Quotes from Time Magazine about Overmedication of Foster Youth

Source: Szalavitz, Maia. Why Are So Many Foster Care Children Taking Antipsychotics?
Time Magazine, November 29, 2011.

• "The influence of pharmaceutical company marketing cannot be overlooked. Ninety-nine percent of youth receiving anti-psychotic medications in the study were given atypical anti-psychotics — the newer generation of these drugs, which are expensive and mostly unavailable in generic form and have been heavily advertised.

• "All of the major manufacturers of these drugs have been fined by the Food and Drug Administration for illegal marketing practices — in part, for marketing the drugs for unapproved use in children — with some convicted of criminal charges.

• "The main condition that antipsychotics are approved to treat —schizophrenia — is extremely rare in children. The rate of schizophrenia in children under 12 is an estimated 2 cases per 1 million children; it affects fewer than 1% of older teens. Anti-psychotics are also approved to treat bipolar disorder, a diagnosis that is highly controversial in children. Some studies suggest that it affects 0.2% to 0.4 % of children, and up to 1% of adolescents.

• And yet, between 1994 and 2003, rates of bipolar diagnoses in youth under 19 rose by a factor of more than 40, according to the National Institute on Mental Health. It seems unlikely to be a coincidence that this rise occurred during the period when atypical anti-psychotics were being illegally marketed for children."

• "Indeed, most of the anti-psychotics used in foster-care youth were for conditions that the drugs were not approved to treat. Fifty-three percent of prescriptions were written for attention deficit/hyperactivity disorder (ADHD), a condition that is ordinarily managed with drugs that have the opposite pharmacological effects as anti-psychotics. The stimulant medications like Adderall and Ritalin, widely used for ADHD, tend to increase levels of dopamine, while anti-psychotics tend to decrease it."

"This study confirms the need for developmentally and trauma-informed practices in the vulnerable foster-care population," says Dr. Bruce Perry, founder of the ChildTrauma Academy. "Misunderstanding the pervasive effects of abuse and neglect leads to the mislabeling of behavioral and emotional symptoms in these children and then to overmedication."

Overmedication of foster youth continues....

A new study, Antipsychotic Treatment Among Youth in Foster Care, examined concomitant antipsychotic use among Medicaid-enrolled youth in foster care, compared with disabled or low-income Medicaid-enrolled youth.

They found that:

• More than a third of youth in foster care without disabilities had multiple anit-psychotic prescriptions lasting longer than 90 days
• Children who were not adopted had the highest rates of prescriptions, representing 38 out of every 100 children in foster care.

In comparison, 26 out of every 100 children who were on public assistance but not in foster care had more than one antipsychotic prescription.

In recent years, doctors and policy makers have grown concerned about high rates of overall psychiatric drug use in the foster care system. Previous studies have found that children in foster care receive psychiatric medications at about twice the rate among children outside the system. 

In 2008, the House Ways and Means Subcommittee on Income Security and Family Support held a hearing on the utilization of psychotropic medication for children in foster care.

In 2010, Senator Daniel Akaka (D-HI) asked the Government Accountability Office (GAO) to investigate the prevalence of prescribed psychotropic medications for children in foster care.

Valuing and Asserting Personal Worth vs. Maintaining Abusive Relationships

 "Describing how the brain changes in response to a child's experience, Bruce Perry wrote, 'Children are not resilient, children are malleable.' Trauma, neglect and abuse influence how synapses develop pathways, how neurons fire, how we translate incoming information...

"The baby learns how the caretaker will respond to his emotional needs, and from this, the baby begins generalizing his experiences and defines the world.

"The failure to consistently meet the infant's needs (emotional or biological) impacts the child's sense of self long before the pain influences her perception of the outside world. 'Unfortunately, the child will interpret this as a product of its own inadequacy,' J. Konrad Stettbacher notes.

"Dependent upon others for survival, the child believes that the cause of pain is his own self and he tries to adapt (they must be right; therefore, he is wrong). In response, he minimizes or relabels his own pain: 'It's not so bad.' Pain is always a signal that something has to change - how we respond to that pain reflects what we've learned early on.

"Similarly, the victim of emotional abuse things, 'If I were better, they wouldn't do this to me,' rather than, 'This other person is causing me pain and if she doesn't stop, she has to exit my life.'

"No infant has the ability to make that distinction - they blame themselves in order to hopefully fit the caregiver, alleviate the pain, and preserve that bond.

"Acknowledging pain is the vital first step in any self-defense. Acknowledging what 'hurts' identifies the boundaries that define each one of us... If a victim can decide whom to trust and then act on this decisions, (he or she will have) the resiliency to emotionally to defend himself...

"Resiliency acknowledges that there will be a cost. The former victim may lose a 'friend...'

"Doing so lifts the burden the victim assigned himself, but also presents a hard decision. To define one's self, there is a cost."

~ Heart Transplant by Andrew Vachss and Frank Caruso

New Federal Requirements for States re: Foster Children, Trauma and Monitoring Medications

President Obama recently signed the Child and Family Services Improvement and Innovation Act (H.R. 2883) into law.

Among other stipulations, this new law:

• Requires States to address emotional trauma in foster children, adopt protocols for using and monitoring psychotropic medications, and describe how they both address the developmental needs of young children in the child welfare system and reduce their length of stay in foster care.

National Clearinghouse on Families and Youth

The National Clearinghouse on Families and Youth recognizes that most homeless youth have experienced multiple traumatic events both before becoming homeless and once on the street. This underscores the importance of trauma-informed practice:

• They suggest that several homeless shelters might need a trauma-informed transformation, considering such details as the need to put a lock on the shower door at a shelter in order to ensure physical safety and emotional security.

• Youth workers need to provide trauma-informed care, seeking to understand each young person’s emotional triggers, build supportive relationships, and give youth opportunities to rebuild control in their lives.

• Individuals who have experienced homeless express the need for expectations and empowerment, and hope that staff members are willing to look beyond external behavior, and recognize the underlying trauma beneath.

Federal Partners Committee on Women and Trauma

According to a recently released report by Federal Partners Committee on Women and Trauma:

• Due to the spiraling number of people impacted and the wide range of consequences, trauma is now believed to be a public health crisis.

•  Violence is gendered: While men are most likely to experience violence from strangers, women and girls are most likely to be hurt by people they know intimately: For women in the military, the greatest risk of harm is from fellow soldiers; for an adolescent girl, it is from a person whom she loves.

• One in five girls and one in ten boys are sexually abused before adulthood. Adolescent girls between the ages of 16-19 are four times more likely than boys to be a victim of rape, attempted rape, or sexual assault.

• Women are twice as likely as men to experience depression, and 54% of depression in women can be attributed to childhood abuse.

Not surprisingly, according the SAMSA's 1998-2003 research study on women and violence:

"The most effective interventions are gender-responsive – they reflect an understanding of the realities of the lives of women and girls, respond to their strengths and challenges, and use knowledge about female socialization and development to guide all aspects of program and system design."

Helping Foster Children Handle Transitions

The Indiana University School of Medicine has developed a one-page tip sheet for Helping Your Child in Foster Care Handle Transitions.

Helping Children Who Have Experienced Traumatic Events

In conjunction with Children’s Mental Health Awareness Day, The Substance Abuse and Mental Health Services Administration (SAMHSA) released their 2011 Short Report on Helping Children and Youth Who Have Experienced Traumatic Events.

and

American Humane Association — along with Zero to Three, the Center for the Study of Social Policy, the Child Welfare League of America and the Children's Defense Fund — recently released A Call to Action On Behalf of Maltreated Infants and Toddlers.

Community System of Care Improves Behavioral Health of Children Affected by Trauma

"Childhood exposure to traumatic events is a major public health problem in the United States. Traumatic events can include witnessing or experiencing physical or sexual abuse, violence in families and communities, loss of a loved one, refugee and war experiences, living with a family member whose caregiving ability is impaired, and having a life-threatening injury or illness. It is estimated that 26% of children in the United States will witness or experience a traumatic event before the age of 4 years."

Children and youth affected by traumatic events improve their functioning when they can access effective community-based programs and supports, according to a study by the Substance Abuse and Mental Health Services Administration (SAMHSA).

This report shows that after 12 months of accessing services within a community-based system of care, 44 percent of children and youth improved their school attendance, 41 percent improved their grades, and youth suicide attempts fell by 64 percent. In addition, the number of youth reporting arrests in the past 6 months fell by 36 percent.

Similarly the report shows that children and youth receiving trauma specific services experienced a 20 percent drop in the number experiencing problems at school, a 59 percent drop in the number with problems with suicidality, and a 57 percent drop in number of children engaging in delinquent behavior after 6 months of service.

Stay tuned for future blog entry on "Hidden Rules"

Free Training on Trauma in Children and Families

Recognizing and Addressing Trauma in Infants, Young Children, and Their Families is an online tutorial for professionals who work with young children that explains the developmental context of trauma in early childhood, and expands professionals' knowledge for intervention through consultation. The tutorial also provides valuable links to a range of resources for further learning and exploration, and includes concrete take home messages.

Those who complete the tutorial will be able to:

• Define trauma, describe two types of trauma, and list common yet diverse types of traumatic experiences

• Describe the impact of trauma on infants, toddlers, and young children from a developmental perspective

• Identify trauma signs and symptoms in infants, toddlers, and young children

• Recognize and understand the role of the consultant in addressing trauma in the early care and education setting

The free tutorial takes between 30 and 40 minutes to complete. It is the sixth in a series for mental health consultants and was funded by the Office of Head Start and developed by the Center for Early Childhood Mental Health Consultation (ECMHC).

The entire series of tutorials are housed on the ECMHC website: www.ecmhc.org/tutorials/trauma/index.html