title: Foster care, externalizing disorders, and antipsychotic use among Medicaid-enrolled youths.
abstract: OBJECTIVE
  The authors investigated the extent to which clinical diagnoses of externalizing disorders explain higher rates of antipsychotic use by foster care youths.
  
  
  METHODS
  Medicaid claims data from 44 states for 2009 for youths in foster care (N=301,894) and those not in foster care (N=5,092,574) were analyzed, excluding those with schizophrenia, bipolar disorder, autism, and major depressive disorder. Logistic regressions assessed the relationship between foster care, externalizing disorders, and antipsychotic use.
  
  
  RESULTS
  Foster care youths had higher rates of externalizing disorders than the comparison group (attention-deficit hyperactivity disorder, 17.3% versus 6.5%; disruptive behavior disorder, 7.2% versus 2.5%; conduct disorder, 2.3% versus .5%) and greater antipsychotic use (7.4% versus 1.4%). Foster care remained a significant predictor of antipsychotic use after control for demographic and diagnostic covariates, including externalizing disorders (adjusted odds ratio=2.59, 95% confidence interval=2.54-2.63).
  
  
  CONCLUSIONS
  High rates of externalizing disorder diagnoses only partially explained elevated levels of antipsychotic use in this vulnerable population.
authors.forename: Lauren
authors.initials: L
authors.lastname: Vanderwerker
authors.forename: Ayse
authors.initials: A
authors.lastname: Akincigil
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
authors.forename: Tobias
authors.initials: T
authors.lastname: Gerhard
authors.forename: Sheree
authors.initials: S
authors.lastname: Neese-Todd
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D019955:Conduct Disorder / Q000188:drug therapy / Q000523:psychology; D005260:Female; D005581:Foster Home Care / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008484:Medicaid; D014481:United States
chemical_list: D014150:Antipsychotic Agents