Child Care Solicitors

It is a parent or carer’s worst nightmare - knowing their child is unwell or in need of support and asking for help, but being accused of inducing, embellishing or fabricating the illness or condition they are reporting, abbreviated to FII.

The rise in these types of cases has been the catalyst for a study published in November 2023 conducted by Cerebra (1), LeAp (2) and the University of Leeds. This report (The Prevalence and Impact of Allegations of Fabricated or Induced Illness (FII)) considers the prevalence and impact on parents/carers accused of creating or exaggerating their child’s difficulties, the parent/carer blame associated with it and the circumstances in which such allegations are often made.

Director Alia Lewis and Caseworker Isabella Gill explore the findings of research into false allegations of fabricated or induced illness, the implications for neurodivergent families and whether there is a need for reform in this highly complex area.

The Statistics

As part of the study, a survey was undertaken of parents/carers who faced allegations of FII in England, Scotland and Wales. A total of 387 responses were received and the following was revealed that:

• 97% of the children of the parents/carers taking part in the survey were considered by their parent to be disabled, and of these, 65% were considered by their parent to be autistic or classified to have a ‘non-visible impairments.’
• More than 40% of the parent/carers who responded identified as autistic.
• 50% of the FII allegations were made after a parent/carer had complained to their public body, suggesting a strong correlation between the making of a complaint and the parent/carer facing FII allegations.
• 84% of FII allegations resulted in no follow up action and were abandoned, with 95% of the cases resulting in children remaining with their parents.

The statistics demonstrate an extremely worrying correlation between allegations of FII being made against neurodivergent parent/carers and parent/carers of neurodivergent children. This gives rise to the following questions addressed in this article:

1. Why does the high correlation exist?
2. What are the outcomes and impact of such allegations?
3. Whether neurodivergent children and families are being discriminated against.
4. Whether there is a need for reform.

The high correlation between FII allegations and neurodivergent families.

The study highlights that the ‘Perplexing Presentation’ (3) guidance, set out by the Royal College of Paediatrics and Child Health (RCPCH), requires professionals to consider ‘alerting signs’ when deciding whether to make an FII safeguarding referral. The ‘alerting signs’ include: discrepancies between parental reporting and the presentation of the child, implausible descriptions, unexplained findings or characteristics of a child’s illness which professionals deem physiologically impossible, parents seeking multiple medical opinions, repeated presentation of a child to medical settings and frequent vexatious complaints about professionals. However, parents or caregivers of autistic children frequently fall into these categories due to a variety of valid reasons that do not amount to FII. Notwithstanding the reasonableness of a parent’s actions, the fact that the ‘alerting signs’ are engaged will inevitably raise suspicion from health and social care professionals and may lead to FII allegations.

What are the outcomes and impacts of false FII allegations?

False allegations of FII can cause significant harm to children, lifelong trauma to families and a consequential distrust of professionals, which in turn can deter parents/carers from getting their children the help they need following the making of such an allegation. These allegations can result in the traumatic removal of children from their families whilst the allegations are investigated. However, as the study shows, over 80% of FII allegations resulted in no further action and over 90% of children remained with or returned to their caregiver. Respondents to the study provided the following feedback:

• “We are not the same people. We are broken and traumatised. We cannot trust anyone anymore” “Devastating for me, but most importantly, delayed my child receiving the care and support needed.” “I had a break down. My eldest two children were traumatised as they thought that they were going to lose their brother to the care system. I am now scared to complain and it has affected my mental health. There was a point that I felt suicidal.”

Are neurodivergent children and families are being discriminated against?

The study raises the question of whether the RCPCH ‘alerting signs’ guidance results in discrimination against neurodivergent families, which is contrary to the Equality Act 2010 and in contravention of their article 8 ECHR rights. The statistics clearly show that neurodivergent families are disproportionately represented within the pool of families subject to FII allegations. Many parents/carers of autistic children will have experienced being disbelieved by health professionals because their child presents differently in public to when at home or because their child presents with a very unusual combination of symptoms. The difficulty these families encounter in being ‘heard’ can result in behaviours commensurate with the ‘alerting signs’ such as the need to make complaints or seek multiple opinions, but which do not actually constitute FII. In our view this leads to the inevitable conclusion that the guidance is discriminatory.

Is there a need for reform?

In short, yes. The study strongly advocates for substantial amendments to the RCPCH guidance, emphasising its critical importance and we support this. There is a notable lack of adequate guidance and training for professionals within this area and no information on how to distinguish reasonable actions taken by parents/carers from true ‘alerting signs’ of FII. Additionally, there is a glaring absence of support for families facing false allegations of FII. This calls for immediate change. It will be interesting to see what comes of the study and whether it will result in reform. In the meantime, if you are a neurodivergent party/responsible for a neurodivergent child within family court proceedings, and require a solicitor who understands your condition and the challenges you face, please do not hesitate to get in touch.

About the Authors

Alia Lewis is a director and award winning child care law solicitor. Alia is a Recommended Lawyer in the Legal 500 2024 edition for her family work across London. Her expertise extends to all aspects of family law relating to children and in particular public law (care) cases and secure accommodation. Alia is highly experienced in representing autistic children and parents in the family court. She has established and leads a ground-breaking neurodiversity team, which provides specialist representation to neurodivergent parties and advocates for reform of the family court system in relation to neurodiversity. Isabella Gill is a caseworker in the child care department based in the firm’s City of London office, with experience in dealing with vulnerable clients. Contact Alia Lewis via email at AliaL@duncanlewis.com or via telephone on 020 3114 1193.

The full report can be found at: https://cerebra.org.uk/wp-content/uploads/2023/11/FII-Final-report-2023-Nov-01.pdf

Appendix:

1. ‘Cerebra’ is a national charity helping children with brain conditions and their families with an aim to provide social care advice and support.
2. ‘Legal Entitlements & Problem – Solving (LEaP) Project’ is an project designed to help families of children with brain conditions cope with the legal barriers they face.
3. Perplexing Presentations (PP)/ Fabricated or Induced Illness (FII) in children guidance. RCPCH Child Protection Portal. Perplexing Presentations (PP)/Fabricated or Induced Illness (FII) in children – guidance – RCPCH Child Protection Portal.