Antipsychotic Prescribing Patterns within a Residential Treatment Facility

Background: Children and adolescents in child welfare settings are more likely to be exposed to questionable mental health treatment practices. For instance, children in foster care and residential treatment settings (when compared with their peers in the community) are often more likely to be prescribed antipsychotic medications, multiple medications (i.e. polypharmacy), and multiple antipsychotic medications; despite a lack of evidence supporting these practices. These practices have serious implications, because they expose children to a variety of adverse effects, including but not limited to: metabolic syndromes (e.g. diabetes, weight gain), movement disorders (e.g. tardive dyskinesia), restlessness/agitation (e.g. akathisia), sedation, cognitive impairment, among others. In addition to standardizing care within child welfare settings, more information is needed about sociodemographic factors (e.g. race/ethnicity, gender, diagnoses) that might put children at greater risk of experiencing these practices.  

Methods: The charts of children (n=432) in a residential treatment setting were collected and reviewed. Information related to sociodemographics, mental health treatment at discharge (i.e. medication/dosage), and history of trauma/abuse was collected. Descriptive and inferential analyses (binary logistic regression) were performed to determine whether factors previously identified within the literature (race/ethnicity, gender, dx of ADHD/Conduct Disorder) increased a child’s likelihood of being prescribed multiple medications (polypharmacy), antipsychotic medication, and multiple antipsychotic medications.  

Results: Of the sample (n=432), 49% of children (n=213) received some form of psychiatric medication. 80% of medicated children received polypharmacy (n=171; 40% of the total sample). 70% of medicated children received an antipsychotic (n=150; 35% of the total sample). 2% of medicated children received multiple antipsychotic medications (n=4; 1% of the total sample). A binary logistic regression was performed to determine how a child's race/ethnicity, gender, and diagnosis (ADHD or Conduct Disorder [CD]) affected their odds of experiencing one of the questionable treatment practices described above. The first analysis showed that male gender (p=.02) and a diagnosis of ADHD (p=.01) were predictive of polypharmacy. With male gender, the odds of polypharmacy change by a factor of .607 [.393, .937], compared with female gender. With a diagnosis of ADHD, the odds of polypharmacy change by a factor of .434 [.274, .687] compared with no diagnosis of ADHD. The second analysis found no statistically significant relation between gender, race, and ADHD/CD and the odds of antipsychotic prescription. Antipsychotic polypharmacy was not prevalent enough to permit analysis.  

Conclusions: This study contributes to our current understanding of medication practices within child welfare settings. The study confirms the results of previous research, indicating widespread prevalence of polypharmacy and antipsychotic prescription in youth residential treatment settings. Interestingly, the study contradicts previous research that identifies race/ethnicity, gender, and a diagnosis of ADHD/CD as strong predictors of increased risk of questionable medication practices. The results of this study support previous calls for re-evaluation of current mental health practices in child welfare settings; and suggest further research be performed to better identify what factors best explain children's risk of questionable treatment practices.