Foster care, externalizing disorders, and antipsychotic use among medicaid-enrolled youths

Lauren Vanderwerker, Ayse Akincigil, Mark Olfson, Tobias Gerhard, Sheree Neese-Todd, Stephen Crystal

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Objectives: The authors investigated the extent to which clinical diagnoses of externalizing disorders explain higher rates of antipsychotic use by foster care youths. Methods: Medicaid claims data from 44 states for 2009 for youths in foster care (N=301,894) and those not in foster care (N=5,092,574) were analyzed, excluding those with schizophrenia, bipolar disorder, autism, and major depressive disorder. Logistic regressions assessed the relationship between foster care, externalizing disorders, and antipsychotic use. Results: Foster care youths had higher rates of externalizing disorders than the comparison group (attention-deficit hyperactivity disorder, 17.3% versus 6.5%; disruptive behavior disorder, 7.2% versus 2.5%; conduct disorder, 2.3% versus .5%) and greater anti-psychotic use (7.4% versus 1.4%). Foster care remained a significant predictor of antipsychotic use after control for demographic and diagnostic covariates, including externalizing disorders (adjusted odds ratio=2.59, 95% confidence interval=2.54-2.63). Conclusions: High rates of externalizing disorder diagnoses only partially explained elevated levels of antipsychotic use in this vulnerable population.

Original languageEnglish (US)
Pages (from-to)1281-1284
Number of pages4
JournalPsychiatric Services
Issue number10
StatePublished - Oct 1 2014

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health

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