Everyone—well, almost everyone—knows the mantra “what gets measured gets done.” We see it again and again for good reason: it’s true. If you want to see fewer foster children medicated, if you would like to reduce dosages for children, if you are hoping to bring about improved medication practices, you will need to know the effects of current practices and the effects of reform efforts. Examples and anecdotes have their place, but you will need numbers as well.
We cannot measure everything. Our lives are too short, our budgets too small, for wholesale and haphazard data collecting. What’s needed is identification of the likely problems followed by data collection laser-focused on those problems.
Here are our nominations for the practices that childhood psychopharmacology data must measure:
- Administration of two, three, or more medications at the same time increases risks without demonstrated benefits.
- High dosages. Adult-level doses in child-sized bodies produce high concentrations of medication in the child’s blood and brain.
- Too soon. Being taken from one’s family, even an inadequate or abusive family, and being placed in care with strangers is traumatic. Until the child has had some time to adjust to the loss of family, symptoms of anger, grief, depression, anxiety, and post-traumatic stress are to be expected. The initial weeks after removal are not the time to make a valid diagnosis of continuing mental illness. This principle also applies to the all-too-frequent changes of foster placements.
- Too young. To the extent that psychotropic medications have been researched in juvenile populations, the research is almost entirely confined to older children and adolescents. Safety and efficacy data for younger children do not exist for most drugs.
- Too long. Children change, mature, and adapt, as parents well know. Foster children do not have anyone to say “he seems better now, so let’s consider tapering off the medication.” Many psychotropic medications carry cumulative risks—the longer the exposure, the greater the risk of morbid weight gain, diabetes, tardive dyskinesia, excessive sedation, heart attacks, and other serious adverse effects.
- Many psychotropic medications have never been tested for safety or for efficacy in children or, if they have been tested, the manufacturers have chosen not to release the results.
- Off-label use. Most pediatric uses of psychotropic drugs are “off label.” Drugs that the FDA has approved only for such relatively uncommon conditions as childhood schizophrenia, psychosis, or autism are prescribed for such childhood problems as disobedience, inattentiveness, poor study habits, insolence, and reluctance to go to bed at the time designated by the caretaker.
- Medication-only treatment. The professional literature in both child welfare and psychiatry is nearly unanimous in recommending psychosocial interventions before and in conjunction with medication, but in practice foster children and foster parents seldom have access to psychosocial assistance.
We think better medication practices will begin when our government agencies collect, analyze, and make public the data related to these eight problem areas.
What do you think? What have we left out? Let us know.