Psychotropic medication use in school-aged children in foster care and residential care within child protective services.

BACKGROUND

Children in the care of child protective services are treated with psychotropic medication at rates that far exceed those seen in the general population.

OBJECTIVE

This study documents the rates of psychotropic medication use among school-aged children in two groups: 1) foster care; and 2) residential care. Socio-demographic variables and mental disorders that predict psychotropic medication use, polypharmacy (≥2 medication), and multiclass polypharmacy (≥3 medication classes) were also examined.

PARTICIPANTS AND

SETTING

The sample consisted of children aged 5 to 12 years in foster care (n = 125) and residential care (n = 106) in the province of Quebec (Canada).

METHODS

Caregivers reported the children's medication use and completed questionnaires on the children's symptoms and diagnoses.

RESULTS

Children in foster care and residential care showed few differences, with the exception of two specific medications (antipsychotic and clonidine). Fifty-nine percent of all children in the sample were prescribed psychotropic medication. The majority (93%) of these children received at least one ADHD medication. Polypharmacy was common, with 21% of all children being prescribed more than one medication. Multiclass polypharmacy was rare. Unique predictors of psychotropic medication usage included male sex, cumulative adversity and a diagnosis of ADHD. Polypharmacy was predicted by diagnoses of ADHD, Tourette's Syndrome and of an eating disorder. The rarity of multiclass polypharmacy (n = 5/231) limited inferential analyses.

CONCLUSIONS

Further research is needed to better understand the high rates of ADHD diagnosis and ADHD-medication among children in the care of child protective services, particularly given that ADHD medications account for most prescriptions.