BOSTON—Before she turned 3, Rebecca Riley was diagnosed with attention deficit hyperactivity and bipolar disorders. By age 4 she was dead. Authorities said her body succumbed to a cocktail of prescription drugs typically given to adults.
Her parents, Michael and Carolyn Riley, go to trial Thursday on murder charges in a case that reignited a long-running debate in psychiatry over whether young children can be accurately diagnosed with serious mental illnesses, and if so, how they should be treated.
The Rileys insist they were just following doctor's orders, and contend the girl died of pneumonia in December 2006.
Prosecutors allege the parents deliberately overmedicated the brown-eyed, chipmunk-cheeked girl to keep her quiet, and ended up killing her.
Carolyn Riley's lawyer, Michael Bourbeau, declined to comment on the eve of the trial in Brockton Superior Court but has said Carolyn Riley gave her daughter only the number of pills prescribed by Dr. Kayoko Kifuji.
"Carolyn Riley has done everything she could as a mother to take care of her child. She relied on the doctor," Bourbeau said during a pretrial hearing.
Michael Riley's lawyer, John Darrell, called his client "a loving parent who cared about his children" and insists the Rileys strictly followed the orders of Kifuji, who he has called "a totally irresponsible doctor."
Kifuji was not charged in Rebecca's death. A grand jury refused to indict her, and in September she was reinstated to her job as a child psychiatrist at Tufts Medical Center in Boston. She has declined repeated interview requests.
Some psychiatrists believe the case illustrates a trend of overdiagnosing bipolar disorder in young children, an illness traditionally diagnosed in adolescence or early adulthood.
"There are some kids who need those medicines, but I think you get on a slippery slope when, rather than acknowledging that it's really tough to diagnose this in preschoolers, there's a tendency to say, 'Let's give her medication,'" said Dr. Oscar Bukstein, a child psychiatrist and professor at the University of Pittsburgh who is not involved in the case.
According to a state medical examiner, Rebecca died of a combination of Clonidine, a blood pressure medication the girl had been prescribed for ADHD; Depakote, an antiseizure 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.
The two prescription drugs, Clonidine and Depakote, are approved by the Food and Drug Administration for use in adults only, although doctors can legally prescribe them to children and often do.
In the months before her death, Rebecca showed signs of being overmedicated. A school nurse said she was so weak she was like a "floppy doll." Her principal said she had to help the girl off the bus and walking on stairs several times because she was shaking.
Relatives told police the Rileys called Clonidine "happy medicine" and "sleep medicine," and gave it to their two other children, who had also been diagnosed with ADHD and bipolar disorder by Kifuji.
Prosecutors have said they believe Carolyn Riley made up stories about losing or accidentally ruining bottles of Clonidine so that she could get more pills to give to Rebecca and the other children.
They also claim the Rileys, of Hull, concocted symptoms of mental illness in hopes of collecting Social Security disability payments for her, as they had with their other kids.
Kifuji, who will be called by prosecutors to testify at the trial, has insisted that she warned Carolyn Riley against giving Rebecca any extra Clonidine.
"The medications that she prescribed and that were used to treat Rebecca are commonly used and highly appropriate to treat ADHD and bipolar," said her lawyer, Bruce Singal. "As long as they are taken as prescribed, they are an appropriate and effective method to treat those illnesses."