Anyone catch 20/20 last night on overmedication of kids in foster care?

[flatearth22]

If not you can watch the full episode here: http://abc.go.com/watch/2020/SH559026/VD55156221/2020-122-overmedication-in-foster-care

Pretty scary stuff....are these just some rogue, incompetent child psychiatrists or is it a general problem in child psychiatry when taking care of extremely troubled kids in foster care? How many different medications would you guys feel comfortable giving kids that young? The episode seemed pretty biased in favor of counseling and therapy over medication.....what are your thoughts on that?

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[dl2dp2]

I
Pretty scary stuff....are these just some rogue, incompetent child psychiatrists or is it a general problem in child psychiatry when taking care of extremely troubled kids in foster care?

The sad state of affairs is that most of the meds are prescribed by pediatricians. It's actually quite rare for a foster care child with mental disturbances to even end up with a long term child psychiatrist followup. Child psychiatrists are often only acting in consultation. I'd say if most of these children were seen by board certified child psychiatrists, and that the government actually spent some good money reimbursing mental health services for underprivileged children, there'd be way less "over-medication." Hell, we might have fewer drug addicted, severely mentally ill adults. But let me not open that soap box.

The reality is, children are on a lot more meds than 30 years ago. And a lot of the meds can be QUITE helpful for some proportion of patients. I think just about every psych resident have seen some dramatic cases when patients were put on meds. Sure they are rare, and doctors need to know how to do the risk vs. benefit analysis and take people OFF meds when it's the right thing to do. But this in the end is a very complicated issue and that is, I think, being spun out of control in popular media without any sophisticated analysis. To be fair, most people are not interested in listening to an hour of lecture, and that certainly doesn't sell any ads.

There's a saying in inpatient medicine that everyone can put people on antibiotics, but an ID specialist knows when to take people OFF one. I think this is truer in psychiatry where the knowledge of non-medication and medication augmentation modalities is genuinely much greater amongst psychiatrists compared to non-psychiatrist physicians.

 

[nitemagi]

I think it depends. I used to cross-cover weekends on a child/adolescent unit, which is a sampling bias which I'm presenting up front.

The kids on that unit though were largely those in foster care/group homes. Long history of abuse in some cases. But what became clear was a large group of them would just feign SI to get out of the house because they felt the hospital was a more supportive environment. The child psychiatrist would diagnose bipolar, or IED, or something else. Add a med or two. I saw kids on 5-7 meds at times. Some of them had barely hit puberty.

That was a big reason I decided Not to do Child Psych.

 

[Therapist4Chnge]

I'm not surprised at all. Research shows that low SES, minorities, and male > female children are more likely to be medicated. These factors (among others) mirror the demographics in foster care. It is really sad that medication is often the replacement for a lack of parents and parenting.

 

[whopper]

A problem here and it also happens in group homes for adults with MR is the medication given is often based on the information given by a caretaker. With children it's usually the parents, but in MR group homes its staff and sometimes their agenda is to literally have the person zonked out instead of actually giving the person the care they deserve.

One should never have an opinion that a child should never be given medication, but one also has to be extremely cautious in doing so. I've written this several times but IMHO I've seen some doctors including psychiatrists overmedicate children on the merest whim, and I've seen others not do it at all when needed. The trend, at least from my experience, the trend is to overmedicate, not undermedicate. That's not to say medication shouldn't ever be done. I've seen some psychiatrists medicate children appropriately, and in doing so follow some basic and common sense rules: use extreme scrutiny, go the extra mile, don't cut corners in diagnosis, and don't continue a medication if there's no noticeable improvement after a reasonable try.

I try not to see children at all, but I have told the office I work at I'm willing to see children 16 years or older. I did actually have one case where I believe the person had bipolar disorder since about age eight because the person had symptoms that were greatly improved with Lamictal and the person had problems ever since the age of eight years. A godsend in this case was the kid's mother is a child psychologist, and even she couldn't tell what was going on until he hit is mid teens. The kid was diagnosed as ADHD and all the meds didn't work.

 

[nitemagi]

I'm not surprised at all. Research shows that low SES, minorities, and male > female children are more likely to be medicated. These factors (among others) mirror the demographics in foster care. It is really sad that medication is often the replacement for a lack of parents and parenting.

I have a colleague and friend who did some therapy outcomes research in children. Interestingly she found a robust factor of parent education as positively correlated with seeking medication for management of child behavior. Meaning parents with higher education were perhaps less tolerant of behavioral problems and thus more likely to seek medication to manage it.

 

[Therapist4Chnge]

I have a colleague and friend who did some therapy outcomes research in children. Interestingly she found a robust factor of parent education as positively correlated with seeking medication for management of child behavior. Meaning parents with higher education were perhaps less tolerant of behavioral problems and thus more likely to seek medication to manage it.

There has definitely been an increase in psychostimulant use, in addition to an increase in antipsychotic use...though there are SES differences in each population. A higher SES parent isn't going to push to get little Jane or Johnny on an antipsychotic, but they will push to get them on Adderall or similar. "His isn't a bad child, he just has a hard time focusing". Anecdotally, I've seen a ton of children coming in for "achievement testing" who are on psychostimulants, far more than those on antipsychotics. SSRI/SNRI use has been higher than I expected, though the data seems to shake out that they are still some of the most prescribed meds.