Federal health officials are failing to monitor how state agencies are doling out powerful psychotropic drugs to foster children, according to a comprehensive investigation released Thursday showing foster kids are being prescribed the drugs at rates 2.7 to 4.5 higher than non-foster children and often at much higher doses.
Hundreds of foster children are being prescribed five or more of the medications at once, which can have severe side effects including diabetes and suicidal behavior. In some regions, foster children as young as one were twice as likely to be prescribed the medications, according to a two-year investigation by the Government Accountability Office. The investigation looks at 2008 data from more than 100,000 foster children in Florida, Massachusetts, Michigan, Oregon and Texas.
Sen. Tom Carper, D-Del, requested the investigation's release after media reports of high prescribing rates and anecdotes from former foster children who said they were on multiple medications at the same time. The report was released ahead of a hearing Thursday by his congressional sub-committee that deals with federal services.
"This report we are releasing today confirms some of our worst fears," Carper said.
Some of the drugs have "black box" label warning for children's safety and are not approved for use by young children. But doctors often prescribe them off label. The drugs affect the central nervous system and can change behavior or perception. They are prescribed for depression, anxiety, schizophrenia and other psychiatric conditions. Little is known about the long term side effects of the drugs and drug, experts said.
"We're kind of flying blind as far as knowing the safety and efficacy long term risks (for children)," said Dr. Christopher Bellonci, a child psychiatrist at Tufts Medical Center.
The report offered several explanations for the high prescription rates, noting the children had greater exposure to trauma before entering foster care and that state agencies were lax in overseeing the prescriptions.
Critics say the drugs are overused as a chemical restraint for unruly children.
Child welfare advocates say there's a nationwide shortage of child psychiatrists, often leaving pediatricians to handle complex behavioral problems.
"I do believe that medications are being used almost in default and my concern is that is being used in lieu of psycho-therapeutic interventions," said Bellonci.
Six-year-old Brooke was on two psychiatric medications for an ADHD diagnosis when Todd and Lisa Ward adopted her out of Florida foster care in 2010.
Over the next two years, doctors put her on an array of powerful drugs as her parents watched her behavior become more aggressive, erratic and agitated. She twice tried to kill the family dog, pulled skin off her nose and wiped blood on the walls, threw tantrums as doctors plied her with more than a dozen medications over the years, her mother said.
"Her hands would just shake insanely and they would tell us, "oh that's just her'. But it wasn't her. It stopped once she went off the medication," he mother said.
The Wards tried desperately to get her into a psychiatrist but wait lists were typically nine months long, so she ended going back to the same mental health center that Ward said constantly overmedicated her.
This past summer Brooke tried to catch the house on fire in an attempt to kill her sister, said Ward, a 39-year-old accountant, who adopted Brooke and her two siblings in 2010.
The Wards placed her in a residential facility where she got intensive therapy for the first time, including yoga and play therapy. Three months later, Brooke is home and down to one medication.
"The difference in her was night and day. She actually can express emotion," said Ward. "They were able to figure out what this girl had held inside for eight years."
Ward, who started a nonprofit to link other foster parents to doctors and therapists, says the medication was just a band aid and notes the girls no longer have the ADHD they were diagnosed with when the Wards adopted them from foster care.
The new report found foster children in some areas were twice as likely to be prescribed five or more of those drugs at the same time compared to non-foster children. Texas foster children were prescribed five or more medications most often.
"No evidence supports the use of five or more psychotropic drugs in adults or children, and only limited evidence supports the use of even two drugs," according to the report.