title: Stimulant and atypical antipsychotic medications for children placed in foster homes.
abstract: OBJECTIVE
  The purpose of this study is to examine the use of prescribed psychoactive medications in a prospective cohort of children shortly after they entered foster homes; and to identify demographics, maltreatment history, psychiatric diagnoses including ADHD comorbidity, and level of aggression that contribute to prescribed use of stimulant and atypical antipsychotic medication over time.
  
  
  METHODS
  The sample included N = 252 children (nested in 95 sibling groups) followed for three years up to 4 yearly waves.
  
  
  RESULTS
  Nearly all (89%) met criteria for at least one of eight psychiatric diagnoses and 31% (75/252) used one or more prescribed psychoactive medications. Over half (55%) were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD); of these 38% used stimulants and 36% used atypical antipsychotics. Of the 75 medicated children, 19% received ≥3 different classes of drugs over the course of the study. Stimulants (69%) and atypical antipsychotics (65%) were the most frequently used drugs among medicated children. Adjusted odds ratios (AOR) showed that male gender (AOR = 3.2; 95% CI = 1.5-9.3), African American vs Latino ethnicity (AOR = 5.4; 95% CI = 2.1-14.2), ADHD regardless of Oppositional Defiant (ODD) or Conduct (CD) comorbidity (AOR = 6.0, 95% CI = 1.3-27.5), ODD or CD (AOR = 11.1, 95% CI = 2.1-58.6), and Separation Anxiety (AOR = 2.0, 95% CI = 1.0-4.0) psychiatric disorders were associated with the use of prescribed stimulants; while male gender (AOR = 3.8, 95% CI = 1.5-9.3), African American vs Latino (AOR = 5.1, 95% CI = 1.2-9.2) or Mixed/Other ethnicity (AOR = 3.3, 95% CI = 1.9-13.7), ADHD regardless of ODD or CD comorbidity (AOR = 5.8, 95% CI = 1.2-28.7), ODD or CD (AOR = 13.9, 95% CI = 3.3-58.5), Major Depression/Dysthymia (AOR = 2.8, 95% CI = 1.1-6.7) psychiatric disorders, and history of sexual abuse (AOR = 4.6, 95% CI = 1.3-18.4) were associated with the use of prescribed atypical antipsychotics.
  
  
  CONCLUSIONS
  The aggressive use of atypical antipsychotics, which has unknown metabolic risks, suggests that the efficacy and safety of such treatment strategies for psychiatrically ill children in foster care should be monitored.
authors: Mount Sinai School of Medicine, Adolescent Health Center, New York, New York, United States of America. oriana.linares@mountsinai.org
authors: L Oriana
authors: LO
authors: Linares
authors: Nuria
authors: N
authors: Martinez-Martin
authors: F Xavier
authors: FX
authors: Castellanos
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000523:psychology; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001010:Anxiety, Separation / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005581:Foster Home Care; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D008297:Male; D011446:Prospective Studies
chemical_list: D014150:Antipsychotic Agents; D000697:Central Nervous System Stimulants