Ontario Foster Care System Overmedicates, Underdiagnoses Kids

July 9, 2015 by Robert Franklin, Esq, Member, National Board of Directors, National Parents Organization

Before you read this article and the following blog post, you might want to go back to Sunday’s post about Molly McGrath Tierney’s excellent TEDx talk in Baltimore last year (Toronto Star, 12/12/14). Her talk is just 11 minutes long, but she pretty much demolishes the system of foster care that we foist on so many children. Tierney’s a veteran of the child welfare system and a successful manager in Baltimore. But she’s clear that the system harms kids and is driven by money. The federal government pays states for each kid taken into care where they are all too often less well off than they were with their parents. Studies show that to be the case and when we ask children their preferences, they say they want to go home to their parents.

The Star article is about the shocking overuse of psychotropic medication on children in foster care in Ontario. Mental health experts agree that kids are overmedicated, but that’s just the start of the problem.

Almost half of children and youth in foster and group home care aged 5 to 17 — 48.6 per cent — are on drugs, such as Ritalin, tranquilizers and anticonvulsants, according to a yearly survey conducted for the provincial government and the Ontario Association of Children’s Aid Societies (OACAS). At ages 16 and 17, fully 57 per cent are on these medications.

In group homes, the figure is even higher — an average of 64 per cent of children and youth are taking behaviour-altering drugs. For 10- to 15-year-olds, the number is a staggering 74 per cent.

The figures are found in “Looking After Children in Ontario,” a provincially mandated survey known as OnLAC. It collects data on the 7,000 children who have spent at least one year in care. After requests by the Star, the 2014 numbers were made public for the first time.

Top CAS officials describe the high number on “psychotropic or behaviour-altering medication” as a crisis.

“The medication problem is huge,” says Raymond Lemay, who retired this summer after 32 years as executive director of the Prescott-Russell children’s aid society. “It’s catastrophic.

“We should be doing other things than medicating these kids,” he says, adding his agency discourages the use of psychotropic drugs. “Medication is inappropriate in many circumstances and will do these kids long-term damage.”

Those percentages for kids in foster care dwarf those for kids in the general population.

For youths in care, the rate of psychotropic drug use is significantly higher than the general population. A 2005 study in the Canadian Journal of Psychiatry estimated that only 2.5 per cent of Canadians aged 15 to 19 were on psychotropic medication.

Of course it can be argued that kids in foster care are those with abusive family backgrounds, and are therefore more in need of medication. That’s probably true, but foster kids rarely receive proper mental health evaluations to determine whether they need medication. That means that kids who don’t need medication often get it anyway and those who do may be getting the wrong drugs or the wrong dosages.

Ontario’s highly decentralized child-protection model — 46 private agencies funded largely by tax dollars — seems to make matters worse.

Only half of children’s aid societies have a prescribed way of assessing the mental health needs of children, and barely 15 per cent of these use methods recommended by the provincial government, according to a 2009 survey sponsored by OACAS, the lobby group representing the agencies.

The lack of standardization “likely means that many children in need are not identified and referred for treatment,” concludes the survey report, co-authored by Elisa Romano, professor of psychology at the University of Ottawa.

The sheer number of kids in foster care and group homes, the lack of diagnostic resources and the need to maintain control of a population that’s experienced the worst of parental care inevitably leads to medicating children as a means of control. Unsurprisingly, the great majority of the medications given are for ADHD.

At the Brant CAS, drugs make up 52 per cent of expenditures on health insurance claims. The top five drugs prescribed and paid for by insurance are all used to treat attention deficit hyperactivity disorder (ADHD), including Concerta, Strattera and Adderall.

Again, many kids are getting that medication whether they’ve been properly diagnosed or not.

A soon-to-be-published report by Klein, Taraba and other child-welfare experts also warns of children who have symptoms of attention deficit disorder being misdiagnosed and given “unhelpful medications” for long periods. “The big question is, what are we treating?” [Dr. Ben Klein, medical director at the Lansdowne Children’s Centre in Brantford] says.

Perhaps worse, the overmedication of the kids obscures real mental health issues many of them have. The drugs damp down and alter behaviors that could tip off a mental health professional as to the proper diagnosis for a child.

Drugs can ease disruptive behaviour. But doctors and CAS officials are concerned that mental-health issues caused by trauma aren’t being addressed..,.,

Medication might make them less likely to act out, Klein adds, but it doesn’t deal with the root cause of a child’s trauma. That requires “trauma-focused cognitive behaviour therapy,” which he says is almost impossible to access in Ontario.

This is all going on despite a relative lack of information on the long-term side-effects of many of the drugs being administered. For other drugs, the side-effects are known to be harmful.

A Star investigation in 2012 found 600 cases, reported to Health Canada during a 10-year period, of children and youth suffering serious side effects while on ADHD medication, including amnesia and suicide.

Finally, kids who’ve endured significant periods of abuse, particularly early on, produce high levels of the stress hormone cortisol that can have long-term deleterious effects on learning and impulse control. That’s not ADHD, but it can be mistaken for it, resulting in both a failure to diagnose the correct problem and the wrong medication.

As a sidelight, boys are more likely than girls to undergo that particular response to abuse early in life. As psychologist David Geary has written, “M. Davis and Emory..,., found that newborn boys showed an increase in cortisol levels after exposure to mild but prolonged stressors, but newborn girls showed no such increase..,., [A]n overall sex difference in cortisol responses..,., would make boys and men more susceptible to growth disorders and other diseases – through suppression of immune functions and growth hormones..,.,” That may explain the remarkable difference between the numbers of boys diagnosed and treated for ADHD as compared to girls.

Add to that the fact that parenting in foster care is, on average, markedly worse than it is in biological families, even somewhat abusive ones, and we have a “prescription” for lasting damage to the very children we’re supposed to be helping.

A recent study co-authored by researchers at the Child Welfare Institute of the Children’s Aid Society of Toronto found that poor parenting in foster homes partly accounts for higher levels of behaviour problems in some children.

Here’s the experience of one boy, Nick Woolridge, profiled by the Star:

Woolridge was taken into care a month before his eighth birthday. He was bounced from foster homes to group homes — a dizzying 22 different homes during 10 years in care.

“I had a lot of anger issues due to my past, and dealing with my family,” he says. “And, growing up in foster homes and group homes, my anger just kept getting worse.”

During visits with his grandmother, Woolridge noticed she patiently found ways to defuse his outbursts and calm him down. Foster parents rarely tried doing so, and Woolridge says the Brant CAS too easily acquiesced to bouncing him around.

“I don’t think it’s right for a kid growing up in CAS to be shipped from foster home to foster home,” he says.

Is it any wonder that, as Molly McGrath Tierney said of kids in foster care, “they just want to go home?”


National Parents Organization is a Shared Parenting Organization

National Parents Organization is a non-profit that educates the public, families, educators, and legislators about the importance of shared parenting and how it can reduce conflict in children, parents, and extended families. Along with Shared Parenting we advocate for fair Child Support and Alimony Legislation. Want to get involved?  Here’s how:

Together, we can drive home the family, child development, social and national benefits of shared parenting, and fair child support and alimony. Thank you for your activism.

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