Psychotropic medications for highly vulnerable children

Expert Opin Pharmacother. 2018 Apr;19(6):547-560. doi: 10.1080/14656566.2018.1445720. Epub 2018 Mar 29.


Introduction: At least 20% of children in the U.S. are highly vulnerable because they lack healthcare and protection. Several factors produce vulnerability: trauma, disruptions of parenting, poverty, involvement in the juvenile justice and/or child welfare systems, residence in restrictive settings, and problems related to developmental disabilities. These children receive psychotropic medications at high rates, raising numerous concerns.

Areas covered: The authors begin this review with a description of the population of highly vulnerable children. They then follow this with a review of the effectiveness and side effects of psychotropic medications for their most common diagnoses, using the highest-quality systematic reviews identified by multiple database searches.

Expert opinion: Highly vulnerable children receive numerous psychotropic medications with high rates of polypharmacy, off-label use, and long-term use, typically in the absence of adjunctive psychosocial interventions. The current evidence contravenes these trends. Future studies of psychotropic medications in vulnerable children should include long-term effectiveness trials and polypharmacy in conjunction with evidence-based, family-centered, psychosocial treatments.

Keywords: Psychotropic medication; behavior problems; child welfare; children; developmental disabilities; mental health; off-label; polypharmacy; trauma.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Child
  • Female
  • Humans
  • Male
  • Off-Label Use
  • Polypharmacy
  • Psychotropic Drugs / pharmacology
  • Psychotropic Drugs / therapeutic use*
  • Vulnerable Populations / psychology*


  • Psychotropic Drugs