Massachusetts finds 35 children on excessive psychiatric drugs, more to come

From a longer report in the Boston Globe

Following the death of a 4-year-old Hull girl from an overdose of psychiatric drugs last December, state officials have set up a unique early-warning system to spot preschoolers who may be getting excessive medication for mental illness. In just the first three months, the system has flagged the cases of at least 35 children for further investigation, and the number is sure to rise.

The state Medicaid program is analyzing records of 82,900 children under age 5, looking for those taking at least three psychiatric drugs or a single prescription of a powerful antipsychotic drug. Mental health professionals will review the care of these children and, if necessary, contact the prescribing doctor for an explanation, say officials of the state insurance program for lower-income families, known as MassHealth.

Although cases like the overdose of Rebecca Riley are rare, the prescription of psychiatric drugs to young children is not. Doctors last year prescribed Clonidine - a drug sometimes used to treat hyperactivity that was found in lethal quantities in the Hull girl's bloodstream - to 955 children under age 7 in MassHealth. Doctors also prescribed antipsychotic drugs, which raise the risk of diabetes and obesity, to 536 children under age 7, according to MassHealth records. MassHealth could not say how many of these cases involve children under age 5 and might be subject to review.

Some psychiatrists have been concerned for years about the rise of psychiatric drug treatment of young children, largely because few preschoolers are old enough to show clear signs of mental illness and there are almost no studies on how the chemicals affect their developing brains. But until Riley's death from three drugs she was taking to treat bipolar disorder and hyperactivity, the state provided little oversight of doctors' prescribing practices.

Riley's death "was a wake up call," said Dr. John Straus, vice president for medical affairs at the Massachusetts Behavioral Health Partnership, one of the organizations that manage mental health care for children in MassHealth. He said MassHealth managers want to make sure that doctors have good reason for prescribing psychiatric drugs to such young patients and that they are not relying solely on the parents or guardians for information about each child's condition. Riley's parents have been charged with deliberately giving her a fatal overdose.

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Riley's death focused attention on the growing use of drugs among preschoolers for another condition, bipolar disorder, which is characterized by wide mood swings and was once thought to begin in late adolescence. Her doctor, Kayoko Kifuji, diagnosed the girl with the condition when she was 2 1/2 years old. Kifuji has voluntarily given up her license to practice medicine while regulators investigate her treatment of Riley, and the girl's mother, Carolyn Riley, said on "60 Minutes" last Sunday that she no longer believes her daughter was bipolar. The parents blame Kifuji for their daughter's death, though she denies wrongdoing.

Despite unease over the amount of psychiatric drugs being prescribed to preschoolers, few states have tried to rein in prescriptions beyond drug educational programs for doctors or other forms of doctor assistance, such as Massachusetts' popular network of psychiatrists who are available for instant phone consultations concerning young patients.

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