Girl fed fatal overdoses, court told

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Four-year old Rebecca Riley was found dead on the floor of the family home in Hull on December 13. Prosecutors are charging her parents with first-degree murder for allegedly “regularly giving her drug overdoses, ostensibly to keep her calm and help her sleep”. (Boston Globe)

Rebecca had been diagnosed at age 2 1/2 [sic] with attention deficit hyperactivity disorder and bipolar disorder and was being medicated by a Tufts-New England Medical Center psychiatrist who was also prescribing nearly identical drug regimens for her older brother and sister. The medical center rushed to stand behind their clinician, stating

“Rebecca Riley’s death is a terrible tragedy. The care we provided was appropriate and within responsible professional standards. The appropriate care of our patients is our greatest duty. Dr. Kifuji has outstanding credentials and is respected within her field.”

With the caveat that of course I don’t know the clinical details of Rebecca Riley’s case, I would have to say that there is at least one psychiatric colleague here in Massachusetts who questions the appropriateness of the care little Rebecca received. I find it difficult to imagine how any 2 1/2-year old could possibly be diagnosed with these disorders in the first place. As readers of FmH know, I think the field suffers from rampant overmedicalization of variant behaviors. In particular, I have vented my spleen about the irresponsible epidemic of diagnosing ADHD — there is not an epidemic of ADHD; there is one of diagnosing it! (Perhaps we ought to have a psychopharmacological treatment for disordered diagnostic practices among caregivers…) And childhood bipolar disorder, a controversial diagnosis which seems defined, Alice-in-Wonderland fashion, by little more than the fact that it does not present anything like the adult bipolar disorder with which we are familiar, is the newest abused diagnosis in child psychiatry. Then consider for a moment, even granting the validity of the diagnoses, whether one should ever medicate small children so heavily, or medicate them at all. The only possible consolation from this horrendous travesty of medical care will be if Rebecca’s death becomes a cause celebre that leads to earnest reform. Whatever aspersions one might cast on the parents’ role in their daughter’s death, this entire family should be considered poster children for the affront to human dignity that mental health diagnosis and treatment have become.

“Prescription drugs and behavioral issues were a part of life in the Riley household, the affidavit indicates. Carolyn Riley told investigators she was taking Paxil to deal with depression and anxiety, and Michael Riley admitted he often became verbally abusive with his children and once, a number of years ago, struck his wife. He blamed his temper on bipolar disorder and “intermittent rage disorder,” conditions for which he said he took no medication…”

Your thoughts?