Girl's death stirs debate over psychiatric meds

Lingering concerns
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.

Slow, painful death
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.

Tantrums or bipolar disorder?
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.

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