Foster Child Medication Not Excessive, Study Finds

More than half of the Los Angeles County foster children who have psychiatric disorders often treatable with medication are not receiving the drugs, according to a UCLA survey suggesting that concerns about overmedication of such children may be misplaced.

While foster children between the ages of 6 and 12 still are far more likely than non-foster youngsters to receive psychiatric drugs, “we did not find evidence of excessive use of medication,” said Dr. Bonnie Zima, the UCLA child psychiatrist who headed the study. Rather, “our findings suggest that more foster children merit a medication evaluation.”

The research, conducted between 1996 and 1998 and reported in today’s issue of the American Journal of Public Health, appears to contradict critics’ contentions that such children are overmedicated. It is believed to be the first to describe the medication patterns of children in foster care.

The inquiry involved a survey of 302 foster parents and children from communities where youngsters are most likely to need foster care: East Los Angeles, North Long Beach and the Antelope Valley. Researchers followed up with clinical evaluations of 266 of the children, all of whom had lived in foster care for at least six months.

Thirteen percent of the children had taken at least one psychiatric medication in the past year--more than twice the percentage among non-foster children in the communities. Zima said that finding was not surprising, given the level of neglect and abuse the foster children generally had suffered.

Supporting the notion that children were not improperly medicated, she said, were findings that the majority took only one drug and that the most commonly prescribed medications were stimulants such as Ritalin, which are proven to work well with attention disorders.

More surprising was that 52% of foster children diagnosed with severe psychiatric disorders for which medication often is prescribed were not taking anything. Those conditions included attention deficit hyperactivity disorder, major depression, bipolar disorder and psychotic disorders.

“This suggests that medication is not being considered as an option perhaps to the degree it should be,” said Dr. Bill Arroyo, medical director for the county Department of Mental Health’s children’s division, which co-sponsored the study with the state Department of Mental Health and the National Institute of Mental Health.

Others said the findings underscore the fact that foster children are not simply victims in need of rescue from abusive environments, they increasingly suffer from underlying psychiatric illnesses that require medical treatment.

“Psychiatrists need to be much more involved” in the lives of youngsters in foster care, said Dr. Ken Steinhoff, director of child and adolescent psychiatry at UC Irvine. He said he was referring not just to performing medication assessments but also to developing overall strategies for the youngsters’ care.

Zima said county mental health officials requested the UCLA study in hopes of improving services. The inquiry, she said, “was inspired” by a Times investigation in May 1998. It found that thousands of children in California’s group and foster homes are routinely given potent psychiatric drugs, just to keep them docile for overburdened caretakers.

The findings helped prompt legislation this year to protect the state’s 100,000 foster children from improper and unmonitored doses of psychiatric drugs.

In her study, Zima said, she did not focus on older children or on group homes, where use of medication and access to psychiatrists may be more common.

Zima and Arroyo said they decided to focus on younger children because of the county’s interest in preventing severe psychiatric illness and because less is known, in general, about the younger age group.

Those who fear overuse of psychiatric drugs cautioned against concluding from the study that more medication is warranted in this young, vulnerable population.

“You cannot draw that conclusion from this study,” said Dr. Loren Mosher, a psychiatrist on the clinical faculty at UC San Diego who believes many psychiatric medications carry dangerous side-effects. “What it reveals mostly is the researchers’ bias. They’re trying to make all the childhood problems into drug-remediable disorders . . . to solve life’s problems with a pill.”

Overmedication remains a serious problem, in general, among foster children, said Janet Knipe, statewide coordinator of California Youth Connection, an advocacy group for current and former foster children.

“They’ve experienced it,” said Knipe, who had not had a chance to read the UCLA study. “They’ve watched it happen.”