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Munchausen by proxy syndrome

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What do we do?

The mother of my partner's children from a previous relationship is constantly having both of her children diagnosed with ailments, which are increasing and escalating. We have concerns that the mother may be showing signs of Munchhausen by proxy syndrome. The eldest of the children has now developed traits of hypochondria.

None of these ailments appear to be caused by physical abuse, however the mother works in the medical industry and appears to stretch the truth when advising the medical specialists of the children's symptoms/behaviours.

What should we do about this? Munchhausen by proxy syndrome is difficult to prove, especially when the children have been diagnoses with these several medical conditions by specialists.

So far, between the two children who are aged 6 and 9, they have been diagnosed and medicated for ADHD, ADD, Aspergers, Autism, Asthma and many other more minor ailments. It seems as though the children are always ill with something and she very readily medicates them, even if the ailment is minor.

The mother has reached the point of having her children deemed special needs and receives funding from the government for this as well as extra money paid to her through her CSA payments and we are very concerned that her efforts to diagnose the children with so many conditions may be for the money and not for the wellbeing of the children. This is also something that is difficult to prove because she can be very convincing by acting like the concerned parent who is in an unfortunate situation.

The mother's behaviour has become very predictable now. I have correctly forcasted her last few diagnosis from specialists and predicted correctly that she would have the younger child on medication as well.

How can we protect the children from this very concerning and escalating situation?
Hi Sparkle

Allow me to share my own personal opinion on this because I too work as a Clinician. I think you need to have a look at what it is youre trying to achieve and what you motivations are. Are you concerned that the kids are being overmedicated/overdiagnosed or are you concerned that the ex is rorting this system?
In order to get those diagnoses, there are rigorous tests that patients go under by a number of clinicians  not just a GP/Paediatrician. If the patient meets the criteria, then perhaps it may be grounds to claim carers allowance  the decision to label the children as Special Needs is made by a variety of Clinicians, not just one and certainly not on what the Mother says alone. I think that the argument that some may use that were over-diagnosing children is perhaps a little untrue. Its more a matter that were more aware of certain conditions, and our ability to test for those are more rigorous then they have been in the past. Disorders such as Autism are spectrum disorders and therefore the Child doesnt need to be the Rainman in order to be diagnosed as Autistic.  Aspergers, ADHD and ADD are also Spectrum disorders so the Child can essentially sit anywhere on that scale be it Mild, Moderate or Severe or anywhere inbetween.
I certainly understand your Partners concern about not wanting his kids to be overmedicated. I dont even like giving my Child Panadol unless its absolutely necessary! I would encourage you to make an informed opinion which means speaking to the Clinicians involved if possible as to why the diagnoses were being made. You would also need to seek your own medical opinion on this so that youre not misinterpreting anything and jumping to conclusions because if the Children are genuine cases, then your partner doesnt want to be seen as the Obstructive Parent steeped in denial with his head in the sand whilst Mum is trying to engage Early Intervention.
Hi Sparkle

I understand your concern and it is valid.  Yes, there are many children diagnosed with these conditions when rightly they should not be.  But that is not saying that the children do not have these conditions, they may very well have.  I understand you need to question it.

Have you thought about approaching this issue through the school psychologist attached to their school?  Maybe the children have already be seen by the school psychologist but it is worth finding out anyway.  You can often pick up clues about the children's behaviour from their school teachers which is useful when determining if a problem exists.

Also, look at family history.  You can learn alot from that.

First they ignore you, then they laugh at you, then they fight you, then you win.  M K Gandhi

They won't listen to the truth

reallyconfused said
Hi Sparkle

Allow me to share my own personal opinion on this because I too work as a Clinician. I think you need to have a look at what it is youre trying to achieve and what you motivations are. Are you concerned that the kids are being overmedicated/overdiagnosed or are you concerned that the ex is rorting this system?
In order to get those diagnoses, there are rigorous tests that patients go under by a number of clinicians  not just a GP/Paediatrician. If the patient meets the criteria, then perhaps it may be grounds to claim carers allowance  the decision to label the children as Special Needs is made by a variety of Clinicians, not just one and certainly not on what the Mother says alone. I think that the argument that some may use that were over-diagnosing children is perhaps a little untrue. Its more a matter that were more aware of certain conditions, and our ability to test for those are more rigorous then they have been in the past. Disorders such as Autism are spectrum disorders and therefore the Child doesnt need to be the Rainman in order to be diagnosed as Autistic.  Aspergers, ADHD and ADD are also Spectrum disorders so the Child can essentially sit anywhere on that scale be it Mild, Moderate or Severe or anywhere inbetween.
I certainly understand your Partners concern about not wanting his kids to be overmedicated. I dont even like giving my Child Panadol unless its absolutely necessary! I would encourage you to make an informed opinion which means speaking to the Clinicians involved if possible as to why the diagnoses were being made. You would also need to seek your own medical opinion on this so that youre not misinterpreting anything and jumping to conclusions because if the Children are genuine cases, then your partner doesnt want to be seen as the Obstructive Parent steeped in denial with his head in the sand whilst Mum is trying to engage Early Intervention.

  Thank you for your opinion, we will take it into consideration. Our motivations are ensure that the kids are not being overmedicated/overdiagnosed in order for the ex to rort the system. The children's wellbeing is our main concern and we want to make sure the ex's motivations are foremost for the children's wellbeing and not to gain as much financial financial support as she can. My partner, the children's father, has already consulted with the specialists. This is how we found out the ex had been stretching the truth when advising the specialists of the children's behaviour. My partner works full time and the mother would make the specialist appointments when he was unable to attend and the specialists would have already formed their diagnosis by the time my partner had the opportunity to see them. There would be no further testing or investigation even after the father reported the conflicting information. I agree that the children may have traits of these disorders, however their behaviour in our home is very different to when they are in the mother's environment. In our home they are given more guidence, boundaries and education on respect, politeness and caring as well as having fun, whereas at the mother's home there are very few boundaries and they are given free reign to behave as they please. This reflects more of an environmental issue rather than social disorders because the behaviour reported by the mother is not the same behaviour the children display when they are with us and she refuses to admit that to any specialist. They are much more well behaved with us and are more settled and content. The youngest child has always been a great sleeper and would have no troubles going to sleep at night, however the mother has managed to convince specialists that the daughter has trouble sleeping and now the daughter is on sleeping medication, in fact both children are now also on sleeping medication. This is only one example of the mother fabricating symptoms. My partner is willing to accept and respect specialist's diagnosis so long as it is based on truthful information that has been provided to them about the children's behaviour/symptoms and in a lot of the specialist appointments the mother has over exaggerated or completely fabricated the children's behaviour/symptoms. When the children stay at their grandparent's, which can be up to a few weeks at a time, the grandparents do not administer any of the medications and report that the children seem better off for it and are very well behaved. They too provide a similar environment to us. We are trying to gain as much information as we can to deal with this and have already spoken to specialists, teachers and psychologists, however they all very much believe every word of the mother because she is the primary carer and do not seem to consider the father's information, even though it is the truth. This issue seems to be excalating and if we ignored it then we would be buring our heads in the sand, however we are becoming more concerned about the mother's behaviour because the children appear to be suffering more now than they were before they were diagnosed with all of these conditions.

This is why we are trying to think outside the square to gain as much information as we can to try to help the children and we value your advice, so thank you all for your time.
From what you have described Sparkle it would be ideal if the children came off all the medication and were assessed all over again with an independent person, someone not seen by them before.  I realise this is difficult since their mother is the primary carer.

If you feel the children are suffering or are worse, look for any kind of evidence such as a deterioration in their school performance or mood which may correlate with over prescribing and or a mixture of medication. Talk with their school teachers, they are the best.

It's usually not good to start, stop, start medication. It can actually be harmful.  Some medications will not have the desired effect if they are taken like this. Some medications can take 6 to 12 weeks to kick in.

It's quite alarming for young children at their age to be on sleeping tablets.  That will deprive them of their REM (deep) sleep and over time can result in sleep deprivation, and more problems.

To be diagnosed with ADD or ADHD the behaviour associated with it, hyperactivity and or poor attention span would be seen consistently across all environments.  Children tend to misbehave when discipline is poor or missing because discipline and boundary setting are important to children's needs and development.

All the best.

First they ignore you, then they laugh at you, then they fight you, then you win.  M K Gandhi
If you are prepared for any outcome you can ask DOCS to look at the situation with the children and mention munchausen by proxy to them.
Typically the person who is gaining makes the child actually ill in munchousen.
There is no such thing as munchasen by proxy syndrome. A person who intentionally overdoes stuff to cause harm is just a child abuser. A person may also be harming a chld because their brain does not function correctly, and may be an injured person or a person with a mental illness. For example, a mentally challenged person might not be able to care for a child properly because they cannot think rationally like a normal person and interpret and provde for the childs needs and responses, or know how to provide care unless assisted. Some mentally challenged parents may do well enough,  but if a stressor comes along that upsets them or interferes with ther routine, difficulties can arise due to the slower or difficult to use brain of the parent.

I do not advise calling DOCS. That would be foolish. Their track record for diagnosing on medical aspects is poor and they are sometimes in conflict with Doctors and Psychiatrists whom are burdened by havng to work with such a poor quality department. This will not help your children.

I would write a letter to the childrens treating doctor and outline your concerns. I would ask the Doctor if the treatment is necessary, and let him know that you oppose the treatments. Perhaps an appointment with the doctor would be better. If you were directly informed, your attitude may change or not depending upon the discussion.The Doctor knows whether or not to refer the mother to a psychiatrist, or whether or not to report the matter to DOCS.

A concerned parent or carer grandparent can make an appointment to see the doctor and be involved in the childs health. If unable to attain the name of the Doctor whether to alleviate your worries or assist n the care of the child, the Court may order the Doctors name be released to you.
Guest…you cannot possibly be serious!!??
Yours would have to be the most ridiculous advice ever given.
The original post is 2 months old.  Let's hope Sparkleservice has dealt appropriately with the problem since then, and thank goodness YOU didn't post your 'advice' earlier.
Ajae

I am glad you made this post as it stops SRL-Resources.org from having to point the post out to Conan up to make a response.

Executive Member of SRL-Resources, the Family Law People on the site (Look for the Avatars).   Be mindful what you post in the public areas
Sparkleservice,
                    there is a great deal of controversy over MSbP, there are those in Australia who are vigorously fighting against it primarily because the perpetrators, according to studies (e.g. Sheridan in 2003 and Feldman et al. in 2007), are almost always mothers and that these groups refuse to believe that any mother can do harm to a child. Nowadays I think the preferred term in Australia is Fabricated or Induced Illness by Carers or FIIC. It would not surprise me at all if the name is changed frequently as this can then be used to push the line that the occurrence is rarer than it in fact is, as previous occurrences diagnosed under a previous name will very likely be excluded.


Here's an extract that may be useful, which I believe is contrary to Guests opinion. It's from A new name for Munchausen Syndrome by Proxy: defining Fabricated or Induced Illness by Carers by Ellen Fish, Leah Bromfield and Daryl Higgins

A new name for Munchausen Syndrome by Proxy: defining Fabricated or Induced Illness by Carers said
What is the focus of the different disciplines?

How useful is the FIIC label for protecting children from harm?

Fabricated or Induced Illness by Carers previously known as Munchausen Syndrome by Proxy is not a condition, psychiatric disorder or diagnosis that a parent or carer has. Fabricated or Induced Illness by Carers is what a parent or carer does to a child. It is important that child protection practitioners, doctors and other professionals who work with children are made aware that there are instances where parents intentionally deceive health practitioners about their children's symptoms so that children are subjected to unnecessary and often painful medical procedures.

Parents who fabricate or induce symptoms of illness in their children may cause their child to experience physical pain/injury or psychological distress. Child protection workers do not need to make claims about the mental capacity or intention of the parents in order to demonstrate negative child outcomes. This raises the question: is the label useful for child practitioners seeking to intervene in order to make children safe?

Practitioner knowledge of Fabricated or Induced Illness by Carers is important in identification, as unless the possibility of FIIC is considered, the cause of a child's symptoms in such cases may not be discovered and the child may continue to be harmed (Lasher and Sheridan 2004).

When applying for a court order, it is better to talk about the parental behaviour (that is, poisoning) and the risk of harm to the child (that is, physical harm and potentially death) as a consequence of that behaviour (Priddis 2004).

Following substantiation of maltreatment within the child protection system, knowledge of FIIC may be useful to guide therapeutic intervention for parents and the strategies put in place to prevent further harm to the child (Pritchard 2004).

Key message:


It is not necessary to use the label Fabricated or Induced Illness by Carers to bring care and protection proceedings before the court. However, the label may be useful in assisting workers to identify the phenomenon and for guiding therapeutic interventions with parents who carry out these behaviours.


Attachment
Here's a PDF of the first article


Here's a link to the article in full A new name for Munchausen Syndrome by Proxy: defining Fabricated or Induced Illness by Carers

Here's a link to another article that may be of interest Munchausen Syndrome by Proxy

Moving on

This issue has not been resolved and will not be resolved in the near future due to the fact that the outcomes always weigh in favour of the mother, regardless of any information provided by the father. It is out of our control because the mother is strongly determined gain financially from both the father of the children and the government and will always continue to do this through having the children diagnosed for any medical conditions she can. She goes to great lengths and spends much time researching ways to gain more money through her children and there is nothing more we can do about it, so we will continue paying these exorbitant child support payments and just accept what she does. We have already moved to a less expensive house to reduce our mortgage and downgraded our car so we can afford the child support. It does not seem fair when the mother of the children has renovated the entire inside and outside of her home and has just bought a brand new car and goes on holidays away regularly.

My partner and I have a child together and we just hope this will not impact on our baby in any way and try our hardest to protect the baby from the trouble the mother of the other children causes.

We have tried everything and it has not helped in the slightest so we just give up and accept the situation. We will focus on what we do and not concern ourselves with what the mother of the other children does. It is her business now because she has far more fight in her than we do. We just want peace and happiness for our family.

Thanks to everyone for your time and advice, it is appreciated. It is just unfortunate that sometimes in life regardless of how unfair things are, you just have to accept it and move on.
Sparkleservice,
                    I'd suggest not giving up, but rather being prepared for all eventualities. Preparing for what could well be the inevitable or perhaps the unexpected. I'd suggest at the minimum of maintaining a diary or records of any events. Often a parent who exploits and thus abuses children makes mistakes, which can result in radical changes that result in an improved situation.
Thank you Mike T for your post. Yes, the most mportant factor here is not a label for the mother, but whether or not the children are being harmed or are safe. It is common for some mothers to try to get every cent they can regardless of the real needs of the children and regardless of the effect this has upon the father.  I noticed that nowhere n the posts did the writer /parent say that they had had the opportunty to talk directly to the doctors treating the children. I will be concerned if authorities and Courts are not doing their bit to ensure that parents, whether primary custodians or part-time custodians or just access parents, can talk directly to the persons treating their children.





I
Aha, I had skipped a bit when reading the posts, later saw that father had been talking to the doctors. Good, perservere, keep up the visits. Perhaps this will help the doctors to notice whom is the truthful parent.
Guest said
There is no such thing as munchasen by proxy syndrome.

Hmmm…. "Munchausen by Proxy" no longer exists. The DSM has re-classified it as "Fictitious Disorder by Proxy". The folks at the Children's Hospital in Sydney seem to be the only professionals in Australia flying this flag. Psychiatrists and Psychologists would be very reluctant to go out on a limb and make such a diagnosis for fear of ridicule. They're a spineless bunch in this country.

In any event, it would be very difficult to make a differential diagnosis. It could be that the mother has a Histrionic Personality Disorder. Fictitious Disorders manifest in a spectrum of severity.


I suspect that my daughter has been subjected to this type of behaviour/condition. I have argued this several times in the Family Court. And all you get is blank expressions because no one in the legal system has the slightest idea what you are talking about.

The subject matter was traversed in MACKILLOP & JELL.

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4MYDAUGHTER
I don't know how others have fared in these situations, but we have found that when one parent takes a child to a doctor's appointment, the details or outcome of that appointment can not be just given out to the other parent, as there are still basic confidentiality issues. The second parent must either be present at the initial appointment, or make a seperate appointment of their own to have the child seen. So having a dialogue with the children's doctor about the previous diagnoses may not be quite that simple (?)

If you really want to test the sincerity of the mother's "concerns" Sparkleservice, or get a more accurate picture of the children's health (this would appear to be the more important issue), the simplest thing I could think of would be to book appointments with completely different doctors and get a second or even third opinion. If you kept details to a minimum, you could possibly avoid the situation where you're asking yourself if the doctor was biased by "suggested" symptoms or conditions. Maybe their dad could simply explain that their mother seems to be continually attributing possible illnesses to the children, and he would like to have them thoroughly examined to put both her mind and his at rest. That way you would know for certain whether these conditions are legitimate, and if so, to what extent and what the treatment requirements will be.

Having said that, I certainly understand the desire to simply let it be rather than spend time and energy and money fighting a ruthless and driven adversary. Good luck.
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