Statement of Dr. Jon McClellan Professor University of Washington Seattle, Wa Senate hearing: December 1, 2011 “The Financial and Societal Costs of Medicating America’s Foster Children”

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The high risk practices identified by the GAO study raise significant concerns regarding the treatment of severely mentally ill and vulnerable youth. Although the focus of this study is on foster care, the concerns raised are relevant to all children and adolescents prescribed psychotropic drugs.

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  McClellan Testimony: Psychotropic Drugs in Children1 Statement of Dr. Jon McClellanProfessor University of WashingtonSeattle, WaSenate hearing: December 1, 2011“The Financial and Societal Costs of Medicating America’s Foster Children”  McClellan Testimony: Psychotropic Drugs in Children2 Mr. Chairman and Members of the Subcommittee; thank you for inviting me to participate in this important discussion regarding the use of psychotropicmedications in foster children.I am a Child Psychiatrist at Seattle Children’s Hospital, a Professor at theUniversity of Washington, and the Medical Director of Child Study and TreatmentCenter, the State psychiatric hospital for youth in Washington State.The high risk practices identified by the GAO study raise significant concernsregarding the treatment of severely mentally ill and vulnerable youth. Althoughthe focus of this study is on foster care, the concerns raised are relevant to allchildren and adolescents prescribed psychotropic drugs.Children in foster care often have emotional and behavioral difficulties. The highrate of medication use in this population is not a new discovery, nor does the use of these drugs always imply bad practice. Several psychiatric medications have beenstudied and approved for use in children and adolescents. When prescribedcorrectly, these treatments can help reduce suffering and enhance the functioningof young people.  McClellan Testimony: Psychotropic Drugs in Children3 However, it is also well documented that many children in the child welfare systemdo not receive high quality psychiatric services. Treatment too often occurs duringtimes of crisis, without adequate support or access to skilled clinicians and programs capable of providing effective social and behavioral interventions.In these situations, medications become stopgaps, used to prevent the child fromhurting themselves or others, or to help control disruptive behaviors that threatenthe child’s foster placement. The lack of effective long-term treatment exacerbatesthe risk for excessive and inappropriate medication use.This problem is evident in the patterns of high-risk prescriptions identified by theGAO study. As a group, children in foster care were more likely than other children to be treated with multiple psychiatric drugs, and also were more likely to be treated with dosages that exceed recommended standards of care.These practices impacted thousands of children. Some young people were prescribed as many as 10 different psychotropic drugs at the same time. Somechildren younger than 5 years of age were prescribed as many as 5 differentmedicines concurrently.  McClellan Testimony: Psychotropic Drugs in Children4 Unfortunately, such practices are not uncommon. At my State hospital, kids areoften admitted taking four or more medications. A few years ago, one young boyadmitted to Seattle Children’s Hospital was taking 13 different psychotropic drugs.There is no research that justifies these practices.The most troubling finding of the GAO study is the use of psychotropic drugs ininfants. Most of the prescriptions in babies were for antihistamines, some of whichmay have been used to treat other types of medical problems. Regardless, there islittle research supporting the use of these medicines in very young children, andthe prescriptions are concerning.Furthermore, dozens of babies were prescribed antipsychotics, antidepressants,clonidine or lithium. Some infants were prescribed more than one drug. The useof psychotropic medications in babies defies both standard of care and commonsense.The findings of the GAO study strongly suggest the need for better oversight. TheBest Principals outlined by the American Academy of Child and AdolescentPsychiatry provide a useful set of monitoring guidelines.
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