Too much medication

It should not have taken the tragic death of 4-year-old Rebecca Riley, allegedly from an overdose of psychotropic drugs, to set off an intense discussion among doctors, parents, social workers, and others about the way society treats children who show signs of possible mental disorder. Health officials should press urgently to determine the advantages of treating children with these medications, and the cautions that must accompany their use.

In the near term, discussion of the issue might deter some parents or doctors from using these drugs in cases where they are warranted. On balance, though, it is important that the public learn how caregivers arrive at their decisions. The issue will be the subject of hearings in March organized by the chairman of the House committee on public health, Representative Peter Koutoujian of Waltham. The focus, Kout oujian said yesterday , will be "how to prevent this from happening, not to assess blame."

Rebecca was not even 3 years old when a psychiatrist diagnosed her with bipolar and attention deficit hyperactivity disorders and began prescribing medications. Among them was the clonidine that, in excessive doses, was found in an autopsy to have caused her death. Clonidine, a blood pressure medicine for adults, is also prescribed for children to make them less aggressive or go to sleep. Koutoujian said the age at which children are started on medications will be one subject of the hearings.

Koutoujian said the hearings will also question whether therapists sometimes diagnose mental health disorders in children who are actually victims of abuse, putting a focus on the responsibility of health professionals and the state Department of Social Services.

Parents and other caregivers are worried about the danger of over-medication, Koutoujian said, but added that, when used appropriately, the drugs can be beneficial. "The whole world opens for the children then," he said. "They can function very well."

Drugs such as clonidine are powerful. One focus of the legislative hearings should also be how much monitoring children receive from the prescribing doctor once they are started on a psychotropic medication. Witnesses at the hearings should also consider the responsibility of doctors -- and the DSS when it is involved -- to assess the ability of parents to administer these potentially lethal drugs.

The immediate cause of Rebecca's death, though, was too much of a drug that might or might not have been appropriate for her. Her case will be all the more tragic unless health officials engage in a soul-searching debate to prevent a recurrence.