Therapies based on brain science and limited use of antipsychotic medications are the answer for thousands of foster kids whose traumatic childhoods have left them with depression and extreme aggression, according to a growing number of experts. Many children taking antipsychotic medications do not have psychosis but trauma-induced behavioral problems with symptoms that mimic mental illness, researchers and child advocates said.

Those symptoms are controlled through potent antipsychotics and antidepressants including Risperdal, Abilify and Zoloft, drugs sometimes prescribed to children for "off-label" reasons outside the realm of Food and Drug Administration recommendations.

Foster kids in 2012 were prescribed anti-psychotics at 12 times the rate of other children on government insurance, which has raised alarms that the drugs are overprescribed to a vulnerable group.

The drugs are among a broader class of mood-altering medications called psychotropics that are prescribed to more than one-quarter of the 16,800 foster children in Colorado. Antipsychotics are the most powerful of the group and have been linked to weight gain and diabetes in children, among other problems.

Momentum in the field of neurological, trauma-based therapies for children is building, and state child welfare programs including in Colorado are reacting by trying to reform their systems to make sure abused and neglected children are receiving appropriate therapy.

The progress is difficult to quantify, however. Colorado does not track how much it spends on trauma-focused therapies, but government insurance claims show the average annual Medicaid spending on psychotropic medications for foster children is $2,295 per child.

There is evidence in Colorado, though, that therapies focused on fixing developmental problems in children's brains caused by trauma are working.

At a Denver residential treatment center for children whose behavior is so explosive many were kicked out of foster homes, therapists try to change the way the kids' brains work and often with lower doses of medication than children were taking when they arrived. The average age of children at Mount Saint Vincent center is 9, and the average number of placements in the system by the time they arrive is six.

Most of the kids at Mount Saint Vincent, a former orphanage in northwest Denver, come full of psychotropic medications, some taking three or four at once to control their outbursts and settle their minds.

Soon after they arrive, consulting psychiatrists and therapists re-evaluate their dosages and try to lower them, sometimes switching to milder drugs from Risperdal to the more benign Clonodine, for example.

Original post:
New thinking on brain-science therapies could help foster kids