Clinical and Non-Clinical Characteristics Associated with Medication Use Among Children with Serious Emotional Disturbance

Abstract

Our study explores the clinical and non-clinical characteristics associated with medication use among children with serious emotional disturbance who are referred into community-based family-driven system of care settings. Using data collected as part of the Comprehensive Community Mental Health Services for Children and Their Families Program initiative, our study provides results from analyses completed on 7,009 children and adolescents with serious emotional disturbance. Using both bivariate and multivariate statistical analyses, the researchers found that females entering systems of care were less likely to have received medication in the 6-months prior to entry, as were children of African-American and Native-American heritage compared to children from non-Hispanic White heritage. Children referred from mental health, child welfare or who were selfreferred were more likely to use medications than those referred from juvenile justice. Children with histories of prior inpatient, outpatient, day treatment, or school-based services were between 2 and 4 times more likely to use medications than children without such histories. Children with family histories of mental illness and those who were Medicaid recipients were also more likely to use medications. Family income was also positively related to medication use and younger children were more likely to use medications than older children. Implications of the findings are discussed.

Utilisation de stimulants du système nerveux central chez les élèves du primaire suivis à l’école pour des troubles du comportement

“…L'étude a été réalisée afin d'identifier la fréquence d'utilisation et les caractéristiques associées à l'utilisation des SSNC chez des élèves du primaire recevant des services scolaires spécialisés pour des troubles du comportement, soit un des groupes les plus susceptibles de se voir prescrire des SSNC 33 . Outre la rareté des études réalisées dans ce type d'échantillon 30 , la présente étude vient pallier certaines limites en portant sur un nombre considérable d'enfants suivis pour des troubles du comportement à l'école et en incluant un nombre relativement élevé de filles.…”

“…C'est ainsi qu'être d'âge scolaire primaire a souvent été relié à une probabilité plus élevée d'être sous SSNC qu'être d'âge préscolaire ou à l'adolescence [26][27][28]32 . Des études montrent aussi que l'usage de médicaments pour le TDAH est plus fréquent chez les enfants provenant de familles aisées 27,33,34 . Il faut vérifier si une telle association s'observe au Québec où l'accès aux services médicaux est universel.…”

Psychotropic Medication Use for Youth in Residential Treatment: A Comparison Between Youth with Monopharmacy Versus Polypharmacy

“…Previous research conducted with youth in non-residential settings has indicated that both clinical (e.g., DSM-IV diagnoses, levels of problem behavior) and non-clinical (e.g., ethnicity, insurance status) factors have been associated with the use of psychotropic medications (Dean et al 2006;Martin et al 2003;Pavkov and Walrath 2008); however, it is not understood why some youth may be prescribed only one psychotropic medication while others may be prescribed more. It has been suggested that physicians may prescribe multiple medications to address complex symptoms or disorders or to treat youth with multiple diagnoses (Safer et al 2003), issues that are particularly relevant for many youth in residential treatment (Duppong Hurley et al 2009).…”

The delivery of youth mental health services in group homes : working towards a facilitating therapeutic environment

“…More specifically youth in group homes are prescribed psychotropic medications at a higher rate than children outside of the system and of children in the system, but placed in a family based environment (Breland-Noble et al, 2004). While the use of medications to treat emotional and psychiatric disorders in youth has been considered controversial in general (Pavkov & Walrath, 2008), concerns specific to youth in care involves exposure to medications that result from misdiagnosis or contextually deprived diagnosis, the use of medication for social control, the lack of youth involvement in treatment decisions and the absence of a consistent caregiver to monitor and participate in treatment regimes (NYICN, 2009).…”

“…As has been identified youth often have fragmented histories hindering psychiatrists in diagnosis; or the psychiatrist or prescribing physician may not be familiar with the specific challenges of being in a group care facility. These challenges increase the likelihood that youth are misdiagnosed, or given a diagnosis or treatment recommendation that is contextually deprived (Pavkov & Walrath, 2008).…”