Pennsylvania Foster Kids Prescribed Too Many Psychotropic Drugs


Amid growing criticism about the over-prescription of psychotropic medication in foster care, Pennsylvania commissioned PolicyLab to conduct an analysis of the use of psychiatric drugs among all of the state’s Medicaid-enrolled children.  The report, released in June, found that the rates of psychotropic prescriptions among youth in Medicaid and foster care are higher than previous estimates.

In an interview with Medscape, the study’s authors discussed their results.  “We are concerned that doctors are turning to psychotropic medications because they are more readily available and easier to access than nonpharmacologic interventions,” Kathleen Noonan, codirector of PolicyLab, wrote. “These medications with less evidence behind them are more plentiful than proven therapies.”

To determine the trends of psychotropic medication use in Pennsylvania’s Medicaid program, the researchers analyzed patient data on youth age 3-18 from 2007 to 2012. They examined the records for foster care status, the use of any psychotropic medication, the use of antipsychotics, and the diagnoses of children receiving polypharmacy.

They found that youth in foster care were prescribed psychotropic drugs at nearly three times the rate (43%) of other youth on Medicaid (16%).  Those in foster care were also four times more likely to be prescribed an antipsychotic (22% vs. 5%) and four times more likely to receive polypharmacy, the prescription of multiple classes of medications simultaneously (12% vs. 3%).

The researchers point out that the majority of youth prescribed antipsychotics only had a diagnosis of ADHD.  A diagnosis for which antipsychotics are neither clinically recommended nor FDA approved.  This is also concerning because “antipsychotic medications are associated with serious side effects in youth” and those with an ADHD diagnosis “receive significantly fewer behavioral health visits than youth with more severe behavioral health impairments, and thus, may not be receiving adequate medication monitoring.”

In an interview for Medscape, the authors make varying suggestions about how to bring down these prescription rates.

Noonan, a lawyer, suggests policy reform.  While she notes that most states have yet to make such changes, she suggests laws “related to the use of psychotropic medications in children; the use of multiple medications; the use of medications in very young children; or the identification of prescribing red flags, such as the use of antipsychotics for a nonindicated condition.”

David Rubin, a pediatric specialist, disagrees. “We can focus on restricting authorization for antipsychotics,” he writes, “but at the end of the day, we are not going to get ourselves out of this crisis without a serious discussion about trying to provide other therapies for children who have been traumatized.”

Public health researcher Meredith Matone proposes a switch to specific therapies that can be offered instead of prescription drugs.  “Evidence-based and trauma-informed nonpharmacologic therapies, such as parent/child interaction therapy, may be a well-suited alternative to medication.”

For the full Medscape interview with the PolicyLab study authors click here →



Matone, M., Sarah Zlotnik, M. S. P. H., Dorothy Miller, J. D., & Kreider, A. (2015). Psychotropic Medication Use by Pennsylvania Children in Foster Care and Enrolled in Medicaid. (Full Text)


  1. First off, DUH! Foster kids in EVERY state are inappropriately medicated and are not provided appropriate psychosocial assistance, all with the agreement and support of the psychiatric community nationwide. They’re a great market – plentiful and powerless and with insurance.

    Second, I don’t know why people don’t get the “ADHD”-antipsychotic connection. These kids end up on antipsychotics because the stimulants make them aggressive and sometimes frankly psychotic! Stimulants INCREASE dopamine, which is associated with increased aggression in a decent proportion of the population. Having made these kids aggressive through stimulant “therapy,” they then apply antipsychotics to DECREASE the dopamine levels that they have been increasing with the stimulants! It is absolute biochemical insanity, but it’s a very obvious explanation for anyone who knows the biochemistry of those two drug categories. I wish more people would speak out about this, because I see it ALL THE TIME in the foster kids I work with, and the stimulants are almost never recognized as a causal factor, even if the kid was less aggressive or not aggressive at all before starting “therapy.”

    Finally, it disturbs me that 5% of the GENERAL POPULATION of kids on Medicaid are on antipsychotics! That is a scary figure, especially when considering the extreme negative long-term health impacts of these drugs.

    — Steve

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    • “Second, I don’t know why people don’t get the “ADHD”-antipsychotic connection”

      I call this deliberate ignorance. Medical professionals just don’t want to believe their meds can cause harm. Easier to blame it on mental illness.

      “”Finally, it disturbs me that 5% of the GENERAL POPULATION of kids on Medicaid are on antipsychotics! That is a scary figure, especially when considering the extreme negative long-term health impacts of these drugs.””

      And people wonder why Medicaid is so costly. A big fat sigh!

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    • Also noted in the repors was the following:

      Specifically, for youth in foster care, youth 11-14 years were the most likely users of antipsychotics (28% in 2012), exceeding use for 15-18 year olds (23% in 2012). More importantly, rates of use in this younger group did not appear to decline from 2007 to 2012 as it did for the overall Medicaid population.

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  2. Good points. But this is as well a clear case of discrimination and abuse of power.

    The “system”, which isn’t known for actually resolving problems, would have to begin by cutting the approved drug costs to turn less profit for those who push them. Then the cloak of impunity for the drug companies and the prescribers would have to be tackled. Then, there would have to be a means of providing professionals to engage in alternate treatments and they would have to be removed from the one size fits most approach and the ignorance that is rampant in mental health. Psychiatry would have to begin a new educational process that teaches them they aren’t God’s of social change and that the medical model is a theory. A theory which holds now validity after decades of pill pushing. Peers involved in the process would be far more valuable than most of the “professionals” I have observed who are so driven by bias and their own blind spots they can’t be effective. I might have missed a few other changes Like getting the schools out of the business of obtaining funding for pushing “disabilities” for every “behavioural issue” under the sun. The over prescription is a symptom of a bigger issue. Can it be changed? Yes! Not easily but it can be done.
    It disturbs me that the 5% is a growing percentage. They are pushing chemical restraints in our local school to 6 year old kids (who have horrible living conditions that are ignored by everyone). That the people involved aren’t even given the ability to make a decision based on all the information dooms these kids. I can’t even imagine what their developing brains and personalities will go through. I fear their futures will be grim.

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  3. Psychotropic Medications for Foster Youth
    Celena Malarkey
    California State University Chico

    Concerns with giving our children psychotropic drugs has been a heavily covered topic in California in the past year or so, so much so that a few different bills were recently passed that will help monitor and lesson the amount of psychotropic drugs prescribed to foster youth. Senate Bills 238, 253, 319, and 484 were all recently passed. It is alarming to know that researchers have proof that a large amounts of children in Pennsylvania are given these medications, even though their diagnosis does not call for them. This article states, “researcher’s point out that the majority of youth prescribed antipsychotics only had a diagnosis of ADHD. A diagnosis for which antipsychotics are neither clinically recommended nor FDA approved”, if this is not alarming, then I would question professionals responsibilities to protect these children. (Karter, 2015). It is disturbing that professionals would prescribe such prescriptions knowing that there are alternative methods of treatment that have less side effects. Many of the children in the Foster Care system have already faced many adversities, why potentially harm this vulnerable population even more? My next thought is why are people talking about this in Pennsylvania, why aren’t laws already in place? Professionals who are overprescribing these medications should be held accountable!

    Celena Malarkey
    [email protected]

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    • “Professionals who are overprescribing these medications should be held accountable!” They should be put in jail, and if true justice were to prevail, technically they deserve to be defamed with one of their “life long incurable” made up mental illnesses, and tortured forever, exactly their goal for these poor abused children.

      This is just disgusting and criminal. Drugs do not cure trauma. What is our government thinking? Don’t they know yet that “forced psychiatric treatment is torture”? And all these little children are forced to take these toxic torture drugs. I’m disgusted.

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