Factitious Disorder Imposed on Another New Mexico Asssociation

Factitious Disorder Imposed on Another New Mexico Asssociation of School Psychologists October 28, 2017

History ¡ formerly known as Munchausen Syndrome by Proxy (MBP) ¡ Munchausen was an 18 th century German baron who entertained his friends with tales from his military experience that grew more exaggerated with each re-telling

History cont’d ¡ Richard Asher, M. D. , first described ‘Munchausen Syndrome’ in 1951 after treating patients who intentionally injured themselves ¡ Roy Meadow, M. D. , coined term “MBP” in 1977 to describe caregivers who induced illness in children

Definition ¡ According to DSM-V (2013) Factitious Disorder Diagnostic Criteria: l Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception l Individual presents him/herself to others as ill, impaired, or injured l Behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder l Need to specify if there is a single or recurrent episodes

Factitious Disorder Imposed on Another Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception l Individual presents another individual (victim) to others as ill, impaired, or injured l Behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder l Need to specify if there is a single or recurrent episodes l

Other diagnostic criteria used by different authors ¡ ¡ Children do not demonstrate symptoms of illness when child is away from caretaker Initially, parents constantly at child’s bedside; later parents tend to spend time elsewhere Parents welcome medical tests, even when told they are painful Parents sometimes have background in health profession

Other diagnostic criteria used by different authors Add or change physicians frequently ¡ Appear overly attached to children even though physical affect is unworried or inappropriate ¡ Develop close relationships with medical personnel ¡ Resistant to psychiatric involvement ¡ Over time of hospitalization, spend less time with child ¡

Pay-off for parent ¡ Attention from family, friends, & hospital staff members for being long-suffering, patient parent of chronically-ill child ¡ Satisfaction of being smart enough to outwit highly respected medical professionals who cannot diagnose what is wrong with their child

Differential Diagnosis ¡ Malingering—definite external incentive for falsifying illness or injury (paid leave from job, disability benefits) ¡ Child custody battles between divorced parents— one parent falsifies injury and blames other parent

What does this have to do with Special Education? ¡ Small body of literature indicating that FD Imposed on another is possibly becoming apparent in special education settings ¡ Pay-off appears to be similar attention from family, friends, & educational personnel without requirement of physically harming the child

Two Ways FDP presents in Special Educational Settings ¡ Child with genuine medical problems that are aggravated/exaggerated by caregiver but blamed on special education staff (teachers, EA’s) ¡ Child who is physically healthy but parent requests/demands repeated evaluation for SLD, ADHD, Autism, and other eligibilities

FDP & Educational Settings ¡ Conditions from research literature that have been falsified include l Attention Deficit/Hyperactivity Disorder (most prevalent) l Specific Learning Disabilities l Behavioral difficulties/emotional disturbance l Neuropsychological problems

Prevalence Estimate ¡ Catherine Ayoub reported an incidence of 11. 5% of her subjects (child victims of FD by Proxy) had falsified conditions that would require special education services ¡ No conclusive way to estimate prevalence of FDP in educational settings (still difficult to estimate incidence of FDP in medical settings)

Implications for Special Education ¡ ¡ Cost of time & money for initial Psycho- educational and Psychological Evaluations Cost of additional psychological or medical evaluations (and possibly others) Cost of providing services to children who are genuinely NOT eligible for services Cost of going to due process hearing to defend school district’s stand that child is not eligible and additional services are not appropriate

Parental symptoms in special education ¡ ¡ ¡ Called ‘high-maintenance’ parent or ‘over-involved’ parent IEP meetings MUST include presence of every person who works with child (i. e. SLP, OTR, RPT cannot send reports) IEP meetings known to last 3 -4 hours Parents bring their own specialists, sometimes attorneys Parents repeatedly bring up other issues before they sign IEP

Other Considerations ¡ Harry & Klingner (2006) called 4 eligibilities under IDEA ‘judgment calls’ because diagnosis requires clinical judgment rather than verifiable data l l ¡ Mild Mental Retardation Specific Learning Disability Serious Emotional Disturbance Speech/Language Impairment Possibly increases chance of disabilities being falsified

Other Considerations ¡ Schreier and Libow (1993) theorize that FD by proxy evolves over time l l caregivers may initially bring child to physician for genuine reason, enjoy attention, and then gradually aggravate or induce illness Possible for caregivers to begin getting attention by demanding educational services and progress to demanding medical care (or vice-versa)

What can you do? When you suspect you may be dealing with parent who demonstrates symptoms of FD Imposed on Another, must decide how far you can go accommodating them ¡ Do your homework & be prepared to defend decision not to proceed with further evaluations or services ¡ As in dealing with difficult child, don’t threaten anything unless you are prepared to follow through ¡

What can you do? Expect parents to get angry with you & insult your training, intelligence, competence ¡ Be prepared for the worst, (parent going to a hearing, or worse, the press) ¡ Have your own legal counsel prepared for parents ¡

Have you had similar experiences? ¡ Difficult to research l l l ¡ Not supposed to evaluate & diagnose parents Not trained for psychological evaluations or diagnoses FDP rarely identified or diagnosed until child is actually physically near death Meet many Ed. Diags. who have similar stories to tell

Want to help? ¡ Give demographics l l l Enrollment data of school district Years of experience as Ed. Diag. Anecdotal information with no identifying information on student or parents Any other information you feel comfortable giving Contact information on you

Sources ¡ ¡ ¡ Bucuvalas, A. (2003). Munchausen by proxy in school settings: an interview with Associate Professor Catherine Ayoub. Harvard Graduate School of Education News, January 1, 2003. Feldman, M. (2004) Playing sick? Untangling the web of Munchausen syndrome, Munchausen by proxy, malilngering, and factitious disorder. New York: Brunner-Routledge Harry & Klinger (2006). Why are so many minority students in special education? Understanding race & disability in schools. New York: Teachers College Press.

Contact Me! Ellen C. Miller, Ed. D. ¡ Ellen. miller@rrps. net ¡ trap 4 trivia@gmail. com ¡