The Rebecca Riley Story

Hull parents arrested in girl's poisoning death

By David Abel, Globe Staff | February 6, 2007

The parents of a 4-year-old girl from Hull were arrested yesterday on murder charges after investigators concluded they poisoned their daughter, prosecutors said.

Michael Riley , 34, and his wife, Carolyn, 32, were taken into custody at his mother's house in Weymouth in the death of their daughter Rebecca in December, said officials in the Plymouth district attorney's office.

Just after 6:30 a.m. on Dec. 13, Hull police responded to a call for an unresponsive girl at the family's home on Lynn Avenue, prosecutors said. They found Rebecca dead on her parents' bedroom floor.

An investigation by State Police and Hull police found the girl had been prescribed the drugs clonidine for attention deficit hyperactivity disorder and valproic acid and Seroquel for bipolar disorder. A psychiatrist had diagnosed her with both disorders at age 2 1/2, prosecutors said.

The medical examiner's office determined the girl died from "intoxication due to the combined effects" of the drugs clonidine, valproic acid (Depakote), dextromethorphan, and chlorpheniramine, the district attorney's office said in a statement.

"This occurred as a result of the intentional overdose of Rebecca with clonidine," the statement said. "The manner of death was determined to be homicide."

Clonidine is approved by the Food and Drug Administration to treat high blood pressure, but is sometimes used to treat hyperactive symptoms.

The mothers of both Michael and Carolyn Riley said last night the couple is innocent.

Valerie Berio , Carolyn Riley's mother, called the homicide charges "ludicrous."

"She was their treasure, their angel," Berio said in a telephone interview. "They loved her more than life itself. They didn't consciously give her anything to make her go to sleep and not wake up."

She said Rebecca had been described as hyperactive in school, but had been recently seen as "a little too quiet" by school administrators.

Berio said the couple grew up in Weymouth, knew each other since they were young, and married in 1994. She said Michael Riley is unemployed and claims disability. "Michael is the sweetest kid in the world. They would have never wanted to hurt their daughter," Berio said. "I love him like he's my own kid."

Kathleen Riley , Michael's mother, described the couple as great parents.

"I can't believe this is happening," she said in a telephone interview. "It's a terrible disgrace. I have no idea how anyone could say this is deliberate. I'm shocked. They loved their children."

She said the couple had a miscarriage six years ago and had been living apart for the last year, though they were in the home together the morning Rebecca died.

"He's been a wonderful father," Riley said. "All the charges against them are false. He cried at night because he had to live with me for the past year. He's been under such pressure. The poor kid. I don't know how he's going to handle this. They just wanted to be together."

Denise Monteiro , a spokeswoman for the state Department of Social Services, said the department "found evidence for neglect" of Rebecca.

On Dec. 13, the agency removed the couple's other children, a 6-year-old girl and an 11-year-old boy, from the home, Monteiro said. They remain in foster homes.

In 2005, DSS began investigating allegations that Michael Riley sexually abused a 13-year-old girl , Monteiro said. Kathleen Riley and Berio identified the girl as Carolyn Riley's daughter from another relationship. The girl had been adopted to another home in 2002.

Also in 2005, DSS launched an investigation into whether Carolyn Riley had neglected her children, Monteiro said.

"We supported the allegations of abuse, and we forwarded that report to the Norfolk district attorney's office," she said. "We also supported the allegations of neglect against the mother."

The status of those allegations was unclear last night.

A spokesman for the Norfolk district attorney's office did not return calls.

Berio called the allegations of abuse "completely ridiculous."

"There's no evidence at all to back them up," she said. "But it devastated them, and now it has snowballed to this."

In June 2005, DSS ordered Michael Riley out of the home, Monteiro said. He was only allowed to see the children under supervision by a DSS official, she said.

"We're investigating why Michael Riley was at the home without supervision," when police found Rebecca dead, Monteiro said last night.

John R. Ellement of the Globe staff and correspondents Franci Richardson Ellement and Michael Naughton contributed to this report. David Abel can be reached at dabel@globe.com. © Copyright 2007 The New York Times Company

DSS dropped inquiry before girl, 4, was found dead

Got assurances on medications

By Maria Cramer, Globe Staff | February 8, 2007

The state Department of Social Services received a report raising concerns about whether Rebecca Riley was taking too many powerful prescription drugs last summer, but dropped the issue after receiving assurances from her mother and doctors that the treatment was appropriate.

Despite the concerns raised by a therapist, the agency did not seek an independent review of the child's treatment until after the 4-year-old died from an overdose on Dec. 13.

DSS spokeswoman Denise Monteiro said yesterday that the agency sought the second opinion after Rebecca died because it was concerned about her 6-year-old sister and 11-year-old brother, who had received similar diagnoses and medication. DSS immediately took custody of Rebecca's siblings and put them in foster homes.

Monteiro would not disclose the conclusions of the review, which DSS received last month.

"After the child died, there was so much questioning about medication, we decided to seek an independent second opinion," said Monteiro. "We hadn't received an autopsy report about her death, and we were concerned that the two children could face similar trauma."

Rebecca's parents were arraigned Tuesday on first-degree murder charges that they gave her a fatal dose of an anti-hyperactivity drug. The child's psychiatrist, Dr. Kayoko Kifuji of Tufts-New England Medical Center, agreed yesterday to stop treating patients while the state investigates her role in the case.

State lawmakers said yesterday they plan to hold a hearing in which psychiatrists, physicians, pharmacists, and others would discuss whether young children are being overprescribed powerful drugs.

"The Rebecca Riley case represents a tremendous failure by the state, parents, physician, and pharmacy, and highlights the need for closer scrutiny of the medications being administered to children," said Representative Peter J. Koutoujian, a member of the Committee on Child Abuse and Neglect.

Legislative leaders created the panel, which wrapped up its first set of hearings this week, amid harsh criticism of DSS over some high-profile cases: Haleigh Poutre, a Westfield 11-year-old whose life support was almost withdrawn prematurely by DSS in January 2006; and Dontel Jeffers, a 4- year-old Boston boy allegedly beaten to death by his foster mother in 2005.

In Rebecca's case, Koutoujian said, he wanted to know why the agency was unable to save the girl despite its history with her family.

The state, the child's parents, the psychiatrist, and the pharmacies that filled the girl's prescriptions all share some responsibility for her fate, he said.

"You've got four levels that could have caught something, and the confluence of misses that created a window for tragedy," said Koutoujian, a Newton Democrat.

DSS has been involved with the Riley family since December 2002, when it investigated alleged neglect of the oldest child.

Last June, the agency received another complaint about the family after the eldest son was taken to a local hospital. Doctors told agency representatives that the boy was hospitalized because of a medical condition, Monteiro said.

Last July, DSS representatives met with doctors, neurologists, and other medical professionals treating Rebecca, her siblings, and their mother, Carolyn Riley, now 32, after a therapist who visited their house in Weymouth told the agency Carolyn Riley seemed sluggish and drugged.

Carolyn Riley later told investigators she takes Paxil for depression and anxiety.

"We were assured that the levels and the amount were within the guidelines," Monteiro said. "We were assured by the mother's doctors as well that the mother was not receiving too much medication."

The therapist from South Bay Mental Health Center in Weymouth later told police that she was concerned by the type and amount of medication prescribed for Rebecca and that Kifuji expressed similar concerns in a phone conversation in May, according to an affidavit in support of the couple's arrest that was written by State Police investigators and released Tuesday.

Last October, the agency received another complaint, said Monteiro. The affidavit said that Michael Riley, 34, grabbed the same child by the neck and slammed his head against the back window of a pickup truck.

Carolyn Riley agreed to file a restraining order against her husband, but, according to the affidavit, she allowed the order to lapse.

In a follow-up meeting on Nov. 10 -- the last DSS contact with the family before Rebecca's death -- Carolyn Riley said that the restraining order had not expired and that she planned to move her family to Hull, Monteiro said.

"We wanted to meet with her and the children and reassure that things are going good," Monteiro said. "She assured us that the husband would not be coming to live with the family."

But two weeks before Rebecca's death, Michael Riley moved back into the house, despite being told by DSS not to be with the children unsupervised.

About 6:30 a.m. on Dec. 13, a breathless Michael Riley called 911. "My daughter passed away in the night," he told the operator.

Police found her dead, wearing only a pink pull-up diaper and lying on her left side on top of clothes and a stuffed brown bear, according to the affidavit.

Within days, Monteiro said, DSS filed a request with the Probate and Family Court to seek a review of the children's treatment from an independent medical agency. "We wanted a second opinion on everything," she said.

Hull Police Chief Richard Billings said yesterday that officers continue to investigate the child's death, but he declined to say whether there would be any charges against Kifuji or any pharmacists who provided the medication.

Between Aug. 15 and Nov. 27, the Rileys obtained 15 refills of clonidine, the drug that eventually killed Rebecca, from a Walgreens in Weymouth, the affidavit said.

Michael Polzin, a spokesman for Walgreens, said the drugstore chain was contacted by a State Police officer who said the company is not under investigation.

"We are deeply saddened to hear about this," Polzin said. "As far as the medication that was taken, we filled a valid prescription authorized by the patient's physician, and all of the appropriate drug information and directions were given to the family."

Koutoujian said he plans to ask pharmacists, physicians, psychiatrists, and other medical specialists to testify at the hearing, which he said would be held in March. .

"The role of this committee will not be to assess blame," he said. "We've got to know what went wrong here, so this travesty is never replicated in the future."

Maria Cramer can be reached at mcramer@globe.com. © Copyright 2007 The New York Times Company

Rebecca Riley Case: Timeline

February 8, 2007

A chronology of involvement by the state Department of Social Services with the family of 4-year-old Rebecca Riley.

December 2002: DSS receives a complaint that the Rileys' oldest child had been neglected while the family was living in Springfield. DSS substantiates the complaint and opens a file on the family.

June 2005: DSS investigates allegations that Michael Riley had sexually abused Carolyn Riley's 13-year-old daughter from another relationship and refers case to Norfolk district attorney's office. DSS also investigates whether Carolyn Riley had neglected the couple's three children.

June 2006: The oldest child, an 11-year-old boy, is taken to the hospital by ambulance. DSS is assured by doctors and neurologists that he was not abused or neglected.

June 2006: A therapist working with Rebecca and her 6-year- old sister files a complaint with DSS after Rebecca's 6- year-old sister said during a home visit that Michael Riley had hit her. DSS had already investigated and did not substantiate the report.

July 2006: The therapist files a second complaint with DSS, saying that during another home visit that Carolyn Riley appeared drugged and pointed out a puddle of urine where Rebecca had wet the rug while napping. DSS says doctors treating the Riley family say the mother and children are receiving appropriate medication.

October 2006: DSS investigates and substantiates reports from relatives that Michael Riley grabbed his son by the neck and slammed his head against a car window. Carolyn Riley seeks a restraining order.

November 2006: DSS meets in the agency's Weymouth office with Carolyn Riley, who says she plans to move to Hull and assures them the restraining order against her husband is still active.

Dec. 13, 2006: Rebecca Riley is found dead on her parents' bedroom floor. An autopsy later indicates she was poisoned by prescription medicine. DSS removes her siblings and places them in foster care. The agency also begins taking steps to seek a second medical opinion on the treatment and diagnosis of Rebecca Riley and her two siblings.

SOURCE: State Department of Social Services, State Police. © Copyright 2007 The New York Times Company

Psychiatrist to suspend practice; denies wrongdoing

By Liz Kowalczyk, Globe Staff | February 8, 2007

Dr. Kayoko Kifuji, the psychiatrist who treated Rebecca Riley in the months before the Hull girl died from an overdose of prescription drugs, agreed yesterday to immediately stop treating patients while the state investigates her role in the case.

The Board of Registration in Medicine accepted Kifuji's voluntary agreement to cease the practice of medicine at its meeting yesterday, a day after Riley's parents pleaded not guilty to murder charges for allegedly giving her excessive amounts of the drug Kifuji prescribed for the 4-year-old.

The agreement does not detail any specific allegations against Kifuji, who works at Tufts-New England Medical Center. But the board said in a statement that such agreements "are one tool available to the Board to ensure the safety of the public during the pendency of an investigation."

Nancy Achin Audesse, the board's executive director, said after the meeting: "Clearly this case and the attention it has garnered is very frightening to patients and to the public, and it raises a lot of questions. A voluntary agreement gives us time to gather information and decide what we need to do next."

Tufts-NEMC issued a statement yesterday saying that Kifuji is on a paid leave of absence, but that hospital executives could not comment further on the case, because of concern about medical confidentiality of the child.

The agreement is considered a disciplinary action that will appear on Kifuji's record as a physician. But she states in the document that "nothing contained in this agreement shall be construed as an admission or acknowledgment by me as to wrongdoing."

The doctor's lawyer said yesterday that she did nothing wrong. "Dr. Kifuji's diagnosis of Rebecca, her prescribing of medication, and the care provided was 100 percent appropriate under the circumstances," said attorney J.W. Carney Jr. "Dr. Kifuji agreed to a voluntary suspension from practice so that she can have the opportunity to present all of the facts to the board staff in a calm and professional setting, rather than the frenzy of an emergency hearing."

When asked whether he expected the Plymouth district attorney to pursue criminal charges against his client, Carney said that Kifuji "provided first-class medical care to her patient and did absolutely nothing wrong medically, never mind anything that was in violation of the law."

Kifuji began treating Riley in August 2004 and diagnosed her with attention deficit hyperactivity disorder and bipolar disorder. She prescribed medications, including clonidine, a blood pressure drug for adults that is also sometimes given to children to reduce aggressiveness and help them sleep. Prosecutors allege that Riley's parents, Michael and Carolyn Riley, intentionally killed their daughter in December by giving her an overdose of clonidine.

In a State Police affidavit filed Feb. 5 in Hingham court, investigators said they interviewed Kifuji twice about the care she provided to Rebecca Riley. She told police she saw the girl in her office sometimes every two weeks and other times every two months.

Carolyn Riley had told investigators that the doctor had said the parents could give Rebecca an extra half-tablet of clonidine at night if she couldn't sleep. But Kifuji emphatically denied that, according to the affidavit. "No! Never!" she is reported as saying.

Kifuji told police that Carolyn Riley called her in the early fall, saying she had lost an entire bottle of clonidine, so she reauthorized the medication. Rebecca's mother called her 10 days later, the affidavit quoted Kifuji as saying, stating that water had gotten into the new bottle and ruined the pills. At that point, Kifuji said, she authorized an additional 10-day supply and required all future prescriptions to be filled every 10 days to prevent more accidents.

Yesterday Carney defended his client's handling of the situation. "It appeared to Dr. Kifuji that she had no reason to disbelieve the mother's account of losing or wetting the medication," he said.

In a second interview with investigators, the doctor said that Carolyn Riley told her in October 2005 that she had gradually increased her daughter's nighttime dose of clonidine to 2 1/2 tablets from two tablets, according to the affidavit. Kifuji told investigators that she was shocked by the statement and explained to Carolyn Riley that an increased dose of the potent drug could kill Rebecca. She said she told her that if she went outside prescribed doses again, she would report her to the Department of Social Services.

Liz Kowalczyk can be reached at kowalczyk@globe.com. © Copyright 2007 The New York Times Company

Bipolar labels for children stir concern

Hull case highlights debate on diagnosis

Rebecca Riley's parents are accused of deliberately poisoning her with her prescription medication.

By Carey Goldberg February 15, 2007

The case of Rebecca Riley highlights a hot debate in psychiatric circles over the growing number of children who are diagnosed with bipolar disorder -- a battle centered largely in Boston but affecting the treatment of young patients nationwide.

Riley, the Hull 4-year-old who died of an overdose of psychiatric medications, was exceptionally young when she was diagnosed, just 2 1/2. But among somewhat older children, the bipolar label has proliferated to the point that some psychiatrists now suspect the diagnosis may be sometimes misused, placing some children at unnecessary risk from the serious medications that usually follow.

Others argue that many children are given different diagnoses, such as depression, when they should really be considered bipolar, a disorder that involves intense mood swings and hitting, biting, kicking, and screaming rages.

One thing is clear: In the past decade or so, the number of children diagnosed with bipolar disorder has risen dramatically. A study of mentally ill children in community hospitals, published last month in the Archives of General Psychiatry, found the proportion of children diagnosed as bipolar shot up from less than 3 percent in 1990 to 15 percent in 2000. Psychiatrists say the rate has continued to climb.

Why the increase? Psychiatrists at Massachusetts General Hospital were among those who spurred it. In 1995, they published research that contradicted the prevailing notion that bipolar disorder was exceedingly rare in children. Rather, they said, 16 percent of the children referred to their psychopharmacology clinic fit the diagnosis. Overall, that would mean perhaps 1 percent of all children may be affected.

"We support early diagnosis and treatment because the symptoms of this disorder are extremely debilitating and impairing," said Dr. Janet Wozniak , director of the Pediatric Bipolar Program at Mass. General. They "bring reckless and impulsive behaviors here and now and a long- term risk" for suicide, drug abuse, and crime, she said.

The psychiatric controversy is over diagnosing children before their teen years. There is virtually no scientific research on children younger than 6. "Diagnosing and treating preschoolers is what I would call uncharted waters," Wozniak said, but research suggests the disorder often begins that early, and "it's incumbent on us as a field to understand more which preschoolers need to be identified and treated in an aggressive way."

Rebecca was prescribed an antipsychotic medication, a drug used to treat bipolar disorder in adults, and a blood pressure medication that is sometimes used to help hyperactive children sleep. She died in December. Her parents are charged with murder, and the Board of Registration in Medicine is investigating the role played by her psychiatrist, Dr. Kayoko Kifuji of Tufts-New England Medical Center.

Recent studies document a steep increase in prescriptions of anti psychotic drugs to children of all ages. That probably stems from the increasing diagnosis of bipolar disorder, said Wozniak, who gets about 90 percent of her research funding from the federal government, 5 percent from philanthropies, and 5 percent from companies that make psychiatric drugs. "Still," she said, "the overall number of prescriptions is probably small relative to the number of children who need help."

The opposing camp, psychiatrists who want to define bipolar disorder more narrowly and sparingly, questions whether the disorder really affects so many children and whether the benefits of the diagnosis outweigh the risks of the drugs in many cases.

"Particularly over the last five to eight years, people like myself have become more alarmed at what we see as the misdiagnosis and the over use of medications," said Dr. Jennifer Harris , a clinical instructor at Harvard University and supervisor at Cambridge Health Alliance. "I think clinical practice got way ahead of the science. . . . There are so many pressures -- some conscious, some unconscious -- to medicate these kids that I think clinicians jumped on this diagnosis way ahead of the evidence."

Harris and others point out that a diagnosis of bipolar disorder is considered more serious than attention deficit hyperactivity disorder or post traumatic stress disorder. A child diagnosed as bipolar thus tends to have much easier access to a range of help, from a spot in a therapeutic school to insurance coverage for hospitalization.

Another factor in the increased use of the diagnosis is the availability of new, potentially effective drugs, particularly anti psychotics and mood stabilizers. As the diagnosis gained popularity in recent years, so did prescriptions for powerful anti psychotic drugs such as Risperdal and Zyprexa -- which have been approved for use in adults, but are prescribed for children.

If there's a chance that a drug may calm down a dangerously out-of-control child and the drug is indicated for bipolar disorder, then it may make sense to diagnose the child with bipolar disorder, said Dr. George Dominiak , medical director of Westwood Lodge, a private psychiatric hospital in Massachusetts.

"It's a tail-wagging-the-dog kind of thing," he said. "The treatments affect our observations and our labeling as well."

Evidence has been mounting, however, that antipsychotic drugs can cause health problems, such as diabetes and significant weight gain. "These are bad enough in themselves, but the concern is that if you have kids on these medications for extensive periods of time, then they may develop major medical problems as adults," said Dr. S. Nassir Ghaemi , director of the Bipolar Disorder Research Program at Emory University. (He has consulted for most of the drug companies that make the anti psychotics.)

Another possible factor in the increase of the bipolar diagnosis is the growing awareness among psychiatrists that if they diagnose a bipolar child as being only depressed and prescribe antidepressants, the drugs could make the child dangerously worse, possibly even suicidal and psychotic. Similarly, if a child has underlying bipolar disorder but is diagnosed as having attention deficit hyperactivity disorder and prescribed a stimulant, the symptoms could worsen, said Cambridge Health Alliance psychiatrist Nancy Rappaport.

Further complicating the diagnosis: Abused or traumatized children can seem to have bipolar disorder when they are actually reacting to horrors in their lives. Academic researchers have begun to make progress in refining the outlines of what constitutes bipolar disorder in children.

But still, Rappaport said, the question of whether to diagnose a child with bipolar disorder can be "an agonizing clinical decision." "Still," she said, "the overall number of prescriptions is probably small relative to the number of children who need help."

Debate Over Children and Psychiatric Drugs

Early on the morning of Dec. 13, police officers responding to a 911 call arrived at a house in Hull, Mass., a seaside town near Boston, and found a 4-year-old girl on the floor of her parents’ bedroom, dead.

She was lying on her side, in a pink diaper, the police said, sprawled across some discarded magazines and a stuffed brown bear. Last week, prosecutors in Plymouth County charged the parents, Michael and Carolyn Riley, with deliberately poisoning their daughter Rebecca by giving her overdoses of prescription drugs to sedate her. The police said the girl had been taking a potent cocktail of psychiatric drugs since age 2, when she was given a diagnosis of attention deficit disorder and bipolar disorder which is characterized by mood swings.

The parents have pleaded not guilty, with their lawyers questioning whether the child should have been prescribed such powerful drugs.

The case has shaken a region known for the excellence of its social and medical services. The director of the state’s Department of Social Services has had to defend his agency, which had been investigating the case before the girl’s death.

The girl’s treating psychiatrist has taken a voluntary, paid leave until the case is resolved. And New Englanders are raising questions that are now hotly debated within psychiatry, and which have broad implications for how young children like Rebecca Riley are cared for.

Tufts-New England Medical Center, where the child was treated, released a statement supporting its doctor and calling the care “appropriate and within responsible professional standards.”

Indeed, the practice of aggressive drug treatment for young children labeled bipolar has become common across the country. In just the last decade, the rate of bipolar diagnosis in children under 13 has increased almost sevenfold, according to a study based on hospital discharge records. And a typical treatment includes multiple medications. Rebecca was taking Seroquel, an antipsychotic drug; Depakote, an equally powerful mood medication; and Clonidine, a blood pressure drug often prescribed to calm children. The rising rates of diagnosis and medication use strike some doctors and advocates for patients as a dangerous fad that exposes ever-younger children to powerful drugs. Antipsychotics like Seroquel or Risperdal, which are commonly prescribed for bipolar disorder, can cause weight gain and changes in blood sugar — risk factors for diabetes Some child psychiatrists say bipolar disorder has become an all-purpose label for aggression.

“Bipolar is absolutely being overdiagnosed in children, and the major downside is that people then think they have a solution and are not amenable to listening to alternatives,” which may not include drugs, said Dr. Gabrielle Carlson, a professor of psychiatry and pediatrics at Stony Brook University School of Medicine on Long Island. Paraphrasing H. L. Mencken, Dr. Carlson added, “Every serious problem has an easy solution that is usually wrong.”

Others disagree, insisting that increased awareness of bipolar disorder and use of some medications has benefited many children. “The first thing to say is that the world does not see the kids we see; these are very difficult patients,” said Dr. John T. Walkup, a child and adolescent psychiatrist at the Johns Hopkins University School of Medicine. Dr. Walkup said that when drug treatment was done right, it could turn around the life of a child with a diagnosis of bipolar disorder.

Dr. Jean Frazier, director of child psychopharmacology at Cambridge Health Alliance and an associate professor at Harvard, said that up to three-quarters of children who exhibit bipolar symptoms become suicidal, and that it is important to treat the problem as early as possible. “We’re talking about a serious illness with high morbidity, and mortality,” Dr. Frazier said, “and for some of these children the medications can be life-giving.” Still, most child psychiatrists agree that there are still questions about applying the diagnosis to very young children. Recent research has found that most children who receive the diagnosis are emotionally explosive but do not go on to develop the classic features of the disorder, like euphoria. They are far more likely to become depressed. And many therapists have found that some patients referred to them for bipolar disorder are actually suffering from something else. “Most of the patients I see who have been misdiagnosed have been told they have bipolar disorder,” said Dr. Bessel van der Kolk, a professor of psychiatry at Boston University who runs a trauma clinic. “The diagnosis is made with no understanding of the context of their life,” Dr. van der Kolk said. “Then they’re put on these devastating medications and condemned to a life as a psychiatry patient.”

Details about what happened to Rebecca are still emerging. A relative of her mother, Carolyn Riley, 32, told the police that Rebecca seemed “sleepy and drugged” most days, according to the charging documents. One preschool teacher said that at about 2 p.m. every day the girl came to life, “as if the medication Rebecca was on was wearing off,” according to the documents.

Defense lawyers are also focusing on the question of medication. “What I want to know,” said John Darrell, a lawyer for Mr. Riley, “is how in the world you diagnose a 2- year-old and give her these strong medicines that are not approved for children.” A lawyer for Rebecca’s psychiatrist, Dr. Kayoko Kifuji of Tufts-New England Medical Center, did not return calls seeking comment.

Some experts say the temptation to medicate can be powerful. “Parents very often want a quick fix,” Dr. Carlson said, “and doctors rarely have much time to spend with them, and the great appeal of prescribing a medication is that it’s simple.” “To me one of the miracle of children’s brains is that we don’t see more harm from these treatments.”

Mom charged in child’s drug overdose says bipolar diagnosis wrong

BOSTON - A mother charged with killing her 4-year-old daughter with an overdose of prescription drugs now believes her daughter was probably misdiagnosed with bipolar disorder, she said in her first interview since her arrest.

In an interview scheduled for broadcast Sunday on "60 Minutes," Carolyn Riley said she believed a psychiatrist’s diagnosis of her daughter, Rebecca, but now has doubts. Riley was interviewed by Katie Couric for a story on the increase of bipolar diagnoses in children.

When Couric asked her what she believed was wrong with her daughter, Riley said, "I don’t know. Maybe she was just hyper for her age."

Riley said she wondered whether Rebecca could be just a normal toddler, (but) "the psychiatrist said that she thought that it was more than just normal." She described Rebecca’s behavior as "constantly getting into things ... running around, not being able to settle down."

Prosecutors claim Riley and her husband, Michael, gave their daughter more pills than the psychiatrist prescribed to keep her quiet and make her sleep for long periods of time. They have claimed they were only following the doctor’s orders. Both are charged with first-degree murder in their daughter’s death.

Rebecca Riley was found dead on the floor of her parents’ bedroom in Hull on Dec. 13. The medical examiner determined she died of a lethal combination of prescription drugs.

Prosecutors allege that Carolyn Riley concocted symptoms of bipolar disorder and attention deficit hyperactivity disorder in an attempt to qualify Rebecca for government benefits.

Rebecca’s two older siblings were also diagnosed with bipolar and ADHD and were receiving Supplemental Security Income, the program administered by the Social Security Administration for disabled children.

Prosecutors say that in one year Carolyn Riley got over 200 more pills than should have been prescribed for Rebecca by claiming she either lost or ruined bottles of pills, and by telling a pharmacy she had run out.

From CBS News 60 Minutes:

What Killed Rebecca Riley?

On Dec. 13, 2006, police responded to a 911 call and found a little girl lying dead on the floor next to her parents' bed. The autopsy revealed that she had died from an overdose of psychiatric drugs. Rebecca Riley was being treated for bipolar disorder, or manic depression, even though she was just four years old.

If that sounds unusual to you, it's not. As Katie Couric reports, until recently the disorder was believed to emerge only in adults. Now, it is estimated that there are nearly one million children diagnosed as bipolar, making it more common than autism and diabetes combined. And to treat it, doctors are administering some medications that have yet to be approved for children. In the case of Rebecca Riley, that cocktail of medications proved fatal and now her parents have been charged with her murder.

Carolyn Riley is now in jail in Boston awaiting trial and is being medicated for depression. She told 60 Minutes her daughter's problems began when Rebecca was only two years old. Carolyn took her to a psychiatrist because she had difficulty sleeping and seemed hyperactive.

"Constantly getting into things, running around, not being able to settle down," Riley remembers.

"Did you ever think, 'Well, she's two and a half years old.' There's this thing called the terrible 2's. Did you think this could, in fact, be normal?" Couric asks.

"Yes," Riley tells Couric. "The psychiatrist said that she thought that it was more than just normal."

The toddler who could barely speak in full sentences was diagnosed with bipolar disorder after several sessions over eight months. She had just turned 3. And she wasn't the only one in the family: her ten-year-old brother and four-year- old sister were already being treated for the same illness by the same doctor at Tufts-New England Medical Center. Rebecca was eventually prescribed three medications to stabilize her mood: Seroquel, an anti psychotic; Depakote, an anti seizure drug; and Clonidine, a blood pressure medication -- medications that would ultimately prove fatal on Dec. 13th.

Riley says she thought Rebecca had just a little bit of a cold and gave her daughter "Children's Tylenol Plus Cough & Runny Nose."

In the middle of the night, Riley remembers her daughter didn't want to go to sleep. "So I brought her in the room. She was right beside me on the floor. And I laid down and went to sleep," she recalls.

Before she put her to bed that night, next to her on the floor, Riley says she gave her daughter half a Clonidine.

Asked why, Riley tells Couric, "Because she hadn't been able to get to sleep since six o'clock."

"Then what happened?" Couric asks.

"Then I woke up to the alarm in the morning. And knelt down to wake her up. And there was no waking her up," Riley replies.

Riley says she knew at that point that her daughter had died. Carolyn Riley and her husband Michael were charged with first-degree murder.

The prosecutor alleged at their arraignment in February that they were overdosing Rebecca by repeatedly giving her more medication than she was prescribed. "It was used on Rebecca, her sister and her brother for one simple purpose by these defendants: to knock them out and make them sleep," the prosecutor claimed.

But the Rileys claim that they were following doctor's orders. 60 Minutes wanted to talk to the psychiatrist, Dr. Kayoko Kifuji, but she declined. Instead 60 Minutes got a statement from her hospital: "The care we provided was appropriate and within responsible professional standards."

60 Minutes did obtain a copy of Rebecca's medical records. In them, Dr. Kifuji notes Rebecca's increased risk of mental illness because of her family history. She diagnosed Rebecca after Carolyn said her daughter was - quote - "driving me crazy" and her mood switches within a minute. She would eventually prescribe the preschooler more than ten pills a day.

Riley says she did feel that that was a lot of pills for a little girl, but she says she went ahead and gave Rebecca the prescriptions. "I trusted the doctor," she says.

Dr. Kifuji has stopped practicing, pending a ruling by the state medical board. But her lawyer has said she was just practicing mainstream psychiatry. It's now estimated that nearly one million children like Rebecca Riley have been diagnosed with bipolar disorder, or manic depression. And while some psychiatrists told 60 Minutes that early diagnosis is saving lives, a growing number of doctors say it is being over-diagnosed.

60 Minutes went to talk to one of the leading proponents of the diagnosis of bipolar disorder in children and whose research Dr. Kifuji has said influenced her. He is Dr. Joseph Biederman, professor at Harvard and head of child psychopharmacology at Mass General Hospital.

"Previous studies that were conducted in the '70s and '80s determined it was very, very rare for a child to have bipolar disorder. And now you're saying up to a million children are running around with this," Couric remarks. "Why such a sea change?"

"The idea is rare if you define it in very strict ways," Dr. Biederman explains. "Our contribution has been to describe the many ways that this condition may emerge in children that may make it a little bit more diagnosable and less rare than people have thought about it."

The classic adult definition for manic depression or bipolar disorder is dramatic mood swings from severe highs to severe lows, which can last for weeks or months. Dr. Biederman's definition for children, though, is much broader. It emphasizes extreme irritability and at least four other symptoms such as recklessness, sleeplessness and hyperactivity. And while most doctors now believe that a child can be bipolar, there is no definitive medical test.

Now there's a cottage industry of bestselling books, magazine covers and Internet sites where you can test your child online. But even the top researchers can not agree on exactly what bipolar disorder looks like in children or at what age it can be diagnosed.

"The average age of onset is about four," Biederman says. "It's solidly in the preschool years."

"What about those who say, 'Oh, come on Dr. Biederman, a preschooler displaying these characteristics is often acting like a preschooler,'" Couric asks.

"Absolutely not," Biederman says. "The bar to consider a diagnosis in a very young child is very high."

Asked if he worries that his work is being used or applied too broadly and that too many children are being diagnosed as a result, Biederman tells Couric, "I am not so concerned if a practitioner recognizes that the symptoms have to be severe, debilitating, devastating, to consider the diagnosis."

Rhys Hampton was three years old when he began to have violent and explosive outbursts. After a year of treatment, his mother, Diana, says a psychiatrist told her he thought Rhys was bipolar.

"Would you describe his behavior as behavior that is extraordinary, severe, dangerous, and effects every, single aspect of his life?" Couric asks.

"Yeah. Every single aspect of his life," Hampton says.

"Bipolar disorder is also described as manic depression. Did he ever get depressed? Did he ever get sad?" Couric asks.

"He would tell us, you know, 'You don't love me.' 'You don't like me.' 'I don't like myself.' 'I hate myself.' 'I'm stupid.' 'Nobody likes me.' 'I wanna die.' Four-year-olds don't talk like that," Hampton says.

After Rhys' psychiatrist suggested a fourth medication, the Hamptons said "Enough."

They took their son to Seattle Children's Hospital, where they were told Rhys wasn't bipolar. He now takes medication for hyperactivity and a sleep disorder. And he's learning to deal with his explosive moods through a behavioral program.

"I mean, there's no comparison to the child that we're parenting today, as opposed to the one that we had last year," Hampton says.

Dr. John McClellan, who's familiar with Rhys' case, says the children's psychiatric hospital he runs in Washington state is filled with kids who have been misdiagnosed as bipolar. He says it has become a catchall for aggressive and troubled children.

"I think it's a problem to label kids with a major adult psychiatric disorder when they're five years old or when they're three years old," Dr. McClellan says. "Little kids are not adults. And little kids do things that if an adult did them, it would be evidence of a mental health problem."

"Having said that, if someone is bipolar and it presents later in life, doesn't it make sense that these issues exist really from birth?" Couric asks.

"No, that does make sense," McClellan says. "The problem is symptoms like irritability or recklessness or high energy when you're an eight-year-old don't necessarily predict in the long run developing bipolar disorder. Some might. Do you expose all those kids to medications to prevent the one kid that's going to get it?"

"Not that I don't use medicines, I do but the average kid comes into my hospital now on four different medicines. We had one kid that was recently admitted to our in-patient program that was on 12 psychotropic agents. At some level, there needs to be something else that's used besides just continuing to add medication after medication," McClellan says.

Dr. McClellan says we don’t really know how these drugs interact or effect developing brains because most are being used off-label, which means they haven't been approved by the FDA for use in children.

"Does it disturb you or worry you that many of these medications, most of these medications are being used off- label, and have not been tested in children?" Couric asks Biederman.

"Yes. I recognize the fact that we have a gap in knowledge," Biederman says. "But the patients that come to me, and the families in tears and despair with these type of problems, I in good faith cannot tell them, 'Come back in ten years until we have all the data in hand.' I still need to use medicines that I am assuming that if they work in adults, with appropriate care and supervision, may also work in children."

Many parents told 60 Minutes their children are so out of control and disruptive, medication is the only option. A parent who took her children to Biederman's Mass General clinic, Maria Lamb says she depends on medication for eight- year-old Annie and nine-year-old Casey, who his mother says would rage for hours when he was just two years old. Casey was recently admitted to a psychiatric hospital when he was taken off one of his medications.

"I don't think they would be able to function. I wish they could. It was a last resort, seeing the kind of rages they would have, destroying their room, kicking the door off the hinges," Lamb says.

But during one recent visit, Maria's worried that Annie is eating incessantly. Dr. Biederman's partner Dr. Janet Wozniak says it could be a side effect from one of Annie's three medications and suggests another medicine may help.

"Actually its most common usage has been to help people with alcohol addictions resist alcohol. But it seems to also have an effect on food cravings," Dr. Wozniak remarked.

One of the biggest problems with these medications is side effects, including major weight gain, hand tremors, shakes, drooling and muscle spasms. And side effects are at the heart of the Rebecca Riley case.

Carolyn Riley tells Couric she never observed any sluggish or lethargic behavior in her daughter.

"This is what her preschool teacher said. She was like a floppy doll. So tired, she had to be helped off the bus. She had a tremor and had to go to the bathroom almost constantly. So how could she have these side effects at school, and yet, you never observed them at home?" Couric asks.

"I don't know," Riley replies. "She never acted like that at home at all."

But the prosecutor is charging the Rileys with murder because, he says, they ignored the warning signs and instead just kept giving Rebecca more pills than she was prescribed, even in the last few days of her life. And key to the case: 200 additional pills Carolyn Riley got from the pharmacy. She insists she was only replacing pills that were lost or damaged.

"For those who see you as somebody, who just wanted her kids to be less annoying and bothersome, who gave them too many pills because she couldn't deal with it, you would say?" Couric asks.

"I don’t know. They weren't annoying. They were my life," she says.

"According to the medical examiner, her heart and lungs were damaged, and this was due to prolonged abuse of these prescription drugs, rather than one incident. Prolonged abuse of these prescription drugs," Couric remarks.

"Yes. And the doctor had Rebecca on .35 milligrams, daily, for months. And I didn't know anything about dosages. How much was fatal," Riley says.

The medical examiner ruled that Rebecca died of a drug overdose from a mix of medications. And that the amount of Clonidine alone would have been fatal.

Today, awaiting trial, Carolyn Riley says she now knows more about bipolar disorder than she ever did when her daughter was alive.

Asked if she thinks Rebecca was really bipolar, Riley says, "Probably not."

"What do you think was wrong with her, now?" Couric asks.

"I don't know," she says. "Maybe she was just hyper for her age."

Produced By Kyra Darnton © MMVII, CBS Interactive Inc. All Rights Reserved.

Tragedy scripted for innocent child

TV version: Lies and whispers

The voices are so soft you have to strain to hear them.

CBS anchor Katie Couric, in her most sympathetic just-above- a-whisper voice, asks Carolyn Riley about the hours leading up to the death of her 4-year-old daughter, Rebecca.

“I just thought it was a little bit of a cold,” she said, describing how she gave Rebecca some Children’s Tylenol Cough and Runny Nose - on top of the three psychotropic drugs she was already taking for her bipolar disorder.

Then Couric asked about the extra Clonidine she also doled out to the child.

"She hadn't been able to sleep since 6 o'clock," Riley responds.

A medical examiner has reported that the amount of Clonidine alone in Rebecca's system was enough to kill her. She also reported that her heart and lungs were damaged "due to prolonged abuse of these prescription drugs, rather than one incident." Couric shares that information with her viewers along with the fact that Rebecca was taking 10 pills a day.

"I trusted the doctor," Carolyn Riley says in that soft, soft voice as she advances her defense strategy.

The camera isn't flattering nor is the orange prison jumpsuit, but this is how television shapes the news - the mother accused of murder in the death of her own child is no monster. No, she was just following doctor's orders.

Oh, and about those 200 extra Clonidine pills Riley managed to get from the pharmacy, Couric asks, and her response to those "who see you as somebody who just wanted her kids to be less annoying . . ."

Riley's voice fades to an even lower whisper.

"I don't know," she says finally.

Yes, "60 Minutes" makes an admirable effort to get behind the vast increase in diagnosing bipolar disorder in the very young. (A recent national study said such diagnoses had increased 40 fold between 1993 and 2003.) And with that rise comes a vast increase in the use of various "cocktails" of psychotropic drugs - anywhere from three or four to a dozen in some rare cases.

In the case of Rebecca Riley, Couric reads, "That cocktail of medications proved fatal."

It's tempting here to paraphrase that old NRA slogan and note that medications don't kill people, people kill people.

Later in the piece Couric returns to the theme noting, "Side effects are at the heart of the Rebecca Riley case."

Side effects!

As to reports from Rebecca's teachers that she was often limp, listless and "like a rag doll," Carolyn Riley says she saw none of that at home.

She tells about the night Rebecca died, and how she put her to bed "beside" her and when the alarm clock went off the next morning she couldn't wake her, knew she was gone. Again her voice barely a whisper.

That's the TV version of the last hours of Rebecca Riley's life.

The affidavit filed with the court by the state police investigator assigned to the case tells a very different story. It describes days of agony for the child, the pleas of relatives living in the Riley household to take Rebecca to the hospital, all of them ignored.

And on that last night of her life Rebecca was not exactly beside her mother, but on the floor next to the bed. And after the alarm went off Carolyn Riley "got out of bed, stepped over Rebecca and went to their son's room to wake him up. When she returned, she bent down and touched Rebecca and felt her to be cool and then noticed ‘stuff' on her face. She turned on the light in the room and yelled for Michael who was still lying in bed.

"Michael stated that he looked and saw ‘white stuff' coming out of Rebecca's mouth. He then felt Rebecca and described her body as ‘cool and rubbery.' "

No, the image of a mother stepping over the body of her dead child isn't a made-for-TV moment. This was about, as investigator Anna C. Brookes told the court, "evidence of the slow and painful killing of Rebecca Riley."

But there was no one on camera to speak for Rebecca.

DA: Michael Riley medicated daughter to ‘shut her up'

BROCKTON - A man accused of killing his 4-year-old daughter with a prescription drug overdose repeatedly ordered his wife to give the girl increased amounts of medication to "shut her up," a prosecutor said Thursday.

Michael Riley, 37, is charged with first-degree murder in the December 2006 death of his daughter, Rebecca. His wife, Carolyn, was convicted of second-degree murder last month in the girl's death.

During closing arguments Thursday in Michael Riley's trial, Assistant District Attorney Frank Middleton told jurors that Riley was a cold-hearted, uncaring father who concocted symptoms of mental illness in his three children, including Rebecca, so he could collect Social Security disability benefits from the federal government.

Middleton said that in the weeks before Rebecca's death, Michael Riley repeatedly ordered his wife to increase his daughter's dose of Clonidine — an adult blood pressure medication sometimes prescribed for children with attention-deficit hyperactivity disorder — to keep her quiet and out of his way.

Several days before her death, as she grew increasingly ill with pneumonia, Riley ignored pleas by three people to take her to see a doctor or to an emergency room for treatment, Middleton said.

The night the girl died, she was given two to three times her daily dose of Clonidine, Middleton said, citing testimony from a doctor who testified for prosecutors.

Middleton said that Riley either gave Rebecca the pills himself or directed his wife to do so.

"He knows it's going to shut her up, and shut her up for good," Middleton said.

But Michael Riley's defense attorney, John Darrell, placed the blame for Rebecca's death squarely on the girl's psychiatrist, Dr. Kayoko Kifuji, who had diagnosed her with ADHD and bipolar disorder by the time she was 3. Darrell said Kifuji failed to carefully monitor Rebecca and repeatedly wrote out prescriptions for higher doses of Clonidine for the girl after her mother had increased the dosage on her own, without Kifuji's permission.

Darrell called Kifuji "the most irresponsible doctor you may have ever heard of in your life," and said Rebecca's life would have been saved if "Dr. Kifuji had stayed in Japan."

A grand jury refused to indict Kifuji in Rebecca's death and in September she was reinstated to her job as a child psychiatrist at Tufts Medical Center in Boston.

A state medical examiner found that Rebecca died of the combined effects of Clonidine; Depakote, an anti-seizure and mood-stabilizing drug prescribed for bipolar disorder; and two over-the-counter drugs, a cough suppressant and an antihistamine. The amount of Clonidine alone in Rebecca's system was enough to be fatal, the medical examiner said.

Darrell said Michael Riley had little to do with the girl's medication because he had not been living with the family in the months before the girl's death. He moved back in with the family seven to 10 days before the girl's death, Darrell said.

The defense also depicted Riley as a father trying to take care of his family while struggling with problems of his own, including bipolar disorder.

The parents of Rebecca Riley were convicted of murder and sentenced to life in prison without parole. The conviction was upheld on appeal. Michael Riley's attorney sought a new trial five years later and this was denied.

COMMENTARY: Wholesale sedation of young children medically, morally indefensible

Posted Mar 27, 2010 at 12:01 AM Updated Mar 27, 2010 at 12:55 AM

By LAWRENCE DILLER, The Patriot Ledger, Quincy, MA

The twin murder trials of the parents of Rebecca Riley, who died at age 4 of an overdose of the psychiatric drug, clonidine, have cast a spotlight on the beliefs and practices of the doctor who prescribed the drug.

Kayoko Kifuji was granted immunity in both trials in exchange for her cooperation for testifying. Reactions from jurors, comments online and letters to the editor based on newspaper accounts of Kifuji’s testimony range from confusion, shock, and outrage directed at the doctor’s role in the tragedy.

Kifuji did go before a grand jury and was not indicted, avoiding any criminal prosecution for her actions. Massachusetts’ medical licensing board, the Board of Registration in Medicine (BRM) initially suspended Kifuji’s license to practice medicine. But after conducting an investigation the BRM fully restored Kifuji’s privileges. She is now back at Tufts Medical Center practicing child psychiatry without any restrictions, penalties or supervision.

Kifuji did not literally place the extra lethal doses of clonidine in Rebecca’s mouth which may explain why she was not criminally charged. Ironically, from testimony at the father’s trial, neither did Michael Riley. Still the jury found him guilty of murder. What’s more disturbing is the BRM’s decision to take no further actions and allow Kifuji unfettered practice.

The testimonies offered at the grand jury and BRM hearings were kept secret so the Riley trials offer the public the first details of Kifuji’s management of the Riley children. Here are some of the facts extracted from the trial transcripts:

Kifuji’s diagnoses were based entirely on reports coming from the children’s mother, Carolyn, herself diagnosed with mental illness and at times heavily medicated to the point of falling asleep in Kifuji’s office.

Kifuji essentially ignored late warnings from a school nurse about possible sedating over dosages to Rebecca and from a mental health counselor for Rebecca whom the mother fired after the counselor alerted the local child protective service agency about potential child abuse.

Kifuji believed testimony from the children as young as 3 regarding “hallucinations” about monsters to support the bipolar diagnosis while discounting any other information reported by the children as “unreliable.”

Kifuji repeatedly allowed, without drawing any effective limits, Carolyn Riley to increase the doses of clonidine she gave her children. For her last month of life, Kifuji overall prescribed 835 pills to Rebecca.

Rebecca at age 3, gained nine pounds in two months on the first antipsychotic drug, Zyprexa, she was prescribed by Kifuji.

Kifuji continues to insist her diagnosis was correct even when it was pointed out that the children’s symptoms literally disappeared overnight when the mother was out of the home for four days and the father was left in charge of the children. Kaitlynne, Rebecca’s older sister by two years, in a foster care home since her sister’s death, is reported to be symptom- and drug-free carrying a diagnosis of Post-Traumatic Stress (which implies she was emotionally damaged by her experiences).

The Massachusett’s BRM in allowing Kifuji to practice again without any penalties or restrictions has essentially told doctors and the public that this kind of management of children’s behavior problems is “within the standards of current medical practice” – a phrase that comes up both in licensing and malpractice cases.

It has sent a message that the psychiatric child abuse of children through drugs will be tolerated in the state of Massachusetts.

A recent survey has reported a doubling in five years of the number of children between ages 2 and 5 receiving anti-psychotic medications like Zyprexa and Seroquel. Many are likely receiving the kind of care the Riley children experienced. It is very difficult to address the behavior and emotional problems of very young indigent children. Non-drug resources are often meager or unavailable. Follow through by overwhelmed parents is inconsistent. Nevertheless, the wholesale sedation of young children condoned and supported by mainstream psychiatric practice is both medically and morally indefensible. Unfortunately it appears more Rebecca Rileys will have to die before these practices change.

Lawrence Diller practices behavioral-developmental pediatrics in Walnut Creek California. He is on the clinical faculty of the University of California, San Francisco and the author of The Last Normal Child.

© Copyright 2006-2017 GateHouse Media, LLC. All rights reserved • GateHouse News

Original content available for non-commercial use under a Creative Commons license, except where noted. The Patriot Ledger, Quincy, MA ~ 400 Crown Colony Drive, P.O. Box 699159, Quincy, MA 02269 ~

By the time Kifuji finally passed the psychiatric board exam – on her fourth try – one of her youngest patients, Rebecca Riley, had a little more than a year to live. Her parents murdered the 4-year-old by overdosing her with one of the drugs Kifuji prescribed.

Both of Rebecca's parents are in prison for her murder. Her mother, Carolyn, was convicted in February; her father, Michael, in March.

Now the spotlight is on the controversial doctor who testified in both trials in exchange for immunity. Kifuji and her employer, Tufts Medical Center, face a malpractice lawsuit filed by Norwell attorney Brian Clerkin, the court-appointed administrator for Rebecca's estate, which was created for the benefit Rebecca's brother and sister, who are now 14 and 9.

Glimpses into Kifuji's background and treatment methods are part of a lengthy deposition she gave in December in the civil suit. The final pre-trial hearing in the case is scheduled for June 1.

Kifuji diagnosed Rebecca Riley and her sister with mental illness and prescribed drugs for both girls and their brother. Prosecutors in the parents' murder trials said the Rileys killed Rebecca because they couldn't get disability payments for her, as they had with their two other kids.

According to the plaintiff's lawyer in the malpractice suit, Benjamin P. Novotny, of the Boston firm Lubin and Meyer, Kifuji said she "trusted the mother" (Carolyn Riley) to tell her how the children were behaving and reacting to the drugs. She relied almost exclusively on what Carolyn told her about the kids when diagnosing them and ordering increasing amounts of drugs for them.

Kifuji also trusted the mother to keep tabs on Rebecca's heart rate and blood pressure for signs of problems with the four drugs she was on. Kifuji, a pediatrician who later became a psychiatrist, told Novotny during the deposition that she didn't realize she had a blood pressure cuff in her office and could check the girl's vital signs herself until after Rebecca was dead. She said she didn't take Rebecca's pulse with her fingers because Carolyn Riley told her the child's pulse "was within normal range."

Kifuji also told Novotny during the deposition:

She prescribed clonidine – the drug that killed Rebecca – during the child's first visit to control the "impulsivity" that Carolyn Riley described. Rebecca was 2 at the time.

She originally came to the United States from her native Japan in 1990 to research dust allergies in children. She switched her training to psychiatry when she went to New England Medical Center in 1994.

In 2000, she took a job at Baystate Medical Services in Springfield because it meant she wouldn't have to return to Japan for two years and wait for an H-1 work visa.

She diagnosed dozens of children as bipolar or having attention deficit hyperactivity disorder (ADHD) or both, and estimated that she prescribed drugs for 99 percent of her pediatric patients.

She usually saw Rebecca for 20 minutes at each office visit because she was seeing all three Riley children in an hour.

She explained that some researchers believe the area of the brain called the amygdala is different in people with bipolar disease. But she admitted she didn't know where the amygdala is in the brain.

Kifuji's medical career has taken her from Tokyo to Detroit and Boston. She was living in Somerville as of December.

She grew up in Kumamoto, Japan, on the southwest tip of the island of Kyushu, and graduated from Tokyo Women's Medical College in 1981.

She's been a permanent legal resident of the U.S. since 1990, and has held a medical license here since 1999.

She worked at Baystate in Springfield from 2000-03. Her outpatients there included the Rileys' two older children, whom she also diagnosed as bipolar with ADHD.

After Rebecca's death in December 2006, Tufts Medical Center placed Kifuji on paid leave after the psychiatrist agreed not to practice medicine. The state Board of Registration in Medicine reinstated her license this past September after Plymouth County District Attorney Timothy Cruz announced that a grand jury would not bring criminal charges against her.

In January, Tufts reaffirmed its support for Kifuji and her treatment methods, saying she provided "appropriate" care to Rebecca Riley. Kifuji began seeing patients again in the fall. As of December, she was seeing five outpatients – four children and one adult – and working with a state-funded child psychiatric access program.

Lane Lambert is at llambert@ledger.com.

Kifuji's treatment of Rebecca Riley

2004

Aug. 27, 2004: Carolyn Riley takes her daughter Rebecca to Kifuji for the first time. Within 20 minutes of meeting the then 2-year-old, she Kifuji diagnoses her with attention deficit hyperactivity disorder and prescribes clonidine as a sedative.

Sept. 1, 2004: Carolyn tells Kifuji over the phone that she has increased Rebecca's clonidine dosage. Kifuji approves.

Oct. 1, 2004: Second office visit lasts 20 minutes.

Nov. 9, 2004: Refills clonidine prescription.

Dec. 9, 2004: Refills clonidine prescription.

2005

Jan. 3, 2005: Kifuji increases clonidine dosage over the phone.

Jan. 5, 2005: Third office visit. Kifuji reports Rebecca's hyperactivity has worsened from mild to moderate. Increases clonidine dosage for the third time.

March 11, 2005: Carolyn tells Kifuji over the phone that Rebecca is having "lots of headaches," a common side effect of clonidine.

May 3, 2005: Diagnoses 3-year-old Rebecca with bipolar disorder after mother tells her the girl has become "moody" and cries "over very small things easily." Prescribes Depakote, an anti-seizure drug.

June, July, August 2005: Refills prescriptions for clonidine and Depakote.

Aug. 4 and Aug. 31, 2005: Sees Rebecca in the office. No changes in diagnoses or dosage.

Oct. 27, 2005: Carolyn tells Kifuji she has increased Rebecca's clonidine dosage again. Kifuji tells her to decrease it and threatens to report Carolyn to the state. Kifuji increases Depakote dosage and prescribes Zyprexa, an antipsychotic.

Nov. 16, 2005: Increases Depakote dosage.

December, 2005: Increases Zyprexa dosage.

2006

Jan. 9, 2006: Increases Zyprexa dosage again. Writes, "Present dose working well. No changes."

Jan. 31, 2006: Increases Depakote dosage again after Carolyn reports that 3-year-old Rebecca is wetting the bed.

Feb. 16:, 2006 Prescribes Seroquel, an antipsychotic. Decreases Zyprexa. Notes Rebecca is gaining "too much weight and she's still very aggressive and impatient."

March 8, 2006: Increases Depakote dosage. Carolyn reports Rebecca is still having problems sleeping, is defiant and having tantrums.

May 24, 2006: Receives letter from a social worker concerned about the amount of drugs being given to the Riley children.

June 22, 2006: Increases Rebecca's Seroquel dosage after 20-minute office visit.

July 20, 2006: Increases Depakote dosage after mother reports Rebecca was "getting into everything."

Aug. 16, 2006: Tells Carolyn Riley she can increase or decrease drug dosages on her own. Changes clonidine prescriptions to 10-day supplies instead of month's supply after Carolyn Riley says the last prescription was destroyed by water.

Aug. 21, 2006: Pharmacist tells Kifuji over the phone that Carolyn came in for pills but didn't have doctor's authorization. Kifuji gives it over the phone. Riley cannot explain 20 missing clonidine pills.

Sept. 15, 2006: Increases Rebecca's Seroquel dosage again, the 13th drug increase she's approved in two years. Tells mother that she can increase it even more.

Nov. 3, 2006: Returns call from the nurse at Rebecca's preschool in Weymouth who says the 4-year-old is like a "floppy doll" and is so tired she can barely walk up the stairs. Nurse says she is concerned about how much medication Rebecca is on.

Nov. 10, 2006: Kifuji notes that mother says Rebecca's sleep is improved and attributes it to Michael Riley having moved back in with the family at their new apartment in Hull.

Dec. 7, 2006: Sees Rebecca for the last time. Tells mother she'll begin decreasing clonidine dosage if Rebecca continues to do well.

Dec. 13, 2006: Rebecca dies of clonidine overdose. Kifuji calls the Rileys and leaves a message for Carolyn.

Dec. 14, 2006: Carolyn calls Kifuji at 6:45 a.m. and leaves a message. Kifuji calls back at 4:45 p.m., 5:15 p.m., 6 p.m., 6:30 p.m. and at 7:20 p.m. when she reaches Carolyn. Kifuji says she called to ask what happened to Rebecca and see how Carolyn is doing.

Defending Dr. Kifuji

John P. Ryan, the lawyer for Dr. Kayoko Kifuji in the medical malpractice suit filed against her by Rebecca Riley's estate, recently talked to The Patriot Ledger about the case. Here is some of what he said.

Here are some of the questions and answers from the interview:

A: "The issues in the criminal trials were narrowed by the nature of the claims in those cases, and the full explanation of the medicines (prescribed by Dr. Kifuji) will be developed in the civil case. It is unfortunate and ironic in the light of the convictions in the criminal trials that there has been an unwarranted displacement of blame onto Dr. Kifuji."

Q: Was Dr. Kifuji too quick or willing to prescribe drugs for a child so young?

A:"The medical records will disclose that Dr. Kifuji had numerous visits with the child (Rebecca Riley), and had the opportunity to personally view and assess the child and follow a treatment regime [I think he means regimen - Jay, Astraea] that is recognized and accepted in the complex field of pediatric psy hiatry. Dr. Kifuji is board-certified in pediatrics, general psychiatry and child and adolescent psychiatry. She is both academically trained and very experienced in her field. We expect in the civil case that competent and qualified expert opinion will both explain and support her treatment of this child."

Q: Was it acceptable practice for Kifuji to approve an increase in the dosage of clonidine after Carolyn Riley told her (over the phone) that she had already started giving Rebecca more of the drug than originally prescribed?

A: "Her decision-making was based not only on observations from the mother, but from Dr. Kifuji's personal observations and experience in the field."

Q: What's your response to the harsh criticism of Kifuji from both prosecutors and defense attorneys during the Riley trials?

A: "The civil action is the proceeding in which Dr. Kifuji has the opportunity to present her affirmative side of the case, with appropriate expert analysis."

Q: When will the civil trial begin?

Troubled toddler or drug-seeking mom?

Dr. Kayoko Kifuji diagnosed then 2-year-old Rebecca Riley with attention deficit hyperactivity disorder after Kifuji's first 20-minute visit with the child in 2004. That's when she first prescribed clonidine, the drug that killed Rebecca in 2006. Kifuji had already diagnosed Rebecca's sister with ADHD and bipolar disorder and prescribed many of the same drugs for her and their brother.

Here are some of Kifuji's treatment notes on Rebecca, which are in a deposition Kifuji gave in December in a pending medical malpractice suit:

A week before her first appointment with Rebecca, Kifuji wrote: "Called mother. Two years old. Very hyper. All over. Last couple of week, not sleeping but keep going like her brother who was not sleeping when he was small."

Kifuji described Rebecca during the first office visit:

"Two-and-half-year-old female with history of colic and not sleeping much in her infancy developed sleep disturbance again. Hyperactivity on and off since four months ago. Then consistently hyper all the time. Climbs up to top of jungle gym without any fears and thinking. Gets into everything. Just walk up to someone and smack them. Never gets aggressive. Hits kicks and spits when she's being disciplined and laughs. Started to say things scared her. Whines and fusses a lot."

During the same visit when Rebecca was 21/2 years old, Kifuji described the toddler as dysarthric, meaning she could not properly pronounce some words. She also described Rebecca as a "happy" child with a "bright affect." During her second 20-minute visit with Rebecca, in October 2004, Kufuji wrote: "Doing okay. A bit tired since yesterday. Coming down on flu. Fine as long as she takes clonidine. Sleeps throughout. Without clonidine gets very hyper and impulsive."

She also wrote: "(Rebecca) is loud and silly at times while she was playing with her sister but redirectable."

During later visits, Kifuji described Rebecca as "very impulsive." She explained that Rebecca's mother said the girl: "Climbs up on top of bureau. Tantrums or sobbing when she was told to clean up her toys" and "she wasn't listening to her mother." Rebecca was 3. Three months after diagnosing Rebecca as bipolar, Kifuji noted that the family is under increased stress because Michael Riley has been accused of sexually abusing a girl. She writes of Rebecca: "Gets aggressive to her sibs with hitting and kicking. Can't go out to play with kids in neighborhood due to the allegations, and they had pressure to move out from (Weymouth)." Asked why she didn't report Carolyn Riley to child welfare authorities after learning that the mother had increased the children's doses at least twice without checking with her first, Kifuji said: "I just can't report to the DSS. I need to ... my role is to work with the parent and not judging them." Asked if she ever told Carolyn not to give Rebecca cold medicine on top of all the drugs the child was on, Kifuji says no, "but it's because Rebecca didn't get sick, and I was never asked ..."

Kifuji's medical career

1981: Graduates from Tokyo Women's Medical College in Japan.

May 1981-April 1983: Resident in pediatrics at Toyko Women's Medical College.

May 1983-April 1987: Fellow in pediatric allergy at Toyko Women's Medical College.

Feb. 1991-June 1994: Researcher on dust allergies in children at Henry Ford Hospital in Detroit.

1994-1999: Resident in pediatrics/psychiatry/child psychiatry at New England Medical Center, Boston.

June 1999: Receives Massachusetts medical license.

October 1999: Board-certified in pediatrics.

February 2000-July 2003: Worked at Baystate Medical Services in Springfield.

August 2003: Began job at Tufts Medical Center, Boston.

October 2005: Board-certified in general psychiatry.

November 2006: Board-certified in adolescent psychiatry.

February 2007: Agrees not to practice following the death of Rebecca Riley.

July 2009: A Plymouth County grand jury decides not to return an indictment against Kifuji, clearing her of criminal charges in Rebecca's death.

September 2009: Returns to practice after state Board of Registration in Medicine reinstates her medical license.

COMMENTARY: We must stop treating childhood like a disease

In 2001, Harry Markopolos of Whitman repeatedly warned the authorities about Bernie Madoff. No one listened. Only a serious downturn in the economy led to Madoff's downfall.

It's not a Ponzi scheme, but once again, no one is listening and the red flags are everywhere. This time the victims are our very young, innocent children in the millions. Today, children as young as 2, are being prescribed powerful anti-psychotic medications. Side effects include tics, drooling, and incessant eating. Some children have gained up to 100 pounds and often progress to becoming diabetic.

This is not the old story about ADD or ADHD and the use of Ritalin or other approved drugs in use since the 1970s. This is not about helping the child who fidgets and can't concentrate in an elementary school classroom.

This is about tens of thousands of energetic, outgoing, healthy, and normal 3- and 4-year-olds who just won't sit still in Mommy and Me. It is those children who have now been diagnosed with a new and controversial diagnosis – Childhood Bipolar Disorder.

On Sept. 4, 2007, The New York Times reported that studies in the 1970s and '80s concluded bipolar disorder was rare in children, but between 1994 to 2003, there was an astounding 40-fold increase in the number of children diagnosed with bipolar disorder.

In a 2007 "60 Minutes" episode, Katie Couric focused on the short life of 4-year-old Rebecca Riley of Hull. Diagnosed with bipolar disorder at age 28 months, she was dead one year later from an overdose of a psychotropic drug cocktail. At one point, Couric asks Rebecca's mother, who had been charged with her daughter's murder, if she thought her child's behavior might have been normal. That in fact, maybe little Rebecca was just exhibiting "Terrible 2s" behavior.

On Nov. 19, 2008, the New York Times reported that 31 children who were diagnosed with Childhood Bipolar Disorder and given the drug Risperdal for tantrums died, and 1,176 suffered serious side effects.

Dr. Joseph Biederman, a prominent Harvard child psychiatrist at Massachusetts General Hospital, and his team are more responsible than anyone for a child bipolar epidemic sweeping America (and no other country) that has 2-year-olds on three and four psychiatric drugs.

In a 2008 article, "Are Our Leading Pediatricians Drug Industry Shills?", pediatrician Lawrence Diller states, "The science of children's psychiatric medications is so primitive and Biederman's influence so great that when he merely mentions a drug during a presentation, tens of thousands of children within a year or two will end up taking that drug, or combination of drugs. This happens in the absence of a drug trial of any kind. Instead, the decision is based upon word of mouth among the 7,000 child psychiatrists in America."

A key issue is the misuse of psychiatric diagnostic labels to explain bad behavior in children. This has resulted in the drugging of young children to a degree unprecedented in our history. To diagnose a 2-year-old as bipolar by adult standards is crazy.

The behavior of a 2-year-old is filled with curiosity about everything and anything. Young children have extraordinary ability in terms of emotions and cognitions. They can be very upset very quickly, very angry, very depressed, because their emotions are so fluid, so available.

These behaviors are seldom the result of blood chemistry issues. Instead, parents should view them as a healthy striving toward necessary independence. Growing up is not a condition. Childhood is not a disease. Children act up and defy authority and they need adults to teach them how to manage difficult feelings and handle disappointment appropriately.

There are ways for parents to do this that are quite effective and don't involve drugs, but they do involve parents being teachers. Our preschool children are far too young to defend themselves. It's up to parents to "say no to drugs" and teach their children that life is meant to be learned and experienced -- it's not just a pill to be swallowed.

Many of the most popular child-rearing books, however, repeatedly urge parents to hold, soothe, comfort, and talk to the child who bites, screams, throws, breaks things, or otherwise behaves in obnoxious, infantile ways.

Children need parents, not pills. Parents need new parenting tools. We have been loving our children into behaving badly and the quick "fix" pills are becoming the easy way out that may have lasting untold psychic damage.

Jacob Azerrad, Ph.D. is a clinical psychologist, in private practice in Lexington and has served on the faculty of the University of Virginia Medical School and University of Virginia.

More on bad psychiatry here