A Bipolar Child Murdered: Prosecutors Allege Parents Made Up Symptoms

The case of Rebecca Riley, a Boston-area four-year-old who died in December due to an overdose of psych meds, keeps getting weirder and weirder. Not that it wasn't already. Riley was diagnosed with ADHD at two-years-old and, later, with bipolar disorder. The case is getting a lot of national attention due to the controversial psych diagnoses in children so young. The implications of this case are rather large, as you'll see.

Prosecutors now allege that Riley's parents made up their daughter's symptoms of hyperactivity and combativeness as a scam to get their daughter on disability. Two older kids of theirs had been diagnosed with bipolar disorder and were on SSI. The family's psychiatrist diagnosed the girl with ADHD based upon the mother's account of her behavior. Then the Rileys applied for SSI. After being examined by two other doctors, the girl was denied SSI, as the doctors asserted that they couldn't find symptoms to back up the ADHD diagnosis.

Don't read too much into the SSI denial yet--the feds often deny people SSI benefits once or twice before finally granting them. But still. And next:

"Carolyn [the mom] then took her back to Kifuji [the psych doc] and said the girl had "mood swings" and was "driving me crazy," Middleton [the prosecutor] said. Kifuji then diagnosed her with bipolar disorder at age 3. Carolyn Riley "continued to feed Dr. Kifuji fabricated symptoms," Middleton said. He said Rebecca's teachers, the school nurse, mental health therapist and neighbors and adults who lived with the Riley's all told the grand jury that "Rebecca showed none of these behaviors."

A second application for benefits was rejected after a doctor said she didn't have signs of the disorder, Middleton said."

If true, that's beyond belief that parents would do all of this to their kid. But, God knows, this was one messed-up family, according to press accounts. Keep in mind, however, that this was a bail hearing and prosecutors regularly allege the most outrageous stuff in order to keep the accused in jail pending trial. Both parents are now held without bail and face murder charges. The psychiatrist has temporarily suspended her practice.

The family's lawyers allege that the doctor killed Rebecca by over-medicating her. We'll see, but I am beginning to doubt that.

But there's something more troubling in all of this that the Boston media didn't bring up in the press accounts I've read.

If, as prosecutors allege, the parents made up symptoms and could convince an experienced psychiatrist of their presence and veracity, then what does that say about how psych docs do diagnostic work-ups of children? Do parental reports about behaviors become the standard of gauging symptoms? Are the symptoms properly related to abnormal behaviors in the first place or are they a convenient place to stuff childhood problems? How, if outside doctors didn't observe ADHD/bipolar symptoms in Rebecca, was the family's doctor able to make these observations?

What does this say about a profession and a treatment paradigm for adults, teens and kids that relies upon self-reporting of symptoms? Can would-be patients or families dupe doctors like this all the time? How many more of the millions of kids diagnosed with ADHD and bipolar disorder carry their diagnoses as a result of parental reporting alone, with whatever biases might be present? Is there a way for child psychiatrists to filter out parental bias?

Two million or so children are running around these days on multiple psych meds in the US. Assuming ADHD and early-onset bipolar disorder are legitimate diagnoses in children so young, how many of them are on meds for the right reasons and how many are on meds to satisfy their parents or schools or as a result of duped doctors?

I am not making assertions here. I am just asking questions. Everyone should be asking questions. And the child psychiatry academy should be asking the most questions and doing the most soul-searching of anyone.

As I've noted before, I suspect we'll be hearing about this case and its implications for a long time.