The Wrong Prescription: Psychotropic Medications and Foster Youth

“I’m not bipolar. I’m just naughty.”

The Wrong Prescription: Psychotropic Medications and Foster Youth

In the past few days, we have all had the honor of getting to know a remarkable young man from Texas named Ke’onte Cook. He has appeared on ABC’s 20/20, testified before Congress, and for many of us, his face is the face we now see when we think about the impact of overuse of psychotropic medications on foster youth.

It’s remarkable to see Ke’onte now—a happy, bright, well-spoken young man—and imagine that he would need anything other than a loving family in order to thrive. Yet he received no less than 12 different medications while in foster care—up to 5 medications at the same time. He received medications used to treat seizures, which he never had. He received medication used to treat bipolar disorder, a condition for which he has never been diagnosed. I am not a doctor, but it is difficult for me to imagine any valid medical reason for those many drugs being prescribed to someone so young.

The new report on psychotropic medication use among foster youth, which was released by the Government Accountability Office this week, is shocking. There is no other word for it. Shocking to imagine that a young person in foster care is 4.5 times more likely to be medicated as youth not in foster care. Shocking to think that in some states, nearly 40% of all foster children are receiving psychotropic medications. Shocking to imagine that these vulnerable youth are being given multiple medications, and often in doses higher than recommended for either children or adults!

Yet, as shocking as these statistics are, it is not news that foster youth are medicated more often than those not in care. In 2010, the Tufts Clinical and Translational Institute (CTSI) reported an increase of psychotropic medications among youth in foster care, including more medications prescribed for young children; increased frequency of use of more than one medication at a time; and increased “blanket authorizations” of prescriptions in residential facilities.

During one of our conversations for the ABC program 20/20, Diane Sawyer asked me why foster children were medicated so frequently. Wasn’t it a fact that foster youth were more troubled than the general population? I answered truthfully—of course they are more troubled. Think about any child in their circumstances: imagine being the victim of abuse or neglect, then removed from the only home you ever knew, and then shifted from one foster home to another to another. Of course these children are troubled.

But we can address the real stresses in their lives without resorting to altering their brain chemistry.  Look at Ke’onte today. Thanks to the dedication of a CASA volunteer, Ke’onte is now living with a loving adoptive family. And thanks to that family and the help of an attachment therapist, he is no longer taking any of these psychotropic medications. He didn’t need them then, and he doesn’t need them now.

The Wrong Prescription: Psychotropic Medications and Foster Youth

Ke'onte with his adoptive parents, Scott and Carol Cook

Of course, I do not believe that psychotropic medications are never warranted. There are youth in foster care facing serious mental health challenges for whom medication can be a great benefit. But these prescriptions must be driven by true need, careful and thoughtful diagnosis and conscientious ongoing monitoring. If, instead, they are driven by money, expediency or simple frustration with an inadequate system of care, then their use is inconsistent with a child’s right to receive proper medical care and to live without the numbing or dangerous side effects of psychotropic drugs.

Is this a turning point? It’s too soon to know. But it’s gratifying to see the national debate beginning. For too long, these children—victims already of abuse and neglect—were victimized again by a system that failed to treat their mental health with the respect it deserves. It’s time for this tragedy to end. It’s time that we stop treating our foster youth like second-class citizens. They deserve better.


To learn more about this issue, listen to the National CASA podcast from January 2011, “The Diagnosis and the Drug: Use of Psychotropic Medication in the Foster Care System.” In this podcast, Stephen McCrea, CASA Supervisor with CASA for Children in Portland, OR, talks about the history of mental health treatment of foster youth including the introduction of psychotropic medications, their use now and what a CASA/GAL volunteer should know when working with medicated youth. Before working with the CASA program, McCrea was a crisis counselor and a residential counselor for youth.

The Diagnosis and the Drug: Use of Psychotropic Medication in the Foster Care System

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5 Responses to The Wrong Prescription: Psychotropic Medications and Foster Youth

  1. SHAWN WEST says:

    I feel that the government should crack down on this type of behavior in the medical sector. When a parent comes in and says that something is wrong with their child, and immediately a drug is used to stop the behavior, I feel that once the child is on medication you will never ever get to know what the real child was or who he or she is. The child’s real personality has or will never be known because of the drugs. Now I certainly agree that their are some children who truly need medication, but all avenues should be exhausted. I feel that some people want the extra dollars from the state so if they can determine that the child has some special issues then they can receive a larger check or get them on some type of state program to pay for their new cars or diamonds.

  2. John Wilson says:

    As a guardian ad litem serving in Vermont for many years, I have read many psychiatric evaluations on children in the system which recommend psychotropic meds as part of the treatment. What I do not see, and what the December 1 senate hearings did not discuss while reviewing the abuse of psychotropic meds, is the treating psychiatrist’s investigation of the child’s diet and nutritional needs as a component of the interview and subsequent recommendation. This is basic stuff. We know that poor diet can exacerbate mental health problems and correcting nutritional deficiencies should be the starting point in addressing the problem. Instead, it is usually ignored and prescription drugs are relied on to ‘correct’ problems that could be addressed with diet, nutritional supplements and therapy. I think National CASA could serve our children well by advocating for a standard protocol which requires prescribing psychiatrists to document that he/she has interviewed and made judgement and recommendations about diet and nutrition of the child prior to prescribing any psychotropic drugs. To implement such a protocol would probably require updating psychiatrists via continuing education about the influence of diet and nutrition in mental health because it is not currently emphasized by the profession and it’s primary post-degree educator, the pharmaceutical industry. There are, however, psychiatrists who understand these issues and could be consulted to help with the protocol and appropriate continuing education content. I doubt if Ke’onte would have been so over-medicated had such a protocol been in place.

  3. susan salim says:

    I now have two children in my home from which were in foster care and are still state involved and one child age 12 is on medication that i see no reason for . she only need help with feeelings and self control . she started taking these drugs i was told for nightmares and anger , fear issues when she thought the man that molested her was getting out of prison, and he is a family member.
    what can i do to help her get off these drugs ? she is a smart strait A student and very loving.

  4. Milehighdad says:

    In our experience, this has been a tragic truth of foster care. It is also common for ADHD medication to be prescribed when other biological or environmental factors can account for the lack of ability to concentrate. I certainly think I would have trouble thinking about school if I was worried about where I was going to be living tomorrow. And, once a child is mistakenly put on stimulants, if it is not truly ADHD, it will create or worsen the attention deficit. Then, with a combination of factors causing stressed-out, hyperactive child, more extreme medications will be started to try to regain control. It is a devastating and difficult-to-reverse slide to disaster for the child.

    • Laree Kreitlow says:

      AMEN! I know the article is focused on kids in foster care facing this problem, but I have 1 of the ‘other’ kids. A kid who might have fared better & been less medicated if in foster care, than in his own ‘home’ where he always felt like he was “the enemy”. He is our nephew who now lives with us, though we are still struggling to get proper paperwork to keep & take care of him. He has been on more meds than he can remember & most of them we have no real idea what they were for (beyond placating his mom). We do know there was an amphetamine, which then led to violence so then another med, which then led to sleep problems, so then another med… We can’t get access to his medical records because of lack of real paperwork. He has been off of all meds since mid Sept when he arrived here, but how much of what we see with him is still lingering effects & how would we know since we don’t know what all he was on????? I can definitely empathize with anyone trying to help these kids through this situation!

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