Angela

HULL, Mass. - In the final months of Rebecca Riley's life, a school nurse said the little girl was so weak she was like a "floppy doll." The preschool principal had to help Rebecca off the bus because the 4-year-old was shaking so badly. And a pharmacist complained that Rebecca's mother kept coming up with excuses for why her daughter needed more and more medication. None of their concerns was enough to save Rebecca.

 

Rebecca — who had been diagnosed with attention deficit hyperactivity and bipolar disorder, or what used to be called manic depression — died Dec. 13 of an overdose of prescribed drugs, and her parents have been arrested on murder charges, accused of intentionally overmedicating their daughter to keep her quiet and out of their hair.

 

Interviews and a review of court documents by The Associated Press make it clear that many of those who were supposed to protect Rebecca — teachers, social workers, other professionals — suspected something was wrong, but never went quite far enough.

 

But the tragic case is more than a story about one child. It raises troubling, larger questions about the state of child psychiatry, namely: Can children as young as Rebecca be accurately diagnosed with mental illnesses? Are rambunctious youngsters being medicated for their parents' convenience? And should children so young be prescribed powerful psychotropic drugs meant for adults?

 

Dispensing drugs to children diagnosed with mood or behavior problems is "the easiest thing to do, but it's not always the best thing to do," said Dr. Jon McClellan, medical director of the Child Study and Treatment Center in Lakewood, Wash. "At some level, I would hope that you'd also be teaching kids ways to control their behavior."

 

According to the medical examiner, Rebecca died of a combination of Clonidine, a blood pressure medication Rebecca had been prescribed for ADHD; Depakote, an antiseizure and mood-stabilizing drug prescribed for the little girl's bipolar disorder; a cough suppressant; and an antihistamine. The amount of Clonidine alone in Rebecca's system was enough to be fatal, the medical examiner said.

 

The two brand-name prescription drugs are approved by the Food and Drug Administration for use in adults only, though doctors can legally prescribe them to youngsters and do so frequently.

 

Rebecca's parents, Michael and Carolyn Riley, say they were only following doctor's orders. Rebecca, they told police, had been diagnosed when she was just 2 1/2, and Rebecca's psychiatrist prescribed the same potent drugs that had been prescribed for her older brother and sister when she diagnosed them with the same illnesses several years earlier.

 

But Rebecca's teachers, the school nurse and her therapist all told police they never saw behavior in Rebecca that fit her diagnoses, such as aggression, sharp mood swings or hyperactivity.

 

Prosecutors say the Rileys intentionally tried to quiet their daughter with high doses of Clonidine. Relatives told police the Rileys called Clonidine the "happy medicine" and the "sleep medicine."

 

Through their attorneys, Michael Riley, 34, and Carolyn Riley, 32, have accused Rebecca's psychiatrist, Dr. Kayoko Kifuji, of over-prescribing medication.

 

Kifuji did not return calls for comment and declined to be interviewed. But Kifuji has vehemently denied any role in Rebecca's death. She has agreed to a suspension of her license while the state's medical board investigates.

 

Kifuji told police Rebecca had been her patient since August 2004, when she was 2. She said she based her diagnoses of ADHD and bipolar disorder on the family's mental health history, as described by Carolyn Riley, and Rebecca's behavior, as described by Carolyn and briefly observed by her during office visits.

 

Kifuji told police she became alarmed in October 2005 when Carolyn Riley told her she had increased Rebecca's nighttime dose of Clonidine from 2 to 2 1/2 tablets, and warned Carolyn the increased dose could kill Rebecca.

 

But Carolyn told investigators Kifuji told her she could give Rebecca and her sister extra Clonidine at night to help them sleep.

 

Tufts-New England Medical Center, where Kifuji worked, issued a statement supporting Kifuji, saying her care of Rebecca "was appropriate and within responsible professional standards."

 

In the months leading up to Rebecca's death, others noticed there was something wrong.

 

Teachers and staff members at the Johnson Early Childhood Center in Weymouth, about 20 miles south of Boston, say they called Rebecca's mother repeatedly to tell her that Rebecca was "out of it," but her mother said the girl was tired because she wasn't sleeping well.

 

A neighbor who lived next door to the family in the last month of Rebecca's life said Rebecca and her siblings seemed listless.

 

"They looked like little robots. They looked very lethargic," Phyllis Lipton said. "I said, `Wow, they don't look right,' but who knew?"

 

Pharmacists at Walgreens in Weymouth called Kifuji twice to complain that Carolyn Riley was asking for more Clonidine, even though her prescription was not due to be refilled yet, according to state police.

 

Once, Riley said she had lost a bottle of pills, and another time, she said water had gotten into her prescription bottle and ruined the pills, according to police.

 

Kifuji authorized refills, but after the second incident, she began prescribing Clonidine in 10-day refills instead of 30-day supplies, investigators said.

 

On Aug. 16, a prescription for 35 Clonidine tablets — a 10-day supply — was filled at Walgreens, even though the Rileys had obtained a 10-day refill only the day before, investigators said.

 

Walgreens spokeswoman Tiffani Bruce said: "The scrip was filled as written, as it was prescribed by the doctor, and all the appropriate information on the medications was given to the family."

 

After Rebecca's death, police found only seven Clonidine tablets in the family's medicine tray; the pharmacist said there should have been 75. All together, prosecutors say, Carolyn Riley got 200 more pills in one year than she should have.

 

The Rileys' lawyers call them unsophisticated people who did not question their children's doctors.

 

Both were unemployed; they collected welfare and disabilty benefits and lived in subsidized housing. Michael Riley, who is also awaiting trial on charges of molesting a stepdaughter in 2005, claimed to suffer from bipolar disorder and a rage disorder; his wife told police she suffered from depression and anxiety.

 

"They are not the sort of people who go on the Internet and look on WebMD. These are the sort of people who, when they go to a doctor, the doctor is God and they do what the doctor says," said John Darrell, Michael's lawyer.

 

Carolyn's lawyer, Michael Bourbeau, said that because the Rileys' three children were all taking Clonidine, Rebecca's prescription may have come up short at times when her siblings were given some of her pills. And some of the pills may have been lost when they were split in half, he said.

 

In July, after a therapist filed a complaint with the state Department of Social Services, social workers met with the family's doctors and other medical professionals and were assured that the medications Rebecca was taking were within medical guidelines.

 

"There were lots of medical eyes on this case and none of them seemed to say there was an issue of over-medication in this case," said Social Services Commissioner Harry Spence, who has come under fire for the agency's handling of the case.

 

Still, there were lingering concerns. When social workers tried to make a home visit in November, Carolyn "resisted and evaded," Spence said. Weeks later, workers resolved to make a surprise check, but Rebecca died the very next day, before they could visit.

 

Rebecca was found dead on the floor of her parents' bedroom wearing only a pink pull-up diaper and gold-stud earrings, on top of a pile of clothes, magazines and a stuffed brown bear.

 

Rebecca's uncle, James McGonnell, and his girlfriend, Kelly Williams, who lived with the Rileys, told police that the Rileys would put their kids to bed as early as 5 p.m. Rebecca, they said, often slept through the day and got up only to eat.

 

When Michael Riley decided the kids were "acting up," he told Carolyn to give them pills, McGonnell and Williams told police.

 

According to McGonnell and Williams, Rebecca spent the last days of her life wandering around the house, sick and disoriented. But the Rileys told police they were not alarmed. "It was just a cold," Carolyn repeatedly said during police interviews.

 

The medical examiner said Rebecca died a slow and painful death. She said the overdose of Clonidine caused her organs to shut down, filling her lungs with fluid and causing congestive heart failure.

 

Williams told police that the night before she died, Rebecca was pale and seemed "out of it." At one point, the little girl knocked weakly on her parents' bedroom door and softly called for her mommy, but Michael Riley opened the door a crack and yelled at her to go back to her room, Williams said.

 

Later that night, McGonnell told police, he heard someone struggling to breathe and found Rebecca gurgling as if something was stuck in her throat. McGonnell told police he wiped vomit from his niece's face, then kicked in the door to her parents' room and yelled at the Rileys to take Rebecca to the emergency room.

 

Instead, Carolyn Riley said, she gave her daughter a half-tablet of Clonidine.

 

Carolyn's mother, Valerie Berio, said that when she visited the kids the night of Dec. 11, Rebecca seemed congested but not seriously ill. In a photograph Berio said she took that night, Rebecca is smiling slightly as her mother holds a new green velvet dress in front of her.

 

Berio said that shows that her daughter and son-in-law could not have known how sick Rebecca was.

 

Rebecca's death has inflamed a long-running debate in psychiatry. Some psychiatrists believe bipolar disorder, which was traditionally diagnosed in adolescence or early adulthood, has become a trendy diagnosis in young children.

 

"As a clinician, I can tell you it's just very difficult to say whether someone is just throwing tantrums or has bipolar disorder," said Dr. Oscar B. Bukstein, a child psychiatrist and associate professor at the University of Pittsburgh.

 

A study of mentally ill children discharged from community hospitals, published in January in the Archives of General Psychiatry, found the proportion of children diagnosed with bipolar disorders jumped from 2.9 percent in 1990 to 15.1 percent in 2000.

 

A report released by the Centers for Disease Control and Prevention in 2002 estimated that about 7 percent of elementary school-age children — or approximately 1.6 million youngsters ages 6 to 11 — have been diagnosed with ADHD.

 

The annual number of U.S. children prescribed anti-psychotic drugs jumped fivefold between 1995 and 2002, to an estimated 2.5 million, according to a study published last year by researchers at Vanderbilt Children's Hospital in Nashville, Tenn.

 

Some child psychiatrists say bipolar disorder may have been under-diagnosed in children for years, partly because several key symptoms are also symptoms of ADHD, including hyperactivity, distractibility and talkativeness.

 

Dr. Janet Wozniak, director of the Pediatric Bipolar Disorder Research Program at Massachusetts General Hospital, said early diagnosis and treatment are critical because the illness can cause social and academic problems, and lead to drug abuse, crime and suicide.

 

"What's commonly overlooked when considering diagnosing and treating children at such an early age is the risk of not treating and not intervening," Wozniak said.

 

Leaving aside the parents idiocy which garners the. with the idiocy of the century award, this case raises questions over how can a four year old ever be bi polar???

Taken from; The National Institute for Mental Health

Can Children and Adolescents Have Bipolar Disorder?

Both children and adolescents can develop bipolar disorder. It is more likely to affect the children of parents who have the illness.

 

Unlike many adults with bipolar disorder, whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day.5 Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.

 

Which means that anyone behaviour type can be diagnosed as one thing or the other. This 'psychiatrist' diagnosed the same symptoms twice!!! Not to mention neither parents have a history of psychiatric disorders (other than being terminally stupid and woefully ignorant. And bad parents)

My other point is how can reports of bi-polar go from 2.9% in 1990 to 15% in the space of ten years. this is unfeaseable. Labelling children with Bi-polar disorder leaves them label forever, there is no cure, only mood stabilising treatments, which manages the effects of the problems.

End of the day, this is crazy that people are trying to have mental disorder de jour, instead of realising these people are lacking in parenting skills. End of day its gone from my child has ADD or ADHD to my child is bi-polar. One way or another we are medicating our children to death instead of instilling discipline.

Discuss

Quote #1 comes from; http://news.yahoo.com/s/ap/20070323/ap_on_...rugged_to_death

Quote #2 comes from; http://www.nimh.nih.gov/publicat/bipolar.cfm#bp6

And I suppose putting the corpse in a freezer would have been a better option. Its a nine hour flight- And I'm sure that it would have been an inconvience to everyone if the landed as well.

 

I think they did what they thought was right.

 

 

I suppose you would have no problem sitting next to a corpse during a flight then?.....

 

A freezer? I doubt they have freezers that size on an airplane.

 

If it were my decision, I would have secured the corpse in one of the first class restrooms. There are usually 2 restrooms there and there are also 2 restrooms in economy class. The inconvienience would be minimal and the passengers wouldn't have to SPEND A 9 HOUR FLIGHT SITTING NEXT TO A CORPSE!!!.....

Would you want your mother locked in a toilet?

I think they did the right thing. Bathrooms happen to be inside locking and therefore the womans remains would have continually fallen out. Its a pity that there are no contingencies planned for, but really who would expect it. They did the right thing, in a bad situation. They put her in a place where, presumably after resus attempts had failed, there were fewer passangers.

This should never have made the papers. But it shows the will whinge and complain, will whinge and complain attitude overides the sane and proper response of respect for the grievig family.

They guy is more than likely trying to bag a free flight out of BA (The great British way I am afraid, that is my personal experience after working i the consumer field here.)

I totally blog, used to here, but I am more involved with Live journal, with whome I have a paid account

http://angelicalangie.livejournal.com for any interested.

It was recently announced that the creator of B-5 is going to be releasing some direct to video B-5 adventures this year. I can't wait!

Squeals with delight. I have just ordered the first season from amazon, and I am watching the tv-movie in the beginning. Yay!!!!

I have been watching the last 4 seasons in the past week. Oh I swear I am kidding you not.

I love this show. I swear, this is the only show where it feels like reading a book, and I am so gonna be missing it when the dvd's run out.

I remember loving it when it was on television, watching in real time is wonderful unless you have to deal with censorship, and time slot changes. At which point it becomes rediculous trying to keep up. I have all but the first season. The one thing that made me think was how did Delenn feel having her ancestor, in the form of Sinclair, on the station, when she found out???

I must admit I just watched an episode of season five where they follow a work crew around the station (Mac and Bo) and I loved the two descriptions of the white star 'plucked chicken' and like 'Angels' both from the same character. For me as someone who ascribes the term social constructionist, as a descriptor of her beliefs on the world, it sums it all up. Somethings meaning is dependant on the context in which one is viewing an object. In non combat, the White Star could look like a 'plucked chicken' but saving ones hide, they too could look like 'Angels'

And furthermore on the subject of the White Star fleet, it was interesting how they were part Minbari and yet also part Vorlon, it kinda made me think that even though the Vorlon's were gone from out galaxy, they still in some respects remained with the B-5 universe.

Trust me if you haven't seen those pictures, it is n image no amount of acid to the brain will get rid of.

Yes this is me speaking from experience *wanders off to throw up* it really is rank.

I feel sorry for the poor girl. Clearly she has finally lost it.

That would be if she ever had it to start with.

Compared to and did songs with Madonna. I swear I had thought of and also 'did' Madonna. I swear the moment her relationship with Justin Timberlake (God I swear he is a reject as well.) went south, she hit themental skids.

Well she is a redneck white trash wannabe a woman.

She'll never be anything but a rich talentless amoeba. (And that is insulting amoeba the world over.)

Lets face it there is no treatment for what Britney has. She has a bad case of idiocy. which explains;

1. Bad marriage

2. getting pregnant the first time

3. getting pregnant the second time even though she knew it was a bad marriage.

4. Friendship with Paris Hilton

5. driving with a baby on your lap.

6. Her entire musical carerr, scarily have 3 too many albums of hers, none of them are that good.

7. A bad case of Anna Nicole copying days after the womans death.

Sorry I just hate Britney.

well that will keep his wife in size 0 dresses (That is stat off 31, 22, 31.5) and scarily those are the measurements of most 8 year olds. I can see where the descision came from. Beckham hasn't the brains to make it, this is wifey's decisionn. Oh and the next thing we will hear is the pair of them become scientologists, they are friends with a bunch of them including Katie Holmes and Tom Cruise. Says it all really.

This has been on the cards for a long time, mostly cause they have been doing the red carpet scene over there for 4 years!

Well it is that time of year. So Merry christmas, hope you have a wonderful day, kids have everything they want, and parents get a few mins where they don't have really pointless ties to untie and to have their feet up in peace, and everyone else gets what they want.

You wanna hear bad our boys are sharing body armour, cause our politicians didn't want to look like we were going to war so didn't order in. Appaling isn't it!

So Single it is depressing. But maybe there is hope.... Yes I will leave it there.

And this is coming from a woman who was recently quoted as saying "I believed in santa until I was 17 when some mean person told me it wasn't true."

Yeah she'd make a real fine mother. [/sarcasm]

Jeez she is the type who wouldn't know one end of mother hood from the other, I mean she was nannied her whole life (that shows) and britney spears as a mother do not make me laugh. She is out more often them motering.

Devolution is occurring folks. And the blonde bimbettes are leading the way.

I can understand, I too am sick to the hind teeth of religion, I don't care what your beliefs are, I will respect that you have them, but having them forced on me at aboard for a show that was athiest. I will miss you ARMS, but I will IM you and make sure you are ok

Watching Torchwood

I recycle, i WALK OR USE PUBLIC TRANSPORT, WHO i AM MORE GREEN THAN MOST

Sry for the caps

One of my lecturers sent out an email and I think it is worth diseminating here.

Dear all

My sister-in-law died of breast cancer a number of years ago. My brother has sent me a request that people log on to the Breast Cancer once a day and underpriviliged people get free mammograms as a result. I suspect this is a worldwide thing rather than UK. It really does only take a few seconds - the place you have to click is right in the middle of the home page of the website.

http://www.thebreastcancersite.com/

http://www.thebreastcancersite.com/

This latest campaign also requests that you forward this request to 10 friends as well. If you can do one or both of these things it would be great.

Thanks.

Anne

Considering most people at this board will come into contact with someone who has this horrid illness and to help someone else, on the previso that really life is in th lap of the fates and it could be any of us, I figure puing this email here. To pass it on to more than 10, if you too can pass it on to friends or family it would be really wonderful.

Hope he gets an 'easy' ride of it all. keep us updated as much as possible, its nice to know he is 'safe' and well.

this may be the only reason I bother watching Lost.

congratulations and the best of luck and karma

there seems to be no portal page or fast reply other than that I am gooood!

IE7 whichmost will have to upgrade to has the same issues.

I have the same issues as CP. I find that Mozilla Firefox (one of the safest browsers around as well as one of the most stable and unhackable) tends to merger the picture and the options toolbar at the top of the page. It is likely that the tabbed browsing compresses the page to create this effect (I won't turn tabbed off though, it is far to useful a feature).

*dies laughing*

sounds about right sometimes.