I'd like to weigh in on this as it cuts close to home for me in many ways. I have three adult sons with bipolar, a ten year old granddaughter with bipolar and have raised multiple children requiring heavy duty psychotropics to maintain a quality of life and to remain in a family home. I'm the type of Mom that rarely hands out a Tylenol. The decision to medicate was not an easy one for me.
Quite bluntly put, Rebecca was killed by the negligence of a number of people. We know much more about bipolar than we did several years ago and it is definitely true that toddlers are being diagnosed more than ever. It's correct that Childhood Onset Bipolar looks nothing like Adult Onset Bipolar. These kids look far more like they have ADHD and Oppositional Defiant Disorder. They are challenging kids. Doctors are caving into parents' requests to "do something" far more often and children in foster care are being diagnosed with greater frequency. Remember, doctors are having these meds pushed on them relentlessly by the pharmaceutical companies.
Let's look at Rebecca for a minute. It is a known fact that all childhood disorders can be triggered and/or exacerbated by a chaotic homelife, domestic violence, and prenatal drug exposure. Show me a group of positive tox screen babies, and I'll bet you big bucks that they'll require some form of psychotropic to maintain in a family home and a regular school. Chemicals caused them to be hard-wired differently and chemicals will most likely be required to maintain them the rest of their lives. This does not mean, however, that some of these disorders don't literally come at kids in wonderful homes from left field. There's so much we don't know. I just know that Rebecca and her siblings are/were at great risk.
We know that little Rebecca was born into the type of home life which I just described. Per the police reports, it does not surprise me in the least that she was put on:
750 milligrams a day of Depakote
200 milligrams a day of Seroquel
.35 milligrams a day of Clonidine
Here's a link to a current article concerning the growing use of these meds for tiny ones, which actually mentions Rebecca:
http://www.reuters.com/article/idUSTRE60E0NC20100115
I think everyone should read this as this is what pediatricians are being taught right now and what parents are hearing when they report worrisome behaviors to the children's doctors. Many people's (mine included) knee-jerk reaction was, "What? No way!!" I think the jury is still out and parents must precede with great caution.
All this said, I'd like to add that Rebecca's case did not follow "best practices". IMO, this family was negligent due to drug use in the home. They clearly put their needs ahead of their child. This doctor put some powerful meds at some very high doses in these people's hands and didn't follow through the way our pediatricians and neurologists have.
We have a 20 year old son, a highly gifted athlete and college student, who took Clonidine from the time he was four for a disorder called Episodic Dyscontrol Syndrome. He would be absolutely fine and happy and fly into screaming rages and argue for hours. He was prenatally exposed to crack cocaine. He had to undergo a full six months of tests and studies at OHSU (EEG's, MRI, psych eval) before he was given the Clonidine.
Clonidine changed our lives. I'll bet if you asked our entire family, they'd all remember the day S started his Clonidine as he became a different little boy--loving, gentle, silly. It was like someone took the monkey off his back. We knew that it had dangers. We knew he had to have an echo-cardiogram every year. We knew to watch him carefully as he became a more active athlete. We knew that it was a blood pressure med for adults being used off-label but it worked. He actually weaned himself off it at age 17 and has been fine for 3 years. It's as if he grew out of his behavior problems with Clonidine taking the edge off for him.
I know psychotropics can be a lifesaver. I also know that if I'd been a drug-user or my husband was violent towards me, I could have over-drugged my boy. Many of these meds make a child sleepy and how tempting is that when you just want to be left alone? We used to go through so much trouble to cut his pills into 1/8s. That's how carefully you have to dose. Too little and the rages came back. Too much and the child would sleep for a whole day. We had to be especially careful when he was sick (like Rebecca) as the meds can mask symptoms.
I am very disappointed that Rebecca didn't get the care that our son did. And being on public assistance is no excuse as our son used a medical card also, due to his special needs adoptive status.
When I look at the doses that little Rebecca was on, I cringe.
She was taking the amount of Depakote and Seroquel that many adults take. She was a toddler and was taking four times the amount of Clonidine our 17 year old son took. I have many concerns about children being on any of these meds as they seem to be a panacea--a quick fix with a sedative effect. Admittedly they work wonders for some children with caring parents and "present" physicians but they can also be a great danger.
I also wonder what doctors expect these children to do when they reach age 18 and have no insurance.
The meds this little girl was on cost somewhere between $300-750/month!! How is a young adult with an entry level job and no insurance going to afford that? And when children, in the system, take these drugs, is this the best use of taxpayer dollars? We've brought this issue up again and again as we see children in the foster care system being placed on these meds as they struggle moving from home to home. Seriously, all it takes is a 30 minute psychiatry consult. It's absolutely amazing how many of the kids can stop the meds once they get into a stable and permanent placement. That tells me that environment and family stressors are playing a huge part in this disorder.
What's wrong with parent training, behavior modification, and therapy to see if it works first? Let's not just blithely hand our kids over to the pharmaceutical companies without a fight and trying every alternative first. Rebecca deserved far better care.
Once again, these are truly miracle drugs......in the right hands.
