Over-medication in foster care at issue
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In December, the U.S. Government Accountability Office issued a report saying that foster children were far more likely to be prescribed psychiatric medication than children who weren't in foster care.
Among the thousands of children studied in five states, the federal agency found, hundreds were taking five or more psychotropic medications simultaneously, and many of the children on such drugs were under a year old.
During more than two decades of work with foster children in California, Tony Stanton faced that reality every day.
Dr. Stanton was the child psychiatrist for the Seneca Center near Oakland, Calif., for 23 years, until the program shut down last year because of budget difficulties. He is also one of the invited speakers at the national meeting of the Society for Humanistic Psychology, being held at Point Park University here today to Sunday.
Most of the children who arrived at Seneca were on at least four psychotropic medications, from Ritalin to antidepressants to antipsychotics, he said. Many were taking eight to 10 medications at once.
And his goal, with each and every child, was to wean them off all those drugs.
What did he replace the medication with?
One response was a highly structured daily schedule. The other was strong relationships with adult caregivers. Children stayed in six-room units, and there often was one adult for every two children, he said.
"We were dealing with children who had horrific backgrounds of trauma," Dr. Stanton said. "We wanted to see if we could treat these most disturbed kids, who had been thrown out of their own homes, out of foster homes, out of group homes. We were sort of the court of last resort.
"A typical case might be that the mom was a meth addict, there was a destructive boyfriend beating her and the child, and she could not engage with her child, and so you might say the child was wired in those first two or three years of life toward disorganization -- and that is not an easy thing to fix."
The first thing Seneca provided was structure.
"From the time they got up in the morning until they went to bed, there was something planned and there was someone there with them.
"So let's say we had a child who would attack the first person they saw. We might have to hold that child and restrain them, but the goal was to get them engaged in some work right away and to get them to experience some success. When they began to get the sense they could be successful, things would begin to turn around."
At the same time, he said, the center was weaning the children off their medications. That was based on Dr. Stanton's belief that most psychotropic medicines work at first but have very little benefit over the long haul.
That puts him at odds with mainstream child psychiatrists, although the American Academy of Child & Adolescent Psychiatry acknowledges that there is a concern that children in foster care have been overprescribed such drugs.
Still, the academy said in its guidelines, "many children in state custody benefit from psychotropic medications as part of a comprehensive mental health treatment plan," and those children "should have access to effective psychosocial, psychotherapeutic and behavioral treatments -- and, when indicated, pharmacotherapy."
Dr. Stanton said his experience is that many child psychiatrists prescribe medications first and are reluctant to get involved in other kinds of therapy.
He thinks too often that stems from "a culture that says people's brains operate independently from their lives. Of course, if you take that to a logical point of absurdity, you get cases like the one child I saw who was growing up in a household where the father was an alcoholic and violent and the mother was determined that the child behave so as not to set off the father, and yet the people prescribing medication for this child were not looking at those facts at all."
The question of whether psychiatric drugs are being overused in children is one of the main themes at the Society for Humanistic Psychology meeting, including a panel at 4 p.m. today that includes Dr. Stanton.
Another key issue at the conference will be the proposed new bible of mental illness, known as the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, being developed by the American Psychiatric Association.
The humanistic psychology group has been one the proposed manual's sharpest critics, suggesting that several disorders it lists run the risk of labeling eccentric or quirky behavior by young people as a mental illness.
The conference is being held at Point Park largely because Brent Dean Robbins, head of the school's psychology program, is active in the society's leadership. He expects it to attract about 200 professionals from throughout the United States and Canada.
He said those attending the conference will have a diversity of opinions on the usefulness and safety of psychotropic medications for children, but overall, "there is certainly concern about the influence of pharmaceutical companies on the integrity of research and the need for adequate understanding of alternatives to medication."
Dr. Stanton said he believes there is a growing body of research showing that there is something much more powerful than drugs that shapes mental health -- relationships.
"Relationship is the most powerful ingredient in shaping the brain," he said, "but whether this paradigm is going to become ascendant, I don't know, because this medication therapy is deeply embedded."
First Published March 29, 2012 12:00 am