Background
6.The father is [XX] years old the mother [XX]. They met when the mother was 18 years old. They have had a continuing albeit unconventional relationship where they have three children and have never lived together. The mother has been the children’s main carer although the father has been present and involved with his children.7.When A was about 8 years old, the mother began to notice some features of her behaviour that later came to be a serious cause for concern. B was born in [XX] and C in [XX]. C was born in very bad health and the professionals did not expect him to survive. In his early years, he remained under the close care of a paediatrician and happily made very good progress.8.The Local authority first became involved with the family later in 2013 by which time A’s behaviour had significantly deteriorated. The local authority’s concern included A’s violence towards her mother, the other children’s safety, the father’s alleged emotionally abusive parenting, the mother’s low mood and general isolation of the family. By this time A was referred for an ASD assessment. B was referred to audiology and the mother was raising general concerns about her daughter suffering with pain in the limbs and possible hypermobility or Ehlers Danlos Syndrome. In December of the same year A was diagnosed with DAMP and assessed as ‘high functioning ASD’ with a referral to an ASD nurse.9.In 2014 mother and A’s school disagreed about the prospects of A having an EHCP and the mother instructed a private educational psychologist to undertake this work. By now the level of medical and professional involvement with the children was at its highest which included referral to a dietician and B being referred to a rheumatology clinic. Happily C continued to make good progress and was able to walk independently wearing his recommended supportive boots. The occupational health assessments of A and B had advised the use of adjuncts within the home and at school. B was provided with a wrist splint to aid her writing. B was diagnosed as meeting the criteria for ASD and the mother questioned if B may also meet the criteria in light of the family history of ASD.10.By 2015, the divergence of opinion about the children’s presentation at school and as described by the mother at home, had become clear. The school did not observe any need to prompt A to eat and neither child appeared to use or need the various aids that they travelled to and from school with and were provided for their use during the school day. Such were the school’s concerns that it raised questions about the mother’s mental health and possibility of fabrication of the children’s medical and health issues. By July of the same year B was diagnosed as having ASD. 11.The children’s health issues continued to dominate the family’s life with an ever increasing difficulty in managing A’s needs. In the main hypermobility, pain and discomfort, audiology, issues around their diet and ASD were the issues that at any given time one or more of the children were assessed for. The school raised concerns about B’s ASD assessment as it was not involved in the assessment by Dr O and B’s description in the report appeared to be very different to the school’s experience of her. Later C was diagnosed as suffering with reflux and was prescribed medication. 12.Regrettably A’s behaviour continued to become increasingly unmanageable with incidents during which she had placed herself at significant risk. She was assaulting her mother, shouting and breaking items around the house causing significant concern and worry for all of the family including B and C. In [XX] 2020, A was detained under s2 of the Mental Health Act (1983). She was subsequently discharged and with the agreement of the mother, she was placed in a semi-independent home. By now children’s services were sufficiently concerned to issue these proceedings. The court permitted the parties to jointly instruct Dr Rose (Consultant Paediatrician). In his first report dated December 2020 he raised a number of concerns about the children’s medical presentation and possibility of misdiagnosis. He recommended the instruction of a psychiatrist that was sanctioned by the court. The parties instructed Dr Surgener who raised a number of significant concerns about the children and the potentially emotionally harmful environment that they were living in. Subsequently the court approved the instructions of an adult psychiatrist Dr Lyall to assess the parents and Mr Crompton Consultant in Trauma and Orthopaedics. I will refer to the detail of their assessments later in this judgment. 13.By June of the same year it was clear that A could not return home and the local authority’s plan for her long term placement away from her home was approved by the court by making a final care order. A’s behaviour continued to be challenging and has been the subject of a number of Deprivation of Liberty Orders. Subsequently, Dr Rose provided his final report which has informed the local authority’s schedule of findings. He raised a number of concerns about the children’s medical history, their presentation and the possibility that the mother may fall within the definition of Perplexing Presentation/Fabricated or Induced illness (PP/FII).