Factitious Disorder by Proxy in Educational Settings: A Review

Abstract

Factitious disorder by proxy (FDP), historically known as Munchausen syndrome by proxy, is a diagnosis applied to parents and other caregivers who intentionally feign, exaggerate, and/or induce illness or injury in a child to get attention from health professionals and others. A review of the recent literature and our experience as consultants indicate clearly that FDP has emerged in educational settings as well. Variants of educational FDP include parents of children with real or fabricated physical disabilities who request excessive or unneeded school health services and parents who request extensive education-related evaluations for children who do not demonstrate any educational need. If such cases continue to emerge, school districts will be asked to test more students who do not have disabilities under the Individuals with Disabilities Education Act. Also, special educational directors will be weighing the cost of providing unneeded testing and educational services against the cost of defending themselves in litigation to prove that the testing and services are unnecessary. A table of guidelines is provided for school and other personnel confronted with repeated requests for unwarranted special education services. Suggestions for future research are included. "I think my child has a disability I read about on the Internet. I want to request a medical and psychological evaluation for it. Don't you think it would help my child if he had additional services and accommodations?" Teachers, special education administrators, Educ Psychol Rev (2012) 24:47-61

Fabricated or induced illness in children: A guide for Australian health‐care practitioners

“…Behavioural, educational and neurodevelopmental conditions are being increasingly recognised in the setting of FIIC. [18][19][20] It should never be assumed that a confirmed diagnosis excludes FIIC, noting that perpetrators who have a psychological need met by engaging with health professionals may begin with appropriate interactions and sick children may be more dependant and therefore vulnerable to victimisation. 4,13 Failing to appreciate this fact leads clinicians to evaluate solely for the presence or absence of disease rather than actively seeking evidence of fabrication or deception when further, and sometimes unexpected, concerns arise.…”

“…Medical conditions commonly seen in this setting include gastrointestinal diseases, apnoea, seizures, allergies and recurrent fever. Behavioural, educational and neurodevelopmental conditions are being increasingly recognised in the setting of FIIC 18–20 . It should never be assumed that a confirmed diagnosis excludes FIIC, noting that perpetrators who have a psychological need met by engaging with health professionals may begin with appropriate interactions and sick children may be more dependant and therefore vulnerable to victimisation 4,13 .…”

Factitious disorder by proxy, parent alienation, and the argument for interrelated multidimensional diagnoses.

“…Although the topic of intervention in FDBP and PA is beyond the scope of this article, (see Bütz, 2019;Dye et al, 2013;Frye & Feldman, 2012: Gardner, 2001Warshak, 2015). The matters that may be addressed herein include entertaining first whether or not an IMD facilitates better communication about these phenomena, and second does the term IMD provide a more accurate description of these phenomena?…”