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.