CAROL MARBIN MILLER
The Miami Herald
Peter grew breasts and began lactating. Maggie fell behind in school because she could not stay awake. Karina says the drugs she was given in foster care made her tremble and drool.
"When I was on that medication, I couldn't function," Karina told The Herald. "I was a zombie. . . . I was always sleeping. I didn't know what was going on. Everything was a blur. I don't even remember the time period I was on the medication. That's how bad it was."
Peter, Maggie and Karina are among scores of children in Florida's foster-care system who developed serious and sometimes bizarre side effects after being given powerful psychiatric medications, sometimes for years. Some of the children were administered "cocktails" of several mind-altering drugs.
The practice of giving psychiatric drugs to hundreds of children in state care has come under intense scrutiny in recent weeks after complaints by a Broward County lawyer and children's advocates. One South Florida agency - the Advocacy Center for Persons with Disabilities - has launched an investigation into the drugging of Florida foster children because of the concerns.
Child advocates say the drugs, intended to fight severe mental illnesses such as schizophrenia, are being used instead as "chemical restraints" on hard-to-manage children - not because of medical need but for the convenience of the children's caretakers.
In a Feb. 8 letter to the Department of Children and Families, Coral Springs lawyer Andrea L. Moore charged that children in state care were being given the psychiatric drug Risperdal "at an alarming rate" without being monitored or treated for side effects.
Officials with the department, which administers Florida's child-protection and foster-care programs, insist they do not encourage drugging children for behavior management and will not tolerate it. Department officials said confidentiality prohibits them from discussing specific cases.
Brenda Lyles-LaVar, who oversees the department's mental health office in Broward, said she grew concerned about the use of psychotropic drugs in the fall while reviewing the records of foster children.
Since then, department leaders in Broward have been scrutinizing agencies that provide mental healthcare for foster children to make sure they are not being inappropriately or overly medicated.
In Miami-Dade County, officials are rewriting policies on caring for children with mental-health and behavioral problems, including developing comprehensive assessments for children entering foster care and monitoring children already in state care.
In interviews with foster children, parents and advocates and a review of various records, The Herald found several South Florida foster children who support Moore's allegations and those of other child advocates: that Risperdal and other antipsychotic drugs are sometimes needlessly prescribed, with harmful effects on the child.
Eighteen-year-old Daniel, for example, had his support from the state cut off because he refused to sign a pledge to "take all required medication, including psychotropic drugs, if they are prescribed," according to records. Daniel was attending school and wanted to remain in a foster home until he graduated.
Daniel is not the youth's real name; like the other children mentioned, he is not being identified to protect his privacy.
Daniel's mother was a drug addict, and he was taken into state care at age 2. Beginning when he was about 13, state officials sent Daniel to treatment centers for behavior problems. He moved in and out of the centers, getting differing diagnoses and medications with virtually every move.
LIVING ON DRUGS
In the years before he was tossed out of the state system, Daniel was prescribed a variety of psychotropic drugs: In 1997, he received Depakote, which treats epilepsy; Paxil, an antidepressant; and Zyprexa to combat schizophrenia. In 1998, he was taking Prozac, an antidepressant; lithium, which treats manic-depressive disorder; Ativan, a tranquilizer; and Haldol, an antipsychotic.
The drugs made him shake violently, as if he had Parkinson's disease.
One of the most alarming cases advocates have encountered in recent years involves Peter, now 17. According to records, he was prescribed several psychiatric drugs while in state care: Depakote, Risperdal, Haldol, Zoloft, an antidepressant, and Cogentin, which is used to fight the effects of Parkinson's disease, or to counteract the side effects of antipsychotic drugs.
Court records say the youth's Children and Families caseworker consented to the medications, often without approval of his parents or the courts, one of which is required by state law.
Peter gained 30 pounds, developed breasts and began lactating.
Risperdal is known to increase the prolactin levels that can lead to lactation, though company officials say the link has not been proved.
Some children, advocates say, are criticized by their foster parents, therapists or teachers for performing badly at school, or in treatment programs - but none of the caretakers ask whether the youths' drug regimens might have contributed to the problem.
Karina, who is now 17 and remains in state care, says she was required to address a host of "problems" while she lived at the Walden Community School, a now-closed residential treatment center in Miami Springs. Among the issues were "depression, as evidenced by poor attention and concentration, [and] lethargy."
At the time of the evaluation, in 1997, Karina was taking three medications: Risperdal, Haldol, and Benztropine, a generic form of Cogentin, which fights the side effects of antipsychotic drugs.
Karina says she can barely remember those years, though what she does remember is not pleasant.
When Karina wasn't sleeping, she says, she shook violently, and drooled - the sorts of behaviors that prompt other children to crack jokes. "I always was picked on," she says. "I learned to deal with it."
"I learned to cope with a lot of things," Karina added.
Karina's sister, 19-year-old Melinda, underwent a full psychological evaluation at Miami Children's Hospital in 1992 when she was in foster care. At the time of the evaluation, Melinda was on several antidepressants, as well as Mellaril, an antipsychotic. The doctor who treated her insisted the drugs were not necessary.
Doctors at the hospital took her off the drugs, and she showed "improvement in behavior and mood, and a marked decrease in episodes of agitation and volatility."
But later, she was put back on medications by different doctors. For the next six years, Melinda was given a host of psychotropic drugs, including Haldol, Serentil, lithium, and Benztropine.
Melinda came full circle in 1998, when, while still in state care, a psychiatrist concluded that she "does not require the use of psychotropic medications."
State officials say they monitor providers and stop using treatment centers they feel provide shoddy care. In the last few years, two of South Florida's largest treatment centers, Miami Springs' Walden and Lock Towns Mental Health Center in Opa-locka, lost their contracts with the Miami-Dade district and are no longer caring for Miami foster children, said District Administrator Charles Auslander.
"There are procedures in place that are earnestly being followed to determine the truth as to whether children require medication as part of their treatment regimen," Auslander said.
NOT FOR CHILDREN
Officials at Janssen Pharmaceutica, which markets Risperdal, say the drug was approved for the treatment of schizophrenia or other psychotic disorders in adults. The medication, they say, "is not indicated for pediatric administration and Janssen does not promote it for this use."
However, company officials also note that Risperdal and other antipsychotics have been helpful in curbing the violence and aggression often associated with "conduct disorders" in children, a diagnosis they say accounts for 50 percent of juvenile delinquency.
"These are way beyond problem kids," said Pam Rasmussen, a Janssen spokeswoman.
"That is why doctors are doing research, trying to find a way to help these children and their families."