Being thrown into the foster care system in the United States sends children hurtling along a path surrounded with potential landmines. If they’re lucky and truly needed to be removed from their homes, they manage to get a good placement with caring foster parents who may eventually adopt them, if that’s an option, providing a stable, safe, healthy home environment. Or they’re able to reunite with their parents after an investigation and determination finds that the children were seized unfairly. Others, though, may find themselves in far more unpleasant environments, where they’re deprived of opportunities from the very start, perpetuating inequalities in society, for many foster children are from low-income backgrounds, and many are children of colour and nonwhite children.
One area of particularly striking concern with foster children in the United States is the suspiciously high rate of psychiatric medication usage among them, including the use of multiple serious medications in the same child. Clinically speaking, it’s highly unlikely that this many foster children have psychiatric conditions in need of medication therapy, and even more unlikely that this number of children with psychiatric conditions have treatment-resistant conditions that require aggressive multi-medication therapies.
So what’s going on here?
In a way, the medication of foster children hearkens back to the early use of antipsychotics and other (then) new psychiatric medications in the 1950s and 1960s, when institutionalisation was a common way of dealing with mental illness. Staff and administrators realised that they had a perfect tool for managing patients while claiming to provide treatment: medications that would effectively render their patients comatose, with side effects so severe that patients couldn’t stand or walk steadily, lost cognitive function, and struggled to perform basic tasks. Drooling patients with shaky hands were considered an acceptable tradeoff, ensuring that serenity reigned in mental health facilities, because patients were too exhausted and doped up from their medications to interact with the world around them.
Such medications are still available and are still used, although newer generation drugs are also available, and these are at least theoretically balanced to allow patients to retain function while still managing specific mental health symptoms. Responsible physicians and medication managers taper their patients onto medications to find the lowest effective dose, finding the point at which the medication helps the patient and creates the fewest side effects.
Even with careful management for patients who choose to take psychiatric medications (those who are compelled to take them are usually not afforded the privilege of respectful, cautious meds management), there are still serious and sometimes irreversible side effects. Psychiatric medications are brutal, and can cause things like rapid weight gain, serious damage to the teeth, tardive dyskinesia (those shaky hands I mentioned above), personality changes, and more. They are not for the faint of heart, they are not to be used lightly, and, critically, they should only be used in children with extreme care because they haven’t been widely tested in children, there’s no standardised pediatric dosing, and children tend to be more sensitive to their environment than adults, with developing bodies that could be seriously harmed by harsh psychiatric medications.
Thus, it’s disturbing to see such a high use of psychiatric medications in foster children, in circumstances which amount to medication abuse. Is the high use of meds really about skyrocketing mental health diagnoses in foster kids and a desire to ensure they get the treatment they need? Or is it about a desire to control foster kids, labeling some behaviours as ‘unwanted’ and assigning them to mental illness in order to access medications to suppress what may be normal childhood behaviours? Once medicated, the behaviours go away, but you’re also changing the brain chemistry of the child and potentially burdening her with life-long health problems.
Children run around a lot. They throw tantrums sometimes. They can be loud, they can hyperfocus on things, sometimes they don’t want to pay attention in class. They get bored. They talk back. They don’t do their chores, or they’re mean to other children. These are all things that children do, and they are all things that foster children may do, because they, too, are children. They’re also all things that can get a kid slapped with a mental health diagnosis and a packet of pills without a careful, responsible evaluation and a long-term followup to determine if this is the best option for the child. Notably, foster kids are usually on Medicaid, which will happily pay for such drugs but drags its heels on counseling and other options.
Once drugged, the child might ‘calm down’ and people might count this as a victory, but is suppressing childhood behaviour really such a great thing? What about the fact that many psychiatric drugs cause cognitive impairment, which could interfere with communicating, learning, and other activities, in addition to causing problems down the line? As an adult on psychiatric medications, I struggle with cognitive impairments, fatigue, and other side effects on a daily basis, and I’m voluntarily making the choice to accept these consequences because the alternatives, for me, are worse. Kids aren’t allowed to make that choice, especially foster children, who are effectively shuttled around like property of the state.
Infants under age one are given harsh antipsychotics and other psychiatric medications. Some foster kids are taking five or more medications at very high doses; individually, all of these medications can cause problems on their own, while together, there’s a risk of drug interactions. Adults and children taking these kinds of drug cocktails often experience debilitating side effects, but people evidently think this is acceptable if foster kids are involved, because in a survey of how, when, and where these drugs are used, it’s mostly foster kids on psychiatric meds, and it’s mostly foster kids with potentially dangerous mixtures and doses.
This is a huge and troubling trend in the United States, and it needs to be brought to a screeching halt. There is no reason we should be drugging children into oblivion when they enter the foster care system. Careful and judicious use of psychiatric medications when warranted should be considered in consultation with detailed guidelines, but indiscriminate prescription practices are a recipe for disaster.