![]() ![]() ![]() At the most extreme end of FII, deliberate harm is caused to the child with the effects misrepresented by their parent or carer to medical professionals. The next step up is falsification, where the parent/carer manipulates evidence of the child’s illness. At the low end of the spectrum, the parent or carer may fabricate accounts of the child’s illness – not directly harming the child, but instead, giving a convincing but untrue account of the illness. Confusion with fabricated or induced illnessįabricated or induced illness (FII) is a rare form of child abuse where the carer, usually the child’s biological mother, fakes or causes the symptoms of illness in their child. They believed Lucy was a victim of fabricated or induced illness (formerly known as Munchausen’s by proxy), and child protection proceedings were instigated with a view to Lucy being accommodated by the local authority under section 31 of the Children Act 1989. Lucy was diagnosed privately as having autism with a PDA profile, but the local authority refused to accept this. ![]() When Janet told the local authority about how unhappy she was doing this, no alternatives were offered. She found herself in the position of being told to wrap Lucy in a blanket (as Lucy refused to wear clothes due to her sensory differences) and carry her to the car, with Lucy kicking and screaming. Janet was advised by Lucy’s school and her social worker to do everything in her power to get Lucy to attend. Consequently, Janet was ‘threatened’ by her local authority with prosecution for her daughter’s non-attendance at school. Janet told me she can’t ‘force’ Lucy to take part in activities she doesn’t want to do. There was nothing I could do to coerce Lucy out of the car.” “If Lucy doesn’t want to do something, it’s impossible… She is fearful of other children … When Lucy arrived at school, she would sit in the car and she was unresponsive. When asked about Lucy’s PDA, Janet commented: Janet is mum to six-year-old Lucy, who has a diagnosis of ASD with a PDA profile. However, this takes trial and error, time and persistence to achieve. PDA is a lifelong condition with the right support, people can learn to manage their anxiety levels by using sensory approaches to self-soothe and finding socially acceptable ways to avoid or navigate anxiety-provoking situations. Their demand avoidant behaviour is rooted in an anxiety-based need to be in control. Individuals who present with this diagnostic profile are driven to avoid everyday demands and expectations to an extreme extent. displays obsessive behaviour that is often focused on other people.appears comfortable in role play and pretence.experiences excessive mood swings and impulsivity.appears sociable, but lacks understanding.uses social strategies as part of avoidance, eg distracting, giving excuses.resists and avoids the ordinary demands of life.The National Autistic Society includes the following as distinctive features of a demand avoidant profile: ‘Demand avoidant behaviour’ is included in the National Institute for Health and Care Excellence (NICE) pathways guidance as a sign and symptom of possible autism. PDA is defined by Newson et al (2003) as “an obsessional avoidance of the ordinary demands of everyday life” and it is now recognised as part of the autism spectrum, a view endorsed by the National Autistic Society. When their needs are reassessed during my involvement with these children and their parents (or adults and their families), their presentations are often found to be best described as a pathological demand avoidance (PDA) profile of autism. Many parents are told that there’s nothing wrong with their child and that their parenting is at fault, with professionals suggesting how parents can rectify their perceived ‘inadequacies’. These efforts are sadly often counterproductive and futile. Parents often tell me that their local authority has recommended they attend a weekly parenting course so they can learn to set appropriate boundaries and manage their children more effectively. Whilst all cases are unique, there’s one thing that all these individuals seem to have in common – traditional parenting or conventional behaviour strategies, even those recommended for autism spectrum disorder (ASD), don’t work. Whereas some individuals have an existing diagnosis or multiple diagnoses, in other cases they have no diagnosis at all. Increasingly in my work, I’m coming across young people and adults whose presentations are complex – they might have a combination of autism, attention deficit hyperactivity disorder (ADHD), dyspraxia, hypermobility and dyslexia, to name a few. By Cathleen Long, Independent Social Worker ![]()
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