The Tragic Death of Rebecca Riley
I read a news story the other day that was upsetting to me on so many levels – as a parent, a mental health advocate and simply as a human being. A four year old girl died from what appears to be an overdose of the prescription drugs she was being given for psychiatric disorders.
Rebecca Riley was taking Seroqel, an anti-psychotic; Depakote, which was presumably prescribed for bipolar disorder; and Clonidine, a blood pressure drug that is apparently used “off-label” to calm children. Off-label means that the drug is being used for a purpose other than the purpose approved by the FDA. Also, none of these drugs were approved by the FDA for use in children, for any purpose.
I have to say that my jaw dropped when I read this list of drugs, especially as Rebecca had been taking them since she was 2, when she was diagnosed with attention deficit disorder and bipolar disorder. Not only is prescribing a medication off-label risky, since it has not been tested for that purpose, but prescribing several off-label medications together is even riskier, since their interaction has not been tested.
On top of the off-label aspect, we do not know enough at this point about how these types of medications affect children. We have no idea how they will affect a child's development and organs. It's unclear at this point whether regular blood tests were being run on Rebecca to determine whether her organs were being affected. Her autopsy did uncover damage to her heart and lungs, due to “prolonged abuse of these prescription drugs.”
The parents, Michael and Carolyn, have been charged with giving her an overdose of Clonidine, to “help” her sleep. Apparently this, along with the Depakote and over the counter cough medicine, led to her death.
Of course, the finger-pointing has already started. The lawyer for the parents is putting the blame on the doctor, questioning whether Rebecca should have been prescribed such strong medicine in the first place. The doctor claims that she specifically warned the mother against giving Rebecca more than the prescribed amount of Clonidine and threatened to report her to the Department of Social Services (DSS) if she did so.
In fact, the Massachusetts Department of Social Services investigated numerous complaints against the parents in the past, of both neglect and sexual and physical abuse. Michael Riley was ordered out of the home by DSS in 2005, but was apparently living there at the time of Rebecca's death.
This whole incident is wrong in so many ways, but one thing that really disturbs me is that I find it hard to believe that you can diagnose a two year old with bipolar disorder and ADD. Kids that age are moving targets. What child at age two actually has an attention span, for instance? What is also disturbing is that Rebecca's doctor prescribed almost identical medication for her two siblings as well. This really stretches the bounds of credulity for me. All three of them had exactly the same problems? Or was it that the doctor relied on the parents' description of the children's' problems for her diagnosis?
Since there was no mention of it in any of the articles, I can only assume that Rebecca and her parents did not see a therapist in order to find non-medication methods of managing Rebecca's behavior. Even though the father, Michael Riley, blamed his temper on bipolar disorder, he did not take medication. So why was it okay to give Rebecca medication?
I know that it's easy for me to be self-righteous about not giving children psychiatric drugs. My son, at least so far, shows no signs of any type of psychiatric disorder. And given that he's a normal child in every other way and not always an angel, I can imagine that caring for a young child with depression or bipolar disorder is a challenge that my husband and I are lucky we weren't presented with. So I have no idea what the Rileys went through. However, I know that my husband and I would try non-medication ways to treat him first. Although I am on an antidepressant and am very enthusiastic about the success of these drugs in treating depression, I would try my hardest not to put my child on one. We just don't know enough about treating children with psychiatric drugs at this point. To my way of thinking, they should be reserved for the most severe cases.
I do know of one parent who had her son's pediatrician prescribe one psychiatric medication after another for her son's “depression.” Unfortunately, she never had her son properly diagnosed with depression by a psychiatrist. She didn't understand why none of the antidepressants worked for him. I was dying to say to her, “That's because he doesn't have depression, you idiot! If you don't have depression, then antidepressants don't do anything!” Talk about stating the obvious. (Ironically, she wasn't at all concerned about the eating disorder she created in her son by telling him he was too fat.)
But I prefer to think that's she's the exception instead of the rule. At the end of the day I believe that what we have, more often than not, are doctors who are taking their best guess, using the information they have available, in treating psychiatric disorders in children and parents who are trying to do their best for their child, but are at their wit's end.
In the Rebecca Riley case, however, in the final analysis I think the tragic result was due to neglect by the parents compounded by a doctor who was too willing to prescribe medicine that probably was unnecessary and excessive. It's unutterably sad that a little girl spent most of her short life with neglectful parents, in a fog from drugs that she didn't need. And it should never, ever happen again.
Published On: February 23, 2007