Griffin Discusses Overmedication of Foster Care Youth with Dr. Phil McGraw and Dr. Michael Naylor
Press Release
At yesterday's Ways and Means Subcommittee on Human Resources hearing on the increasing use of psychotropic medications by children in foster care, Congressman Tim Griffin (AR-02) questioned Phil McGraw, Ph.D., host of the "Dr. Phil" show, and Michael Naylor, M.D., Associate Professor of Psychiatry at the University of Illinois at Chicago School of Medicine, regarding the disparity between the number of psychotropic medication prescriptions for children in foster care versus children in the general population. He also discussed the success Arkansas has had in implementing federal law passed in 2011, which has reduced the abuse of these medications for children. The witnesses addressed underlying causes and differences between mental illness in foster care children and non-foster care children.
TRANSCRIPT:
Rep. Griffin: Thank you Mr. Chairman. Thank y'all for being here. I am from Arkansas and we have had quite a bit of success in Arkansas dealing with this particular problem. You know there are a lot of jokes and a lot of things said about Congress, but I'll tell you that a lot of the progress we've made has been because of the laws we've been able to get in place. I was just reminded in 2011, which was my first year serving here; we had the Child and Family Services Improvement Innovation Act, which deals specifically with the protocol for prescribing psychotropic medication for children.
When I look at some of the results of what has gone on in Arkansas it's been incredible, and it has no doubt been encouraged and sometimes mandated by the federal government. But the boots on the ground as we say in the Army has been at the state level. A number of specific "edits," as they're called, or changes were put in place. One of them in particular was having child psychiatrists review all requests for psychotropic medications for children under 5, and a whole host of things, but the numbers are staggering. There was a reduction for foster care children under six years old, a reduction of 86%. That's almost elimination. For non-foster care children, there was reduction of 92%. So there is a gap between the non-foster care children and the foster care children. When you get to 6-12 years there is a reduction of 38% for foster care children, 49% for non-foster care children. There is something that works here, it seems to me. And I think the point that Dr. Phil you made, and some others, and some folks up here made is a good one, and that is that look we've seen that throwing money at a problem doesn't work. The VA has been getting more money for administration after administration. I think we've tripled the money for the VA in little over a decade, and it is still a disaster in many ways. So we've got to make sure that we are funding the rights things. That we're funding things on the ground, not more administrators, and I think that is critically important.
A couple things to ask here. First of all, Dr. Naylor, in Arkansas even though there have been significant reductions and very affective reforms there is still a gap between foster care children and non-foster care children. And Dr. Phil mentioned earlier that there are certain problems or patterns with foster care children. I think you've said there are more mental health problems as a percentage than in the general population. Maybe that explains the gap. Dr. Naylor and Dr. Phil, if y'all could both speak to that. What's the gap? Why is there a gap? So when we see a reduction that is not as much with the foster care population as it is with the non-foster care.
Dr. Michael Naylor: I think that there are several reasons. I summarized some of them in my testimony. I really think that you cannot, first of all, pathologize kids in foster care or foster children, because the vast majority of them are able to carry out their rules that they are supposed to be carrying out. Being a part of a foster family, being part of a home of a relative, going to school and things like that. There is a sub group, and I think that this is a larger group in foster kids than in the general population.
I was asked by Brian Samuels, who came from Illinois, and he asked me if I really believed that there was a higher rate of mental illness among foster kids. And my answer to him was, if you really wanted to come up with a model for developing mental illness in a population that is the perfect model. You have kids, a subpopulation anyway, who are born to very impulsive, very aggressive, sometimes mentally ill, very often substance abusing, and even sociopathic parents. Strike one.
Strike Two. In these families very often there is neglect. Neglect is probably worse in some ways even than physical abuse is. Physical and sexual abuse, and there's often in utero exposure to drugs, which you know between tobacco and alcohol you have the two biggest risk factors for screwing up a kid's brain. We continue on through disruption of the primary attachment and when you look at these kids and you think how can you possible love a mom who treats you like this, or a dad who treats you like this, but they do. And that's what they know.
I think the major trauma in the child welfare system is when and how you take the kids into custody. People talk about the trauma of taking kids out of the home. But let me paint a picture for you. You're going to school and all of a sudden the police come to you at the school. They pick you up, chuck you in the back seat of the car, and bring you off to some strange place. Now if you look at this from an evolutionary point of view abduction equals death. So when you are responding to this as a child you're not responding to just oh what a bummer you were taken away from your family, you are responding to a potentially life threatening situation. I mean that is what your brain is telling you. I think when we end up then seeing incredible sadness and maybe even a howling rage by some of these kids at being taken out of their families. Then the first foster home sometimes stick, but for a lot of these kids there is multiple placement disruptions, and every single disruption that you have is accompanied by a decrease in sense of self-worth and an increase in behavioral problems. And so we have the perfect system for developing emotional, behavioral and psychiatric problems.
Chairman Dave Reichert (R-WA): I think this is an important question. The time has gone two, almost three minutes over. Dr. Naylor you did an outstanding job. I happen to have been one of those police officers years ago that was put in those positions, and I will allow Dr. Phil to respond in a sound bite please.
Congressman Griffin: Thank you, Mr. Chairman.
Dr. Phil McGraw: I'll be as quick as I can. I don't disagree with anything Dr. Naylor just said, but I might approach it with a different standpoint. Being a foster child is a social circumstance, it is not a mental illness. It is a social circumstance. You do not treat a social circumstance with a drug. You have to fix the underlying problem, and you have to do a differential diagnosis. Is the etiology here organic? Is there a biochemical imbalance that needs to be corrected inside the body, or has someone gone through some type of psychological trauma that has threatened their safety, and security, and their self-worth, and their ability to predict the consequences of their life and actions? And if that is the case I just don't believe you are going to fix that with medication long term. Now that doesn't mean it can't help short term because it certainly can, but particularly for these young children there is not one shred of evidence that many of these drugs are appropriate to use with one and two year old children. Certainly in a policy pharmacy circumstance. And I'm not down on psychotropics because let me tell you that they can save and change lives when appropriately used. Being a foster child is a social circumstance, not a mental illness. Now it can trigger depression and some other things that will have to be dealt with, but what is the treatment of choice? Is the treatment of choice to begin drug therapy or is the treatment of choice to begin some type of evidence based psychological therapy and I think the former has many more side effects than the latter and therefore is much more dangerous.
Chairman Reichert: Thank you for your answer.
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