Are Bipolar Drugs Safe For Kids?

A Child's Death Has Raised Questions About Diagnosing And Treating Bipolar Children

Rebecca Riley died from an overdose of her bipolar disorder medication. (CBS/The Early Show)

(May 3, 2007) -- (CBS) Rebecca Riley was a vibrant, smiling 4-year-old, but suffered from bipolar disorder and was placed on a cocktail of adult medications.

On the morning of Dec. 13, 2006, she died in her home in Hull, Mass., where was found lying on the floor next to her parents' bed.

Whether it was a horrible accident or something more may now be decided in a court of law. But the diagnosis and treatment of children for the disorder is highly controversial.

Valerie Berio lost more than her grandchild — her daughter, Carolyn Riley, and son-in-law, Michael Riley, are in jail, charged with Rebecca's murder. Prosecutors say they gave her an intentional overdose of drugs used to treat her disorder.

"It's still hard to believe she's gone," she told The Early Show national correspondent Tracy Smith. "It's impossible to believe she's gone. They (Rebecca's parents) adored her. They adore all of their children."

Rebecca was born into a family with a history of mental problems and was diagnosed as hyperactive at age 2 and as bipolar at 3. She was then put on several medications, which District Attorney Timothy Cruz, who is prosecuting the case, said were not properly administered.

"You're dealing with children and some children at the age of 2, 2 1/2," he said. "They may be nonverbal, so ask yourself this: Where is the doctor getting the information regarding this child?"

Cruz is asking that the Rileys be sentenced to life in prison if found guilty. The parents blame the doctor, the prosecutor blames the parents and overarching the whole story is the question of whether kids so young should be given such dire diagnoses and prescribed such dangerous drugs.

Many psychiatrists say that diagnosing children under the age of 8 is a very gray area. There is no data, very few case studies and they barely understand what bipolar disorder looks like in very young children, much less what these medications will do to them.

Dr. Janet Wozniak is not associated with the Riley case but is a leader in the field of diagnosing and treating bipolar disorder in children. She said she would rely on a parents' report and a short visit with the child to prescribe medication for a child.

"Because the symptoms of bipolar disorder are not always present in the office visit with the doctor," she said.

Rebecca was given a fatal dose of clonidine, a high blood pressure medication, which Wozniak says is commonly prescribed to bipolar kids.

"The medicine is often used because it has a sedating side effect," Wozniak said. "So it's used at bedtime to facilitate sleep, or it's used to decrease aggressive and hyperactive states during the day."

Dr. Kayoko Kifuji, who diagnosed Rebecca and prescribed the clonidine, has voluntarily stopped practicing, pending an investigation by the state licensing board. The Early Show's request for an interview was denied, but Tufts Medical Center, where Kifuji practices, released these statements: "Dr. Kifuji is on paid leave from the hospital and has voluntarily agreed not to practice medicine during this time," and "The care we provided was appropriate and within responsible professional standards."

Prosecutors argue the Rileys used Rebecca's bipolar diagnosis as an excuse to keep her sedated. Cruz said they were overmedicating her and Carolyn Riley often asked that a prescription be refilled early, because she'd lost or ruined some pills. In fact, within the last year more than 400 pills had been dispensed by the doctor to Rileys because they alleged that they lost pills, the pills were destroyed, the pills were contaminated or for other reasons.

"When they moved from Weymouth to hull they lost a bottle," Carolyn Riley's attorney said. "Is that unusual? Another bottle she said got wet. Is that unusual? Other pills that may have been lost may have been lost when they were broken in half because the pills are very, very tiny."

Bourbeau says they were only following doctor's orders and never gave Rebecca more pills than the doctor prescribed.

But a police report says Rebecca showed symptoms of overdose in the days leading up to her death. Berio disagrees.

"She never, ever appeared to be a child that ill," she said. "She had a cold! Kids get cold in the winter!"

Cruz argues that her parents should have known the difference between treating her and overmedicating her.

"For more than three days this little girl was dying at their home, at their premises, that other individuals present at the scene asked them, begged them to take this child to the hospital and they did not," he said.

But six days before Rebecca died, Bourbeau said she was seen by the doctor.

"Who else do you rely on but the doctor and the medical providers?" he said. "The parents are following the advice of the doctors."

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Berio says that it comes down to a simple issue of trust. The Rileys believed what the doctors told them.

"They should have asked more questions, yeah," she said. "But like I say they simply trusted that the doctor knew the best answer because she was trained and they weren't."

By: Tracy Smith
Source: CBS

Last updated: 05/07

Related Information:

• Psychiatrist Won't Practice Medicine After Girl's Death
• About Early-Onset Bipolar Disorder
• Diagnosing Bipolar Disorder in Children
• Prognosis Worse with Childhood Bipolar Disorder
• UC Study Finds Just 40% of Teens Rebound After Bipolar Treatment
• Study Looks at Bipolar Youth
• Mood Swings and Substance Abuse in Adolescents
• Toddlers Diagnosed with Bipolar
• Impact of Antidepressant Discontinuation on Relapse, Remission, and Mood Episode Cycling in Bipolar Disorder
• Children of Rage and Sorrow - More Children are Battling Mental Illness
• Course of Bipolar Disorder in Youths Described for the First Time
• Bipolar Disorder in Children: How Common Is it?
• About Early-Onset Bipolar Disorder
• How to Help Your Child
• Treatment and Parent’s Role in Treating Your Bipolar Child
• Addressing Educational Needs of Children with Bipolar Disorder
• Living with Bipolar as a Teen: Dealing with School (for teens)
• Mood Swings and Substance Abuse
• Girls with Bipolar Disorder
• Bipolar Patients Show Differences in MRI
• Brain Damage From Bipolar Disorder
• What Causes Bipolar Disorder?
• Bipolar is a Serious Psychiatric Condition

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