Presentations in Special
Education
2011 TEDA Conference

• History
• Definition/Diagnostic Criteria
• Impact in educational settings
• Implications for special education
• Symptoms
• Recommendations
• Assistance in research

• better 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

• 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

• According to DSM-IV (1994) Factitious
Disorder is:
– ‘intentional production or feigning of physical or psychological signs or symptoms’
– Motivation—assume role of sick person without external incentives, i.e., economic gain
– Factitious Disorder by Proxy (FDP) falls under category of “Factitious Disorder,
Not Otherwise Specified”

• According to DSM-IV-TR uses same definition with 3 subtypes
–Primarily physical symptoms
–Primarily psychological symptoms
–Both physical & psychological symptoms
–Again, FDP falls under ‘Factitious
Disorder, Not Otherwise Specified’

• 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

• 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

• Attention from family, friends, & hospital staff members for being longsuffering, 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

• 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

• Small body of literature indicating that FDP scenario is occurring in educational settings
• Pay-off appears to be similar attention from family, friends, & educational personnel without requirement of physically harming the child

• Child with genuine medical problems that are aggravated/exaggerated by caregiver
– Parent may request extensive, unnecessary nursing care at school
• Child who is physically healthy but parent requests/demands repeated evaluation for
SLD, ADHD, Autism, and other eligibilities

• Conditions from research literature that have been falsified include
– Attention Deficit/Hyperactivity
Disorder (most prevalent)
– Specific Learning Disabilities
– Autism
– Behavioral difficulties/emotional disturbance
– Neuropsychological problems

• Ayoub reported an incidence of 11.5% of her subjects (child victims of FDP) 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)

• Cost of time & money for initial Full Individual
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

• Called ‘high-maintenance’ parent or ‘overinvolved’ 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 2+ hours
• Parents bring their own specialists, sometimes attorneys
• Parents repeatedly bring up other issues before they sign IEP

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

• Schreier and Libow (1993) theorize that
FDP evolves over time
– 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)

• When you suspect you may be dealing with FDP parent, must decide how far you can go accommodating them
• As in dealing with difficult child, don’t threaten anything unless you are prepared to follow through
• Do your homework & be prepared to defend decision not to proceed with further evaluations or services

• Expect parents to get angry with you & insult your training, intelligence, competence
• Be prepared for the worst, (parent going to press)
• May need legal counsel for yourself separate from school district’s lawyer

• Difficult to research
– 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

• Give demographics
– 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

• 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.

• Ellen M. Frye, Ed.D.
• efrye@lubbockisd.org
• trap4trivia@aol.com
• ellen.frye@wayland.wbu.edu