Dr. Cathy Ayoub
speaker
148 appearances
1 recordings
1 series
first heard Dec 2024
last heard Dec 2024
Dr. Cathy Ayoub’s voice in public audio — every appearance, attributed to the second.
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And so we tried to understand what the mothers really looked like. I've got lots of different information. First, we looked at their IQs and they were all, you know, some were very high. And then there were people whose IQs were not that high. So just want to say, I think, you know, these are, and these were people from multiple walks of life.
So you can look at these moms in a number of different ways. The person who I think looked at the most carefully, and I think this was so interesting, is Dr. Southall, who was the pediatrician in the UK, who actually did surreptitious video surveillance of children who had unexplained breathing episodes, or what we call apparent life-threatening events where kids stop breathing.
And what he found was that when they analyzed those tapes, all of these individuals were suffocating their children on videotape. Again, they didn't know they were being videotaped. He found three distinct groups. So one of the ways to think about these moms is how do they act with their children?
And what he found was that there was one group of mothers who had no interaction with their children except to reach into the crib and suffocate them. So no connection, no interaction. When the nurse came in, they would play with the child, they would change the child, but when they were alone, nothing. Second group of mothers
who seem to engage with their kids in a pretty normal way, and then they'd reach out and suffocate them. And then a third group who would pinch their children, one mother even broke their child's arm. They were really hurting the child in multiple ways. That third group of women I think are probably in the acute situation the most dangerous.
Now, these were all women who were suffocating their children, and that is the most likely form of medical child abuse to be fatal. And in our study, of 45 families, we had a 17% mortality rate. That is so high when you compare to other chronic diseases. For example, the most common cause of death in children is infectious disease. In the child one to four, there's a 10% mortality rate.
In four to 14, there's a 5% mortality rate. If you're born with a congenital heart condition, you have a 2% mortality rate now. It used to be seven in 1990, and now it's gone way down because we know how to treat these children.
When you think of children with chronic illnesses or even with acute, the most common illnesses that actually lead to serious injury or death in children, Munchausen by proxy is way up there. And it's primarily because of the children who are being suffocated. Although there were also several children in this study who died of chronic intestinal problems because they were just so debilitated.
And I've also seen, sadly, I've seen young adults, 21, 22 year olds, I get a call from their internist, what can you do? I think this mother's making this young woman sick or this young man. And at that point, there are no protections. Anyway, I haven't gotten off the topic there.
They had a variety of different kinds of problems, GI disorders, asthma. myocondrial disorders, seizures. I mean, I have a list. I could even read it off for you. I think we saw a little bit of everything. Poisoning. We did have some apnea or suffocation cases.
And we also had 10% of the cases were cases in which the illnesses that were being fabricated, exaggerated or induced were psychological or psychoeducational. So it was either they were seen in schools or they were being seen by mental health professionals. So we were able to identify that as a form of victimization as well.
We tried to craft a term back in 2002. And I think it was too complicated, but it was child abuse by illness falsification. And we really said illness or condition falsification so that it wasn't just physical abuse. But I think this is still a struggle. And unfortunately, the term medical child abuse is
is a great one for pediatricians, but it doesn't differentiate the dyadic nature of Munchausen by proxy, which there's a diagnosis for the parent, there's a diagnosis for the child and you put them together and that's Munchausen by proxy. And unfortunately in our healthcare system, you can't have a dyadic diagnosis.
Anyway, lots of Ds here. We also talk about Munchausen by proxy as being one of a number of disorders of deception. And getting back to these three groups of women and some other things you can think about, disorders of deception as a more global term are people who fabricate or exaggerate or change their reality. Or some of them are what we commonly know as pathological liars.
Now, with Munchausen by proxy perpetrators, some of them are very focused on their children, on their children's symptoms. And in a number of cases, I've had some perpetrators say to me, My child has these physical symptoms. They would never have psychological problems. Or my child has these psychoeducational problems, and they would never have physical symptoms.
And sometimes there are a combination of both. I think the child's symptomatology also tells you something about actually how many children in the family are going to be targeted. So that's kind of another issue we can come back to if you're interested.
But then thinking about the perpetrators, they may also be evaluated or be identified based on their whatever is motivating them to keep this secret or to actually make an admission.
I've been involved in long-term treatment of a small number of cases, but significant cases and had the privilege of actually working with these families for seven or eight years from the time they were identified to the time that the children were completely reunified. And it was really quite extraordinary.
And then I've seen several of the families when the children were adults and their siblings. So that's, been very interesting. And in those cases, those mothers each said to me, I happened to be the forensic evaluators for each of them. And in one case actually got a full confession, which was just extraordinary because it just doesn't happen.
But each of these mothers essentially said, I was waiting for someone to find me out. Why didn't, for example, there was a woman who was in a hospital here in Boston and her child was getting ready to, her four-year-old was getting ready to have surgery to have part of his pancreas removed. because he kept having excessive insulin production.
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