Munchausen syndrome by proxy: A family affair

Munchausen syndrome by proxy is an unusual form of child abuse: a child presents with an illness that has been factitiously produced by a parent, typically the mother. A case of chronic illicit insulin administration to a one-year-old girl is described. Despite temporary separation of the child from the mother and long-term psychiatric intervention, factitious illnesses continued, including urine specimen contamination, laxative-induced diarrhea, suspected bladder catheterization, and suspected poisoning. Retrospective review of the medical records of the mother and two siblings demonstrated previously unrecognized evidence of factitious illnesses. The medical records contained evidence of 30 separate episodes of suspected or documented factitious illness in these four members of the same family. This unique family illustrates the significant morbidity of Munchausen syndrome by proxy and a poor response to psychiatric treatment.     

Munchausen syndrome by proxy: a survey of professionals' knowledge

This study examined professionals' knowledge of a relatively rare form of child abuse, Munchausen syndrome by proxy (MSBP). Eighty-six professionals representing hospital or other medical settings, community services programs, the state children's service agency, and various law enforcement agencies were surveyed. Results indicated that professionals employed in medical or hospital settings were three times more likely to have heard of the syndrome than those employed by community service agencies. Journal articles and colleagues were the most popular sources of information pertaining to MSBP. Respondents identified 77 possible cases of MSBP in their caseloads over the past year. Findings suggest the need for educating community professionals as well as the possibility that the incidence of MSBP has been grossly underestimated. Implications for future research and preventive efforts are discussed.     

Munchausen by proxy: a case, chart series, and literature review of older victims

The history of an older child victim of Munchausen by proxy (MBP) is described. He was referred for evaluation after repeated sinus surgeries for recurrent sinus infections believed to be related to a falsified history of an immunodeficiency. The perpetrator was the mother of this 14-year-old victim, consistent with the majority of such cases. This case prompted a review of cases of MBP in older children reported in our hospital as well as a literature search for other cases in older children. METHODS: This study was a chart review of children over 6 years of age who had been evaluated by social services at the Children's Hospital at the Cleveland Clinic and reported as cases of Munchausen by proxy to Child Protective Services between January 2001 and June 2003. Also, an OVID, Psychline, and Pubmed literature review of published cases of Munchausen by proxy were identified, and cases occurring in the older child were selected for review. RESULTS: Older children who are the victims of Munchausen by proxy may have an induced illness, but falsified reports of symptoms and medical history to coerce the child to undergo medical procedures may be more common. Collusion of the victim with the perpetrator may also become a factor as the child ages and adopts the deception. Given the complex relationship that exists between the parent and child, it is difficult to predict whether the victim either will assist the caregiver in maintaining the factitious illness or be able to recognize the falsification. CONCLUSIONS: Older children who are the victims of Munchausen by proxy may fear consequences of revealing the factitious illness. Physicians must consider the possibility of this diagnosis whenever there are discrepancies in a child's illness that makes a factitious illness a consideration.     

Web of deceit: A literature review of Munchausen syndrome by proxy

Munchausen syndrome by proxy (MSBP) is a form of child abuse wherein the mother falsifies illness in her child through simulation and/or production of illness, and presents the child for medical care, disclaiming knowledge as to etiology of the problem. From the literature, 117 cases of MSBP were reviewed. The most common presentations of MSBP were bleeding, seizures, central nervous system depression, apnea, diarrhea, vomiting, fever, and rash. Short-term morbidity rate was 100%; long-term morbidity rate was 8%. Mortality rate was 9%. Failure to thrive was associated with MSBP in 14% of cases. All perpetrators of MSBP were the mothers. The origins of this type of aberrant maternal behavior remain abstruse, as do the long-term psychological effects on the child victims. Guidelines for medical, social service, and legal management are provided.     

Functional school refusal subtypes: Anxiety,avoidance, and malingering

Chronic school refusal has traditionally been classified under broad categories such as school phobia and truancy. However, the need for improved recognition and treatment of school refusal has heightened efforts to identify subtypes of school refusal behavior. Recent efforts have focused on functional subtypes of school refusal. This article purposes to extend recent efforts by showing that the three basic subtypes of anxiety, avoidance, and malingering are not only functional, but consistent with refusal characteristics, empirical evidence from factor analysis and clinical diagnosis over the past decade, and treatment approaches. Such extension is intended to aid practitioners in further understanding and using functional subtypes. © 2000 John Wiley & Sons, Inc.     

The deceit continues: an updated literature review of Munchausen Syndrome by Proxy

OBJECTIVE: This article presents an updated review of the literature of Munchausen Syndrome by Proxy (Factitious Disorder by Proxy, MBP). METHOD: Four hundred fifty-one cases of MBP were analyzed from 154 medical and psychosocial journal articles. RESULTS: Typical victims may be either males or females, usually 4 years of age or under. Victims averaged 21.8 months from onset of symptoms to diagnosis. Six percent of victims were dead, and 7.3% were judged to have suffered long-term or permanent injury. Twenty-five percent of victims' known siblings are dead, and 61.3% of siblings had illnesses similar to those of the victim or which raised suspicions of MBP. Mothers were perpetrators in 76.5% of cases, but as knowledge of MBP grows a wider range of perpetrators is identified. In a small number of cases, MBP was found to co-exist with secondary gain or other inflicted injury. CONCLUSION: Although published cases form a non-random sample, they add to knowledge about MBP and validate claims that it occurs. More knowledge about non-medical aspects of MBP, and more pooling of data, is desirable.     

On the importance of motivation in Munchausen by Proxy: the case of Kathy Bush

The recent trial and conviction of Kathy Bush for abusing her daughter is used to illustrate (1) the nature of the motivation, in at least some cases of MBP, and (2) the importance of distinguishing the motivation found in MBP from that found in other forms of child abuse and other conditions involving factitious illness production.     

Small-scale deceit: deception as a marker of two-, three-, and four-year-olds' early theories of mind

This research report summarizes the results of a study into the abilities of 2-, 3-, and 4-year-old children to deceptively lead others into false beliefs, and is intended to help arbitrate a growing controversy as to when young persons first acquire some theory-like understanding of other minds. Utilizing a novel hide-and-seek board game as a context within which to observe children's spontaneous use of deceptive strategies, a total of 50 subjects between the ages of 2 1/2 and 5 were tested. In contrast to the competing findings of others, which are claimed to establish that children younger than approximately 4 suffer a cognitive deficit that wholly blocks them from the possibility of entertaining any sort of contrastive beliefs about beliefs, the results of this study show that even 2 1/2-year-olds are capable of already successfully employing a range of deceptive strategies that both trade upon an awareness of the possibility of false beliefs and presuppose some already operative theory of mind.     

Atrazine biodegradation efficiency, metabolite detection, and trzD gene expression by enrichment bacterial cultures from agricultural soil

Atrazine is a selective herbicide used in agricultural fields to control the emergence of broadleaf and grassy weeds. The persistence of this herbicide is influenced by the metabolic action of habituated native microorganisms. This study provides information on the occurrence of atrazine mineralizing bacterial strains with faster metabolizing ability. The enrichment cultures were tested for the biodegradation of atrazine by high-performance liquid chromatography(HPLC) and mass spectrometry. Nine cultures JS01.Deg01 to JS09.Deg01 were identified as the degrader of atrazine in the enrichment culture. The three isolates JS04.Deg01, JS07.Deg01, and JS08.Deg01 were identified as efficient atrazine metabolizers. Isolates JS04.Deg01 and JS07.Deg01 produced hydroxyatrazine(HA) N-isopropylammelide and cyanuric acid by dealkylation reaction. The isolate JS08.Deg01 generated deethylatrazine(DEA), deisopropylatrazine(DIA), and cyanuric acid by N-dealkylation in the upper degradation pathway and later it incorporated cyanuric acid in their biomass by the lower degradation pathway. The optimum pH for degrading atrazine by JS08.Deg01 was 7.0 and 16S rDNA phylogenetic typing identified it as Enterobacter cloacae strain JS08.Deg01. The highest atrazine mineralization was observed in case of isolate JS08.Deg01, where an ample amount of trzD mRNA was quantified at 72 h of incubation with atrazine. Atrazine bioremediating isolate E. cloacae strain JS08.Deg01 could be the better environmental remediator of agricultural soils and the crop fields contaminated with atrazine could be the source of the efficient biodegrading microbial strains for the environmental cleanup process.     

Consultation and handicapped preschoolers: Priorities,goals, and models

A survey of 50 early childhood special educators was conducted regarding issues germane to school psychological consultation. Results indicated that behavioral and home-related problems were major concerns, and that goals in seeking consultation were primarily motivated by a lack of knowledge. A variety of service-delivery models was chosen, with a slight preference for an indirect, mental-health model.     

Learning Styles: An overview of theories,models, and measures

Although its origins have been traced back much further, research in the area of learning style has been active for—at a conservative estimate—around four decades. During that period the intensity of activity has varied, with recent years seeing a particularly marked upturn in the number of researchers working in the area. Also of note is the variety of disciplines from which the research is emerging. Increasingly, research in the area of learning style is being conducted in domains outside psychology—the discipline from which many of the central concepts and theories originate. These domains include medical and health care training, management, industry, vocational training and a vast range of settings and levels in the field of education. It is of little wonder that applications of these concepts are so wide ranging given the centrality of learning—and how best to do it—to almost every aspect of life. As a consequence of the quantity of research, the diversity of the disciplines and domains in which the research is conducted, and the varied aims of the research, the topic has become fragmented and disparate. This is almost certainly how it must appear to practitioners and researchers new to the area, with its complexities and convolutions difficult to comprehend and assimilate. As such, it is perhaps timely to present an account of the central themes and issues surrounding learning style and to consider the instruments available for the measurement of style. This paper aims to provide such an account, attempting to clarify common areas of ambiguity and in particular issues surrounding measurement and appropriate instruments. It aims to bring together necessary components of the area in such a way as to allow for a broader appreciation of learning style and to inform regarding possible tools for measurement. It is anticipated that such an account will promote research in the field by presenting it as more accessible and by developing a greater appreciation for the area across disciplines and in researchers and practitioners new to the area.     

Identification of structural equation models with latent variables: A review of contributions by Bekker,Merckens, and Wansbeek

Identification, Equivalent Models, and Computer Algebra. Paul A. Bekker, Arjen Merckens, and Tom J. Wansbeek, New York: Academic Press, 1994, 211 pages, $59.95.