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

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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
Side Effects of Psychotropic MedicationSide effects of psychotropic medication vary widely. Physical symptoms can includestomach upset, vomiting, acid reflux, and diarrhea. Agitation, nervousness,and irritability can be common. Sleep disturbances can include insomnia, bedwetting,middle-of-the-night awakening, and nightmares. Some medications canactually cause paranoia, hallucinations, or intrusive thoughts. SSRIs can cause “activation”or an increase in agitation in preschool children. 35 Appetite disturbancesare common, including appetite loss in stimulant medications and increased appetitein antipsychotics. Weight gain is one of the most disturbing side effects ofantipsychotics, such as Seroquel. 36When a Child Should Be Placedon Psychotropic MedicationMedication can be important to successfully treat a child or teen dealing with amental illness. Medication can be helpful when a child is disturbed or overwhelmedby his or her own behavior and has not been able to learn to manage thesymptoms through other means. A medication trial might help control the interferingsymptoms and increase self-esteem and functional ability.A medicationtrial mighthelp controlthe interferingsymptomsand increaseself-esteem andfunctional ability.Children who are self-abusive, impulsive, or aggressive to others may need medicationto help them manage their impulses and aggression. Children and teenswho hear voices or have visual hallucinations may require medication to alleviatethese symptoms. Medications can also support physiologic regulation that oftengets out of sync with mood disorders and trauma; in other words, medication canhelp stabilize sleep patterns, appetite, and concentration.Medication use can be helpful and is often instrumental in treating mental healthissues in children and teens. The concerns lie in what medications are being used,if they are being well monitored, and if they are the right ones for the child basedon symptoms, age, functional ability, and improvement.21
Page 3 and 4: &PracticePolicy BriefPsychotropicMe
Page 5 and 6: Children who enter foster care face
Page 7 and 8: Table 1:Common School-age Child and
Page 9 and 10: A Multimodal Approach to ManagingMe
Page 11 and 12: Table 2:Psychotropic MedicationsTyp
Page 13 and 14: Typical Side Effects Symptoms/Medic
Page 15 and 16: Drawbacks of Psychotropic Medicatio
Page 17 and 18: Josh, age 5Josh was on multiple med
Page 19 and 20: Off-Label UseMany medications used
Page 21: While the age of consent for childr
Page 25 and 26: 6. Prescribers should be cautious w
Page 27: Medication and thePregnant TeenPreg
Page 30 and 31: • Who will monitor the ongoing us
Page 32 and 33: ConclusionMedications improve lives
Page 34: 32 Psychotropic Medication and Chil

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