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Mental Health Drugs for Kids Alarm Officials

Posted on: Saturday, 26 February 2005, 03:00 CST

Shirley Allen's son was first prescribed mental health drugs when he was 3 years old, to help him behave in preschool.

By the time the West Palm Beach boy came into state care at age 9, a psychiatrist had him taking at least five drugs at the same time, including an antidepressant, an antipsychotic, a drug to prevent hyperactivity and a drug to prevent seizures.

There might have been more, Allen and the boy's father told caseworkers, but they couldn't remember them all.

The drugs calmed him down, Allen said, but she worried about their effects.

Sometimes, Allen said, when he was on the medications "he'd just be staring, like into outer space."

As a national debate is under way about the safety of giving children drugs originally developed to treat serious mental illness in adults, some state leaders are calling for better oversight and regulation.

The state's Medicaid cost for psychotropic drugs - those that affect the mind - has nearly tripled from $238 million five years ago to an estimated $680 million this fiscal year.

Child advocates and state leaders said they were alarmed by a recent survey showing that one in four of the state's foster children are taking at least one mind-affecting drug. One in 10 are prescribed three or more drugs at the same time.

Nearly 2,100 children in state custody take powerful antipsychotic drugs, first developed to treat serious adult mental illness but now used by some doctors to curb severe aggression in emotionally disturbed kids.

A medical consultant hired by the state questioned the appropriateness of prescriptions to 1,273 children in state care. Many of those children were given unusually high doses or were prescribed two or more of the same type of drug at once.

Child advocates worry about the effects of psychotropic drugs, which come with a host of warnings and side effects and which for the most part have not been tested on children.

Under a law passed last year, the state Agency for Health Care Administration is combing through prescription records, looking for unusual doses or combinations of drugs. The agency has sent letters to about 1,600 doctors notifying them of the state's prescription guidelines, and officials plan to follow up with any doctors whose prescriptions seem inappropriate.

Andrea Moore, executive director of foster child advocacy group Florida's Children First, hopes the agency will look closely at drugs given children living in teen offender programs, mental health wards, foster homes and centers for teenagers.

Moore worries that doctors who work for residential programs may be too quick to give kids drugs that will help staff control their behavior. At programs for abused kids who are out of control, drugs that subdue outbursts are considered an easier fix than long-term therapy and the stability they need.

Maxine Williams, an attorney who represents about 30 Palm Beach County teens in state custody, said about a third are on some type of psychotropic medication. Many have suffered abuse and neglect and are growing up in foster homes and residential treatment programs.

Williams worries about the lack of good information about how the drugs can affect a growing brain and body. She wonders whether the children will continue to rely on the prescriptions when they leave care at age 18.

"We're not teaching them how to cope without it," Williams said.

Shirley Allen said she was sometimes worried about the effects the drugs were having on her son, whom The Palm Beach Post is not naming because of his age.

Doctors stopped prescribing him Depakote at age 5 because it caused him to hallucinate, according to his file. Allen said other drugs left him listless and blank.

"He'd be looking like a zombie when he took the medications," she said.

Doctors have scaled him back from five medications to three, and Allen said she hopes that will succeed. Now 12, her son is living in a residential program for troubled youth.

Though Allen and the boy's father are heavily involved in their son's treatment, many kids in state custody are not so lucky.

In many cases, Florida's Children First's Moore said, kids are removed from their homes by caseworkers who get little or no medical information from parents.

Doctors who prescribe powerful drugs sometimes have no access to records of family histories or the child's allergies, Moore said. A parent or a judge must approve the prescriptions, but judges don't often feel they have the expertise to overrule a psychiatrist.

State Sen. Walter "Skip" Campbell, D-Tamarac, proposed a law this session that would require caseworkers to give judges a standard form listing the benefits and risks of each drug.

Judges would be able to seek second opinions if anyone disagrees with the prescription.

Moore hopes the bill will be strengthened to ensure doctors also have the most complete medical files possible on children before they make a decision. She hopes the state will be as vigilant in overseeing the psychiatrists as it promises.

"The main issue for me is the safety of the children," Moore said.

kathleen_chapman@pbpost.com

Source: Palm Beach Post

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