Antipsychotic Drug Use Among ADHD-Diagnosed Foster Care Youth Is Increasing

Kermit Cole
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Research in the Journal of Child and Adolescent Psychopharmacology finds that “Over the last two decades, the increased use of atypical antipsychotic medications, often for unlabeled indications including attention-deficit/hyperactivity disorder (ADHD), has been profound.” Children diagnosed with ADHD in foster care, in particular, were three times more likely to to be prescribed antipsychotics in the absence of a comorbid psychiatric diagnoses than other Medicaid-eligible children, with nearly one third of ADHD-diagnosed foster care youth receiving the drugs.

Burcu, M., Zito, J., Ibe, A., Safer, D.; Atypical Antipsychotic Use Among Medicaid-Insured Children and Adolescents: Duration, Safety, and Monitoring Implications. Journal of Child and Adolescent Psychopharmacology. Online April 1, 2014.

See:
Antipsychotic drug use among ADHD-diagnosed foster care youth is increasing (Science Codex)

From the article:
“”This study adds critical hard data to our understanding of a persistent and unacceptable trend in pediatric psychiatry,” says Harold S. Koplewicz, MD, Editor-in-Chief of Journal of Child and Adolescent Psychopharmacology, and President, Child Mind Institute, New York, NY. “Our poorest, most vulnerable children, lacking access to evidence-based care, are receiving potentially harmful treatment with little oversight. The highlight of Burcu et al.’s paper for any reader should be the simple but necessary recommendations for antipsychotic prescribing and monitoring in these populations.”

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]

9 COMMENTS

  1. A sleep specialist explained the relationship between sleep apnea and the symptoms of ADHD which resolve for some children when tonsils and adenoids are removed. A study is underway(see link in following post) and results are expected this year.

    It is a shame, that without advocates, these children in foster care will be diverted into the psychiatric system , rather than receive a medical screening and sleep test which could possibly make a difference for some of the children. However, there is no parity of medical care for adult patients, either, in psych wards.

  2. Daisy, you are so right about ADHD and sleep apnea. It is also true that foster youth (with whom I work extensively) often have other sleep issues based on nightmares and other trauma-related manifestations. They are diagnosed with “ADHD” at much higher levels than the general population, and often with less justification (if there really is ever a justification for such a vague and subjective diagnostic category).

    Additionally, it is common that foster youth react to stimulants with increased levels of aggression. This is a known adverse effect of stimulants, but it is almost always attributed to the child’s “disorder” and atypicals are often used to reduce aggression that is most likely being caused by the stimulants. Sometimes these kids are diagnosed with “bipolar disorder,” and those kids would not be included in Julie Zito’s stats, so the problem is actually much bigger than her estimates (though I know she eliminated them to make sure that “bipolar” wasn’t presented as an additional justification for the atypicals).

    This approach is particularly bizarre if you consider the brain chemistry involved. Stimulants increase dopamine levels in the brain (as well as norepinephrine), and this is probably what leads to the increased aggression (as one often sees with meth users). But rather than decreasing or eliminating the stimulants, they add “antipsychotics,” whose main action is to DECREASE dopamine levels, which you have artificially INCREASED with the stimulants!

    How this is not malpractice is beyond my comprehension. It can only be rationalized by viewing the “patient” as an object you are playing around with to see what happens. There is not even a warped and strained scientific argument that could be made for doing so. But it is happening a lot, all over the country, to millions of foster kids. It is a crime.

    —- Steve

    • People who take ADHD drugs essentially are meth users. These drugs active substances are amphetamine, methamphetamine or some analogues of them. The funny thing is: if you tell that to people who are for giving them to their kids they deny it and shout at you that you’re trying to stigmatise their kids. And that does not really change even when you read them the label…

    • Steve,

      After several years on psych meds, including stimulants, I was diagnosed with sleep apnea a few years ago. Unfortunately, I have had a hard time adjusting to pap therapy which is a whole other issue.

      But on apnea boards, there are many posts by people in similar situations who did successfully adapt. Sadly, trying to get psychiatrists to understand that patients should be screened for sleep disorders who have sleeping problems before being placed on psych meds is an exercise in futility.

  3. It is no surprise that children diagnosed with ADHD are eventually prescribed anti-psychotics. The drugs of choice for ADHD are frequently amphetamine preparations and amphetamine psychosis has been recognized for years.

    There goes the US Seed Corps, another threat to our National Security. Might as well turn the production of all the kids over to Monsanto.

  4. As has been stated over and over in explaining the difficulty in curtailing the cost of any government program, “Everybody’s money is nobody’s money”. Well, I would propose a similar maxim when it comes to children turned over to a government program: “Everybody’s kids are nobody’s kids”. As imperfect as parents are, they are generally far more protective than any state entity will ever be!

  5. .

    One reason the use of anti psychotics is going up is VYVANCE !! The amphetamine that just keeps “working” for 12-14 hours !

    It takes about an hour and a half to two hours to start working. Once it starts working, it works for about 4 hours. .So, in effect, it’s exactly the same thing as taking instant release Dexedrine or Adderall but it takes longer to kick in and the crash is longer and more severe causing worse anxiety, insomnia, “psychosis” and all that fun stuff .

    I know I have taken Dexedrine , Adderall and that nasty VYVANCE.

    Tweaking a drug who’s patent is about to expire, and then patenting and marketing that “new and improved” drug is all the rage these days! It’s not just Shire. They all do it. The “improvements” usually aren’t really improvements, but then the marketing machine and the army of sales reps goes out with free samples or vouchers in hand, and convinces all the doctors that this “new” version of the drug is so much better. I mean, it’s such a joke, and the doctors just swallow it.

    Vyvance is no doubt part of the problem here.