Psychotropic Medication and Children in Foster Care - American Bar ...

Frankie, age 8Frankie is a sensitive, bright, articulate eight year old who has been in therapy sinceentering foster care at age six after the death of his grandmother, who was raising him.Frankie experienced emotional dysregulation meaning he could not control his outbursts attimes. He would call names, disrupt the class, and clash with his peers, leaving him with fewfriends. He was unable to learn positive social skills and demonstrate them with his peers.Frankie began to display highly sexualized behavior and talked about sexual thingsregularly. He became obsessed with thoughts about sex and one time he wrote the word “sex”about 50 times on a school paper during a test. He later said he did this to get it out of his head,but it did not work. Frankie also began displaying compulsive behaviors like checking the doorsof the house at night and watching out his window in a hypervigilant state. At times, Frankieappeared frenzied, with a wild look in his eyes; he spoke rapidly and would be very tangentialwithin his conversations.Frankie was discovered to have sleep apnea, but even with treatment his symptoms didnot abate. Medications were discussed, including putting him on an antipsychotic, which raisedconcerns. Instead, Frankie was started on a low dose of sertraline (Zoloft—an FDA approvedmedication in the treatment of childhood obsessive compulsive disorder). Within two weeks,Frankie was more emotionally regulated and this also seemed to allow him the organizationalabilities to disclose sexual abuse by his older foster sibling’s sister who visited occasionally.Frankie was able to successfully manage the investigation, engaged even more thoughtfullyin therapy, relaxed with his peers, and got back on track in school. He was stabilized on50 mg. of sertraline and no longer shows any of his frenzied behavior, obsessive-compulsivesymptoms, or preoccupation with sex.20 Psychotropic Medication and Children in Foster Care