Experts are warning that rising numbers of Canadian children are being over-medicated with psychotropic drugs.
Vulnerable kids under the care of children's aid societies are being given too many psychotropics, with those in group homes being over-medicated the most.
Documents recently obtained by the Globe and Mail under Ontario's Freedom of Information Act revealed that in a random sample of five Ontario children's aid societies, 47 percent of the children were prescribed psychotropics last year for a range of mental health diagnoses, including depression and attention deficit hyperactivity disorder (ADHD).
The Globe article reported that this number is more than triple the rate of drug prescriptions for psychiatric problems among children in the general population.
Furthermore, it said last year prescriptions for antidepressants, including Ritalin, which is widely prescribed to children to treat ADHD, rose more than 47 percent to 1.87 million, according to Montreal-based pharmaceutical information company IMS Canada. In addition, prescriptions for a new generation of antipsychotic drugs increasingly being used on children almost doubled, rising to 8.7 million.
Dr. Marty McKay, a clinical psychologist who has consulted for children's aid societies across south-western Ontario for 31 years, cites even more alarming figures. The 47 percent rate of psychotropics used refers to all children in Crown care, including foster homes and group homes, but "if you look only at the group homes, it's about 90 per cent, in my experience."
McKay brought this to public attention last year after working with a patient, a now-13-year-old boy, who was prescribed a "drug cocktail" of three psychotropic drugs while living in a group home near Toronto.
"He had eight diagnoses but has none of those disorders," she said.
The World Health Organization defines psychotropic drugs as "a loosely defined grouping of drugs that have effects on psychological function." They include antidepressants, tranquilizers, antipsychotics, and anti-anxiety drugs.
In a "very troubling" finding, McKay said large numbers of group home children are being prescribed not just one psychotropic but cocktails of usually about three different drugs, many of them not authorized for use in children.
She says it's unreasonable to believe so many of these children would have so many different psychiatric diagnoses.
Some of the disorders are actually the result of the drug itself, she said. For example, a child usually receives a first diagnosis of ADHD and is given Ritalin. If ineffective, the dosage is increased, leading to motor ticks, a known side effect of the drug. Instead of reducing the dosage, the child is then diagnosed with a further disorder of Tourette's syndrome and given another drug.
McKay believes these children are not psychotic but are victims of neglect or abuse, whose anger or agitation are normal responses. She called the drugs "chemical straitjackets" and a "gross violation of children's human rights."
"It's like turning [children] into zombies" since the drugs are "basically lobotomizing agents," said McKay. "It constitutes criminal assault to forcibly give them these drugs that have such a devastating effect on their brain chemistry and learning ability."
Studies show long-term results of risk for diabetes, thyroid dysfunction, central nervous system disorder, Parkinsonism, and liver, kidney, pancreas, and other organ damage, she said.
In group homes, the children's aid workers signing consents often lack training and knowledge, said McKay. Burdened with high caseloads, they might only see a particular child once a month.
Instead of doing a thorough assessment, psychiatrists often prescribe based on group home workers' descriptions of behaviour, or checklists filled out by a teacher or parent. The children typically are not given the right to protest or a chance to refuse treatment.
Many group homes are often private, for-profit businesses where the workers are not well educated and lack training to be able to recognize drug side effects. Although the homes are provincially regulated, the regulations only cover a few aspects, and hiring practices is not one of them, said McKay.
This is reiterated in report released last week by Ontario's Chief Child Advocate Judy Finlay on the quality of care of three children's aid societies.
"Typically, staff in group care are young, poorly paid with limited training and insufficient supervision. They often lack the professional qualifications, experience, and judgement required to assume the task of managing the range of behaviours and circumstances in group care."
While the situation in group homes and child welfare is severe, a new study is prompting urgent concern about widespread overmedication among Canadian children in general.
According to research published in this June's issue of the Canadian Journal of Psychiatry, of 212 survey respondents, 94 per cent of 176 child psychiatrists and 89 per cent of 36 developmental paediatricians across Canada are prescribing atypical antipsychotics to patients under 18 for diagnoses that included psychotic, mood, anxiety, and behaviour disorders.
Although the researchers said that these drugs are not approved for use in children, of all the prescriptions, 12 per cent went to children under nine, including some as young as three.
"These medications are currently being used off-label without clear guidelines for indications, dosing, and monitoring," noted the report, saying there is "an urgent need for more data regarding safety and monitoring of these medications in children."
McKay said filing a complaint with the college of physicians doesn't achieve anything, as the college will contact one of its "so-called experts" who will say prescribing those drugs is "standard of practice." Thus the prescribing physician is not disciplined, even if the patient suffers from the drugs he is given for disorders he did not have.
Kathryn Clarke of the Ontario College of Physicians and Surgeons explained that the college itself does not develop standards or guidelines about treatments and monitoring but relies on experts within the medical profession.
As for Health Canada, spokesperson Carole Saindon says that as the federal regulator, her department approves drugs for safety and efficacy and ensures as many indications on the label as possible. Beyond that, prescribing practices are in the hands of physicians and other health care providers.
Counseling, 'Kinship Settings'
The National Youth in Care Network, an advocacy group for youth in Crown care, says medication, often seen as a "quicker, easier, and cheaper alternative" and a means of controlling behaviour and enforcing compliance, should not be the sole focus of interventions.
In a report published in 2006, the network calls for informed consent, access to counselling and other mental health services, and a regulatory body to oversee all agencies involved in the use of chemical restraints for these youth.
McKay said she would like to see group homes essentially eliminated and foster placement emphasized, particularly "kinship settings" with grandparents and extended family members. Moreover, she urged increasing budgets for counselling, psychotherapy, and cognitive behavioural therapy to teach kids how to cope with feelings of anger, hurt, and frustration.
Canada is a signatory to the United Nations Convention on the Rights of the Child, she said, yet it is not living up to that commitment.
"Get psychiatry out of child welfare," said McKay. "Child welfare, especially group homes, should not be like miniature mental institutions for children."