Pediatric Condition Falsification in Attention-Deficit/hyperactivity Disorder
Rittner, Linda, Pulos, Steven, Lennon, Randy, North American Journal of Psychology
The purpose of this study was to investigate the frequency of occurrence of pediatric condition falsification (PCF) in Attention-Deficit/Hyperactivity Disorder (ADHD). Questionnaires were sent to family practice and pediatric primary care physicians across the state of Colorado (N = 500). Response rate was approximately 10% (N = 53). By self-report, 30% (n = 15) of these physicians reported they had encountered parents who falsified symptoms of ADHD in their children. A second major finding was that for this sample, over one-fourth (26.4%) of responding physicians had prescribed medication for a patient presenting with symptoms of ADHD based solely on the basis of a teacher's recommendation.
While the diagnosis of attention deficit / hyperactivity disorder (ADHD) is common in school age children (Barbaresi, Katusic, Colligan, Weaver, Pankratz, Mrazek, & Jacobsen, 2004; Goldman, Genel, Bezman, & Stanetz, 1998), it is surprisingly easy to falsify (Jachimowicz & Geiselman, 2004). Consequently, it is possible that at least some of the diagnoses of ADHD are based upon Pediatric Condition Falsification (PCF). PCF has been defined as a form of child abuse in which an adult falsifies symptoms, physical or psychological, in a child (Ayoub, Schreier, & Keller, 2002).
The diagnostic category of PCF grew out of the attempt to clarify the constellation of behaviors associated with Munchausen by Proxy syndrome. The American Professional Society on the Abuse of Children suggested that the Munchausen by Proxy syndrome be conceptualized as two separate diagnostic entities: 1) a caregiver perpetrator component based upon a caregiver who abuses a child through illness falsification due to the psychiatric condition of factitious disorder by proxy; and 2) a child victim component, PCF, based upon the child who is the victim of maltreatment (Ayoub & Alexander, 1998). Unlike Munchausen Syndrome by Proxy or factitious disorder by proxy, the diagnosis of PCF is not concerned with caretaker's motives.
Caregivers may engage in PCF with ADHD (PCF-ADHD) for several reasons. First, they may have a deep-seated need to be seen as caring, involved, and self-sacrificing (Ayoub, Schreier, & Keller, 2002). Second, they may have a strong need for attention and use their child as a means to satisfy the need (Wilde, 2004). Third, caregivers may be exaggerating or falsifying symptoms of ADHD in their children to compensate for their failure in parenting by shifting blame to their child's behavior problems (Smelter & Rasch, 1996). Fourth, the caregiver may be motivated by a desire to obtain Ritalin or other methamphetamines for resale or personal use (Leo, 2000). Regardless of the perpetrator's motive, the determining factor in the diagnosis of PCF is whether the child has been mistreated.
PCF-ADHD can have major effects on the child and society. Untreated PCF can lead to severe psychological harm in the affected child (Rosenberg, 1994). Further, when a child is misdiagnosed, due to PCF, as having ADHD, the child is likely to be given unnecessary medications and deprived of the interventions needed to ameliorate the problem (Schreier, 1997). The failure to diagnosis PCF-ADHD may also result in a drain on our limited educational and medical resources (Goldstein, 2002). These effects will be proportional to the prevalence of PCF-ADHD.
While there is growing concern about PCF-ADHD (Coard & Fournier, 2000; Goldstein, 2002; Smelter & Rasch, 1996; Wilde, 2004), little if anything is known about its prevalence. Ascertaining the prevalence of PCF is notoriously difficult (Siegel & Fischer, 2001). Since PCF is based upon deception, it can only be seen when the deception is not successful (Feldman, 1994). Second, many professionals do not believe that a caregiver can seek help for a child while simultaneously harming the child under their care (Wright, 1997). Third, most professionals lack the experience, training and time to assess PCF (Coard & Fournier 2000; Siegel & Fischer, 2001). …