Miami-Dade County

Girl in Facebook Live hanging was prescribed drug with suicide warning

A post on Naika Venant’s Facebook page shows shows a whimsical side of the girl. But she was diagnosed with ADHD and depression.
A post on Naika Venant’s Facebook page shows shows a whimsical side of the girl. But she was diagnosed with ADHD and depression. Facebook

When a Miami psychologist examined Naika Venant in June 2015, she found a “depressed, angry and fearful young girl” who thought often about death and dying. “She expects people to abandon and betray her,” the psychologist wrote.

Terilee Wunderman diagnosed Naika with “significant depression,” and post-traumatic stress disorder, and recommended that she see a specially trained therapist to mend her broken psyche. Wunderman also warned against filling the 12-year-old with pills, because the medication she was taking “sometimes can cause the side-effect of depression.”

During the next 18 months, however, Naika’s doctors reached for the prescription pad again and again, increasing the dose of an ADHD medication, and adding another drug, Zoloft, records indicate. The anti-depressant comes with a critical warning: an increased risk of suicide in children.

Naika had been prescribed both drugs when she took her own life Jan. 22, hanging herself in the bathroom of her foster home while streaming the suicide on Facebook Live. The Zoloft dose had been doubled Dec. 8, records show.

The mother of Naika Venant, who committed suicide on Facebook Live, speaks to the media on Jan. 25, 2016.

In death, she joined a little boy named Gabriel Myers, also born in 2002, in a rare and haunting distinction: Florida foster children who hanged themselves while prescribed drugs linked to a heightened risk of suicide.

Zoloft is among a class of anti-depressants that carry a U.S. Food and Drug Administration “black box” label warning for children’s safety, the strongest advisory the federal agency issues. It’s not approved for use among children, except for youngsters with obsessive-compulsive disorders. Doctors routinely — and legally — prescribe the drug “off-label,” to treat a diagnosis for which it has not been determined to be safe and effective.

“They do black box warnings for a reason,” said James Sewell, a child welfare consultant and retired assistant commissioner of the Florida Department of Law Enforcement. “It’s too much of a danger.”

“How can we allow drugs that are black-boxed and are not supposed to be used for children under a certain age because of a risk for suicide? We can’t allow that to happen. It has to be a hard-and-fast rule,” said Sewell, who chaired a 2009 commission that investigated Gabriel Myers’ death.

Agency self-evaluation

Thomas Biegi, a spokesman for Zoloft’s parent company, Pfizer, said the black box warning includes a note to families and caregivers about monitoring patients for suicidal thoughts or unusual changes in behavior.

READ MORE: Mom of Naika Venant: I thought hanging might have been stunt

A “rapid response” review of Naika’s death undertaken by the Department of Children & Families acknowledged that her volatile behavior, worsened by her unstable environment, made it difficult for caregivers to navigate “a complex behavioral health system.” While other children on risky psychiatric medication have vigilant parents to heed warning signs, Naika had a parade of caregivers, some lasting only days.

Good parents wouldn’t allow a child to be treated like that, Sewell said. “Why should we be any different.”

Shortly after Naika died, the Miami Herald filed a petition in Miami-Dade Circuit Court, asking Judge Maria Sampedro-Iglesia to release thousands of pages of records that detail the girl’s eight-year odyssey toggling back and forth between state care and living with her mother. Sampedro-Iglesia ordered the records released, saying there was good cause for the public to review them. The documents chart Naika’s path from a too-chaotic childhood to a too-soon death.

They do black box warnings for a reason. It’s too much of a danger.

James Sewell, child welfare consultant and retired assistant commissioner of the Florida Department of Law Enforcement

DCF declined to discuss Naika’s medication history with a Herald reporter, though an agency spokeswoman did issue a detailed written statement, and answered questions by email. “DCF does not prescribe medication, only doctors do that. Any assertion that DCF determines what medication children take is absolutely false,” Secretary Mike Carroll said in the statement.

Scott Segal, who doubled the Zoloft dosage as the last psychiatrist to work with Naika, according to the records, did not respond to several phone calls. Nor did Segal’s then-colleague, Alon Seifan, who previously continued an existing Zoloft prescription for Naika’s depression. In the same documentation, he acknowledged the danger of suicidal thoughts.

Gabriel Myers was removed from his mother’s care in June 2008 when his mom was found slumped inside her car at a Broward County restaurant, a stash of illegal narcotics scattered around her. Investigators determined that a 14-year-old boy in Ohio earlier had molested Gabriel after reaching inside his pants. Gabriel, reports say, had begun to act out sexually on other children with whom he came into contact.

Thomas Biegi, a spokesman for Zoloft’s parent company, Pfizer, said the black box warning includes a note to families and caregivers about monitoring patients for suicidal thoughts or unusual changes in behavior.

As his 10 months in foster care unfolded, caregivers realized the youngster’s difficult past had left him scarred and unmanageable, portending a fraught future. On April 16, 2009, Gabriel locked himself in the bathroom of his Margate foster home and wrapped a detachable shower hose around his neck. By the time his teenage caregiver broke into the bathroom with a screwdriver, Gabriel was unresponsive.

In their report, members of the Gabriel Myers Work Group reiterated an oft-claimed criticism: Mental health drugs are, at times, prescribed more for the convenience of “parents, teachers and other caregivers” than for the treatment of children.

READ MORE: Before suicide by hanging, girl pleaded in vain for mom’s acceptance

The panel found that foster children being given powerful psychiatric drugs often are not apprised of the risks they face, and are “not adequately monitored” for signs of unintended consequences. “This is particularly troubling for children on medications with ‘black box’ warnings,” the 39-page report said.

DCF, the panel said, “should ensure that those involved in a child’s care are required to complete training on psychotropic medications, including requirements for informed consent, monitoring of ‘black box’ medication warnings [and] signs and symptoms to be monitored for adverse reactions.”

Naika, however, lacked the kind of stability such oversight required. Since last April, when she returned to state care for the third time, Naika shuffled from home to home 14 times, state records indicate. During one week alone in October, Naika’s living arrangements changed four times.

The then-12-year-old’s answers to a set of half-sentences are, in hindsight, more a siren than a cry for help: ‘The thing I want to do most of all is die happy,’ Naika wrote. Other answers included: ‘My best friend is I don’t have a best friend,’ ‘The people I like to have hug or touch me are nobody,’ and ‘I would do anything to forget the time that I made my mom cry.’

Should Naika have been on a drug with a black box warning when she had no consistent caregiver who was able to recognize the signs of danger? “That’s an easy question,” said George Sheldon, the former DCF secretary who appointed the Gabriel Myers Work Group. “The answer is no.”

“The question becomes: Were lessons learned from Gabriel,” said Sheldon, who subsequently spent two years as an assistant secretary for the federal Administration for Children & Families in Washington and now is secretary of the Illinois Department of Children & Family Services.

Attorney Howard Talenfeld, who represents Gina Alexis, Naika’s mother, said the combination of Naika’s instability and the drugs’ risks left the teen in danger. “You have to be very concerned,” Talenfeld said Thursday. “Naika went through 14 non-therapeutic foster homes, and she was being prescribed very powerful psychiatric medication. She could not possibly have been appropriately monitored.”

Alexis told the Herald she does not recall ever being told by a doctor — or anyone else — that Zoloft was linked to an increased risk of suicide among children. “No one talked to me about the drug, or the possible side effects of the drug,” she said Thursday.

Jessica Sims, DCF’s spokeswoman, said key initiatives that arose from the work group were implemented and strengthened in the nearly eight years since Gabriel’s death: greater protection for parents through a more rigorous informed consent process; a review of prescribing for children younger than 11 by a team of University of Florida consultants; and real-time data collection within the state’s child welfare computer system, the Florida Safe Families Network.

READ MORE: Girl who hanged herself on Facebook Live was sexually abused, beaten, rejected, DCF says

Child welfare investigators and case managers are specially trained in the use of psychotropic medication, and they are empowered to seek a second opinion at any time after consultation with a supervisor, Sims said.

Informed parental consent

Among all 23,993 children in state care as of a week ago, about 2,640 currently are taking at least one psychotropic medication, DCF records show. Adolescents like Naika are far more likely than younger children to be prescribed mood-altering drugs: Among children in state care ages 13-17, 1,203 children — 26.3 percent — are taking at least one mental health drug. The number of children in out-of-home care on psychotropic medication has decreased by more than one-fourth since reporting began in 2009, Sims said.

In the case of Naika, mental health drugs first were prescribed by her own doctor while she was still in her mother’s care, and “each time the child’s medication regime was changed by a physician after coming into care in 2016, the required informed parental consent was obtained,” Sims wrote, meaning the mother who had been stripped of custody for mistreating her child still had say-so over the medications prescribed to her.

The teen had been removed from Alexis for the first time in 2009 when Alexis struck her 30 times with a belt, leaving marks on Naika’s arms, legs and back. She returned to foster care in 2014. She had run away, and later told authorities she was afraid her mother was going to beat her for allowing her baby brother to hurt himself when she was left alone to babysit him while her mother went out for diapers.

Last April, Alexis abandoned Naika with a child welfare agency, DCF records show, saying she had “had it” with the girl.

DCF does not prescribe medication, only doctors do that. Any assertion that DCF determines what medication children take is absolutely false.

DCF Secretary Mike Carroll

The parallels between 7-year-old Gabriel, born in January 2002, and 14-year-old Naika, born the following December, are striking: Authorities believed both children had been sexually victimized, and were showing signs of becoming aggressors themselves. Both children had experienced tremendous loss and displayed symptoms of significant depression. Both children had developed extraordinarily challenging behaviors that made it difficult to achieve any stability in caregiving. Both children had been prescribed psychiatric medications that were not approved by the FDA for use among children like them.

Naika received a diagnosis of ADHD by 2010 and doctors began prescribing Adderall for it in 5 mg doses. In 2014, a comprehensive behavioral assessment by Kristi House, a child sexual abuse treatment center, said that in February 2011, “it was alleged that Naika was having suicidal thoughts because she “can’t do anything right.”

In a June 2014 “bio-psychological assessment” prepared for Naika’s case-management agency, the Center for Family and Child Enrichment, a therapist noted one element of the girl’s thoughts, emotions and behavior that was most worrisome: “suicidal ideation.” That same month, a mental health assessment reported that “when angry, [Naika] has verbalized suicidal ideations.”

While a raft of doctors saw Naika as a young girl with severe hyperactivity and an unwillingness to control her own behavior, Terilee Wunderman, the psychologist, in 2015 described a child whose sadness was overwhelming her.

“She fears being yelled at, hit, and abandoned by her mother,” wrote Wunderman, who evaluated the child on the orders of a magistrate. “Naika fears that the family will be pulled apart traumatically once again.” Naika was living with her mother at the time, having been returned to Alexis from foster care “because there was no other placement” that would accept her.

 Naika Venant and and her mother, Gina Alexis, smile in a photo posted on Facebook. 

The then-12-year-old’s answers to a set of half-sentences are, in hindsight, more a siren than a cry for help: “The thing I want to do most of all is die happy,” Naika wrote. Other answers included: “My best friend is I don’t have a best friend,” “The people I like to have hug or touch me are nobody,” and “I would do anything to forget the time that I made my mom cry.”

Wunderman was convinced that Naika’s longstanding ADHD label was a mistake that could augur calamity. “Although Naika has been diagnosed with [ADHD],” she wrote, “there is much concern that her attention problems are due to anxiety and trauma, rather than true ADHD... . Her distractability appears primarily due to trauma-based intrusive thoughts, fears and worries.”

The psychologist warned: “Naika’s medication should be reevaluated due to her pronounced depression. Since Adderall sometimes can cause the side-effect of depression, and Naika is coping with considerable depression related to her traumas, her medication should be reevaluated to determine if another regimen might better address her emotional difficulties.”

‘Suicidal ideations’

How well were Wunderman’s warnings heeded? By four months later, October 2015, Naika’s Adderall dose rose from 15 mg to 20 mg. And, something new had been added — 25 mg of Zoloft, used to treat depression, obsessive compulsive disorders (OCD), panic attacks and post-traumatic stress disorder in adults. In teenagers, the FDA approved it only to address OCD.

Vyvanse, a different ADHD drug, appears for the first time in Seifan’s April 2016 medical report for prescribing psychotropic medication. Seifan prescribed Vyvanse in 50-mg doses and continued prescribing the Zoloft. When asked how long the drugs would be needed, Seifan wrote: “Indefinite.”

Seifan diagnosed the teen with ADHD and depression, and noted the drugs were intended to improve the child’s “mood.”

Under side effects for her caregiver to watch for, the doctor wrote: “suicidal ideations.”

Seifan checked off the box next to “I find that it’s likely any delay in taking this medication will cause significant harm to the child.” But, when asked to describe “the nature and extent of the harm the child will likely experience,” he left the space blank.

And to the question of other treatment options instead of using the psychotropic drugs he prescribed, Seifan checked off, “No.”

This was less than a week after Gina Alexis’ final abandonment of Naika, and the ensuing nine months in foster care turned the teen into a vagabond. Her depression worsened, records show. By September, Naika’s depression was rated as “moderate to severe.”

The question becomes: Were lessons learned from Gabriel.

George Sheldon, former secretary of DCF, now head of Illinois’ equivalent, speaking of a Florida boy who hanged himself while on psychotropic drugs.

In November, case-managers were told to look for a therapeutic foster home for Naika, where she could receive intensive services without all the disruptions.

“Naika has not been stable since being placed in foster care and continues to bounce from school to school and placement to placement,” said a mental health assessment dated Nov. 25, 2016.

But there was a long waiting list for the therapeutic foster home, and the teen hopscotched yet again, eventually landing in a Miami Gardens foster home, her 14th move.

The home had been licensed by DCF only two days before Naika moved in Dec. 21. A home study, dated Dec. 19, noted that the foster mom “does not have any experience dealing with children with difficult behaviors. She feels she is equipped to deal with a child with minor behavioral challenges.”

Though her living situation changed sometimes daily, medication was Naika’s constant: The Zoloft remained at 25 mg until a Dec. 8 appointment with Segal. Segal’s diagnosis included ADHD and “major depressive disorder, single episode, unspecified.” He raised the daily Vyvanse dosage, which had been briefly reduced to 30 mg, back to 50 mg and doubled the Zoloft to 50 mg daily.

Naika hanged herself 45 days later.

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