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examination of potential factors, such as limited access to psychosocial interventions and the need for oversight and prescribing protocols. Cosme et al. examined psychotropic prescribing patterns in youth aged 2 to 19 years in foster care in Nevada, USA. They analyzed data from an institution's electronic medical records from July 2019 to June 2022 and reviewed 569 distinct psychotropic treatment episodes. They found prevalent use of psychotropic polypharmacy, non-stimulant ADHD medications, atypical antipsychotics, and antidepressants. Further research is needed to understand the reasons behind these prescribing practices and the implications for youth.Two papers share their perspectives on ADHD. Banaschewski and colleagues challenge the notion of ADHD as exclusively a natural entity and note that societal and environmental factors need to be considered. They stress that recognizing ADHD as a social construct is crucial for diagnosis and treatment decisions, emphasizing the need for a person-centered approach within a context-dependent model. Dekkers' commentary agreed with the suggestions from Banaschewski et al., emphasizing a paradigm shift towards viewing ADHD as a social construct, aiming to address overmedication and stigma. Dekkers argues that decontextualizing ADHD from solely biological causes may reduce prognostic pessimism, stigma, and overreliance on psychotropics, and thus offer more holistic support for youth. These proposed approaches would move away from 'medicalized' care to a wider sociological orientation steeped in the socioeconomic and educational context of youth's and families' lives.Finally, Monson and colleagues describe and evaluate The Utah Psychotropic Oversight Program (UPOP) for prescribers caring for foster care youth in the USA. The study analyzed 8,523 youth over 4 years. Fostered youth receiving antipsychotics through UPOP tended to be older males with disruptive behavior disorders and high rates of polypharmacy. With the oversight program prescription rates decreased over time without raising the need for higher levels of care. The study suggests that oversight programs like UPOP can influence prescribing practices. This Research Topic highlights concerns regarding psychotropic use among youth, particularly some of the most vulnerable youth, those involved in the foster care system. Dörks et al., Monson et al. and, Cosme et al. all emphasize the prevalence of antipsychotics and/or polypharmacy and the need to understand prescribing patterns and their implications. Monson et al. underscores the importance of oversight programs and their potential influence on prescribing practices. It is important to note, that in many states and countries, government and payor initiatives have already initiated oversight programs and experts have developed guidance around deprescribing psychotropic medications in youth (28,29). Banaschewski et al. and Dekkers challenge the notion of ADHD as purely biological and advocate for a broader and more nuanced understanding that considers societal and environmental factors. Ultimately, these studies collectively emphasize the need for a more integrated youth centered approach to balance psychopharmacologic and psychotherapeutic treatment, particularly for those in out of home placement by youth welfare services (e.g. foster care, looked after children), while also acknowledging the influence of broader social and environmental contexts on diagnosis and treatment decisions.
McLaren et al. (Mon,) studied this question.