This blog is my place to vent and share resources with other parents of children of trauma. I try to be open and honest about my feelings in order to help others know they are not alone. Therapeutic parenting of adopted teenagers with RAD and other severe mental illnesses and issues (plus "neurotypical" teens) , is not easy, and there are time when I say what I feel... at the moment. We're all human!

Monday, October 1, 2012

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.

6 comments:

Last Mom said...

Most people just can't grasp the sleep struggles. I know when I say my daughter was up all night, it's pretty much only other trauma moms that get that I mean she was UP ALL NIGHT! Sleep is so important. I have really come to treasure it when we see it!

Marianne Milton said...

The problem with these types of articles about overmedicating children in foster care (which may happen at times) is that the solution to the problem ends up causing misery and mayhem in the lives of children in foster care and foster parents. For example, in Massachusetts, we have to go to court, for a Rogers Order, in order for a child to be on an atypical antipsychotic, such as Risperdal, and in general, unless you have a helpful, cooperative, experienced psychiatrist, most p-docs refuse to go that route, and instead prescribe medications that don't work as well so as to avoid asking a judge (who is not a medical professional) to approve the use of a psychiatric drug that they may know little or nothing about.

The other problem with these kinds of articles is that they never address the opposite end of the spectrum: all the kids in foster care who don't get any appropriate medical treatment for their psychological conditions, but instead get moved from foster home to foster home until they end up hospitalized, in residential treatment centers, or juvenile detention---and may (may) finally get the medication that they need. Why not diagnose the children in foster care early on and put them on appropriate medications? Well, if their social worker hopes to place them for adoption, a correct diagnosis could scare the bejeezus out of all potential adoptive parents. And many social workers share the anti-medication bias that the general public seems to have when it comes to mental illness or psychological/behavioral disorders, and so they may not encourage foster parents to obtain the proper evaluations. And many kids in foster care with severe problems are moved from placement to placement (because they "bomb out") that they're never in one place long enough to get a diagnosis, start medication treatment, and then get that medication "tweaked" until the kinds and dosages of medications are correct.

So often, the solution to crises in the lives of children in foster care is to move them, assuming that there's a mismatch between the child and the family, when sadly that "mismatch" happens again and again because the next family is not educated about the child's needs because *nobody* has accurately determined what that child's needs are, through a definitive diagnostic work-up.

OK---rant over!

Thanks for posting the article---and thanks more for writing your excellent commentary.

marythemom said...

Sending HUGS and PRAYERS Last Mom! Yes, I do know what you mean about up all night!

Thanks Marianne! When our kids came to us, 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 a REAL psych eval, they were diagnosed with bipolar disorder (which apparently they'd been diagnosed with before entering foster care and had been removed), 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 - mostly effecting memory and processing), Complex Post Traumatic Stress Disorder, learning disabilities, and emerging personality disorders. The discrepancy was huge, their medications were all wrong, the kids were 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.

Johanna said...

I was reluctant to medicate - we gradually took our kiddo off his medication because I wanted to see what he was like in a permanent home and unmedicated (and he was five). But gradually it became very obvious that things weren't right and weren't going to be fixed by consistency and love. My kiddo has a mood disorder and I know the difference medication has made in his life. We shouldn't be reluctant to admit that many kids in foster care do come from backgrounds that include mental illness and that they deserve treatment that is appropriate so that they can have a life.

Michaela McCoin said...

Amen!
As my therapist friend said to me when my child was 4 years old... "At a certain point it is cruelty NOT to try medication."

Adrian said...

I like that you mentioned you put as least as much effort into finding the diagnosis as finding the medication. It was a really helpful edit to how the rest of the thing came off.