Medicating Children of Trauma - Edited

State is tackling pills for foster kids

Nearly 1 in 4 foster children in Ohio has been prescribed mind-altering drugs.
In Ohio and across the country, foster children are more likely than other youngsters to be prescribed psychotropic drugs, which can bring serious health risks and side effects. The medications also are expensive, costing millions to the tax-funded Medicaid program that insures foster children.
Yesterday, state officials announced a $1 million initiative to improve psychotropic-drug management by closely monitoring prescriptions and improving coordination of physical and mental-health care for Ohio’s 12,000 children insured through Medicaid.
“The rate of prescribing has gone up, but it’s not clear that the rate of mental illness has gone up to the same extent,” said Dr. Mary Applegate, medical director for Ohio’s Medicaid program.
“We are seeing kids who are taking two or three or four of the same type of drug at the same time.”
The effort comes about a year after a federal report based on a two-year investigation found higher prescription rates among foster children.
Psychotropic medications are used to treat mental illnesses such as depression and bipolar disorder. Although foster children tend to have a higher prevalence of such ailments because of a greater likelihood of trauma and stress, usage still appears too high.
Pam Harris of Greene County said her 13-year-old son was on eight medications at one point, and she was overwhelmed trying to coordinate care by pediatricians and psychiatrists while she looked after him.
“The pediatrician wants to prescribe to help keep everyone safe, and then we may wait six weeks to see the psychiatrist. They don’t coordinate, and it’s frustrating to see the side effects,” Harris said. “I asked the psychiatrist about side effects and he said ‘Ask the pediatrician.’ I asked the pediatrician and he said ‘Ask the psychiatrist.’  ”
Then 5, her son suffered tremors and other problems after he started taking medication for what doctors believed was an attention-deficit disorder. When his behavior turned aggressive, he was given more drugs and immediately gained 10 pounds. Problems persisted, and he had to move out to ensure the safety of his siblings.
“Any parent or caregiver of a child with severe emotional disorder facing the prospects of having their child or foster child placed on psychotic medications struggles with very mixed feelings,” said Terry Russell, executive director of the National Alliance on Mental Illness of Ohio.
“On one hand, knowing that such medications can literally be lifesaving ... and improve their child and their family’s quality of life. ... On the other hand, parents are also fearful because they know such medications can cause serious side effects if they are not properly used or monitored.”
Advocates for children and the mentally ill joined state officials at a Statehouse news conference yesterday to support the initiative, saying it will help ensure safe use of psychotropic drugs and improve overall care.
“Through the initiative, the state will determine which children are receiving more than two psychotropic drugs at a time, their ages and their diagnosis, the maximum dosage, dosage for children,” said Crystal Ward Allen, executive director of the Public Children Services Association of Ohio.
“These are all big unknowns, and it’s often a challenge in the child-welfare system to be the custodian without the medical expertise.”
State officials said they will monitor prescriptions of such drugs and inform doctors when multiple medications have been prescribed or when safe dosage has been exceeded. Often, Applegate said, more than one doctor is involved in a child’s care because a child moved, and the physician is unaware of other prescriptions.
Last year, taxpayers spent nearly $37.7 million on prescription-drug costs for foster children, with some prescriptions costing as much as $500 a month. Officials have not projected any savings through the initiative, but avoiding duplicative prescriptions, lowering usage of such medications and increasing use of alternative treatments such as counseling will reduce costs.
ccandisky@dispatch.com

A friend posted this article recently. I wanted to share my thoughts on the subject.

I think one reason we see a high rate of prescription drugs for our kids is there is such a prevalence of mental illness in foster kids. I've seen a lot of "like attracting like" among my kids and other kids in the foster care/ mental health care system (can you say Kleenex girls?). 2 bipolar parents (or alcoholic or emotionally disturbed or whatever) often means scary genetics for the child. Plus being raised by a mentally ill parent, frequently leads to abuse as well.

I know a lot of times there is a huge resistance to giving children meds, and while I agree that there are times some foster children are over medicated, I also believe that it often means kids are struggling and they can't heal if they feel like they are existing as though they are in the middle of a war zone or they are struggling with basic coping skills, unable to function.

Medication Cocktails
The article makes a big deal about kids taking more than one of the same type of medication. I know that for bipolar people, taking two or more different mood stabilizers is frequently recommended to stabilize the person. Especially when there are multiple diagnoses, it can take a med cocktail to help the child stabilize, and unfortunately our body chemistries are unique, and with growth and puberty added in... well one can necessarily feel like a human guinea pig.

Over the Counter Sleep Meds
My kids suffer from PTSD (like most kids of trauma) and sleep is HARD! If you don't get enough sleep, then you can't learn in school and it's harder to control your emotions - sleep deprivation is a common form of torture! If you're living in a war zone in your head (PTSD), or you can't focus (due to ADHD), then you aren't learning (my kids have HUGE gaps in their education). If you're struggling with depression or anger (bipolar, RAD, mood disorder NOS, ODD...) then you're so busy fighting or coping that you can't learn the developmental lessons or how to get along in a family.

Over-Medicating
I'm not recommending we drug our kids into zombies (although we did have to do that once for a short period of time to keep our son and family safe while we waited for a bed to open up in an RTC), and yes, there are some nasty side effects from medications that aren't tested on children... but without meds, my children would have been virtually unadoptable and my son would have ended up dead (self-medicating with drugs, gang life, suicide...) or in juvie many years ago.

Years of the right medications gave my son time to mature, learn, and attain coping skills... When he decided to stop taking his medications at 18, he learned very quickly that he needed them, but I also believe that the consequences of his actions off the meds were much less severe because of that time of growing/ healing.

Edited to add:

Proper Diagnosis and Medication
When our kids came to us, they weren't properly diagnosed or medicated.  Bear was diagnosed with PTSD, mood disorder NOS and possible conduct disorder.  Kitty was diagnosed with ADHD (unmedicated for some unknown reason), ODD and "attachment issues" (which the caseworker claimed couldn't be true, because she was such a loving child who always hugged the caseworker *roll eyes*).

After we'd known them for long enough to get an accurate psych eval, they were diagnosed with:

• Bipolar Disorder (which apparently they'd been diagnosed with before entering foster care and had been removed for some reason - possibly because many doctors don't believe in child-onset bipolar, or maybe because it made them seem less adoptable, but if the latter was the case then they sure left a LOT of other stuff in!), 
• Reactive Attachment Disorder (I asked their foster care therapist why this wasn't seen before and she claimed not to have seen it - it's possible that in previous foster homes no one had tried to bond with them), 
• ADD/ADHD, 
• brain injuries (cerebral dysrhythmia - strongly effecting memory and processing), which is probably tied into Kitty's learning disabilities, but for Kitty also effects her emotions.
• Complex Post Traumatic Stress Disorder, 
• emerging personality disorders.  

The discrepancy was huge, their medications were all wrong, the kids were raging and miserable, and their "misbehavior" had made a mess of their lives.  I won't say medications fixed all their problems, but... without it I know we couldn't have adopted Bear - he wasn't safe, and Kitty has come SOOOO far with her healing that she couldn't have done without alleviating some of her symptoms through medication.

For a follow-up to this post check here.