At 5:30 a.m., the street lights are still on outside the Tustin group home where 5-year-old Steven, warm and rumpled from his bed, gulps down his first Ritalin dose of the day.
Half an hour later, the drug's effects have yet to take hold, and Steven, in his pajamas, is hopping like a frog on the couch, doing flips off the arm--like any rowdy kindergartner.
"He should calm down pretty soon," says a child-care worker.
At 6:45, two workers lead a breakfast table cheer when Steven's sleepy-eyed little brother, Kenny, 4, swallows an orange Dexedrine pill on his first try.
"All right, Kenny!"
Throughout the day, Steven will pop pills with the regularity his parents once chased a methamphetamine high. He will be given Ritalin three more times to control hyperactivity; Mellaril, an anti-psychotic, twice; and clonidine, to counter the insomnia caused by the Ritalin, at bedtime.
Kenny will take Dexedrine, another anti-hyperactivity drug, two more times. It is the brothers' daily routine.
Social workers took Steven and Kenny from their mother three years ago, after they were found half-naked, covered with lice and bruised. When social workers arrived, Kenny was playing with a six-inch knife in an apartment strewn with garbage.
To protect the two boys, the county placed them in a group home for abused children. But there, no one protected them from the child welfare system, say a number of child psychiatrists and children's advocates.
The story of Kenny and Steven takes place in Orange County, but it is repeated over and over in California group homes and foster homes every day, experts say.
The dosages and the combinations of drugs given to Steven are "too much," says Dr. Thomas Hicklin, head of the child psychiatry ward at the Los Angeles County-USC Medical Center after learning of Steven's prescription amounts. "I think it's dangerous."
Hicklin also questions why Steven, who weighs just 56 pounds, was being given both clonidine and Ritalin after researchers from UCI and UCLA published articles saying the combination had caused sudden death and heart problems in a small number of children. "I wouldn't use that medicine in that combination," he says. "Why risk it?"
Dr. James McGough, an assistant professor of child psychiatry at UCLA, who also reviewed the boy's medications, agrees: "All they're really doing is putting him in a chemical straitjacket. . . . There are no studies that show a 5-year-old benefits from Mellaril."
There are nearly 3,800 Orange County kids living, by court order, with relatives other than their parents, with foster families or in group homes. Hundreds of these children are given psychiatric drugs tested and approved only for adults.
County officials don't keep track of how many of these children are given psychotropic medications, or of the problems children experience with them. Of the children whose cases The Times reviewed, some were being given prescriptions that didn't match their diagnoses. Others, like Steven, were given drugs in dosages or combinations that a number of prominent child psychiatrists found excessive and dangerous.
Contrary to state law and the practice in some California counties, Orange County's judges do not personally inspect and approve requests to drug children under their care. Instead, they have relegated that responsibility to Department of Children and Family Services managers with no special training in the use of such drugs on children.
When asked, several older children listed a raft of potent medications they had been given that did not appear in their court files. And children were given drugs without the knowledge or consent of their social workers, their attorneys or their biological parents.
Mary Harris, deputy director of the county's Department of Children and Family Services, says she is not confident that her agency knows every child that is receiving psychiatric medications. The group home doctors often refuse to share the medical records of children under their care with social workers.
"We believe we have the legal authority to see the records, but it's easier said than done," she says.
Even the Toddlers Want Their 'Meds'
Whereas such medications were once the rare exception, reserved for the severely emotionally disturbed, depressed or hyperactive, they now are a common sight to abused children. At the county's temporary shelter, the Orangewood Children's Home, children as young as 3 are medicated several times a day to control their depression and rage, as well as their sniffles and infections. At times, all the children at Steven and Kenny's group home are given psychotropic drugs, and even a 22-month-old knew the word "meds."
In Orange County, the inability of the county to monitor children's medications occurs at the most basic level.
Many children are first assessed and treated at Orangewood, where one therapist says she feels pressured to diagnose troubled--or merely troublesome--children with something.
"Once we get a diagnosis, the next question is, 'What sort of medication do they go on?' Not, 'What sort of therapy do they need?' " one therapist says. "I think any time a child doesn't listen or acts out, the kid's diagnosed with ADHD and put on meds. . . . A lot of these things are normal reactions to the situations kids are in."
When children leave the shelter and enter a group or foster home, they disappear down a "black hole," says Tim Mullins, until recently the county director of mental health services.
The children's medical records are often lost as they are shuffled from place to place, picking up new doctors along the way, according to psychiatrists and group home workers. The children's pediatricians, who presumably would know if a child had health problems that could be exacerbated by certain drugs, frequently don't have any contact with the psychiatrists prescribing powerful medications.
Many group home directors say they are forced to scavenge to find psychiatrists to work for the low fees set by Medi-Cal, though most of the homes the county uses get $4,000 to $5,000 a month per child.
As a result, a number of group home chains are served by "circuit docs" whose ranks included--until he lost his medical license last year--an 80-year-old Newport Beach psychiatrist who was using his roommate, a convicted child molester, to chauffeur him to the children's homes. In recent days, the psychiatrist was arrested and charged with molesting a 16-year-old boy on several occasions at his home. Arraignment is scheduled for May 28. The boy, who was drugged during the alleged attacks, was a patient of his at a Costa Mesa group home.
Psychologist Maya Laemmel, who works with a chain of group homes known as COPES (for Child or Parental Emergency Services Inc.), said she called "every psychiatrist in the Yellow Pages" before finding someone willing to treat the children at Steven and Kenny's group home.
The fragmented care of these children prompted one group home counselor to ask: "It's the fundamental question, isn't it: Is it better to be taken from your parents and abused in the system, or abused at home by your parents?"
Two Boys, Nine Doses by Early Afternoon
At a public playground on a breezeless afternoon, Steven continues his daily drug regimen.
Group home worker Kelly Allebato yells, "Steven! Meds!" The sturdy kindergartner scrambles off the huge wood jungle gym and sprints across the wood-chip play area.
While Allebato fishes 2 1/2 tiny pills out of a plastic bag, Steven hops from foot to foot with his mouth open. As she drops the pills into his mouth, one falls to the grass, where he dives to retrieve it.
It's 2:30 p.m. and Steven has taken four doses of Ritalin and two of Mellaril. Half an hour earlier his brother Kenny, a smaller replica of his sibling down to their unruly cowlicks, took his third dose of Dexedrine.
"It must be a relief. They must know they're like this," Allebato says, clenching up her body. "and they can take this pill and they can relax."
Steven, Kenny and their sister, Stephanie, 6, have spent more than a third of their lives in the Tustin group home. It is the longest they've stayed in one place. (Since a Times reporter observed them in the home last fall, Kenny and Steven have been moved to the children's shelter and then to another group home; Stephanie has been moved four times since then.)
Their childhood memories are of sitting on one motel rug or another and watching their father beat their mother until, as one of them put it, "blood came out of her mouth and nose." If they moved or cried, their mother got it worse. Once, Stephanie says, her dad beat her mom so badly that she "died." Paramedics had to revive her.
Their mother later went to prison for selling drugs. Their father bounced in and out of prison on drug and assault charges.
When social workers rescued the children, they were angry, violent and inconsolable. Three-year-old Steven, who had loop-shaped contusions on his back and buttocks, threw tantrums and bit other children. Stephanie hurled things. She told her social worker, "Our house wasn't clean. My mommy hits me. Stevie hits me. Kenny hits me, and Grandma hits me real hard--real, real hard."
Shortly after they were taken from her, the children's mother says she was told by the group home therapist that Steven had to be given Ritalin because the staff couldn't control him.
The therapist "said it would work against me if I didn't sign" a consent form, says the mother, who had hoped to regain custody of the children one day. In an interview at the Central California Women's Facility in Chowchilla, where she was serving a two-year sentence on drug charges, she said once she signed the initial authorization, Steven was put on more drugs without her consent.
"I was a teenage mom with three kids and I never had to drug them to take care of them," she says.
Nearly three years later, the children are still on a variety of drugs they call "meds," which, their caretakers say, control their rage and despair.
The drugs steal Steven's emotions, says Eva Marmont, a volunteer appointed by the court as his advocate two years ago. "After he takes them, he has no expression hardly in his face. One time, right after I gave him the medicine, he fell dead asleep on the floor and peed all over himself he was so out of it."
After years on medication, no one could say what Steven or Kenny are like without it. "Was [their behavior] there from the beginning, or did we help them become that way?" asks Allebato, one of the home's workers.
Allebato and Laemmel think Kenny's mental state has worsened in the time he has spent there. Kenny was 22 months old when social workers took him--too young to remember his father's cruelty. But after living in a group home, Kenny began to mimic the other children's behavior, joining in sudden violent battles.
"A year ago, Kenny would have looked great to anyone" seeking to adopt a child, says Laemmel. "Now he's so angry. Because there have been so many personnel changes, he doesn't trust anyone."
At 8 p.m., at the end of another typical day, Steven and Kenny and the other children in the home lie on the floor with their blankets to watch "Babe." When the movie is over, Steven takes his final pill--clonidine. It counters the effects of the other pills and helps him fall asleep.