Munchausen Syndrome by Proxy: Implications for Professional Practice in Relation to Children's Education

Abstract

This article discusses the wider implications of a pattern of behaviour in which a parent, usually the mother, persistently presents a false story of illness or disability in the child. Such behaviour can be harmful to the child. The parent may deliberately produce symptoms of illness; the child may be exposed to unnecessary but painful and damaging medical investigations and treatments; the child's participation in education and social life may be unnecessarily limited; and the child may develop a view of themselves as disabled. Should this pattern of behaviour be seen solely in a medical context, or can the behaviour occur in educational contexts, too? The literature includes a small number of cases where members of school staff, psychologists and education administrators have faced persistent but fabricated claims of illness, disability or learning difficulty needing special educational provision. Identifying such fabrication presents professionals with emotional as well as practical challenges. The notion that a mother might deliberately fabricate or provoke symptoms of illness or disability in her child is in itself an assertion that is hard to accept. Strongly-held, polarised views can be generated between those professionals who defend particular mothers and those who suspect them. There may be aspects of special educational needs law and practice that add to the difficulties faced by practitioners needing to distinguish between benign parental advocacy and malign fabrication. Some tentative suggestions are offered about how practitioners can be alert to possible cases of fabrication; and about how our knowledge about educational manifestations of fabrication might be refined.

Acknowledgements

The author gratefully acknowledges helpful comments on an earlier draft of this article made by Professor Nick Frost and by the two anonymous reviewers.