Fabricated or Induced Illness (FII)
Parenting exists along a broad continuum of parental/carer responses to managing childhood illness and childhood difficulties. Some parents may exhibit anxiety and a degree of protectiveness towards their children which is within the normal range of behaviour while with some parents/carers’ this may run the risk of becoming dysfunctional in terms of supporting their child. At the extreme end of this continuum, the condition of Fabricated or Induced Illness (FII) exists where a child or young person is treated by the parent/carer as if he or she has significant medical and/or emotional difficulties when these are either mild or don’t exist.
Multi-agency assessments contributing to FII diagnosis are of extreme importance as well as multi-agency planning for intervention.
In situations where diagnosis of FII for a child may be considered, the process of diagnostic decision making is informed by observation, record keeping and the development of a chronology of both the child’s and the parent’s behaviours. FII is a condition where a pattern of observable behaviours and information indicate physical and/or emotional abuse of the child.
A multi-agency risk assessment process by partner agencies will support identification and appropriate intervention. The assessment information provided by all partner agencies for the purpose of identification of FII will involve the use of a range of risk assessment tools including a Multi-Agency Child’s Chronology.
What is Fabricated or Induced Illness?
‘Essentially Fabricated or Induced Illness is a descriptive term and therefore substantially defines itself.’ Bools (2008). As FII is not a discrete medical syndrome a multi-agency approach to its identification is therefore paramount.
HM Government Guidance states that there are three main ways the carer can fabricate or induce illness in a child. These are not mutually exclusive and include:
- fabrication of signs and symptoms
- fabrication of signs and symptoms and falsification of documentation and other assessment materials
- induction of illness
Impact and risks of FII on the health and wellbeing of the child or young person
There are likely to be long-term consequences for the child who has been the subject.
The impact and risks to the child or young person include:
- Children can become confused and anxious about their health to an inappropriate degree
- The risk of suicide is increased
- There is a significant loss of ability to make independent decisions
- There is a risk of significant psychological and emotional harm
- Limited development of appropriate social skills particularly in adolescence if FII remains unaddressed
- Risk of social isolation from peer group
- Risk of severe physical harm
- Risk of death
Guidance Checklist for FII
Educational, Health and Social Work professionals, and other supporting professionals, should be aware of the factors which can indicate that a child may be at risk of harm as a result of FII, they include:
- The parent/carer has a history of seeking disability and medical diagnoses
This may include for instance parent/carer actively promoting sickness in the child or young person by exaggeration or non-treatment of real problems, fabricating or falsifying signs and/or induction of illness (sometimes referred to as “true” FII).
- The parent/carer has a strongly driven self-belief there is something seriously wrong with the child
- The parent/carer refuses treatment for the child to clarify/rule out possible explanations for reported conditions on the part of the parent/carer
- The child presents as normal when not in the presence of the parent/carer
- Evidence of symptom coaching with the child by the parent/carer
- The child participates in the fabrication of symptoms i.e. becomes complicit with the parent
- school non-attendance
- There is a family history of mental health difficulties, problems at birth and family relationship difficulties
- The parent/carer has a style of intimidation and registering complaints if professionals do not comply with their mindset or when issues are solved or parental claims about illness proved to be unfounded. This may in some cases be associated with depressive illness in the carer
- There is a repeat pattern of non-engagement with professionals when solutions are found
- The child may present unexplained physical symptoms (e.g. salt poisoning)