A Boys Town child psychiatrist told attorneys and child advocates Thursday they should challenge the use of psychotropic medications for children -- especially powerful antipsychotic drugs -- and look more often to behavioral and other therapies to treat mental health problems in children.
Many state wards and youths who wind up in the state's juvenile justice system take multiple psychiatric medications.
In Nebraska, prescriptions for state wards for mental and behavioral health and substance abuse in fiscal year 2010 ran $7.3 million, paid for by Medicaid and the Children's Health Insurance Program.
The state needs better funding for behavioral mental health treatments for kids, and those treatments should be the first option rather than psychiatric medications, said Dr. Kayla Pope, a Boys Town National Research Hospital child and adolescent psychiatrist and an attorney.
Behavioral therapy should be more accessible and based on the best available research and expertise about what works, she said.
"If a child is on multiple medications, it's time to take a closer look at the factors that are contributing to the situation and whether the medications are effective and are warranted," Pope said.
She also would recommend better monitoring of kids who are on those treatments.
"I do think people need to be more aware of the health risks associated with use, especially of atypical antipsychotics. … They should be used very cautiously," she said.
There really is no evidence to suggest that antipsychotic drugs are therapeutic in children, Pope said. It may just be that aggression is being controlled through sedation.
Whoever is authorized to make medication decisions for a child should be informed on the expected benefits of the treatment, how long the treatment might last, what the significant possible side effects are and what changes to expect from the drug.
A 2010 study of 1,159 foster children in Nebraska showed 22.5 percent were taking psychiatric drugs.
The drugs prescribed were stimulants for attention deficit and hyperactivity disorders, antidepressants and antianxiety medications, antipsychotics and mood stabilizers.
A 2011 study by the Georgia Supreme Court said the complexity of the drugs and their long-term effects on children who still are growing rapidly, dictate caution and special expertise in prescribing for children -- especially those whose parent is the state.
Brain studies show that childhood and adolescence are times of significant growth and change in brain development, including impulse control and information integration.
Functional magnetic resonance imaging has demonstrated that kids are far less efficient in thinking through and solving problems. They also have a much harder time following rules and switching strategies.
Kids also have a tendency to see a threat where it doesn't exist, are less able to process facial expressions accurately and have less insight into the emotional experiences of others.
Children diagnosed with attention deficit hyperactivity disorder have a delayed development of brain systems involved in connecting past experience with present action. That brain system is used in planning, organizing, strategizing, paying attention to and remembering details, and managing time and space. These kids can be impulsive and have trouble organizing information and carrying out tasks.
Her favorite intervention for these kids is sports, Pope said.
"They just do great. Get them outside, get them to play, and it really is effective," she said.
Pope said children at risk of mental or emotional problems often are not identified, despite early signs of significant problems. But early identification and prevention strategies can significantly alter outcomes for these children.
She recommends that all children have a 10-minute computer-based mental health screening every year before the school year begins.
"I think over the long haul, we'd save a lot of money, certainly in terms of long-term mental health care," she said.
The new Nebraska Children's Commission, authorized this year by the Legislature, likely will study the issue of prescribing psychotropic drugs to state wards.
The Nebraska Supreme Court's Through the Eyes of the the Child Initiative sponsored the lecture on medications for mental health problems in children.