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Stimulant and atypical antipsychotic medications for children placed in foster homes
L Oriana Linares1, Nuria Martinez-Martin, F Xavier Castellanos
1Mount Sinai School of Medicine, Adolescent Health Center, New York, New York, United States of America. oriana.linares@mountsinai.org
Insights
Many children in foster care receive psychoactive medications, with stimulants and atypical antipsychotics being common. Factors like male gender, ethnicity, and specific psychiatric diagnoses influence prescription patterns.
Area of Science:
- Child and Adolescent Psychiatry
- Pediatric Psychopharmacology
- Foster Care Research
Background:
- Children in foster care exhibit high rates of psychiatric disorders.
- Psychoactive medication use is prevalent in this vulnerable population.
- Understanding factors influencing medication prescription is crucial for optimizing treatment.
Purpose of the Study:
- To examine the use of prescribed psychoactive medications in children entering foster care.
- To identify demographic, maltreatment, diagnostic, and behavioral factors associated with stimulant and atypical antipsychotic use.
- To analyze medication trends over a three-year period.
Main Methods:
- Prospective cohort study of 252 children in foster care over three years (four waves).
- Data collected on demographics, maltreatment history, psychiatric diagnoses, and aggression.
- Analysis of prescribed stimulant and atypical antipsychotic medication use.
Main Results:
- 89% of children had at least one psychiatric diagnosis; 31% used psychoactive medications.
- Attention Deficit Hyperactivity Disorder (ADHD) was diagnosed in 55%; 38% used stimulants, 36% used atypical antipsychotics.
- Male gender, African American ethnicity, ADHD, Oppositional Defiant Disorder/Conduct Disorder, and Separation Anxiety were associated with stimulant use. Male gender, African American/Mixed ethnicity, ADHD, ODD/CD, Depression, and sexual abuse history were linked to atypical antipsychotic use.
Conclusions:
- Atypical antipsychotic use was significant, raising concerns due to unknown metabolic risks.
- The efficacy and safety of these medications in psychiatrically ill children in foster care require careful monitoring.
- Further research is needed to guide evidence-based psychotropic prescribing in this population.
Objectives:
The purpose of this study is to examine the use of prescribed psychoactive medications in a prospective cohort of children shortly after they entered foster homes; and to identify demographics, maltreatment history, psychiatric diagnoses including ADHD comorbidity, and level of aggression that contribute to prescribed use of stimulant and atypical antipsychotic medication over time.
Methods:
The sample included N = 252 children (nested in 95 sibling groups) followed for three years up to 4 yearly waves.
Results:
Nearly all (89%) met criteria for at least one of eight psychiatric diagnoses and 31% (75/252) used one or more prescribed psychoactive medications. Over half (55%) were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD); of these 38% used stimulants and 36% used atypical antipsychotics. Of the 75 medicated children, 19% received ≥3 different classes of drugs over the course of the study. Stimulants (69%) and atypical antipsychotics (65%) were the most frequently used drugs among medicated children. Adjusted odds ratios (AOR) showed that male gender (AOR = 3.2; 95% CI = 1.5-9.3), African American vs Latino ethnicity (AOR = 5.4; 95% CI = 2.1-14.2), ADHD regardless of Oppositional Defiant (ODD) or Conduct (CD) comorbidity (AOR = 6.0, 95% CI = 1.3-27.5), ODD or CD (AOR = 11.1, 95% CI = 2.1-58.6), and Separation Anxiety (AOR = 2.0, 95% CI = 1.0-4.0) psychiatric disorders were associated with the use of prescribed stimulants; while male gender (AOR = 3.8, 95% CI = 1.5-9.3), African American vs Latino (AOR = 5.1, 95% CI = 1.2-9.2) or Mixed/Other ethnicity (AOR = 3.3, 95% CI = 1.9-13.7), ADHD regardless of ODD or CD comorbidity (AOR = 5.8, 95% CI = 1.2-28.7), ODD or CD (AOR = 13.9, 95% CI = 3.3-58.5), Major Depression/Dysthymia (AOR = 2.8, 95% CI = 1.1-6.7) psychiatric disorders, and history of sexual abuse (AOR = 4.6, 95% CI = 1.3-18.4) were associated with the use of prescribed atypical antipsychotics.
Conclusion:
The aggressive use of atypical antipsychotics, which has unknown metabolic risks, suggests that the efficacy and safety of such treatment strategies for psychiatrically ill children in foster care should be monitored.
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