdal, Cogentin, Zoloft, and Clonidine.  Each had diagnoses consistent with Dr. Crystal’s findings.  There are others.      

 Kids are not magically adults at age 18.  Chris Nobles altered his destiny.  Many do not.

A University of Chicago study on foster alumni in Illinois, Wisconsin, and Iowa found that by age 26, fewer than half, 47%, were employed; most of those who worked earned less than $12 an hour.  Many had been sporadically homeless.       

They are also the parents of the next generation of dependent children.  

 The Journal report highlights the groundswell of foster-care alumni sounding the alarm about how freely psychiatric drugs are doled out to kids.

It’s long past time.