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Primum non nocere
February 26, 2007 1:51 PM   Subscribe

Rebecca Riley died of a drug overdose in December. The police charged her parents with murder, alleging that they poisoned her with an overdose of clonidine. What's clonidine? A drug used to treat hyperactivity. You see, Rebecca was diagnosed with attention deficit hyperactivity disorder (ADHD) and was prescribed clonidine. She was also diagnosed with bipolar disorder and put on valproic acid and Seroquel. Rebecca was diagnosed with both disorders by a psychiatrist when she was 2 1/2 years old. She died when she was 4 years old. Some in the psychiatric community are outraged.
posted by Pastabagel (84 comments total) 6 users marked this as a favorite

 
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posted by p3on at 1:59 PM on February 26, 2007


Dextromethorphan? Was she at a rave?
posted by nathancaswell at 2:00 PM on February 26, 2007


Putting children on medication for mental illness is just so wrong. I was totally schizo as a kid, surely that's just a good imagination?
posted by twistedonion at 2:03 PM on February 26, 2007


How could anyone, let alone a psychiatrist, decide a 2-year-old was bipolar? She was probably barely talking!
posted by me3dia at 2:03 PM on February 26, 2007


some of us are gonna be outraged, too.
posted by lester's sock puppet at 2:05 PM on February 26, 2007


I have two 18-month-olds. I LOVE it when they're a tad hyper and full of energy (esp. since we don't feed 'em processed sugars and such.) It's fun to watch them take such unbridled delight in their own physical movement.

I won't say whether the meds are a good thing or not; my opinion on that is only valid for my own kids and my own situation. However, I have to wonder: did the doctor pay attention to the diet these kids were being fed? We know a lot of parents with spastic kids, and to a one they're getting a steady diet that includes juices, candy, and other sugar-heavy stuff (whereas my kids only regularly drink milk and water, and candy isn't on the menu yet, although they did each destroy a birthday cake on their 1st birthday; sugary sweets aren't off-limits entirely, just rarely given.)
posted by davejay at 2:08 PM on February 26, 2007


Oh, and most of those kids also have irregular sleeping habits.
posted by davejay at 2:09 PM on February 26, 2007


Pediatric Bipolar? Really? Who are these asshole doctors?

Those 'parents' deserve murder charges. Any debate there?
You need a license to catch a fish but these devolved, brainless scumbags are allowed to procreate.
posted by ElmerFishpaw at 2:09 PM on February 26, 2007 [1 favorite]


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.

Yes, this is messed up. It's unbelievably messed up, and the drug overprescription looks like just a part of it.
posted by gurple at 2:09 PM on February 26, 2007


I certainly hope the psychiatrist in question will be brought in as an accomplice.....

That's messed up.
posted by elendil71 at 2:09 PM on February 26, 2007


ugh.
posted by YoBananaBoy at 2:10 PM on February 26, 2007


From what I've read, other industrialized countries don't drug their kids nearly as much as we do in America, and yet their kids turn out smarter and get better test scores. I wonder what's up with that.
posted by Afroblanco at 2:10 PM on February 26, 2007 [2 favorites]


Here are the diagnostic criteria for bipolar disorder. This quote from thelastpsychiatrist.com blong made sense to me:
We decide to call a group of behaviors bipolar disorder-- and meds can help them, for sure-- but this decision is completely dependent on the context of the symptoms. Being four necessarily removes you from the appropriate context, in the same way as having bipolar symptoms during, say, a war, also excludes you from the context
And I note, like me3dia said, that she was actually 2 and a half when diagnosed? I can't help but think that the parents had to push for it (because in my naive mind no doctor would ever do this), but I would think that the doc might suggest some alternative non-drug treatment instead, if for no other reason than the hazardous effects these drugs might have on a toddler's mental development.
posted by Pastabagel at 2:11 PM on February 26, 2007


It’s no wonder that people think psychiatrists are a bunch of hacks. (from a linked article)

My mother is incredibly mild-mannered, and her husband (my dad, natch) is suffering from Lewy-body Dementia. The symptoms are very Parkinson's-like, but things that often work for treating Parkinson's have adverse effects on Lewy-body patients -- for instance, anti-anxiety meds that work on Parkinson's patients can cause anxiety and severe hallucinations in Lewy-body patients.

My mother's been dealing with Psychiatrists for years on this issue, and recently my father started being treated by a Psychiatrist that would fall into the "hack" category. Nurses and doctors tell my mother to call the Psychiatrist when his condition changes, but he tells her not to call*, saying that it "puts the responsibility on (him)". My father is in the hospital right now, and the Psychiatrist perscribed an anti-anxiety medication that has thrown my father into terrors and hallucinations in the past; when my mother tried to tell him this, he first resisted changing the meds and then told her "I don't want to be his Psychiatrist any more" and walked out. Seriously, like a child.

So yeah, there's hacks in every field, and some of them make big mistakes in prescribing meds.

*I might understand if my mother were a nuisance type, but she's the antithesis of it; as mild-mannered and polite as they come, and she'd only called him the one time when he said it.
posted by davejay at 2:14 PM on February 26, 2007


Those 'parents' deserve murder charges. Any debate there?

Yes, being as most people don't know anything about these sort of things, and trust doctors with whatever they say. They trust that the doctor is going to be competent. After all, they did all of that med school stuff.. why would they want to risk losing their liscense giving a bad diagnosis? Do your parents/family trust you intrinsically when you give them computer-related help?

Secondly, all child have ADHD and are bipolar. They're all hyper, and it's part of being young. We want children to sit patiently, be quiet, and do what we tell them. Just like what the adult world expects of you. I believe that doctors diagnosis these 'illnesses' to children because we, as adults, want children to act like adults way too early.

Except when it comes to sex, in which case they need to be at least 30 before they know what a penis is.
posted by triolus at 2:15 PM on February 26, 2007 [5 favorites]


You can tell a Great Civilization, in the historical sense, by the rate and gusto with which it devours and discards its young. Remember the view from up here, it probably can't last much longer.
posted by freebird at 2:16 PM on February 26, 2007


From what I've read, other industrialized countries don't drug their kids nearly as much as we do in America, and yet their kids turn out smarter and get better test scores. I wonder what's up with that.

Well, obviously the drugs are the only thing making our kids smart enough to compete at all; we'd better ramp 'em up!

yes, a joke.
posted by davejay at 2:17 PM on February 26, 2007


The reason he walked out davejay, is that deep inside he knows he is a hack (quack) and that to stay any longer would be to invite a malpractice lawsuit. Good on your mom for confronting him.
posted by vronsky at 2:21 PM on February 26, 2007


I think a psychiatrist would be a really difficult person to be. Having to make calls that affect the mental state of your patients, and having incredible scrutiny on any decision you made, with such high stakes involved.

Not that any of that excuses hackery. I'm just really glad I'm not a psychiatrist.
posted by gurple at 2:27 PM on February 26, 2007


required reading for adults with children
posted by vronsky at 2:30 PM on February 26, 2007


Jesus, Seroquel is a heavy duty atypical anti-psychotic. I was on it briefly when I was being weaned off of Effexor (another nasty drug, this one an antidepressant) when I was first diagnosed as bipolar (at 40 years of age), and was working with a doctor to try and find the right combination of medicines.

Seroquel knocked me out for 16 hours of the day, and the remaining 8 hours were spent trying to wake up. I can't believe a drug that potent would be given to a toddler. Wow. Just wow.
posted by WolfDaddy at 2:31 PM on February 26, 2007


I can't believe a drug that potent would be given to a toddler.

Well, they make a cherry-flavored version.
posted by davejay at 2:32 PM on February 26, 2007 [1 favorite]


they should punish the doctor too.

.
posted by amberglow at 2:36 PM on February 26, 2007


The really fucking demented part about this whole episode is that it illustrates just how close we as a culture are to pathologizing childhood entirely.

I'm going to go give my kid some sugar and put a water pistol in his hands now.
posted by Emperor SnooKloze at 2:37 PM on February 26, 2007


I predict with absolute certainty that this will be made into a Law and Order episode.
posted by drezdn at 2:37 PM on February 26, 2007 [7 favorites]


I think a psychiatrist would be a really difficult person to be. Having to make calls that affect the mental state of your patients, and having incredible scrutiny on any decision you made, with such high stakes involved.
posted by gurple at 5:27 PM EST on February 26


I think this is the distinction between psychiatrist and therapist. The psychiatrist is going to turn to drugs first, because as a medial doctor, that's their frame of reference. But a therapist (say a freudian analyst who has 7 years of therapy trainging) is going to very slowly talk the patient through it, saying very little, interacting very little.

With kids, if I'm not mistaken, therapy takes the form of play therapy. The kid plays, and the therapist watches behaviors that emerges from the play. Perhaps they ask questions about what's happening in the play (who is that doll, what are they doing, etc) but it's really quite non-invasive.

The problem here (well, another problem) is that while on these drugs, play therapy isn't going to work. These drugs are so totally infering with standard process in the brain that a kid's play while on these drug's isn't going to be normal. So putting rebecca on these drugs actually foreclosed therapy and other non-pharmaceutical treatments.
posted by Pastabagel at 2:38 PM on February 26, 2007


Hypersexuality:

* “Children may masturbate frequently, initially openly, and then when told not to do it publicly will simply make frequent trips to the bathroom to continue the stimulation.”
* “Adolescents develop romantic fantasies and delusions about teachers.”



Well then, lock me the fuck up.

One of the most depressing things about my internship at a State Hospital in Minnesota was seeing seemingly normal kids, drugged beyond belief. I would sit there in group with them feeling unable to do anything but communicate on the most basic levels. Sure, there may be a few that would slit my throat as I slept, given half the chance but I couldn't help but feel that most of them had no business being on anti-psychotics. Some were simply warehoused there since they were "too much trouble" to deal with by apathetic parents. To me, it seemed to my altruistic eyes, that all of them were thrown away by the very people that should have taken care of them. And what a special joy it was to see a 12 year old suffering from Tardive Dyskinesia!

God this story is fucking depressing.
posted by KevinSkomsvold at 2:49 PM on February 26, 2007


I believe the psychiatrist should be charged with accessory to murder -- and I believe the parents should be charged too. The drugs that this child was given! Valproate is extremely toxic -- you need tests every couple of months to make sure your liver hasn't shut down. The other drugs aren't quite as toxic but are incredibly strong for a 2-1/2 year old child. My God. Dead at four from a drug overdose.
posted by lupus_yonderboy at 2:50 PM on February 26, 2007


IANAP (but I majored in it in college). Pastabagel, you're right on about most of children's therapy and whatnot being done with play.
This sort of thing freaks me out. A lot. My brother and I were fucked up kids and every time we got into trouble in school (my brother especially) they would drag his ass into the psych's office and the person would twirl their mustache and make up some bullshit diagnosis and attempt to get my parents to dope the shit out of him. With me, they didn't know what was going on. I had issues distinguising fantasy from reality, which led to some really fucked discussions. They wanted to put me on drugs too. Luckily my parents refused and while my brother and I aren't exactly the most well-adjusted people out there, who knows what would've happened if they had decided to dope us up from elementary school?

I'm all for the helpfulness of therapy and the practice of psychiatry, but stories like this just make me want to choke some bitches.
posted by sperose at 2:51 PM on February 26, 2007


Before you blame the psychiatrists, just as others have, in the past, blamed video games and Hollywood movies for kids firing semiautomatics into high school cafeterias, I'm wondering yet again why there is scant mention of parental responsibility in this thread.

The Boston Globe article specifies that the father, Michael Riley, was once charged with sexually abusing a 13-year-old girl (as it so happens, his stepdaughter, adopted from another home) by the Department of Social Services. DSS also removed two other children that the couple had. Further, Carolyn Riley (the mother) was being investigated by DSS for neglect.

Further, DSS ordered the father out of the home, where he was only allowed to see the children with a DSS official watching him. So why was the father there when Rebecca (the daughter) died?

Instead of making this yet another story where you blame everything but parental neglect, why pin this exclusively on the psychiatrists? That's as disingenuous as claiming that Littleton happened because of id Software.

Yes, I don't understand why these psychiatrists diagnosed this kid for ADD and bipolar. To me, it sounds fishy.* But then I'm not a licensed psychiatrist, and I'm guessing that neither is anyone reading this thread. And until we hear an explanation from the psychiatrist as to why so young a child was prescribed so potent an antidepressant, I'm disinclined to form an opinion until all the facts are in.

What I do know is this: the facts presented in the article suggest the probability of parental neglect. This is what I can form an opinion about, and it's something that can be altered, should the Globe or the Hull Police present additional evidence that might reinforce or rescind my opinion.

* -- Further, were not the parents the ones administering the antidepressants to their daughter? Were not the parents in the position of talking with the psychiatrist and saying, "Hey, you know, that's pretty fucking potent for our four year old. Are you sure about that?" Why was there complete trust in the psychiatrist? Unless, of course, they contrived a homicidal answer to their parenting problems from the get-go.
posted by ed at 2:54 PM on February 26, 2007 [2 favorites]


Last night I was at my boyfriend's parents house, along with his four nieces and nephews ranging from 8 months to 7 years old... I'm pretty sure they're all nuts, but bipolar? No. Just nutty little kids. How the hell could you even tell what abnormal behavior is for a 2 year old?
posted by Green Eyed Monster at 2:57 PM on February 26, 2007


but it's not just parental neglect, and there's no evidence of sexual abuse. The doctor prescribed those drugs (prob wrongly), and either did not read or learn of the family history, nor instruct the parents well. If they just were bad parents, the kid most likely wouldn't be dead now. It's the drugs that killed her, which the doctor told the parents to give her.
posted by amberglow at 2:58 PM on February 26, 2007


Are the parents responsible if the drugs were prescibed and administered correctly? Wouldn't the doctor has responsibility? Unless the parents changed the dose.

But there is more happening here than is clear from the article - it just sounds like a tragedy all around.
posted by jb at 2:59 PM on February 26, 2007


How the hell can a 2 1/2 year old be diagnosed with ADHD and Bipolar? She was barely even talking & walking at that age.
posted by mike3k at 3:06 PM on February 26, 2007


jb: I certainly agree with you that the doctor would bear responsibility if this prescription, as administered accurately by the parents, caused this child's death. But here's what the Pembroke Mariner says:
The child’s death was primarily attributed to an overdose of prescribed drugs that were allegedly mismanaged while the youngster was in the care of her parents.
(Emphasis added)
posted by ed at 3:06 PM on February 26, 2007


The big question: Who prescribed the drugs? Was it the "therapist" who filed complaints with the DSS? (Was it just your garden varity therapist or the psychiatrist who prescribed the medicine?)

And, by the way, if you MeFites want to dig up information, the doctor who prescribed the drugs is Dr. Kayoko Kifuji. While the case is being investigated, Kifuji has agreed to immediately stop treating patients.
posted by ed at 3:10 PM on February 26, 2007


This would never have happened in a Scientology family.
posted by hoverboards don't work on water at 3:15 PM on February 26, 2007 [3 favorites]


More on Kifuji.
posted by ed at 3:22 PM on February 26, 2007


Before you blame the psychiatrists, just as others have, in the past, blamed video games and Hollywood movies for kids firing semiautomatics into high school cafeterias, I'm wondering yet again why there is scant mention of parental responsibility in this thread.
posted by ed at 5:54 PM EST on February 26


Ed, the two blogs are both written by psychiatrists, criticizing the psychiatrists. In particular, thelastpsychiatrist.com appears to be a pretty critical insider's view of the profession (and the business).

The thing is, it is the psychiatrists fault if the parents were neglecting the kid, because if they are going to treat a child for psychiatric disorders, they at least have to interview the parents to see if they are causing the behavior, right?

But this psychiatrist was clearly working by the book, and by that I mean rigidly ticking off symptoms in the DSM like a supermarket checklist. Does she have this? Next, what about this? Okay, she can get seroquel! Ugh. Don't child psychiatrists as a rule also treat parents as like a family counseling thing? Should the step dad have set off alarms?
posted by Pastabagel at 3:24 PM on February 26, 2007


Well, just to throw some more kindling on the fire.

What do you call a med student who graduated last in his class?


Doctor.

Remember that when you look at the diplomas on the wall of your shrink/pediatrician/surgeon.

Of course, the guy who told me this joke was the Army surgeon who was about to remove my appendix, just before they put me under. I swear he said his name was Hawkeye.
posted by daq at 3:29 PM on February 26, 2007


Those 'parents' deserve murder charges. Any debate there?
You need a license to catch a fish but these devolved, brainless scumbags are allowed to procreate.


Sometimes you procreate with all the best intentions and yet things just get out of hand. Pick your partner wisely and insist on a thorough background check. But be prepared for the possibility of maybe a recessive gene going all day-glo nuclear in your offspring. And there is no catch and release here in the real world.

We hosted a BiPolar parents group several years ago and most of the meetings were spent comparing horror stories of mis-diagnoses and psychiatrists too busy writing scrips to even look at the child in the 15 minutes per month alloted by an insurance plan.

I met parents who had kids threatening siblings with kitchen knives, kicked out of schools, and punching up the house. Don't recall any one being a scumbag but enlighten me on the ones you've helped.

They all were looking to science for a solution and they were in a desperate position of needing one right quick for the very survival of the family. Most didn't have a PDR at home. All trusted their doctor to do the right thing; they followed his/her advice, found a way to pay for some ruinously expensive meds, brought the child in for regular checkups and calibrated the progress as best any devolved, brainless scumbag of a parent could under the circumstances.

Not one wanted to medicate their child.
posted by hal9k at 3:36 PM on February 26, 2007


As the aging treatments improved and the demographic bulge moved at cohort-speed toward immortality, the Young came more and more to be seen as a different culture or civilization - even species - from the "grown-ups". At first this seemed a normal trend - the old have always mistrusted the young, blamed their culture for imagined crimes, decried the shortcomings of "kids these days".

As the gap between the bulges in the distribution widened, this became more pronounced. No great surprise - the world view of an active nonagenarian could only more incompatable with that of a teenager than would a middle aged perspective. As the psychological and sociological sciences progressed, it seemed natural that there should be more diagnosable conditions to be found. So little wonder that a rising percentage of the worlds young should be under treatment.

In time, this growing population of chronically institutionalized youth became a serious economic burden: maintained under constant supervision in expensive facilities on expensive drugs - to what avail? Most would never recover from their conditions, and it wasn't too many decades (as the aging treatments got better and better) before laws were passed allowing the recovery of non-essential material. Someone who'd be on a hospital diet their entire life surely didn't need both kidneys, after all. Really, what use did someone kept under vegetative sedation have for both legs?

Thus, the flood of youth which has rushed down through history becomes held - dammed up by science for the benefit of an undying overclass of fearful centenarians. The pink and hale flesh that buds and flowers in the spring of each Generation reaped and processed to make splints and crutches for the old grey wood of their elders. Vast stretches of hospital wings and institutions full to brimming with children dulled and silenced in treatments for their supposed "symptoms" and "maladjustments", awaiting nothing but the harvester's scythe.

The undying elders growing further and further from a natural lifespan until it became unthinkable to relinquish that control. After all, how could the wisdom and experience of a leader who has lived three centuries yield the reins of power to a wild and unlearned child? The species splits in two - the static overclass of ageless elders forced to maintain themselves at the expense of a youth kept from maturing to maintain the former and prevent the collapse of an ancient and succesful civilization.

The pressures build, the old stories play out, potential energy surges into kinetic. The streets run with blood, the old makes way for the new, the eternal myths of change and revolution flash across the page. The new regime of course spirals in perfectly emulative rejection of the old as it always does, and younger and younger grow the purges for the crime of being old.

In time, infants and fresh cheeked children stand picking flowers and playing tag in the smoking and abandoned ruins of the towering structures their parents built. Wondering eyes wide and fresh, they wander into the howling dark wilderness as it leaps and clambers over the lost cities of their birth.
posted by freebird at 3:39 PM on February 26, 2007 [7 favorites]


Pastabagel: From the above-referenced article:
The police report also outlined a distressing pattern of Rebecca's mother's ability to obtain re fills of her medications, even when some pharmacists and a local therapist, who worked with the Riley family, raised questions to the doctor about the girl's medications. Michael Bourbeau, attorney for Rebecca's mother, said the mother insists that Kifuji sanctioned the giving of an extra dose of clonidine, the drug blamed in her death, if the girl had trouble sleeping at night. Kifuji has vehemently denied that during interviews with police.
So what we have here is a she said/she said situation. Carolyn Riley (the mother) was somehow able to obtain additional refills for the many medications, while imputing that Kifuji prescribe an extra dose of clonidine for a non-prescribed purpose (sleep, as opposed to stabilizing mood). But why then did Carolyn Riley over-medicate her daughter and why did she refill her prescription with all the zeal of an alcoholic stocking up on forty ouncers? (Convenience, you might argue. In the event that the drugs ran out. Well, if this was the case, why the "distressing pattern" identified by the police?)

Kifuji is also described in that article as "an expert in psychopharmacology" (which may explain the non-FDA prescribed drugs) and someone who would treat highly volatile family situations when no other doctors at the Tufts-New England Medical Center would.

If Kifuji did this ethically, I presume that she informed the parents that she was prescribing drugs that were outside the FDA's purview. But the parents were under no obligation to carry on with this doctor. Indeed, the other mother mentioned in the article, Dawn Bruneau, noted that she was uncomfortable with Kifuji's pharmaceutical approach and went elsewhere.
posted by ed at 3:43 PM on February 26, 2007


While I agree with the argument that we want kids to behave like short (and boring) adults these days, I don't think that really has any bearing on this situation. As someone said last week, "That is all different colors of messed up!"

So that being said, I'm going to push back against the "all kids have ADHD and we shouldn't be medicating our children" line of reasoning. I was identified as having ADHD as a child but my parents were worried about just how much calmer I got when on whatever they had me on for a while and discocontinued treatment. (I vaguely remember when I was taking it but don't remember responding one way or another).

As an adult I came to the conclusion that if I wanted to get ahead in life (or even stay employed) I had to do something about my issues and went the meds route. It has been very helpful in some regards, but it hasn't magically unlearned decades worth of the half-assed coping strategies that kids with ADHD come up with so they can get by.
posted by Kid Charlemagne at 3:55 PM on February 26, 2007 [1 favorite]


Just one data point but my aunt, a full grown woman of 40, had some sort of stroke while taking Seroquel, leaving her mostly paralyzed (and still schizophrenic as ever). A very sad story. Seroquel is no joke. I've observed people stumbling all over themselves after taking half a normal dose of that stuff. (Please don't hurt me AstraZeneca)
posted by Astragalus at 3:59 PM on February 26, 2007


In the interest of fairness, I should add that their promo pens are the nicest ones around.
posted by Astragalus at 4:02 PM on February 26, 2007


I certainly can't imagine what would constitute abnormal attention deficit and hyperactivity in a 2 year old. I've seen video of myself from when I was that age and I really liked to run around naked and accidentally pee on things while spinning in circles. If that's normal........

I am also constantly surprised by doctors diagnosing kids with disorders at an age where it would seem like they would need some sort of information from the child about her experiences that she isn't able to offer yet. For instance, I knew a little one year old boy that wore glasses. I wonder how his parents knew he had a problem or how the doctors test for that sort of thing. I'm sure, though, that it couldn't have been his inability to read the bottom line on the eye chart. Different case, but still a curious one to me.
posted by inconsequentialist at 4:08 PM on February 26, 2007


I have seen parents push doctors into prescribing psychotropic meds for their children (not me, thankfully). The problem is that psychiatric diagnosis and treatment is largely based on the history of the illness as given by the patient. Do you hear voices, do you feel sad, etc. In the case of children, it's the parents who provide the history. Most of the time, these people wind up in a shrink's office because something is out of control at home, and the parent has either an explicit or implicit interest in keeping their kid doped up. Add to the mix the fact that these are usually poor kids, on Medicaid, and an overburdened psychiatric system that might be able to see these kids for 15 minutes every 3 months instead of the hour each week they need to properly diagnose and treat them -- it's a mess. I would fall short of saying that these meds should never be prescribed, but they should certainly be prescribed with a great deal more care than our broken health care system can provide.
posted by Slarty Bartfast at 4:11 PM on February 26, 2007


Just a side issue, but I wonder what the labels on the meds actually said? And if these parents understood them?
posted by dilettante at 4:17 PM on February 26, 2007


hal9k wrote: "I met parents who had kids threatening siblings with kitchen knives, kicked out of schools, and punching up the house."

hal9k, this girl was *two and one half years old* when she was put on medication!

No one disputes that some kids are crazy and need medication -- but this was a child who had probably barely just learned to speak.
posted by lupus_yonderboy at 4:18 PM on February 26, 2007


Am a medical student. Spent three weeks in a child/adolescent inpatient psychiatric hospital.

The youngest we got was a five year-old with a bona fide case of attention deficit-hyperactivity; however, the bulk of his behavioral issues were related to a less-than-stellar homelife. Note that he wasn't abused or even coddled: he just had inconsistent discipline, lax and neglectful in one household and draconian in another.

There is a place for pharmacotherapy of children; but often, as in the case I mentioned, it must be combined with other kinds of intervention, many of them at the level of the family.

Still, I can't imagine the psych attending at my hospital ever passing such a diagnosis on a 2 1/2 year-old. I don't know the whole story there, so I can't pass a definitive judgment. But I find it very strange, anyway. One thing child psychiatrists have to keep in mind is that very few drugs are explicitly studied in children; and besides stimulants for ADHD-type disorders, even fewer psychoactive drugs are tested in children. So it's always experience and reports and sometimes anecdotal evidence that drives their use in kids—and, in the prudent psychiatrist, a lot of caution. What they say on the first day of pediatrics—"that children are not just miniature adults"—holds true in nearly every aspect of medicine.
posted by adoarns at 4:18 PM on February 26, 2007


I met parents who had kids threatening siblings with kitchen knives, kicked out of schools, and punching up the house. Don't recall any one being a scumbag but enlighten me on the ones you've helped.

a) The kid was four.

b) She had been poisoned by these primates she had the misfortune of having as parents since she was two and-a-fucking-half.

c) She was only four.

d) The 'dad' is a suspected child molester.
posted by ElmerFishpaw at 4:21 PM on February 26, 2007


One further point: By the time the parents I met had arrived at a diagnosis of bipolar and were just getting into the crapshoot of various prescriptions, they all walked in in a deer-in-the-headlights state. Their kid did something to bring them to this point (expelled from school, frequent fights) that ostracized them from family, friends, school, neighbors and any other support they could once count on.

This stuff breaks up families wicked quick. I understand your argument of lousy parenting but consider how much lousier it becomes when one of them torques off into the sunset when that whole family dynamic doesn't quite match his/her June and Ward Cleaver expectations.

The psychiatrist (assuming they can even find one) may be their last hope and probably the only one who has seen it before. This is the point where being a good consumer has to kick in. The side-effects are many. The research takes a good deal of time that most don't have.
posted by hal9k at 4:27 PM on February 26, 2007


It seems that a diagnosis of both ADHD and bipolar disorder in a young child is extremely rare or, rather, it may be highly unlikely that a child is afflicted with both disorders and difficult to determine if she in fact is.

Some info from WebMD on such a joint diagnosis and the hazards of drug interactions.
posted by inconsequentialist at 4:37 PM on February 26, 2007


I understand that there is an instinctive need to comment on this case, but the level of asinine, uninformed speculation in this thread just blows my mind.
posted by docpops at 4:39 PM on February 26, 2007


hal9k wrote: "their kid did something to bring them to this point (expelled from school, frequent fights)"

Again, you seem to have missed the point that the kid was two and one-half years old when she went on medication.
posted by lupus_yonderboy at 4:45 PM on February 26, 2007


The problem is not likely with this specific doctor, so much as it is with a whole clinical profession that believes that medications are the only or necessary answer to every life problem ("If the only tool you have is a hammer, everything looks like a nail.").

Pediatric diagnoses of adult mental disorders has been slowly gaining acceptance amongst many mental health professionals who treat children. Not because there's science or research to back up this assertion (although there is some), but more so because people in need come to them with apparent problems (the child's behavior) and they don't have many answers outside of, "Well, this looks a lot like adult bipolar disorder, so let's try this med..."
posted by docjohn at 4:46 PM on February 26, 2007


The correct response in many of these cases would be to say, in effect, "Your child is irretrievably screwed-up for life because you, the parent, lack the minimum basic skills necessary to nurture a healthy child. I can't help your child, because I cannot change the fact that you, the parents, are incompetent shitheads". But that just isn't realistic in the real world, for better or worse, because there is a real hope, I think, from the Psychiatric community, that these medications may be able to mitigate the collateral damage [school failure, ostracism, parental abuse] that occurs in horrible parenting situations.
posted by docpops at 4:54 PM on February 26, 2007


I think docjohn has it. Mental health professionals are primarily trained to prescribe medicines and there are usually few other resources for these kids. Even if they resist the pull to put these kids on meds, odds are pretty good that someone will eventually.

In this case, it contributed to the death of a little girl. Ultimately the person with the most liability is probably the prescriber although I am very sympathetic to the position they are in. Basically, you have a kid who's out of control, on the fast track to a life of school suspensions, learning disabilities, and problems with law enforcement. Your choices are A. prescribe medications that *might* be effective or B. do nothing.
posted by Slarty Bartfast at 4:59 PM on February 26, 2007


Also what docpops said.
posted by Slarty Bartfast at 5:00 PM on February 26, 2007



Another possibility is that mom or dad has Munchausen's by Proxy. This is where a parent deliberately makes a child ill or even kills the child to get attention.

My co-author is a leading child psychiatrist who is not drug-happy but not drug-opposed. He pioneered work on clonidine and naltrexone for child PTSD-- clonidine calms the stress system and a lot of ADD often turns out to be misdiagnosed PTSD, this is why it is used "off-label" for "tuned up" kids who seem to have over-active stress responses. Sadly, there are only a few pilot trials after years of off-label use-- no money in finding out whether it works since it's generic.

Anyway, he had a case that we describe in our book in which a child was claimed by his mother to have all these crazy behavioral problems. He "overdosed" on his meds; he "jumped out" a window. Turned out he was forced by her to take the pills and pushed out the window.

Previous clinicians had believed Mom-- but my colleague was puzzled by the child's failure to behave the way his diagnosis suggested he should behave around everyone except Mom.

True Munchausen's-by-proxy is really rare-- but the people with it seem to have an incredible ability to convince doctors just how uniquely ill their child is and this could be part of how you get someone prescribing for a 2 and a half year old.
posted by Maias at 5:03 PM on February 26, 2007 [1 favorite]


Heartbreaking.

That said, couldn't we rationalize most 2 year olds as bi-polar or ADHD? I didn't think we were even supposed to have an attention span of longer than 3 minutes at the age of two. I could go on and on about the crazy shit my daughter did at age 2 - and guess what? She grew out of it by the time she was 3...

Sometimes though, I think doctors misdiagnose, or for lack of a better term "do something" because they want to appease pushy or desperate "customers." Or maybe they don't want to come across as not knowing what to do, so they do "something." These parents were morons who should have had the good sense to run away from the idiot(s) who put the child on those medications.
posted by queenofthegeeks at 5:12 PM on February 26, 2007


That said, couldn't we rationalize most 2 year olds as bi-polar or ADHD?

No, and if you spent time around a lot of toddlers you would see there is a tremendous difference between really unusual and reasonably normal behavior in pre-schoolers.

I could go on and on about the crazy shit my daughter did at age 2 - and guess what? She grew out of it by the time she was 3...

Congratulations on your good fortune. Your study of N=1 does not qualify you for further cogent analysis.

Sometimes though, I think doctors misdiagnose, or for lack of a better term "do something" because they want to appease pushy or desperate "customers."

You could be right.
posted by docpops at 5:16 PM on February 26, 2007 [1 favorite]


From what I've read, other industrialized countries don't drug their kids nearly as much as we do in America, and yet their kids turn out smarter and get better test scores. I wonder what's up with that.

The number of kids medicated isn't really enough to alter average test scores. Also I think it's unlikely that medicated kids would do worse in school then medicated ones.

You can tell a Great Civilization, in the historical sense, by the rate and gusto with which it devours and discards its young. Remember the view from up here, it probably can't last much longer.

This is an isolated incident. Come on.
Look this case seems simple: Fucked up parents gave their daughter way more pills then they were supposed to

...In time, infants and fresh cheeked children stand picking flowers and playing tag in the smoking and abandoned ruins of the towering structures their parents built. Wondering eyes wide and fresh, they wander into the howling dark wilderness as it leaps and clambers over the lost cities of their birth.

Try again but this time with a little bit more schlock.
posted by delmoi at 5:20 PM on February 26, 2007 [1 favorite]


When my seemingly normal daughter reached about 18 months of age she suddenly became a raving lunatic, waking up in the middle of the night and screaming for hours, crying uncontrollably for no apparent reason, crawling around on the floor in fits, etc. My wife and I were distraught, terrified even. Our pediatrician suggested taking her to a child psychologist, who diagnosed Sensory Integration Dysfunction. She was immediately enrolled in New York City's early intervention program, which included weekly home visits by three separate specialists: an occupational therapist, a behavioral specialist and a speech therapist—all paid for by the city. The results were dramatic. After about a year she was reevaluated and the regimen reduced to once-a-week OT. At age four it was determined that she didn't need therapy anymore. She's now a perfectly healthy though slightly offbeat seven-year-old.

I cannot relate how grateful I am that NYC had such a program in place, and that our doctors were wise enough to address our child's needs appropriately, without medication. I can see how parents (not necessarily the ones in the story above) without those resources available to them might be led down another path.
posted by stargell at 5:20 PM on February 26, 2007 [1 favorite]


stargell - that is a really amazing anecdote. I often envision such environments when I think of an attainable Utopia for the treatment of child and adolescent mental health, but then am reminded of the fact that Oregon, like many other places, is so ambivalent and hostile to taxation for basic services that there isn't a chance in hell it will happen in my lifetime. But your story simply illustrates how possible and cost-effective, ultimately, treatment in a multi-discliplinary fashion is.
posted by docpops at 5:27 PM on February 26, 2007


I am in 100% agreement that these parents were totally unfit and culpable for the death of this little girl.

As a parent of a kid with severe ADHD, however, I want to say that very young children can display extreme behaviors that are quite obviously not just childhood energy and exuberance. I have no idea how this little girl presented, but I will tell you that my son, from about 2 years on, was obviously VERY different from his peers. That said, our doctors (and this was 9-10 years ago) wouldn't even consider ADHD until he was 6, by which point I practically needed medication myself from trying to parent a kid who made the Tasmanian Devil look like Perry Como.

These days he's on rather large doses of Adderall and Clonidine, and closely monitored by his doctor. He's anything but a drugged-up zombie. He is a lively 12 year old with a curious intellect, a wild imagination and a gentle manner. Without the meds, those qualities would be hidden behind the constant noise, movement and compulsive behaviors. He's still different from his peers, but in a "what a charming little boy" way, rather than a "what is wrong with that freak?" way.

I guess I just get cranky when intelligent people dismiss ADHD and other pediatric mental issues as the imaginings of lazy parents and fed-up teachers. My husband and I are educated, dedicated parents and I resent the assumption that we must be neglectful idiots because my son is medicated for what is, for him, a debilitating disorder.
posted by Biblio at 5:33 PM on February 26, 2007 [4 favorites]


You know, being a parent sucks, in that when you hear these stories, you first want to throw up, and then die, so that you don't have to think about a child just like yours suffering so much. I never knew how many parents killed their kids until I had one and had to start dodging the news.

On the other hand, I think people do really believe that if the doctor prescribes it, it's ok, even for their kids, especially if they're having trouble handling their kids. I don't think we know enough yet; this little girl may have just fallen into the cracks of her parents' ignorance and the medical systems' lack of protocols for someone so young.

Not that that makes it any better. Poor little thing. I'm going to go watch my little boy sleeping now.
posted by emjaybee at 7:07 PM on February 26, 2007 [1 favorite]


Biblio, do you think your child should have been on medicine from 2? Wouldn't his development have been affected? (2 seems really really young, brainwise, no?)
posted by amberglow at 7:17 PM on February 26, 2007


My adopted sister was on some of these kinds of medication since she was very little. From having to live with her I think they just made things worse, she was still crazy, seriously...but with the meds she was numb crazy, with no emotion to be able to control herself. No shame, no love, no empathy for herself or anyone else. She is now 19 (almost) and a registered sex offender, having to live in a group home because she is so violent and unpredictable she is not safe to be in normal society. The medicine has made her a cold cold person. I have no doubt that this has affecter her life expectancy, and it almost did kill her several times growing up.

These kind of medication stories make me sick. I dont know who is to blame, the parents or the doctor, most likely a combination of both.
posted by Jenny is Crafty at 7:52 PM on February 26, 2007


"the level of asinine, uninformed speculation in this thread just blows my mind."

I'm not sure who this remark is aimed at docpops, but I think we all respect your informed comments on the situation. But some of us have seen family members, and maybe even themselves harmed by prescription happy psychs. So you might take that into consideration.
posted by vronsky at 8:05 PM on February 26, 2007



How could anyone, let alone a psychiatrist, decide a 2-year-old was bipolar?


Well, sometimes she'd cry uncontrollably. Other times she'd giggle at nothing in particular. Then she'd spew nonsense syllables. She was obviously insane.
posted by jonmc at 8:25 PM on February 26, 2007


(kidding aside, as someone who was put on Ritalin around age 7-and this was in the 70's before they satrted sprinkling it on the brekfast cereal- I am extremely wary and skeptical about the drive to medicate the population.)
posted by jonmc at 8:27 PM on February 26, 2007


Also you chastise one comment as n=1 nonsense, then praise another as a wonderfully illustrative anecdote. Kinda contradictory huh?

What was it daq said above?
posted by vronsky at 8:42 PM on February 26, 2007


Quiet? A little too quiet.
posted by telstar at 8:45 PM on February 26, 2007


.
posted by nickyskye at 11:18 PM on February 26, 2007


I predict with absolute certainty that this will be made into a Law and Order episode.

If I weren't reading the headlines on the blessed 'Filter, bastion of truth, I would think it already WAS a L&O episode. The question is, will the pyschiatrist be complicit, placing it in the camp of Criminal Intent, or will there be suspicion of molestation on the part of the parents, placing it on Special Victims Unit?

Tune in to find out!

On a more serious note, I have this friend step-brother who was placed on various drugs - including clonodine - at age nine for various "disorders" including ADHD. The outcome? He was still a fuxored kid, especially considering that his parents had the combined parenting skillz of a particularly dull rock. He started abusing his prescriptions - taking Ritalin to feel high and clonodine to fall asleep again. He hardly ever ate anything and spent most of his childhood underweight, underslept, and spaced out. At twelve, he turned to alcohol. At fourteen, weed. He even huffed air freshener at one point. (I mentioned to him the irony that his room always smelled like something died in it, so why oh why did he huff behind the garage? Couldn't he maybe have used a little in his den of filth first?) He was in and out of rehab before most people have even graduated high school.

Do I blame his parents' decision to over-medicate him as a child on the fact that he is now a homeless drug dealer? Yes. Yes I do.
posted by grapefruitmoon at 2:36 AM on February 27, 2007


I'd also like to note that I've taught preschool and that yes, you can really REALLY tell the difference between a developmentally normal child and one who might be showing early signs of learning disorders and/or ADHD.

Everything, every single stupid or weird thing, a child does is done in response to a stimulus. As an adult, it is sometimes very hard for us to understand that the color red can make someone cry, but for a two and a half year old, LIFE IS HARD. Children do not burst into tears for no reason, rather, we as adults don't understand their reasons and so we wrongly assume that there isn't one. Pretty often, there's nothing that can be done about the fact that the other kid looked at him or that they are not at grandma's house RIGHT NOW, but that doesn't mean that these aren't legitimate reasons for a complete breakdown at age two.

Even at two, most children can respond to external cues. I have only witnessed one, and only one, child who seemed to me to be suffering from some sort of mental illness. This child was four years old and not only was incapable of responding normally (for his age group) to the outside world, but seemed to be responding to a separate reality existing only in his head. Most kids have good imaginations, but most kids also don't start responding to you as if you had just spoken when you hadn't said anything. Make-believe arguments and a kid who seems to truly be hearing voices are entirely different things.

I also had a kid who seemed to be having ADD related issues, who was able to get under control once he was forced to nap (by which I mean he was gently held on his cot until he fell asleep as he was otherwise incapable of holding still) at school and his parents placed more limits on his behavior at home. Once they realized that no, this wasn't exactly normal, they were more than willing to help control his impulsiveness. By the time I left him, he was still a hyper kid, but by no means disruptive in the ways that he had been.

I just thought that I would provide some insight into the fact that yes, there is a huge difference between a "normal" kid and one who is probably suffering from a learning disorder or mental illness. I would also be among the first to say that these kids should be given support and time to work out their issues long before any medication was prescribed. Some kids truly DO have ADHD, and some kids truly ARE bipolar (I have a friend who was diagnosed at 12, after she took a knife to her mother) and these kids need all the help they can get - pharmaceutical or otherwise. However, the vast majority can get by with a little extra help from parents, teachers, and doctors.
posted by grapefruitmoon at 2:56 AM on February 27, 2007


Sorry for jumping on you, Elmer. We're in agreement on this particular crime.

Effective treatment requires a team: a psychiatrist, a psychologist, and a pediatrician. And regular visits with each. You allow them to share any and all information with each other. Any one of the team, including the parent, can call bullshit.

Let me be first: I consider adolescent bipolar as bullshit and a blanket diagnosis for "beyond these synapses there be dragons." But it is the best we, personally, have to work from at this point. A good deal of the treatment is behavioral; timid parents need not apply. An adult-only dosage tested drug regimen to treat a vaguely defined mental illness, given to a child, yes, is horrible and unforgivable - thanks to all for that insight - but it is not necessarily uninformed.
posted by hal9k at 3:35 AM on February 27, 2007


Hi. I woke up to find my site had been hit, and I see that one of my posts had been linked, above. I hope it's ok to add one more comment here.

The primary issue is that psychiatry is set up to impersonate a medical discipline, but it lacks the fundamental core: physical pathology.

With few exceptions, psychiatric diagnoses are associations. "These behaviors go together." But this does not imply pathology (physical) nor even that they should be grouped together. For example, polyuria and polydypsia seem to go together, maybe it's a kidney problem? And so psychiatrists focus on the kidney. Meanwhile, the actual disease is something (diabetes) entirely different.

So psychiatry doesn't have nearly enough relevant science to use a diagnosis as a basis for treatment. You don't give kidney drugs for polyuria, despite how "logical" it may seem.

There's merit in saying "whenever a person is extremely impulsive, X drug works for that." But there is no rational reason to move from diagnosis to treatment: "Oh, I've figured out he is an undiagnosed bipolar, so therefore we should use Depakote." But that is exactly what happens, and happened to that kid. He described a collection of behaviors as bipolar-- which has no clear physical correlate-- and then moved, blindly, along treatment guidelines to the medications used for bipolar.

It's not that psych drugs are inherenetly bad (or good.) But the extreme shift towards biology in the absence of actually finding any useful biology guarantees that a) all behavior can be pathologized; b) --and this is where psychiatrists should really take a look at themselves-- means that responsibility for the pathologized behavior now rests with psychiatrist. If your patient kills someone, and it is "bipolar," then it is your fault.

I've written other posts on my blog about this issue, check out under "Politics."
posted by TheLastPsychiatrist at 6:42 AM on February 27, 2007 [5 favorites]


I have no degree in psychiatry, but I have taken valproic acid (a.k.a. Depakote) for several years successfully. On the other hand, I'm approximately 6 feet tall and 200 pounds, yet I have to take Depakote before going to bed, because it can make me sleepy. For a 4-year-old, I wonder if it can make them so sleepy that they don't wake up. In addition, if you take Depakote, it's generally recommended that you get your blood drawn at semi-regular intervals so that you can have the valproic acid levels in your blood checked. Aside from the problematic status of prescribing valproic acid for a four-year-old, if they prescribed it without checking blood levels, that alone might constitute psychiatric malpractice.
posted by jonp72 at 7:47 AM on February 27, 2007


I don't understand the diagnosis at all. How does a psychiatrist even agree to attempt to diagnose a two year old, give there is such variation from one two year old to the next in development, speech, etc. And it isn't bad parenting that causes the differences, but rather different priorities in parenting. two year old who spend a lot of time around other two years olds are going to be different than two year olds who spend a lot of time around adults.
posted by Pastabagel at 8:06 AM on February 27, 2007


Drugs are bad, kids.

Now, take your medicine...
posted by Revvy at 9:27 AM on February 27, 2007


I had terrible ADHD as a child (or so my parents/psychologist told me) and was on Ritalin for 5 years. In the intervening years, I have realized what an incredibly dull, shy, and withdrawn person it made me during that critical step in social development, and I think it shines some light on why I am so socially retarded today.
posted by tehloki at 1:40 AM on February 28, 2007


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