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Sunday, January 9, 2011

The role of medication with foster children

Research in the past has shown that mental health issues are a major concern with children in foster care. Given the circumstances that surround the entry into foster care for most children, that is not surprising. When children have experienced neglect, maltreatment, abuse or been exposed to domestic violence,they may well feel depressed, anxious or oppositional. Various forms of therapy have proven helpful including attachment therapy, play and expressive art therapies, cognitive behavioral therapy and mentoring to name a few. Of course, each case is different.

A program I recently attended on adolesecnt depression, showed that relaxation therapies where highly beneficial and much more so than medication. Interpersonal training, relaxation and social skills training were all found to be superior to medication. ( See for example slide 26 of that presentation.

A recent PBS program, Need to Know, has looked at the over use of medication with foster children. Of concern is something that I see clinically quite often not only with foster children but also with teenagers getting into drug abuse - a long list of diganosis all of which are getting medicated. The PBS program highlights this. You can watch it online at It is the first 20 minutes of the program.

The issue is further highlighted by research on the questionable use of atypical antipsychotics. Researchg at Stanford University and the University of Chicago shows this quite clearly.A summary of the research shows, "Many prescriptions for the top-selling class of drugs, known as atypical antipsychotic medications, lack strong evidence that the drugs will actually help, a study by researchers at the Stanford University School of Medicine and University of Chicago has found. Yet, drugs in this class may cause such serious effects as weight gain, diabetes and heart disease, and cost Americans billions of dollars."

Medication is a faster fix for foster children. I am actually not against medication because I have seen it make a real difference in the lives of some kids. The problem is that it has become the quick fix as opposed to it being considered as part of an overall treatment plan when it makes sense to include it there.

The issues are complex and giving meidcation will not solve them. They mask symptoms or alleviate them without addressing what lies below. Even when medication is used, research has shown that it is most effective when combined with other therapies. That requires more intense case work for child protection workers already facing high work loads.

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