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 $630.00 USD 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