Medication Use over Time for Youth in Foster Care: The Role of Sibling Living Situation

Background: Youth in foster care are prescribed psychotropic medications at rates 2-3 times higher than those of low-income, at risk-youth not in foster care (Zito et al., 2008).  Research has demonstrated that such medications may covary by youth age, gender, ethnicity, and mental health symptomatology (Raghavan et al., 2005). However, while siblings in foster care may share important developmental pathways and have related socioemotional experiences, research has not determined whether youth medication usage rates vary for siblings living together vs. apart. The current study sought to use innovative dyadic measures from an NIMH funded RCT focused on youth in foster care (Kothari et al., 2017), to examine how sibling living situation and child characteristics may predict ADHD medication use over time.

Methods: Quantitative data were drawn from the Supporting Siblings in Foster Care study, a longitudinal RCT of a sibling relational enhancement intervention (Kothari et al., 2017). Siblings ranged from 7-15 years old at study enrollment; about 60% of participants were youth of color. At baseline, caregivers completed the Child Behavior Checklist (CBCL) externalizing subscale, and also reported on child gender, race/ethnicity, age, placement with relative (or non-relative), and sibling co-placement status. Over 3 data collection waves (baseline, 6 months post baseline, and 12 months post baseline), caregivers also reported on whether the child was taking any medication for ADHD. This binary ADHD medication use variable was used as a dependent variable in a multilevel mixed-effects logistic regression model to examine whether sibling co-placement was associated with ADHD medication use over time, controlling for additional factors.

Results: At baseline, the CBCL externalizing subscale total score was 59.6.4 (range 33-95), and 72% of siblings were co-placed. Over time, the percentage of ADHD medication users ranged from 18% to 13% over the 12 month period. The multivariate regression model showed a significant sibling co-placement by time interaction, such that siblings who lived apart showed significantly higher odds of medication use at baseline, followed by a significant decline over time such that by 12 months post baseline, there was little difference in the odds of medication use for siblings placed together or placed apart. Higher CBCL externalizing scores and being male were associated with significant time-based increases in medication use.

Conclusions: Results suggest that placement with a sibling significantly predicts ADHD medication use, as well as declines in use over time. Possibly, youth who are separated from each other may display more severe behaviors (Waid, 2014), but also may receive more mental health services due to the severity of those behaviors (Danielson, 2015), contributing to a greater decline in use over time. Youth with ADHD have more negative experiences with siblings living with them, which may also impact trends of medication use over time (Mikami & Pfiffner, 2008; Steinhausen et al., 2012). These findings are useful for social workers considering placement strategies and treatment plans for youth in foster care with ADHD, as sibling relationships may be an important factor to consider.