Rebecca Jeanne Riley (April 11, 2002 – December 13, 2006) was a four-year-old girl from Massachusetts. In December 2006, Riley's parents gave Riley—who had been diagnosed with attention-deficit hyperactivity disorder and pediatric bipolar disorder between two and three years old—a lethal dose of clonidine. Her death sparked significant controversy over the diagnosis of psychiatric conditions and subsequent prescription of psychotropic medication for children.
Background Rebecca Jeanne Riley was born on April 11, 2002, in Springfield, Massachusetts, to Carolyn (née DiSalvo) and Michael Riley. Riley lived with two older siblings, Gerard and Kaitlynne. She also had an older half-sister, Ashley, whom Carolyn had surrendered in an open adoption at two years old.
Most of the Riley family had been diagnosed with mental illness. Michael, who had unmedicated bipolar disorder and "intermittent rage disorder", had reportedly been arrested for assault and battery in 1998. Carolyn took medication for migraines and Paxil for depression and anxiety. Gerard and Kaitlynne were reportedly under the care of child psychiatrist Kayoko Kifuji for pediatric bipolar disorder and attention-deficit hyperactivity disorder (ADHD). Kaitlynne had been diagnosed with bipolar disorder in April 2003, when she was two years old, and prescribed the mood stabilizer Depakote (valproate). A social worker disagreed with Kaitlynne's diagnosis, stating that her behavior was normal for a toddler.
Both parents were unemployed, lived in Section 8 housing and received monthly Social Security Disability Income. Gerard and Kaitlynne both qualified for Supplemental Security Income payments, which totaled about $2,300 per month. The family received an estimated total of $2,700 per month.
Relatives and Kifuji noted that the Riley parents did not administer medication according to doctor's orders. Both parents reportedly nicknamed mood stabilizers and clonidine "happy medicine" and "sleep medicine," respectively. Carolyn allegedly offered her Paxil and migraine medications to a housemate, and had given Kaitlynne some of Gerard's clonidine tablets before Kifuji had prescribed the medication for her.
Psychiatric treatment Beginning of psychiatric treatment On August 27, 2004, when Riley was two years old, her parents reported to Kifuji (then working at the Tufts-New England Medical Center) that the girl was hyperactive, getting little sleep, and acted violently towards her older siblings. Kifuji, who had already been treating the older two Riley children, stated that she believed Carolyn was accurately reporting her children's behaviors and reactions to the medications. Riley was diagnosed with ADHD and prescribed one tablet of clonidine, an antihypertensive drug that is also used off-label for ADHD in children. At this point, Kifuji was reportedly seeing all three children in the span of an hour, giving her approximately 20 minutes to assess Riley's behavior.
After the diagnosis, Riley's parents submitted an application for Supplemental Security Income, which, if approved, would have provided another US$630.00 to the Riley family. However, the application was denied.
Within less than a week, Carolyn began giving Riley two tablets of clonidine without Kifuji's approval. On September 1, she informed Kifuji of the increased dosage over the phone. Though Kifuji had not given her permission to do this, she authorized the increase. Kifuji reportedly increased Riley's clonidine dosage again in January 2005.
In May 2005, Riley's parents claimed to Kifuji that the now three-year-old Riley was experiencing mood swings and crying frequently. Kifuji diagnosed Riley with pediatric bipolar disorder, which she later explained was due to the girl's in-office behavior and family history. For bipolar disorder, Riley was prescribed the mood stabilizer Depakote (valproate).
Early Social Services involvement Michael Riley was arrested in June 2005 after Carolyn's 13-year-old daughter accused him of sexual assault. In light of these allegations, the Massachusetts Department of Social Services (DSS) required him to leave the Weymouth apartment, only see his children under direct supervision, and barred him from staying at the apartment overnight. Afterwards, neighbors allegedly became hostile towards the family, vandalizing their apartment and car.
There were no documented changes to Riley's prescription regimen until October 27, 2005, when Carolyn reported that she had increased Riley's nightly dose of clonidine to two and a half tablets, allegedly to help the child sleep. Kifuji, alarmed, explained to Carolyn that such an increase could prove fatal and told her to talk to her about adjustments to Riley's medications. She allegedly told Carolyn that if the mother further increased the dose on her own, she would report her to DSS. Riley was then prescribed Zyprexa (olanzapine), an atypical antipsychotic frequently used for the treatment of bipolar disorder.
Attempts at intervention Riley was enrolled in preschool in January 2006, where school faculty quickly grew concerned about her wellbeing. She displayed symptoms of overmedication: she had a tremor in her hand and appeared "lethargic" and "unsteady on her feet," shaking so severely that she could not use stairs or exit the school bus without an adult's help. The Depakote caused her to constantly need to urinate. The school nurse noted the girl was weak and not particularly resistant, describing her as being like "a floppy doll." One teacher noted that Riley would become more attentive and lively around 2 PM, "using words and attempting activities," and suspected this was around the time the girl's medication was wearing off. None of the faculty noticed mood or behavioral symptoms consistent with pediatric bipolar disorder or ADHD; by contrast, some testified that Riley was "a very sweet little girl."
School faculty tried to share their concerns with Riley's parents, but had little success. Michael did not go to the girl's preschool, and while Carolyn was reachable by phone, she showed up infrequently. She reportedly dismissed concerns about Riley's behavior, saying the girl had been sleeping poorly. Officials noted that Carolyn had a flat affect, spoke in monotone, and regularly appeared lethargic herself, leading some to suspect Carolyn was also overmedicated. Despite their concerns, the school did not file a report with DSS.
In February 2006, Kifuji began transitioning Riley from Zyprexa to Seroquel (quetiapine).
A social worker from South Bay Mental Health Services began treating Riley and her sister Kaitlynne at the family's apartment in May 2006. Upon arrival, the children were frequently asleep; while she worked with them, she noted that both girls were too weak to draw with a crayon. The social worker also noted that Carolyn appeared sluggish, "drugged out," and frequently neglected the children, once failing to clean a puddle of urine off the floor. Like the preschool faculty, the social worker did not observe any mood or behavioral symptoms in Riley that would require pharmaceutical treatment.
During the summer of 2006, the social worker filed two reports with DSS. One alleged neglect, while the other was in response to Kaitlynne stating Michael had struck her. She also placed a call to Kifuji to express concern about the children's medication regimen; Kifuji allegedly stated that she was also concerned, but that according to Carolyn's reports during appointments, the children's behavior did not improve on lower dosages. After Carolyn was contacted by DSS officials in July, she abruptly fired the social worker, then placed a call to Kifuji asking her to tell DSS they did not need to investigate. DSS later closed both of the social worker's reports as "unsubstantiated."
Carolyn's half-brother, James McGonnell, moved into the family's Weymouth apartment in August 2006. That same month, Carolyn began attempting to obtain extra prescriptions of clonidine from the pharmacy. Though she sometimes had an explanation for needing more clonidine (such as claiming she lost the previous prescription or that the pills were damaged by water), she often did not. By late August, Kifuji began prescribing the children's clonidine in ten-day increments due to the lost pills.
At some point, Michael began visiting Carolyn and the children without supervision, in violation of DSS requirements. In October 2006, during one of these visits, Michael allegedly grabbed Gerard by the throat and slammed his head against the rear windshield of his pickup truck. Carolyn subsequently filed for a restraining order against Michael. Later that month, Kelly Williams and her six-year-old son moved into the Weymouth apartment.
Williams later recalled that Carolyn stored the children's medications in a large pill box and would give them their clonidine tablet at 7:30 pm each night. Though Riley was supposed to be receiving three half-tablets of clonidine daily, Williams and McGonnell told police that when they had seen Carolyn give Riley her medication, she had always been given full tablets. According to Williams, Carolyn had once confessed she thought the amount of medication was "excessive," but was following doctor's orders.
Move to Hull In early November 2006, officials at Riley's preschool contacted Kifuji, stating that they were concerned about the amount of medication administered to the girl. Kifuji planned to discuss decreasing Riley's clonidine dosage, but Carolyn reportedly became agitated upon hearing of the phone call, claiming the school had not contacted her.
Carolyn did not renew the restraining order against Michael, leading it to expire in November 2006. However, according to DSS officials, she claimed on November 10 that the restraining order was still in place. She additionally informed DSS representatives that she intended to move to Hull, Massachusetts, with McGonnell and Williams and that Michael would not move in with them. That same month, Michael was attacked by a neighbor at the Weymouth apartment.
On November 14, the Rileys (excluding Michael), McGonnell, Williams, and their son moved from Weymouth to Hull, Massachusetts. Michael moved in with them at the beginning of December, despite the restrictions on seeing his children and Carolyn's claims that he was not going to live with them. McGonnell and Williams later testified that upon Michael's return to the household, the Riley children would stay in their rooms when their father was home, as Michael would become upset at "disruptions." Williams stated Michael would reportedly demand that Carolyn give the children clonidine to "shut these kids up" or "calm them down," leading Carolyn to begin administering the children's nighttime clonidine dose as early as 5:30 PM.
Riley's condition visibly deteriorated in the months preceding her death. McGonnell and Williams said that the girl grew "zombified," not speaking and approaching people silently; she would sleep for as long as 17 hours per day, only waking to eat. Faculty at Riley's preschool noted that Riley became so weak that an aide needed to support her body when sitting. A neighbor noticed that Riley and her siblings appeared "listless" and robotic.
Final days and death Kifuji last saw Riley and Carolyn at an appointment on December 7, 2006. Kifuji told Carolyn that if Riley continued improving, they could discuss reducing her clonidine prescription at the next appointment.