4 Year-old Dies of Seroquel Overdose-Parents Charged-Debate over use of Risperdal, Seroquel in Children

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Debate Over Children and Psychiatric Drugs

Higgins/Associated Press

and Carolyn Riley were arraigned last week on charges related

to the death of a daughter.

By BENEDICT CAREY

Published: February 15, 2007

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,

and Carolyn Riley, with deliberately poisoning their daughter

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 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.

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. le 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. T. Walkup, a child

and adolescent psychiatrist at the s 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. 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 are still emerging. A relative

of her mother, Carolyn Riley, 32, told the police that 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 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 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 ’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.”