Rebecca Jeanne Riley (April 11, 2002 – December 13, 2006) was a four-year-old girl from Massachusetts. In December 2006, Riley's parents gave Riley—who had been diagnosed with attention-deficit hyperactivity disorder and pediatric bipolar disorder between two and three years old—a lethal dose of clonidine. Her death sparked significant controversy over the diagnosis of psychiatric conditions and subsequent prescription of psychotropic medication for children.
Background Rebecca Jeanne Riley was born on April 11, 2002, in Springfield, Massachusetts, to Carolyn (née DiSalvo) and Michael Riley. Riley lived with two older siblings, Gerard and Kaitlynne. She also had an older half-sister, Ashley, whom Carolyn had surrendered in an open adoption at two years old. Most of the Riley family had been diagnosed with mental illness. Michael, who had unmedicated bipolar disorder and "intermittent rage disorder", had reportedly been arrested for assault and battery in 1998. Carolyn took medication for migraines and Paxil for depression and anxiety. Gerard and Kaitlynne were reportedly under the care of child psychiatrist Kayoko Kifuji for pediatric bipolar disorder and attention-deficit hyperactivity disorder (ADHD). Kaitlynne had been diagnosed with bipolar disorder in April 2003, when she was two years old, and prescribed the mood stabilizer Depakote (valproate). A social worker disagreed with Kaitlynne's diagnosis, stating that her behavior was normal for a toddler. Both parents were unemployed, lived in Section 8 housing and received monthly Social Security Disability Income. Gerard and Kaitlynne both qualified for Supplemental Security Income payments, which totaled about $2,300 per month. The family received an estimated total of $2,700 per month. Relatives and Kifuji noted that the Riley parents did not administer medication according to doctor's orders. Both parents reportedly nicknamed mood stabilizers and clonidine "happy medicine" and "sleep medicine," respectively. Carolyn allegedly offered her Paxil and migraine medications to a housemate, and had given Kaitlynne some of Gerard's clonidine tablets before Kifuji had prescribed the medication for her.
Psychiatric treatment
Beginning of psychiatric treatment On August 27, 2004, when Riley was two years old, her parents reported to Kifuji (then working at the Tufts-New England Medical Center) that the girl was hyperactive, getting little sleep, and acted violently towards her older siblings. Kifuji, who had already been treating the older two Riley children, stated that she believed Carolyn was accurately reporting her children's behaviors and reactions to the medications. Riley was diagnosed with ADHD and prescribed one tablet of clonidine, an antihypertensive drug that is also used off-label for ADHD in children. At this point, Kifuji was reportedly seeing all three children in the span of an hour, giving her approximately 20 minutes to assess Riley's behavior. After the diagnosis, Riley's parents submitted an application for Supplemental Security Income, which, if approved, would have provided another US$630.00 to the Riley family. However, the application was denied. Within less than a week, Carolyn began giving Riley two tablets of clonidine without Kifuji's approval. On September 1, she informed Kifuji of the increased dosage over the phone. Though Kifuji had not given her permission to do this, she authorized the increase. Kifuji reportedly increased Riley's clonidine dosage again in January 2005. In May 2005, Riley's parents claimed to Kifuji that the now three-year-old Riley was experiencing mood swings and crying frequently. Kifuji diagnosed Riley with pediatric bipolar disorder, which she later explained was due to the girl's in-office behavior and family history. For bipolar disorder, Riley was prescribed the mood stabilizer Depakote (valproate).
Early Social Services involvement Michael Riley was arrested in June 2005 after Carolyn's 13-year-old daughter accused him of sexual assault. In light of these allegations, the Massachusetts Department of Social Services (DSS) required him to leave the Weymouth apartment, only see his children under direct supervision, and barred him from staying at the apartment overnight. Afterwards, neighbors allegedly became hostile towards the family, vandalizing their apartment and car. There were no documented changes to Riley's prescription regimen until October 27, 2005, when Carolyn reported that she had increased Riley's nightly dose of clonidine to two and a half tablets, allegedly to help the child sleep. Kifuji, alarmed, explained to Carolyn that such an increase could prove fatal and told her to talk to her about adjustments to Riley's medications. She allegedly told Carolyn that if the mother further increased the dose on her own, she would report her to DSS. Riley was then prescribed Zyprexa (olanzapine), an atypical antipsychotic frequently used for the treatment of bipolar disorder.
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