Munchausen Syndrome by Proxy and Other Forms of Parental Abuse in Children with Screen Addiction and a Diagnosis of Autism (ASD) and/or ADHD

Violeta R. Manolova and Stoyan R. Vezenkov

Center for applied neuroscience Vezenkov, BG-1582 Sofia, e-mail: info@vezenkov.com

For citation: Manolova, V.R., Pashina, I.H., Mateev M.I, Vezenkov, S.R. (2025) Munchausen Syndrome by Proxy and Other Forms of Parental Abuse in Children with Screen Addiction and a Diagnosis of Autism (ASD) and/or ADHD. Nootism 1(2), 11-30, ISSN 3033-1765 (print), ISSN 3033-1986 (online)

Abstract

This study offers a novel perspective on the growing body of literature concerning Munchausen Syndrome by Proxy (MSbP), expanding its conceptual boundaries by examining parental behaviors in the context of early childhood screen addiction. While classical cases of MSbP are characterized by medically fabricated symptoms and overt physical interventions, this report highlights a subtler - but equally destructive - form of abuse: chronic screen overstimulation induced by caregivers, resulting in developmental arrest and neuroregulatory dysfunction. The inclusion of screen addiction and delayed neurodevelopmental profiles as potential markers of abusive caregiving behavior is, to our knowledge, unprecedented in the clinical literature.

An analysis of 162 clinical cases reveals an alarming pattern of parental behavior marked by significant screen exposure, denial of harm, resistance to therapeutic recommendations, and ultimately, sabotage of the child’s recovery process. Although these behaviors are often presented as forms of care, they align with the core psychological motives described in the MSbP literature - including the caregiver’s conscious or unconscious need to maintain the child in a dependent and symptomatic state in order to obtain social attention, validation, and emotional gratification. Unlike classical MSbP, however, the harmful behaviors observed in this study are rarely recognized as abuse, as they are socially normalized.

Another distinctive aspect of the study is the integration of psychophysiological profiling of the parents—a methodological innovation in this field. The use of HRV, skin conductance, and other autonomic measures enabled objective assessment of self-regulation capacity, emotional availability, and stress resilience. The data revealed clear correlations between poor autonomic regulation in parents, low adherence to therapeutic guidelines, and high rates of therapy dropout. This provides new therapeutic avenues for managing the syndrome using biofeedback, significantly improving children's potential for recovery.

The study also identifies a typology of parental sabotage behaviors—socially acceptable yet systematically undermining the therapeutic process. These include minimizing screen exposure, withholding key developmental information, failing to implement prescribed tasks, and abruptly discontinuing therapy during critical phases. The fact that such behaviors often intensify precisely at moments of potential recovery suggests an unconscious, yet organized, psychological mechanism for maintaining the child’s dysfunction.

The study calls for a reconceptualization of caregiver-mediated neurodevelopmental disorders, particularly in cases with ambiguous etiology such as ASD and ADHD. It proposes the hypothesis that a subset of these conditions may be iatrogenically maintained - or even induced - through digitally mediated neglect, emotional enmeshment, and pathological caregiving patterns. Such a perspective has serious implications for diagnostic practices, therapeutic approaches, and child protection protocols.

Keywords: Munchausen Syndrome by Proxy (MSbP), Screen Addcition, Caregiver-Induced Developmental Delay, ASD, ADHD

Introduction

At our research and therapeutic center, we work with children affected by screen addiction and their families, with the ultimate goal of therapy being the child’s full recovery and return to a healthy developmental trajectory. The removal of diagnoses such as ASD and/or ADHD is a secondary outcome; the path to recovery begins with the treatment of screen addiction and the complex developmental disorders it causes (Vezenkov and Manolova 2025b).

This process requires the full involvement of parents: they must adhere to the weekly program we prescribe, manage their child’s withdrawal crises, and commit themselves physically, mentally, and emotionally to a range of weekly tasks and exercises. It also demands the development of certain skills and personal qualities - qualities that, if they had been present earlier, might have prevented the emergence of screen addiction and the resulting severe developmental deficits.

This is why, in parallel with the children's therapy sessions, we also conduct individual (or joint) therapeutic sessions with the parents, incorporating biofeedback techniques. The primary goal is to support parents in achieving an optimal psychophysiological state in order to facilitate their child’s recovery.

Throughout the therapeutic process - at different stages and in varying forms - we encounter identifiable patterns of sabotage by one or both parents. These behaviors contribute either to a deterioration in the child’s condition or to a missed opportunity for improvement.

A portion of the cases present all the hallmark features of Munchausen Syndrome by Proxy. In instances where the parental profile does not meet the full criteria for this syndrome, the most accurate description would be a form of child abuse, sometimes occurring unconsciously but with a discernible motivational pattern, and in other cases—consciously and deliberately perpetrated.

Munchausen Syndrome by Proxy was first introduced in 1977 by Dr. Roy Meadow, who emphasized that clinical cases were so rare that, without the support of specialized literature, professionals would hardly even be aware of the phenomenon’s existence (Meadow, 1977).
In 1995, Meadow published a more concise article delineating what is - and what is not - Munchausen Syndrome by Proxy, drawing attention to the fact that the increasing recognition of the syndrome had led more and more professionals, particularly physicians and healthcare workers, to begin observing parental behavior more closely. This, in turn, enabled them to identify forms of abuse involving induced illness and the maintenance of symptoms in the child by their own parents (Meadow, 1995).

Munchausen Syndrome by Proxy (MSbP) is observed when the following conditions are present:

The child presents with an illness that is either fabricated or induced by a parent or caregiver;
The child is repeatedly taken for medical evaluations and subjected to various medical treatments and procedures;
The perpetrator denies the actual cause of the child's illness;
The acute symptoms and signs of illness typically disappear when the child is separated from the perpetrator (Meadow, 1982; 1985).

Meadow also discusses what does not constitute MSbP, emphasizing that certain patterns of harmful behavior should instead be categorized under other forms of child abuse.

As a result of a series of reports published by medical professionals between 1977 and 1995, the syndrome was incorporated into the DSM-IV, with the following diagnostic criteria:
(A) The intentional production or feigning of physical or psychological signs or symptoms in another person under the individual's care;
(B) The motivation for the perpetrator’s behavior is to assume the sick role indirectly—through the illness of another;
(C) There are no external incentives for the behavior (e.g., financial gain);
(D) The behavior is not better accounted for by another mental disorder.

The clear distinction introduced by Meadow lies in motivation: in cases of Munchausen Syndrome by Proxy, the underlying drive is the caregiver’s desire for sympathy, attention, special treatment, and care. If the caregiver does not display a susceptibility to such forms of gratification, then the behavior should not be classified under MSbP, but rather understood through alternative motivational frameworks. Thus, the defining criterion becomes the need to be cared for.

This report aims to highlight the widespread manifestations of both phenomena: MSbP and other forms of parental abuse through the induced illness of children. These manifestations are most commonly found in cases involving diagnoses of unclear etiology, such as Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) (Perry & Szalavitz, 2007). These conditions are marked by ongoing scientific debate regarding their origins (whether congenital, genetic, or acquired), complex and variable symptomatology, and a lack of scientific consensus on effective therapies, prognostic expectations, and recovery timelines. Notably, these are often considered incurable conditions.

In our clinical practice, we encounter both types of cases: parents who deliberately induce illness in their children and willingly engage in therapy, as well as those whose behavior is not motivated by a personal need for comfort and care, but rather by other psychological or situational drivers. The cases presented here illustrate not only the characteristics and psychological profiles of the caregivers involved but also demonstrate the potential for successful therapeutic intervention.

Within Munchausen Syndrome by Proxy, the two most problematic aspects are: (1) diagnostic identification—as healthcare professionals generally assume good faith on the part of parents—and (2) therapeutic effectiveness (Rusinovska et al., 2023). The literature is replete with summaries and reports that document the failure of most forms of therapy, including psychotherapy and pharmacological intervention, in cases involving parental abuse through the induced illness of the child (Sousa, 2017).

Precisely for this reason, we present our clinical experience with both successful and unsuccessful therapeutic processes, in order to identify the key factors that contribute to positive and negative outcomes, and to outline the profiles of the cases in which we were unable to achieve therapeutic success.

Perpetrators of Munchausen Syndrome by Proxy (MSbP) are most commonly mothers, though there are documented cases involving fathers or adoptive parents. Typically, they provide false, misleading, or deceptive information to medical or therapeutic personnel regarding the child’s symptoms and condition, actively induce illness, and covertly obstruct the recovery process (Rosenberg, 1987). As a result, affected children are deprived of opportunities for normal development, they fail to thrieve. The most vulnerable population includes children under the age of five (Rusinovska et al., 2023).

The caregiver may repeatedly exaggerate or intentionally provoke symptoms in order to receive sustained medical attention and emotional support from family, peers, or medical professionals (Meadow, 1977). Approximately 40% of these parents suffer from Munchausen Syndrome themselves or have unresolved medical or psychological issues, which they project onto the child in a distorted attempt to meet their own unmet emotional needs (Abdurrachid & Marques, 2020).

These individuals are often driven by a compulsive need for emotional connection, reassurance, and attention elicited by the child’s illness. Consequently, they invest substantial time, effort, and resources into maintaining or worsening the child’s condition. Children may undergo dozens—sometimes hundreds—of diagnostic and therapeutic procedures, some of which are invasive or life-threatening. Caregivers frequently change hospitals and medical teams, sometimes traveling across regions or countries in search of new interventions. When improvement occurs, they often terminate therapy or relocate to new providers.

These parents may conceal medical records, manipulate documentation, and recruit family members, school staff, or other professionals to corroborate the fabricated or exaggerated symptomatology. Their manipulation of information is fluid and opportunistic. In this constructed chaos, the parent often finds a sense of meaning and emotional security.

They may insist that only they can feed, bathe, or sleep with the child, creating a dynamic of emotional and physical enmeshment. Both parent and child are caught in a dysfunctional system. Approximately 70% of perpetrators present with undiagnosed personality disorders, and up to 80% report comorbid depression or substance abuse. Emotionally, they are often disconnected from the other parent, who may be absent, marginalized, or stripped of parental authority.

As early as 1977, Meadow observed that these mothers often exhibit profound deficits in empathy—a striking insight years before the discovery of mirror neurons. These caregivers do not allow their children to recover; instead, they systematically induce illness while simulating care and cooperation during medical treatment. Typically, these mothers appear cooperative, well-versed in medical terminology, and open to interventions. Yet, they often choose the precise moment to discreetly undermine the child’s condition. When they are present, the child’s health tends to deteriorate, with profound psychological and physical consequences (Rosenberg, 1987). The mortality rate associated with Munchausen Syndrome by Proxy (MSbP) is estimated to be approximately 10%. The American Professional Society on the Abuse of Children (APSAC) classifies several categories of falsification used to deliberately worsen a child's condition:

Fabrication of information
Exaggeration of symptoms
Simulation (feigning illness)
Withholding of care or recovery opportunities (neglect)
Induction (actively causing symptoms)
Coaching, including the involvement of other individuals such as co-parents, grandparents, or healthcare professionals in affirming or supporting the parent’s fabricated narrative.

Munchausen Syndrome by Proxy has been documented in hundreds of clinical cases, and several seminal reviews have provided comprehensive profiles of parental characteristics and behaviors (Bools & Meadow, 1994; Sheridan, 2023; Yates & Bass, 2017). This paper aims to expand that knowledge by introducing a specific subgroup of parents with children with screen addiction whose behaviors are influenced by the unique nature of their children's diagnoses, particularly in relation to disorders such as Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) - conditions characterized by ambiguous etiology and complex therapeutic pathways.

Methods and Participants

This study presents an in-depth analysis of clinical data and parental behavior in 162 cases in order to outline the profiles of parents exhibiting Munchausen Syndrome by Proxy (MSbP) and other forms of child abuse through illness fabrication. The methodological approach included the use of structured questionnaires, guided interviews, and data collection from therapeutic sessions.

For each case, the following were documented:

The objective condition of the child
Comorbid diagnoses
Parental reports
Observed parental behavior
Therapists’ clinical observations
The child’s psychophysiological profile
The therapeutic process and trajectory of recovery
Autonomic nervous system (ANS) functioning and its modifications during therapy

A subset of 12 family cases was selected for detailed case study descriptions, focusing on therapeutic dynamics and outcome trajectories.

Instrumentation used:

EEG recordings were obtained using a 19-channel monopolar montage, utilizing Neuron-Spectrum-4P hardware and Neuron-Spectrum.NET software (Neurosoft LLC, Russia).
Peripheral autonomic signals were recorded, including:Heart rate (HR), Heart rate variability (HRV), Peripheral temperature, Respiratory rate, Skin conductance level (SCL), Electromyography (EMG)

These signals were recorded with 8-channel Gp8 Amp hardware and Alive Pioneer Plus software from Somatic Vision Inc., USA.

Analysis of HRV parameters (including HR, SDNN, Total Power, LF/HF Ratio, Smoothness, Stress Index, SNS Index, and PNS Index) was performed using Alive Pioneer Plus and further processed with Kubios HRV Scientific Lite.

Results

All 162 children included in the study were identified as having screen addiction, with some presenting early-onset screen addiction of varying severity. Among them, 133 children (82%) were diagnosed with Autism Spectrum Disorder (ASD) and/or Attention Deficit Hyperactivity Disorder (ADHD). The remaining 29 children (18%), aged between 16 and 40 months, exhibited clear symptomatic characteristics but had not yet been formally diagnosed, as specialists remained cautious due to their young age.

Parental involvement in the development of screen addiction was distributed as follows:

Parental Structure	Number of Cases	Percentage
Mothers raising children without paternal involvement	47	29.0%
Co-parenting within the same household	42	25.9%
Co-parenting from separate households (post-separation)	32	19.8%
Families where the mother is the primary caregiver and the father has a nominal role (e.g., financial support only)	29	17.9%
Children raised by grandparents (grandmother and/or grandfather)	7	4.3%
Adopted children raised solely by their adoptive mother	2	1.2%
Fathers raising children without the mother’s involvement	3	1.9%

Behavioral Characteristics of Parents Associated with the Development of Screen Addiction and Neurodevelopmental Deficits in Children:

Early Exposure to Screens.
In all 162 cases (100%), children were systematically exposed to screen stimulation before the age of three. Despite the widespread availability of information and warnings from pediatricians and other professionals regarding the developmental risks, parents themselves allowed their children to spend hours in front of television screens, fed them while they were watching phones, entertained them with tablets during travel, etc. Some parents initially denied any screen use, but during the first clinical assessment, specific developmental markers indicated otherwise. Consequently, parents began adjusting their narratives—stating that perhaps someone else (the other parent, a grandparent, etc.) might have occasionally exposed the child to screens.
Throughout therapy, these accounts continued to shift, with parents spontaneously revealing specific details of screen exposure. This raises the question: Did these parents knowingly harm their children, or is this a form of neglect?
Symptoms develop gradually.
All of the children were diagnosed with ASD and/or ADHD. Initially, all of them displayed typical developmental progress up to a certain age. Subsequently, symptoms began to emerge progressively—such as sleep and feeding disorders ("won’t eat without a phone"), avoidance of eye contact, lack of words, disinterest in surroundings, irritability, tantrums, etc. These symptoms did not develop overnight but rather evolved over time. Parents typically sought professional help only after the symptoms had multiplied and the developmental delay had become visibly apparent. Their narratives regarding the onset and nature of the symptoms frequently contradict each other (both between the two parents and across different therapy sessions). The sense of deception and distortion of truth is clear. This raises the question: Why did the parents not seek professional help at the early signs of mild symptoms?
Visible reaction to screen withdrawal.
In almost all cases, children demonstrated (or previously demonstrated) clear withdrawal symptoms when screens were removed—refer to the Screen Trauma Report (Manolova & Vezenkov, 2025). Despite this, parents continued to expose their children to screens. Reactions included frustration, hysterical crying, tantrums, aggression, and/or self-harming behavior. These episodes occurred repeatedly. Nevertheless, parents did not stop screen use but continued employing screen devices to calm the child or to secure personal time during which the child would not disturb them. This raises another question: Why did they not implement a complete screen ban, but instead continued to deteriorate the child's condition?
Temporary improvement after screen restriction, followed by reintroduction.
In nearly 30% of cases, parents reported that at some point they had significantly or completely restricted their child's screen exposure. They observed a period of improvement in the child's condition. However, for various reasons, they later reintroduced screens into the child’s routine. The explanations varied: "as a reward," "to have time to get something done," "because I work from home and need the child occupied for a few hours," or "so they don't feel left out compared to other children who watch TV, videos, or play digital games." Subsequently, they observed a deterioration in the child's condition. Around 60% of these parents attempted to remove screens again—either permanently or temporarily—but noted a significantly weaker improvement compared to the initial withdrawal. This raises the question: What truly motivates parents to reintroduce screens after personally witnessing their negative effects on their child?
Despite public awareness of screen-related harm in early childhood development, nearly 40% of the parents had been directly advised by a professional—psychologist, psychiatrist, neurologist, or pediatrician—to eliminate screen exposure for their child before seeking help from our team. However, they did not comply.
These same parents administered prescribed or self-prescribed medications, took the child to various therapies, medical examinations, and interventions, yet failed to take the most basic, preventive step—removing screens. Upon initial assessment, screen addiction and/or screen trauma was identified in the child; either during assessment or therapy, one or both parents admitted that screens had significantly contributed to the child’s developmental impairments. They also acknowledged that true recovery would not be possible without screen detox. This raises the question: By continuing medical and therapeutic efforts while allowing the harmful screen exposure to persist, who are these interventions actually helping?
After the onset of symptoms, many parents—over months and even years—exacerbated the child’s condition through their own behaviors, instead of addressing the child’s needs with basic behavioral regulation.
In these cases, the dynamics resemble what Meadow (1995) called "mothering to the death." These include prolonged bottle-feeding up to 4–5 years of age, continued diaper use well beyond age two, co-sleeping with the child until ages 14 or 16, and treating the child as an infant—carrying, cuddling, and using baby talk. These parents appeared emotionally consumed by hovering over the child, often displaying signs of extreme fatigue and burnout. This behavior, combined with continued daily screen stimulation, severely impedes the child's capacity to outgrow their infantile functioning. The symptoms are thus reinforced indirectly by parental behavior and directly by screen exposure.
Less than 10% of parents express guilt or take responsibility for the child’s condition when it becomes clear that screen addiction was a contributing factor.
1) Some parents shift the focus immediately to their own difficulties—explaining how hard it was to raise the child, how they had to work, or were exhausted or depressed. Some even stated that, given the chance, they would again use screens to cope with the demands of parenting.
7.2) Others go through a strong phase of denial—claiming they never gave screens, or only did so occasionally and briefly. In cases of separated parents, they may blame the other parent or their family, with unclear or inconsistent timelines. These narratives often change over time and diverge from those of the other parent, grandparents, or siblings, who informally or formally share facts with the therapy team.
7.3) In 23 cases, parents created elaborate stories about the sudden onset of symptoms, typically attributing it to a single event—such as a vaccine or an unspecified incident at kindergarten. However, further investigation and information from family members often revealed that developmental deficits had been present for months or even years before the reported incident, which likely only intensified existing symptoms.
Doctor shopping. (Rosenberg, 1987)
Children are routinely subjected to dozens of medical examinations, diagnostic procedures, and therapeutic interventions. These may occur every 3 to 6 months. The children are taken to various specialists—psychologists, speech therapists, occupational therapists, nutritionists—as well as to hyperbaric oxygen therapy, stem cell infusions, and other interventions. In some cases, the children are forcibly restrained, screaming, during blood draws or EEG procedures. Despite these efforts, full recovery is rarely achieved, yet the cycle continues for years. Specialists, clinics, and even countries are frequently changed, not based on a treatment protocol or physician recommendation, but at the discretion of the parent. There is no consistent oversight from a pediatrician or primary care physician who monitors the child’s general condition, assesses progress, or evaluates treatment efficacy. Documentation is withheld, procedures are not disclosed, and the process lacks medical coordination. These practices are widespread—nearly universal—among parents of children with developmental disorders. Because official medicine still classifies these conditions as untreatable and provides no standardized therapy protocols, complete freedom and chaos reign. Whenever a new therapy emerges, the child is subjected to it—regardless of the cost: financially draining the family and often harming other siblings through resource deprivation, emotionally exhausting everyone involved, and causing pain or discomfort to the child. Parents expose children to unverified or trendy therapies—often pseudoscientific or mystical in nature—without regard for the cumulative impact on the child’s well-being or the long-term risks to development and life.
This raises the critical question: Why are these medical and therapeutic decisions left entirely to the discretion of the parents rather than being guided and monitored by a medical professional?
Parents often develop a stable identity and extract dividends from their role as caregivers to a child with developmental delays or special needs.
In many cases, their motivation surpasses the classic attention-seeking described in Munchausen Syndrome by Proxy. Still, this craving for attention may be the root from which a broader identity is constructed. Regardless of its origin, the motivation is multifaceted, with emotional, financial, and social rewards. These parents build a “special” image in their social circles—one that is validated and even reinforced by professionals. They see themselves as saints, martyrs, heroes, or superhumans raising “extraordinary” children. These self-concepts are not merely external projections but have deeply embedded themselves into their self-perception and identity. In some cases, they benefit materially—from the other parent, from social welfare funds, or from the extended family. Sometimes the financial support is generous, other times just enough to survive, but for some, it is a welcome justification to remain in that role. In certain families, parents manipulate guilt and inadequacy to entrap their spouses, leveraging the child's deficits to maintain control and secure continued attention and resources.
Approximately 60% of the cases show strong attachment to the child's diagnosis, particularly in instances of ASD or ADHD. These diagnoses grant parents full autonomy to change therapies and programs, worsen the child’s condition through screen exposure and personal behaviors (which are not condemned by society and often not recognized by professionals as contributing factors), and to rely on the prevailing notion that these conditions are incurable. Through such a diagnosis, they secure a lifetime status as patients and recipients of services and attention.
Because the child often lacks the capacity to articulate what is happening, and because the parent’s external behavior is socially acceptable - at least the part visible outside the home - such abuse flies under the radar of child protection systems. Social norms dictate that the more therapies and specialists a family consults, the more committed and caring the parents are presumed to be. These parents tend to engage only in therapies that do not lead to meaningful change. The idea of "accepting the diagnosis" satisfies them entirely, and they no longer seek full recovery or developmental rehabilitation for the child. In 90% of the cases, some form of sabotage of the child's recovery process is observed during therapy.
- Parents fail to carry out assigned home exercises or follow behavior-modification guidelines provided by therapists.
- They often do the opposite of what is prescribed, intensifying the child's dysregulation and symptoms.
- They skip critical therapy sessions - either reporting the child is ill (e.g., with a cold) or leaving for vacation - exactly at moments when the child is poised to make a significant developmental leap, causing these windows of opportunity to be lost.
These parents display a precise intuition regarding the recovery phases of their child and sabotage them with subtle, almost invisible, acts. This intuition is not random—it has been developed through intimate observation of the child during the process of deterioration. The same way a child’s decline follows certain phases, marked by attempts at self-regulation and cascading dysfunction, parents have learned the mechanisms of maintaining the child's impaired state and now skillfully intervene to disrupt progress. For example, they may leave the child for two days with grandparents who allow screen time, then return feigning surprise at the regression. Timing is critical during therapy intensification, and parents seem to know this deeply - because they also knew the timing of the child’s initial deterioration, with details specific to the individual child.
When significant developmental improvements begin to emerge—noticed by the therapists, the parents themselves, and often by third parties—the therapy is abruptly discontinued. This may occur without explanation, or be attributed to financial issues, sudden life events, or disagreements with the therapeutic team, often claiming falsely that “no progress has been made” (despite documented improvements).
In some cases, this interruption occurs during a therapeutic crisis - precisely when parental commitment is essential for restoring developmental momentum. This behavior may indicate fear of exposure: if the child fully recovers, it may become evident that the deficits were not due to uncontrollable factors, but rather to screen overuse and parental neglect. (Petrova et al., 2025)

Psychophysiological profiles and family system

Within the framework of a therapeutic program targeting children with screen addiction and their parents, data were collected concerning the psychophysiological profiles of the adults involved—specifically their capacity for autonomous self-regulation, resilience to stress, and the presence of symptomatic manifestations. A total of 162 cases were analysed, comprising 157 women and 32 men. Several predominant parental configurations emerged, each exhibiting distinct psychological and physiological profiles.

The largest proportion of cases involved mothers raising their children independently, without the father's involvement—47 cases, representing 29% of the sample. All these mothers participated in the therapeutic process. Among them, a significant incidence of anxiety-depressive symptomatology was observed (45 cases), along with chronic fatigue (43), screen addiction (39), and serious sleep disturbances (34). Additionally, many reported a lack of intimate life (38) and feelings of loneliness and social isolation (45). Of this group, 26 mothers successfully completed the entire therapeutic process.

In the group practicing co-parenting within a single household (25.9% of all cases), 42 mothers and 18 fathers participated in therapy. Among the women, anxiety-depressive symptomatology was recorded in all cases (42), whereas among the men, this type of functioning was less frequently observed (4 cases). Chronic fatigue was present in all mothers (42 cases) but was comparatively less pronounced among fathers (6). Screen addiction affected 28 mothers and 14 fathers, while sleep disturbances were noted in 38 mothers and 15 fathers. Sexual dissatisfaction impacted 31 mothers and 14 fathers, and feelings of loneliness were reported by 38 mothers; none of the fathers reported experiencing such feelings. From this group, 33 families completed therapy.

The third main group comprised families in which the parents were separated but maintained co-parenting across different households. Out of 32 cases, 30 mothers and 11 fathers engaged in therapy. Anxiety-depressive experiences were reported by 28 mothers and 9 fathers, while chronic fatigue was universal among mothers (30 cases) but significantly limited among men (2 cases). Screen addiction was common in both groups—28 mothers and 11 fathers. Sleep disorders were present in 26 mothers and 9 fathers, and the absence of intimacy was reported by all 30 mothers and 11 fathers. Only mothers reported feelings of isolation (30 cases). From this subgroup, 25 families successfully completed therapy.

Among 29 families (17.9%), the father's involvement in child care was minimal, limited to the role of financial provider. In these instances, the primary caregiving responsibility fell entirely on the mother. All 29 mothers participated in therapy, with anxiety-depressive symptoms identified in 28 of them and chronic fatigue in 21. All reported screen addiction, and 26 indicated sleep disturbances. Intimacy issues were found in 22 cases, and feelings of loneliness were reported by 28. Therapy was successfully completed by 23 of these mothers.

A smaller yet significant group included cases where children were raised by grandparents—seven in total. All grandmothers participated in therapy, during which anxiety and depression were observed in three, chronic fatigue in two, and screen addiction also in two. Sleep disturbances were common (four cases), the absence of intimate life was universal (seven cases), and social isolation was reported in only one case. Six of them completed therapy.

There were also two cases involving adopted children raised solely by the adoptive mother. Both women engaged in therapy, during which symptoms of anxiety, chronic fatigue, screen addiction, sleep disturbances, and feelings of loneliness were identified in both cases. Only one of them completed therapy.

The final group comprised three fathers who were single parents. All participated in therapy and reported anxiety-depressive functioning, chronic fatigue, screen addiction, and sleep disturbances. Only one reported a lack of intimate life and experiences of loneliness. All three successfully completed therapy.

Of all 162 cases included in the therapeutic program for children with screen addiction and their families, therapy was successfully completed in 117 cases. This included 26 single mothers, 33 families practicing co-parenting within a single household, 25 separated families with active participation from both parents, 23 cases where the mother was the primary caregiver and the father's involvement was minimal, six cases involving grandparents, one case of an adoptive mother, and three single fathers. Thus, the success rate of therapy completion was approximately 72.2%.

Conversely, 45 of the participating families - about 27.8% - did not complete the therapeutic process. These dropouts were distributed across various family configurations.

Analysis of the 45 dropout cases within the therapeutic programme for children with screen addiction reveals a concerning pattern of parental behaviour contributing to the emergence and exacerbation of the addiction. In each case, at least seven of the 11 previously described behavioural models associated with chronic neglect, psychological abuse dynamics, or controlling behaviour were identified, and all cases aligned with the profile of Munchausen Syndrome by Proxy. The parents systematically neglected their children during the earliest developmental stages, permitted intensive early screen stimulation, introduced screens despite evident harm, and sabotaged the therapeutic process through direct or indirect mechanisms. They frequently failed to assume responsibility for their child's condition and exhibited a visible need for special attention, seeking understanding and consolation. These recurring patterns delineate a distinct structure of parental behaviour with pathological characteristics underlying developmental disorders in children.

Case Descriptions

This section of the report examines the profile of the children and parents in the context of Munchausen Syndrome by Proxy, noting that despite the characteristic features, it may also be combined with another hidden, unspecified form of parental abuse toward children diagnosed with autism spectrum disorder, with or without hyperactivity and/or attention deficit. The case descriptions emphasize the potential motives behind the atypical parental behavior.
In cases with a positive therapeutic outcome, the report outlines the key moments of profound change, which, according to the therapists involved, are significant for the recovery of the parent(s) and the child.
In cases of therapy failure or incomplete therapeutic process, the moments of therapy withdrawal, the parents’ explanations for this decision, and the therapists’ observations are described.

1) Case Description: The Long-Awaited, Yet Unwanted Child by Her Mother

B. was a 10-year-old girl with screen addiction, diagnosed with Childhood Autism (ASD) and Attention Deficit, first identified at the age of 3 years and 6 months. She was nonverbal and non-communicative, exhibited multiple stereotypies, and experienced frequent tantrums. She made no eye contact, did not engage in play with others, and did not play alone with toys. According to her parents, she had spent more than four hours a day using a tablet or phone, watching English-language cartoons. She could automatically pronounce approximately ten English words (her native language was Bulgarian), but did not use them in context. She often vocalized a single syllable for more than an hour.

She tested positive on the SIPVR assessment and showed a strong maladaptive response to having her eyes covered. She could not tolerate wearing hats, jackets, or even shoes—particularly during seasonal transitions. She developed fixations on one or two shirts, prompting her parents to buy five or six identical ones. She refused to have her hair cut or her teeth cleaned, and she had a significant buildup of tartar that injured her gums. She had not yet lost any baby teeth.

Her diet was extremely limited—she ate only bread and, occasionally and unpredictably, added cheese or nuts, though her mother was unable to identify a pattern. She also consumed large quantities of ice cream—sometimes as many as ten per day. She would only use the toilet with her mother and only in the shower. She held her urine all day and urinated only at night. Her bowel movements occurred every few days and were severely constipated. Clinical examination revealed signs of irritable bowel syndrome (IBS).

In addition to food, she frequently ingested inedible substances such as plaster, tree leaves, and rubber door seals. Her sleep schedule was unclear; her parents did not know when she fell asleep. They would go to bed at some point in the evening, and she would eventually fall asleep—often still holding a phone or tablet—somewhere in the house: on the floor, the couch, or in an armchair. In the mornings, they had to search the house to find her and wake her for school.

B.’s mother was extremely talkative, spoke incessantly, and struggled to stay on topic. When asked a question about her daughter, only about 5% of her response was directly relevant; the remainder quickly drifted into personal reflections, emotions, stories others had told her, or comparisons with other children—ultimately focusing on her own suffering. Redirecting her attention to the topic at hand was difficult, as she lacked focus and seemed unable to understand the purpose of specific questions.

She was a woman in her early 50s, married, managing a successful family business, and evidently of high financial standing. Her psychophysiological functioning was depressive: she had low HRV, a narrow HR range (max–min < 5), skin conductance in freeze mode below 3 µS, was unresponsive to stimulation, and showed a peripheral body temperature of 21°C with no variation between rest and task. She reported chronic exhaustion, and even regular vacations did not help her recover. She was preoccupied with her husband’s frequent hypertensive episodes and feared he might suffer a heart attack, leaving her to care for their daughter alone.

There had been no intimacy in their relationship since before B. was born. B. had been conceived via IVF after more than ten years of unsuccessful attempts. The mother described that period as emotionally and physically devastating. She reported having been traumatized by the pressure her husband exerted to have a child - something she did not want but agreed to in order to please him. The conception eventually occurred in a clinic abroad, and she implied that her husband might not be the biological father - although he remained unaware of this.

After the birth, B. was primarily cared for by nannies so that her mother could continue to work and travel. The father, who accompanied the mother everywhere as she led their business, remained uninvolved. Neither parent noticed the early developmental delays. Only when B. was enrolled in a private kindergarten at age three the staff expressed concern and urge an evaluation.

Despite visible symptoms and a formal diagnosis, the parents remained emotionally detached and again delegated childcare to hired help. However, by the time B. was ready for first grade, her behavior had become so unmanageable that every caregiver—including trained special educators and professionals experienced in autism—refused to continue. The parents spent nearly a year unsuccessfully searching for someone who could fill the role.

Eventually, they enrolled her in a private special-needs school with a part-time schedule. After school, both parents took turns looking after her. They drove her to malls or followed predetermined routes while she ate ice cream. Each day, she received a new toy of her choice. They returned home only for dinner. Regardless of the season, they were always out, following the same routines.

Both parents demonstrated extreme emotional detachment and intolerance toward B. During her stereotypical behaviors and tantrums, they remained frozen, showing no response. If the driving route deviated from her expectations, B. would scream, point insistently, and, if ignored, would destroy parts of the car—mirrors, levers, headrests. The father passively observed, waiting for the episodes to pass. She never wore a seatbelt, as she refused, and they did not insist.

The mother reported significant monthly financial losses due to B.’s tantrums. She also believed that their business had nearly collapsed over the past four years because of the constant mental and physical strain of caring for her.

Since her diagnosis, B. had attended numerous therapy programs and centers - including work with psychologists, speech therapists, occupational therapists, ABA, art therapy, and more. She had undergone countless tests: bloodwork, heavy metal screenings, leaky gut diagnostics, genetic testing, food intolerance panels, etc.

In parallel, the mother took her to faith healers and psychics who claimed they could "connect" with the child and "heal" her. The mother believed someone, somewhere could "fix" B., yet never acknowledged any link between their parenting and the onset or persistence of her condition. Although she admitted that B. had been exposed to screens from infancy—by both herself and the nanny—she rejected the idea that this had contributed to her daughter’s symptoms. Instead, she attributed the condition to karma.

Despite these beliefs, the mother began therapy alongside B. and demonstrated a certain level of cooperation. However, therapy yielded no significant changes in her. She openly admitted that she did not follow the at-home recommendations, citing a lack of time—even for her own IBS treatment.

The main obstacle was that after every therapy session, despite detailed instructions and demonstrations, the parents did not implement the guidance at home. This was evident to the therapeutic team: B.’s progress was unusually slow compared to similar cases. Exercises and their purpose were explained repeatedly, week after week, but still not followed. Even during the first five weeks, the parents failed to stop providing unlimited daily ice cream.

The father’s profile was also concerning. He experienced frequent panic attacks, hypertensive episodes, and chronic insomnia. His HRV was extremely low, with a resting heart rate of 90 bpm, which spiked to 120–130 under emotional strain. His skin conductance levels suggested high neuropsychic tension, and his peripheral temperature remained at 22°C—indicating pronounced sympathetic nervous system dominance.

Around the fifth week, the father began to express a desire to be more involved after observing minor improvements in B.'s behavior. Despite initial resistance, the parents succeeded in eliminating screen exposure within two weeks. The father was surprised by the results and intrigued by the therapeutic techniques. However, several more weeks passed before he became truly committed. Until then, he remained emotionally withdrawn and largely unfamiliar with his daughter's inner world.

Once he was educated on behavioral dynamics and regulation strategies, he began to believe in the therapeutic model. With growing consistency, he managed B.'s crises, and long periods of calm followed each success. B. began to notice him, which emotionally moved and engaged him. He started therapy himself and made significant progress: within 7–8 weeks, his fatigue and insomnia had greatly improved. Beta blockers helped manage his hypertensive episodes, and biofeedback training increased his HRV range from 2 to 15. He committed to the at-home program, and in the weeks that followed, B. showed extraordinary improvement.

By week 18, B. no longer displayed stereotypies or tantrums. She consumed more than 15 different foods, including fruits and vegetables. She engaged in play and dance with the therapists, brought toys from home to show and share, and waved goodbye at the end of each session—sometimes even saying “bye” in Bulgarian. She laughed, mimicked, and formed a bond with her favorite doll, whom she hugged, dressed, and brushed. Each night, she and the doll fell asleep together on the couch, wrapped in a blanket—something she initiated herself.

She allowed her hair to be brushed and wore weather-appropriate clothing without resistance. She used the toilet multiple times a day, wiped herself, and washed her hands. She had undergone a profound transformation, although she was still not yet speaking. Intensive speech and cognitive therapy had only just begun.

At this critical turning point, the mother announced that she was ending therapy because a respected psychic-medium had recommended hyperbaric oxygen therapy (HBOT) to stimulate speech. They began HBOT several times per week. However, in order to keep B. calm in the chamber, she was given a tablet to watch cartoons.

The father reported this development, having—like the team—observed a sharp regression during the first week: the tantrums returned, and B. struck him violently across the face. The therapists strongly advised discontinuing screen exposure again, but the mother refused and chose to end therapy. The father, despite his objections, had no influence over the decision.

Two weeks later, they were scheduled for a final assessment but did not attend. The team has had no further contact since.

The mother never processed the trauma of B.’s conception and birth or the coercion she endured for over a decade. She refused to acknowledge her emotional rejection of the child—a factor that had profoundly affected B.’s early development. She denied needing therapy and made no meaningful contribution to her daughter’s recovery. The father’s progress was remarkable, but ultimately insufficient to compensate for ten years of emotional estrangement. His lingering insecurity likely stemmed from the mother’s unspoken secret regarding B.’s conception.

In the end, the mother contributed nothing of lasting value to her child’s healing. She sabotaged the therapeutic process at a critical moment and nullified the father’s efforts to reconnect and reclaim his relationship with his daughter.

2) Case Description:The Child as Hostage of a Lonely Mother

E. was a 3.5-year-old boy with screen addiction. The teachers at his kindergarten insisted that he be evaluated for autism and ADHD. His mother, frightened by the possibility of a diagnosis, began searching for ways to support her child’s neurodevelopment. After six months of therapy with a speech therapist, psychologist, and occupational therapist, along with numerous tests and consultations with psychiatrists and neurologists, she brought him to our clinic for an assessment of screen addiction and therapeutic intervention.

One month before their visit, the mother had already abruptly removed all screen exposure after learning about its possible connection to her son’s condition. E. was nonverbal and showed clear signs of autism—he avoided eye contact, flapped his hands, and made compulsive finger movements in front of his face, accompanied by high-pitched squeaking sounds. He ate only a narrow range of puréed foods, wore diapers day and night, did not respond to speech, and slept in the same bed as both parents. He experienced frequent tantrums—more than ten per day—whenever his wishes weren’t immediately fulfilled. When he wanted something, he took his mother’s hand and used it to point, exhibiting the classic “hand-leading” behavior. He appeared completely unaware of his father’s presence.

Most of the time, E. sat still or lay on the floor, staring into space. Occasionally, he shifted into a more active state, running around, pushing objects, making sounds, and flapping his hands for three to four minutes—then curling into his mother like a baby and putting his fingers in his mouth. He didn’t play with adults or other children. He had been introduced to screens before the age of one. He tested positive on the SIPVR, showing a strong maladaptive response to eye-covering stimuli (Vezenkov & Manolova, 2025a). He pinched and scratched when physical contact was attempted. In the evenings, it took up to two hours for him to fall asleep.

His mother showed clear signs of chronic fatigue and depressive collapse. Three distinct physiological patterns emerged (to the mother): a depressive state with very low heart rate variability (HRV) and freeze-level skin conductance (SCL); a sharply anxious response when discussing her son, with her heart rate jumping from 80 to 110 in less than a second and SCL rising from 2–3 to 15–18 µS within 30 sec; and a poor recovery profile, with stress signals lasting over 15 minutes after conversations ended. However, when she closed her eyes and allowed herself to relax, her signals quickly normalized—SCL dropped to baseline (2 µS) in under 30 seconds, and she fell asleep during the session, still connected to the biofeedback sensors. During the first minute of sleep, her HRV range increased from 5–6 to 15–20.

We initiated biofeedback neurotraining, which helped regulate both her depressive and anxious states. By the second week, she was diagnosed with IBS, and a personalized treatment plan was developed. We also began addressing spinal misalignments sustained during pregnancy through targeted physical exercises.

The first therapeutic crisis occurred during the fifth session (the tenth week overall, due to absences). The mother arrived emotionally overwhelmed and tearful, eager to share a series of insights. She described how, after several weeks of feeling more energetic and alive, she had suddenly crashed. In her exhaustion, she asked her mother-in-law to watch the child for a few hours. The grandmother initially agreed, then withdrew at the last minute. No one else stepped in. The mother cried for a long time during the session, revealing that since her child’s birth, no one had helped her—not with parenting, not with the household, not even with her part-time online work. She described her husband as a workaholic who had been emotionally distant for years and entirely disengaged from their child. His family, she said, mocked her behind her back, ridiculing her for “not being able to handle a single child.” She had no close friends left - everyone had gradually distanced themselves. She was burned out, sleep-deprived, and emotionally worn down by her son’s frequent crises.

In desperation, she had introduced screens to the child when he was about one year old - just to buy herself time to cook, clean, or rest. Sometimes he watched for hours. She missed her mother and sister deeply; they lived in a distant city, and she longed to move closer to them. On the rare occasions when she visited them, she felt peaceful and rested. But upon returning to her husband’s family environment, she felt crushed, unsupported, and subtly humiliated. Though her husband admitted the environment was toxic, he remained passive, advising only that she “ignore them.” She continued asking for help, but it was often denied—and when granted, it came with criticism. She grieved that her in-laws never showed warmth to the child and treated him as a burden, using his condition as a way to shame her.

At this stage, her physiological signals regressed, but both depressive and anxious states resolved more quickly—within three to five minutes of rest. We discussed practical ways to reduce her daily burden: getting more sleep, hiring help with cleaning and chores, spending more time outdoors with her son, and starting light exercise, such as Pilates at a nearby gym.

From the beginning, we divided the home exercises for the child between both parents, assigning the larger portion to the father. He later admitted—with visible fear and shame—that the mother had emotionally monopolized the child since birth and wouldn’t allow him access in her absence. Despite this, his physiological profile was nearly ideal for a healthy 30-year-old male, and we entrusted him with primary responsibility for the child’s therapeutic work. By the third week of therapy, significant improvements were observed. The tantrums were under control, and E. began making sporadic eye contact. Bedtime became much easier, sometimes almost immediate.

Then the child became ill, and therapy was paused for two weeks. Upon their return, progress resumed. A feeding program had started, and E. began accepting certain fruits and vegetables. After another illness and another two-week pause, they returned - this time as the mother was processing her emotional crisis. It became increasingly clear that the child’s illnesses mirrored the emotional states of his mother - a psychosomatic link that many parents still overlook.

During this time, the father continued doing evening exercises with E. every night for at least two hours. This gave the mother space to rest, exercise, and reconnect socially. Two weeks later, she returned and announced her decision to separate from her husband. She believed he wasn’t a good role model and intended to move back in with her own mother, where she would receive more support. The couple had not been intimate for over a year. The mother began resting more, taking care of herself, and was determined to cut ties with the toxic presence of her in-laws. This decision brought her visible relief. Her husband, though unwilling to separate, said he wouldn’t stand in her way if it would bring her peace.

At this point, the mother became fully engaged in the home-based work with the child. She spent quality time with her son each day and built a genuine, joyful connection with him. The child increasingly sought her attention and affection. The progress was remarkable. By the eighteenth session, E. no longer had tantrums. Stereotypical movements were rare. He understood instructions from both parents and therapists—he put on his shoes, washed his hands, and picked up toys to avoid stepping on them, placing them neatly on a shelf. He imitated gestures, drank from a glass independently, used the potty instead of diapers, and fell asleep easily on most nights. He started using contextual words, displayed signs of shyness, maintained eye contact, and played with other children—preferring their company over being alone.

By the twentieth session, the mother shared that she had decided to stay in the marriage. She and her husband began communicating more openly, discussing both problems and dreams. Intimacy returned, and she no longer saw his family as a threat—just as people she wasn’t close to. The child was enrolled in a mainstream kindergarten, and the mother began looking for work in her field.

Six months later, during a follow-up assessment, E. demonstrated fully developed verbal communication. It became evident that the child’s condition had mirrored his mother’s profound sense of isolation, exhaustion, and emotional neglect. Long hours of screen exposure had been allowed without much awareness, and for a time, she felt no guilt for disengaging. Yet she possessed the inner determination to confront her pain and lead her child into recovery—even when the path was filled with setbacks and hardship. The father’s role proved crucial: emotionally stable and committed, he carried his responsibilities with sincerity and gave his wife the space she needed to rediscover herself. Together, they laid the foundation for the family’s healing and renewal.

3) Case Description: The Child with “Alien Genes” and a Schizophrenia Diagnosis

M. was a 14-year-old boy who had been diagnosed with schizophrenia and was undergoing pharmacological treatment. He showed signs of screen addcition, although he was verbal, fed himself, and used the toilet independently. His speech was simple and concrete; he struggled to understand abstract concepts and had no sense of humor. He was brought to therapy by his father, who had held sole custody for the past four years. The parents had separated when M. was four years old. By the age of ten, M. had begun physically assaulting his mother, prompting the father to assume full custody.

The father was a tall, physically strong, and well-trained man who remained dominant over his son. He had steady employment and maintained a respectable social standing. According to him, the child had not had meaningful exposure to screens. Since taking custody, he and M. had visited dozens of therapists and diagnostic centers, both domestically and abroad.

In the context of therapy, the father presented with a strongly narcissistic profile. Physiologically, his functioning was overall stable, though his heart rate variability showed a narrow range. He completed the prescribed home-based exercises for the child with mixed results. Observations by the therapeutic team suggested that his approach was rigid, bordering on sadistic. Although there was no direct evidence, the team suspected that the child was being abused. M. exhibited strong fear-based reflexes—shielding his face or curling into himself whenever a therapist made a sudden movement, even during dance-based interventions. When asked questions about his father, he experienced visual hallucinations. On one occasion, he described seeing Spiderman descending from the ceiling, threatening to eat his head, and then ran around the therapy room screaming in terror.

Initially, the mother refused to participate in the process. After several weeks of building therapeutic rapport with the child, the team addressed the father directly about the lack of emotional connection. He responded by stating that he could not bond with M. because he believed the child had alien DNA. He claimed that certain lab tests had confirmed this and maintained that his son was not fully human. He went on to elaborate on this theory in great detail.

At that point, the team insisted that the mother attend the next session. It had become clear that the father had no real motivation to support the child’s healing—his only interest appeared to be in controlling the boy’s behavior to avoid public embarrassment. He wanted a quiet, manageable child but was convinced that recovery was impossible.

The mother did come to the following session. She explained that M.’s decline had begun shortly after the separation, which she had initially attributed to the stress of the transition. But instead of improving, the crises had deepened. Over the years, she had administered various calming substances: ibuprofen, valerian root, and melatonin to help him sleep. She admitted that M. had watched large amounts of television, especially while in the care of his grandmother, who had often been the only caregiver while she worked full-time. The grandmother, she said, had kept the television on all day, and many times the mother had come home in the middle of the night to find them both asleep in front of the screen—or worse, the grandmother asleep while the child was still awake and watching at 2 or 3 a.m.

She acknowledged that the boy had been aggressive from the beginning of his crises and that she had often responded with aggression herself. As he grew and physical punishment stopped being effective, she began calling the father for help. She openly admitted that she no longer believed recovery was possible—only medication could help—and she expressed no desire to work with her son or on herself. She did not wish to see him, speak to him, or be involved in his life. She had come to the session only because the father had insisted, and she was dependent on him.

Throughout the meeting, she spent most of the time expressing how miserable she felt for ever becoming involved with the child’s father. She described him as a violent man - weak-willed and spineless - completely under his own mother’s control, down to her choosing his shoes. She concluded by saying that she wanted to forget both him and the child.

By the fourth week of therapy, changes in the child remained negligible. The team held a direct and serious conversation with the father, challenging his belief in the “alien gene” narrative and reminding him that this was his human child—one who needed human care, presence, and emotional connection in order to rejoin the world, as emphasized by trauma-informed models of care (Perry & Dobson, 2009). The father listened, engaged, and said he would do whatever was necessary.

But after that session, neither he nor the child returned. They did not answer phone calls, and the center’s administrative team was unable to reach them. No further contact was made, and we had no information about the boy’s subsequent development.

In conclusion, we encountered a gentle and systematically beaten child, punished for his tantrums and lack of self-regulation—dysregulation that had likely stemmed from excessive screen overstimulation, just like in many other children. During his sessions with the team, he did not display any aggression or inappropriate behavior; on the contrary, he participated willingly and seemed to enjoy the therapists’ attention. Tragically, the child had been emotionally abandoned and physically abused by both of his parents and would likely remain trapped in his dysregulation for life—alleviated only to the extent that pharmacological treatment could ease his symptoms.

4) Case Description: The Child Delegated to the Drivers

Sh. was a 4-year-old boy with screen addiction. Until the age of three, he had been raised exclusively by nannies. He was the second son in the family; his older brother was ten years older. When Sh. was born, his father had been fully immersed in managing a successful business and had taken no part in the boy’s care—unlike with the first child, toward whom he had once been a deeply devoted parent. The mother, after years of breastfeeding and taking the older child to the park, had decided she no longer wanted to engage in intensive parenting and had instead devoted herself to enjoying life. The family lived in considerable wealth. The mother spent her days working out, attending beauty treatments and massages, shopping, meeting friends, and also working at her father’s company—he, too, had been a successful businessman. The child had been left entirely in the care of others.

At age three, Sh. began attending kindergarten, where staff noticed developmental delays. He was referred for evaluation, and at three years and two months, he was diagnosed with ASD and ADHD. The mother fell into a depressive state after the diagnosis and began taking antidepressants. The family visited our center, where early screen addcition was identified. Therapy was not initiated at that time—by the mother’s choice—but screen time was abruptly discontinued. Within two months, the child, who had previously been completely nonverbal, began to speak. However, the other symptoms persisted. At three years and nine months, they returned and began therapy, with weekly sessions involving the mother.

The mother showed a striking level of emotional detachment from her child. She did not know his daily schedule, his preferences, or even what he ate. She claimed that he ate “nothing,” just bread and French fries. In the mornings, a nanny prepared him for kindergarten; in the evenings, another nanny put him to bed. During the day, he attended various therapies and was chauffeured between them by the family’s drivers. If time allowed, the drivers also took him to the park and played with him there. The parents did not go on holidays with their children—not with the younger nor the older son—as they saw them as a burden. They traveled often, at least every other weekend and for longer trips each month, always without the children. The couple had not shared any intimacy for years.

The mother grew upset when we recommended she spend more time with her son. She complained that she had not been to a restaurant in a month, and described this as a tragedy.

The child showed strong potential for recovery, but no one worked with him at home. We gave instructions to the mother, who passed them on to the drivers. What was actually carried out remained unclear. The child’s progress was slow but noticeable. The mother expressed a strong desire for his full recovery—not because he was suffering, but because she could not imagine herself caring for him indefinitely or facing public embarrassment due to his condition.

She initially resisted any therapeutic work with herself, expressing strong verbal objections, but eventually began to cooperate. Her biopsychological indicators improved rapidly. A former athlete, she emerged from her depressive state within a few weeks. She was not amenable to training in self-regulation techniques, but she managed to find new ways to exercise that supported her recovery (rigidity can also emerge in recreational sports, and it must be addressed by therapists)

Once her psychophysiological functioning stabilized and she reached a state of calm, the mother disclosed a major trauma from her youth. She had lost her sister and, shortly afterward, had been sent abroad to boarding school at the age of twelve. For ten years - until she returned at twenty-two - she had lived in profound confusion, loneliness, and isolation. Therapy deepened around this trauma. We worked carefully through her body’s response to those memories, tracking even the smallest details. This trauma had shaped her adult life and had left her trapped in a dissociative state, where emotional distance from those closest to her had felt like the only way to protect herself.

This phase of therapy lasted about five months. During that time, the child’s progress was minimal. But eventually, the mother “woke up” to her own life, and dramatic changes began to unfold in her son. She told us that, for the first time since his birth, she genuinely enjoyed being with him. She took both children on a weekend spa getaway, without her husband, and described having a wonderful time with her two sons. This was followed by other shifts: she began connecting with her children and drawing both joy and meaning from those relationships. She said she hadn’t just been depressed for the past year, but since the age of twelve - and that, finally, she felt free.

A key turning point came when she redirected her emotional focus away from her parents. For years, she had played the role of arbiter between them following their divorce and had unknowingly projected that same toxic dynamic onto her relationship with her husband, preventing herself from finding joy with him. Healing her relationship with herself led to a reevaluation, deepening, and revitalization of her relationship with her husband. Ultimately, she embraced motherhood fully for the first time, and in the two months that followed this inner transformation, all autistic traits and ADHD-like behaviors in Sh. disappeared. At a six-month follow-up, we saw a calm and connected mother and son—two souls finally in sync.

5) Case Description: The Queen Bee of the Hive

A. was an 11-year-old girl with screen addiction diagnosed with ASD. She was verbal, but her speech resembled that of a two-and-a-half-year-old in both intonation and articulation. Her words were slightly slurred, and she tended to accelerate and shoot out phrases, especially those containing the letter "R." She did not grasp complex context, associations, or humor. When she was not directly engaged in conversation, she repeated motifs from children's cartoons. She was incapable of remaining silent and exhibited strong stereotypical behaviors. On the surface, she appeared endlessly calm. If left alone, she could spend an entire day drawing characters from a specific cartoon series with remarkable precision.

However, if anyone dared to draw so much as a line or a circle on her paper, she erupted - screaming and launching into fast, intense physical aggression. Her attacks were rapid and often directed at the face, hands, or body of anyone nearby. For example, if she was playing with modeling clay and someone asked, “Is this a chicken?” - but in her mind it was a particular cartoon character - the resulting frustration overwhelmed her. She could not respond verbally and instead immediately lashed out, scratching at eyes or arms, slapping, punching, and kicking chaotically. During the initial sessions at our center, she managed to scratch or hit several therapists.

A.’s mother was a highly successful businesswoman. She also had a 23-year-old daughter who was professionally and personally well established. The mother had bought numerous properties—for herself, her older daughter, and her own parents. She supported everyone financially, donated to various causes, and was involved in multiple organizations, foundations, and social initiatives. Tireless and hyperactive, she multitasked constantly and insisted on maintaining full control of everything in her orbit. She was highly verbal, offered explanations for everything, and had taken A. to numerous therapies over the years—including visits to faith healers and psychics.

According to these “specialists,” A. was not like other children; she was supposedly an alien, had supernatural abilities, was extremely intelligent, and simply despised human beings, which was why she physically attacked them. This narrative seemed to please the mother. It reinforced a sense that both she and her daughter were exceptional, even superior, and it likely served to buffer her from facing the painful reality of her daughter’s condition.

Our impression was that they had not come to us with the goal of helping the child improve, but rather because it was fashionable to take your child to every possible therapy. We were just another addition to a long list - a classic case of “doctor shopping.”

The mother exhibited signs of sympathicotonia and seemed incapable of rest or emotional regulation. No therapeutic work was done at home. Our recommendations were not followed, and when asked why, the mother typically responded that she simply did not have time. On several occasions, the child showed signs of regression. When we inquired whether screens had been reintroduced, the mother answered, “Well, yes… her father gave them to her again,” and then dismissed the matter with a derisive remark about how useless he was. She indirectly suggested that she had a lover and implied that the father was kept around merely for appearances, as divorce in their community was viewed as the ultimate personal failure. Given her inability to follow through with any part of the therapeutic plan, we requested a session with the father.

The father arrived the following week and made it immediately clear that he saw both his wife and daughter as static and unchangeable - “they were the way they were,” he said, “and they always would be.” He claimed he had no time to do exercises with the child because he was too busy working, and in his free time, he was developing a prototype for a perpetual motion machine - the only thing that interested him. His daily routine, he said, ended with beer and pornography, often into the early hours of the morning. He stated flatly that the mother handled everything related to the child, that they got along just fine, and that he had no desire to be involved. It was clear he had only come because the mother had pressured him to.

By the tenth week of therapy, it had become apparent that no one was working with the child at home, and that no meaningful progress had been made. As a result, the sessions were discontinued.

This was a case of a child with notable behavioral potential, but who lived in an environment that offered no real support for developmental change. The mythologizing of her condition by her mother, combined with the father’s complete detachment and escapist tendencies, created a household in which no therapeutic intervention could take root. The family system was neither willing nor able to create the conditions necessary for meaningful recovery. Consequently, the sessions were terminated.

6) Case Description: The Child of the Childless Aunt

V.was a 3.5-year-old boy with screen addiction and diagnosis of ASD. He was not hyperactive but was completely shut down. He did not speak or participate in any activities. He sat with a vacant, glassy-eyed stare, making it difficult to tell whether he was awake or asleep with his eyes open. Any change in state triggered a tantrum - whether his mother tried to remove his shoes while he was sitting, suggested leaving, or simply offered him water. Every simple act was preceded by a meltdown. His mother waited patiently, curled in on herself, until the episode subsided before completing the action. His crises were not severe in intensity but occurred very frequently. He ate only yogurt with biscuits and still wore diapers.

The mother was deeply committed to her child’s recovery. She had already read extensively about the effects of screen addiction, was convinced that this applied to her son, and was determined to do everything possible to help him. She did not work and was financially dependent on her grandfather. She could not place the child in kindergarten, as every institution had rejected him. She was separated from the child’s father due to domestic violence and was visibly traumatized. Her own parents were deceased. The mother's psychophysiology showed markers of depression and trauma.We were unable to establish contact with the father.

In the course of therapy, V. made rapid progress. Within five weeks, he began making eye contact, used syllables in attempts to speak, indicated when he needed to urinate, started eating eight new foods, and experienced significantly fewer tantrums. The mother followed all instructions carefully, practiced the exercises, asked questions, shared her observations, and was clearly encouraged by the child’s improvement. With each positive change, her motivation grew. At the same time, she expressed anxiety over her dependence on her grandfather and her sister, who drove them from a distant town to attend therapy, bought food and clothing for the child—often expensive items—and sometimes even took the child on trips, occasionally without the mother.

By the sixth week, the mother had already shown notable improvements in her psychophysiological markers. However, she confided that her grandfather and sister were pressuring her to stop therapy. They threatened to withdraw financial support and cease transportation if she continued. When asked why they were doing this, she said she didn’t know and broke into tears. She left the Center, only to return moments later with both her sister and grandfather, who apparently had been waiting nearby.

What followed was, quite simply, disturbing. The aunt - her sister - insisted that she took care of the child more than the mother, that she better understood his needs, knew how to communicate with him, bought him everything he needed, and was “almost a psychologist.” She claimed the child was “special” and would always have special needs, which she was prepared to meet because the mother was “incapable” - adding, pointedly, that the mother wasn't even fully divorced yet. She spoke with the conviction of someone who truly believed the child belonged to her, leaving no space for discussion.

Then the grandfather joined in. We had hoped for some measure of reason from the man - clearly over ninety years old but physically strong. Instead, he began shouting. He insisted that the child was the way he was and always would be, that no therapy could change anything, and that no one had the right to tell them how to raise him. He declared that they would raise him themselves, because he was their child. He stated that no one would prevent them from letting the child watch television, since the boy loved it more than anything - and because the grandfather watched TV all day, the child would too. He demanded that we stop putting ideas in the mother’s head and leave them alone.

Throughout this entire confrontation, the mother stood trembling, tears running down her face. The aunt and grandfather refused to hear a single word from us. Eventually, they left, but only after spending thirty-five minutes trying to remove the child from the therapy center—he did not want to go with them. We did not assist in that struggle. We never saw them again.

7) Case Description: Cream Soup for Dinner

H. was a 4-year-old boy diagnosed with ASD. He had a younger sister, aged 2. Both children exhibited markers of screen addiction. The parents were young, educated, and appeared kind and likable at first glance.
The mother displayed severely depressive functioning, with delayed reactions and emotional flatness. Low HRV, frozen SCL, and a complete lack of activation were observed. The analysis of the autonomic nervous system indicated vagotonia.Throughout the course of therapy, she repeatedly complained about the father—not valuing her, not loving her, not recognizing her as a woman, not appreciating her maternal sacrifices, not buying her expensive gifts. She claimed she worked in the family business, which was owned by her husband and father-in-law, but said her professional input was ignored. Whenever she was asked a question about the child, she deflected the conversation back to herself, focusing on her own needs, frustrations, and emotional grievances. She showed little interest in engaging with the therapeutic process, undermined the therapists’ efforts, and displayed visible arrogance and disregard. There was hardly any progress in the child, which led the team to request the father’s participation in the third week of therapy.

The father’s account of the family dynamics painted a very different picture. He explained that the mother did not actually work but spent most of her day browsing the internet for different diagnoses and compiling long lists of doctors, centers, and therapies to pursue for the children. In the afternoons, she picked the children up from daycare and lied to them, claiming she had been working. She then left them in his care while she returned to scrolling online. Each evening, she boiled a pot of vegetables, pureed them into cream soup, and served it to the entire family—this had been their dinner, without variation, every evening for the past four years. At one point, he even asked the therapists if it was true that they had “allowed” the children to watch four hours of television per day on weekends, something that was categorically false. At the very beginning of therapy, a complete screen detox had been prescribed, which the mother had visibly violated, while deceiving the father by claiming that the therapists had permitted screen time during weekends.

The father, a former athlete, demonstrated excellent psychophysiological functioning. He was assigned responsibility for the home-based therapeutic exercises and screen-time regulation. Under his care, the child progressed rapidly. After twenty weeks of consistent work, H. had completely recovered - every sign of autism had disappeared.
By that point, the parents were undergoing divorce proceedings, and the father was pursuing full custody of the children. He stated that he would never forgive himself for allowing the mother of his children to harm them in such a cruel and damaging way.

8) Case Description: The Accomplices

F. was an 8-year-old boy with screen addiction enrolled in a specialized school. He had been diagnosed with ASD and ADHD and was nonverbal. In addition to the typical features of early screen addiction (Vezenkov & Manolova, 2025), he exhibited severe fear responses: when someone around him made a sudden movement, he immediately covered his entire head with his hands and bent forward into a tight crouch. Sometimes, he dropped to the floor, curled into a ball, whimpered, and shielded his head.

His mother and father attended every therapy session together and consistently presented themselves as concerned and engaged. However, it was evident that no therapeutic work took place at home. Each week, when asked how the assigned exercises went, they were unable to explain or demonstrate any of them, even though they took notes during the sessions. The child often arrived with bruises on his arms. When asked about them, the mother explained that the school staff restrained him by grabbing his arms when he became aggressive.

The mother complained of lack of tone, chronic fatigue, and insomnia, as well as obesity (over 40 kg above the average for her age and height). The autonomic nervous system (ANS) showed dysregulation, with co-relaxations, freeze responses under stress, and an inability to relax or release tension.

She displayed clear signs of deep trauma and emotional toxicity. When asked directly, she confirmed that the father had subjected her to long-term physical abuse. When asked why she had never pressed charges, she explained that he worked for the Ministry of Interior and knew how to cover his tracks. The couple had separated three years prior, after the father had begun an affair, but during that period, every visitation between the father and the child had resulted in violent outbursts from the child toward him. Eventually, the parents had decided to reunite.

At the time of therapy, they lived under the same roof without intimacy, split bills, and maintained separate lives. According to the mother, this arrangement suited her perfectly, and she had no intention of changing it.

The therapy team strongly suspected that the father had been physically abusive toward the child and that the mother had covered for him. Despite his trauma, F. was cooperative and made efforts to connect with everyone at the center, including the receptionist, but he did not interact with his parents. The recommended home exercises were never implemented. The therapy fees were paid by the maternal grandmother, and when the decision was made to terminate therapy due to lack of progress, the parents did not object. In fact, they appeared relieved, even hinting that the money previously spent on therapy could now be used for vacations.

This case reflected a situation in which the child was most likely being physically abused, while both parents were complicit - one through active violence, the other through silent compliance. Although the child demonstrated clear potential for connection and repeatedly attempted to reach out, he remained trapped in an environment devoid of emotional safety. Under such conditions, therapeutic progress was impossible. The family system not only failed to support the child's development but actively obstructed it, choosing convenience and denial over responsibility and change.

9) Case Description: The Psychologist

N. was a 12-year-old child diagnosed with Attention Deficit Disorder (ADD). He was intelligent but suffered from extreme anxiety. In addition to ADD, the child also exhibited some mild autistic traits. He engaged in compulsive phrase repetition, demonstrated fear of change, and had no peer relationships. A functional assessment was conducted, revealing markers of screen addiction: an alpha-theta type attention deficit on the qEEG (Stefanova et.al 2025), with occipital epileptiform activity in O1, hemispheric inversion, and alpha peaks in C3 during cognitive tasks. The autonomic nervous system showed markers of high anxiety and a complete freeze response under cognitive demand. Recovery began with a sharp activation of skin conductance level (SCL), reaching amplitudes of 20–25 µS per second, while achieving relaxation took more than thirty minutes of focused exercises. The child’s hedonic screen time had been at least four hours a day, primarily spent gaming and much more during vacations.

The mother, a practicing psychologist with a successful private practice and a strong sense of professional confidence, was firmly convinced that her child’s attention deficit was congenital. She categorically rejected any suggestion that screen exposure could be a contributing factor. The father, on the other hand, believed that the symptoms had been induced by screen overuse and was able to describe their progression in parallel with the introduction and gradual increase of digital exposure.

Therapy was initiated with the mother as the main point of contact. She accompanied the child to sessions and managed communication with the team. Over the course of four weeks, it became clear that the child was gaming daily, watching cartoons every evening, and had even been promised a PlayStation by the mother as a reward for academic success. Throughout the sessions, the mother continued to reject the idea of screen addiction and refused to participate in any part of the therapeutic process.

Following this, the father was invited for a consultation. After that meeting, he assumed full responsibility for the child’s care. Within the same week, he removed the mother’s belongings from their home, prohibited her from returning, and filed for full custody of the child. They had not been legally married. He stated that they had not lived as a couple for years and that her attitude toward him had been consistently hostile. However, he had at least believed that she was taking proper care of the child. When he realized that she had been worsening the child’s condition by allowing screen stimulation during therapy program, he made the final decision to separate. This was followed by a confrontation, during which she attempted to manipulate him emotionally, but he did not give in.

Therapeutic work with the father began with some difficulty. He struggled with guilt for not having protected his son sooner and blamed himself for allowing the child’s condition to deteriorate under the influence of a woman who, in his words, “never loved him, and therefore could not love their child.” Despite these emotional obstacles, therapy moved forward steadily. After four months, the child no longer exhibited signs of attention deficit, and a follow-up EEG showed fully normalized brain activity. At a one-year follow-up appointment, the child again demonstrated excellent cognitive and physiological functioning.

10) Case Description: The Avenger

A 6-year-old boy with early screen addiction, nonverbal, had been diagnosed with Autism Spectrum Disorder. He was the father’s first child, but the mother’s second. The father did not acknowledge the needs of her first child and focused exclusively on their son. The mother, in turn, displayed unconscious aggression and a desire for revenge toward the father, which manifested as quiet yet destructive neglect of their shared child.

The mother exhibited anxious functioning, with an elevated resting heart rate (100 bpm at rest and above 100 under load), low heart rate variability (HRV), and a gradually increasing skin conductance level (SCL) with low amplitudes, both with and without task demands. Her breathing was shallow, and peripheral skin temperature was recorded at 25°C. No difference was observed in her physiological responses with eyes open versus closed, or between task engagement and resting state. She demonstrated extreme rigidity toward change and overall maladaptive functioning.

She deliberately provoked the father’s emotional instability. As a result, he spent his nights obsessively reading about diagnoses and theories online -many involving aliens - which left him entirely unfit during the day to care for the child or participate meaningfully in family life.

After four months of therapy with minimal progress in the child and no meaningful cooperation at home, a significant turning point occurred within a single week. This shift was the result of prolonged therapeutic engagement with both parents. They went through a series of confrontations, mutual accusations, emotional admissions, and acts of forgiveness, and ultimately reached a state of conscious partnership in the care of their children.

Following this transformation in their relationship, the child began to recover rapidly. Within one month, he began to speak. Within another three months, most of his autistic traits had disappeared.

11) Case Description: Everyone Is Too Busy

The family was financially well-resourced, and both parents were career-driven. They had three children, the youngest of whom was a 10-year-old boy. He exhibited social anxiety, motor tics, refusal to leave the house, school avoidance, and, two months prior to the assessment, had stopped speaking entirely—though he shouted and swore while playing video games. He spent approximately six hours per day gaming. Assessment revealed a severe form of screen addiction. All members of the family, including the two older siblings and both parents, showed signs of screen addiction.

Therapy was initiated, but the parents demonstrated no willingness to reduce, let alone eliminate, the children’s screen time. They stated that they did not have the time or emotional capacity to manage tantrums or meltdowns, and that gaming kept their son “quiet and out of the way.” During family dinners, no one spoke - each individual scrolled through their personal device.

The mother and father jointly stated that they were not prepared to give up their phones. The father was addicted to pornography; the mother, to online shopping. They openly declared that they would seek a psychologist for the child who would not require any reduction in screen time, either for him or for any other family member—arguing that they were not "Neanderthals," but modern people who "needed their phones."

12) Case Description: Mother’s obsession

A 5-year-old girl had been diagnosed with ASD. She was completely withdrawn and unresponsive. The mother exhibited severely depressive functioning, while the father was addicted to gaming. Therapy for both parents continued for nearly a year and was marked by extreme rigidity regarding the implementation of any change. Although they lived together, there was no emotional closeness or trust between them.

In parallel, the child showed progress, but it was very slow. The mother appeared deeply entangled in her role as the caring, protective “special” mother of a “special” child. She had fantasies about being able to intuitively know at any moment exactly how her daughter felt. Her interpretations of the child’s behavior were consistently inadequate. The mother repeatedly sabotaged therapy by reintroducing the child to infantile and compulsive behavioral patterns. For nearly five months, she did not move the child to a separate bed.

It was suspected that the child had been re-exposed to screens, although both parents denied it. During therapy sessions, the mother often burst into tears without any clear trigger and was unable to calm down for the remainder of the session. There was a pervasive sense of secrecy and insincerity between the parents, which they did not disclose or acknowledge in any way.

The mother appeared entirely fused with her caregiving role - fully identified with it - and expressed no desire for any other aspect of life. She had no plans for employment, education, friendships, or engagement in activities outside of her child. The father was aware of this dynamic but did not respond in any way.

A year later, the child had made significant improvements—she ate well, spoke, read, dressed herself, and bathed independently. However, she still did not think independently and regularly retreated into a fantasy world. In this case, it remained unclear who or what had truly impeded the child’s recovery.

Summary of the Therapeutic Cases

Out of the 12 described cases, 7 had a negative therapeutic outcome—the parents demonstrated an unwillingness, combined or not with an inability, to change themselves and their attitude toward the child, which is a key factor in full recovery (Jackson et al., 2023). Although the children suffered from severe forms of screen addiction and were not harmed solely by parental neglect, screen addiction itself turns out to be a form of neglect with severe consequences. In these cases, therapy was discontinued before the child’s full recovery.

There are 5 cases of successful recovery, where the dynamics between the parent’s healing and their attitude toward the problem are shown to correlate with the tempo, regressions, or resistance in the child’s therapeutic progress. In all 5 cases, the mothers exhibited all the characteristic features of parental alienation and Munchausen Syndrome by Proxy. In two of these cases, the mothers refused to accept change, and the fathers provided an environment of closeness and full engagement with the child, effectively removing the mother from the child’s life. Although this led to recovery, it is unclear what the long-term consequences of the child’s alienation from the mother will be - an alienation that had, in fact, occurred long before the physical separation but remained invisible to others (Dobson & Perry, 2010; Anda et al., 2005).

In two of the cases, the couple found the strength to overcome their codependencies, which had formed around the special needs of the child, and managed to regulate their relationship without waging their battles on the territory of the child’s life and health. In the process of recovery, the fluctuations and unresolved issues between the parents clearly correlated with the light and dark periods in the child’s condition, with a 3-to-7-day delay between a change in the parents and a corresponding change in the child. One mother, through therapy, managed to process her childhood trauma and reconnect fully with her loved ones, which transformed the life of the entire family and led to the successful recovery of the child.

These three turnaround cases—the two couples and the one mother who recovered—clearly illustrate the contrast between Munchausen by Proxy as a syndrome on its own, and the same syndrome loaded with additional personal motives, whether conscious or not. In the mothers whose deep unmet need for care and attention was addressed during therapy, there was a visible transformation and genuine involvement in family life and the child’s healing.

Particular attention should be given to the parents’ drift toward theories of alien origin and occultism, which dehumanize the child (4 out of 12 cases - cases 1, 3, 5, and 10). In two cases, the parents behaved as co-conspirators, holding a deep and unspoken secret that kept the child trapped. Outwardly, they demonstrated high involvement, but in practice, they did not engage with the child, and did things at home that worsened the child’s condition (Cases 8 and 12).

In two of the cases, the mothers were fully identified with the role of ultra-special mothers ("mothering to the death"). One inflated her ego with the idea that she was exceptionally successful despite having a child with special needs and maintained the child’s condition by every means possible, as it made both of them seem extraordinary (Case 5). The other mother (Case 12) had eliminated all other aspects of her life and plunged into a fantasy-based symbiosis with her child, determined to care for her “until death,” likely also as a way to punish the father—though this remains speculative and was not confirmed in therapy.

In conclusion, Munchausen by Proxy cases can be successfully addressed through targeted therapy of the mother, aimed at healing a wounded soul that suffers from loneliness and disconnection, unable to bond with herself and others due to trauma, toxicity, or isolation. It is especially striking how some mothers recover and change their lives within 4 to 6 months; some of them have been in a regressed state for more than 10 years (Cases 2 and 4), or entered a depressive state shortly after childbirth, triggered by feelings of loneliness and helplessness (Cases 2, 6, 7, 10, 12).

Conversely, when Munchausen Syndrome by Proxy is combined with other goals and motives, personal or otherwise (as in Case 6, where the mother was eliminated by the aunt and grandfather), caregivers become highly rigid to change and do not allow the child to recover—because recovery would weaken their power and control tools.

In this sense, two models stand out: the first cries out from helplessness and desperation for help (classic Munchausen by Proxy), while the second simulates a search for help, but uses the assistance received to build a mechanism of power and control, which is maintained as long as it serves their interests (other forms of child abuse, combined or not with Munchausen by Proxy).

Discussion

This report raises important and often unspoken questions regarding the role of parents in the development, deepening, and maintenance of neurodevelopmental disorders in children—particularly in the context of screen addiction, commonly diagnosed as Autism Spectrum Disorder (ASD) and ADHD. The most striking trend is that in a significant proportion of cases, it is the parents’ own behavioral patterns, traumatic experiences, and personality traits that lie at the root of the child’s deterioration—not genetic or “innate” factors, as is frequently claimed.

The report emphasizes that children with screen addiction and accompanying symptoms are often subjected to neglect, mixed messages, inadequate care, and even direct sabotage of their recovery. In approximately one-third of all cases, signs are present that meet the criteria for Munchausen Syndrome by Proxy - one of the most destructive and hidden forms of psychological abuse against children. In other cases, it concerns chronic misunderstanding and emotional immaturity on the part of the parents, leading to an inability to respond adequately to the child’s needs.

Particularly alarming is the pattern of some parents discontinuing or sabotaging therapy just as the child begins to show improvement - either by reintroducing screens, refusing to do therapeutic tasks, or through total or partial disengagement. This behavior cannot be explained solely by a lack of knowledge or resources; rather, it is often linked to unconscious resistance to losing an identity based on the child’s suffering - especially in parents with personality deficits or traumatic personal histories.

At the same time, the report highlights positive examples: when there is willingness, active therapeutic work with parents, and resolution of internal conflicts, recovery in children is not only possible but can occur remarkably quickly through the therapy program for screen addiction. The practical value of this analysis lies in identifying the factors that support or hinder therapy, and in proposing a comprehensive paradigm of work that does not focus on “fixing” the child, but on restoring the entire parental system, which then supports the child’s recovery. This requires effort, resources, and sometimes painful realizations, but it is the only sustainable path to improvement.

There is a critical need for more physicians, therapists, specialists, teachers, parents, and social workers to be aware of this risk. The urgency of broadening awareness of Munchausen Syndrome by Proxy and other forms of parental abuse toward children with screen addiction diagnosed or not (but have some traits) with ASD, ADHD cannot be overstated. These conditions are often treated as purely medical problems, but practice shows that deep family, psychological, and behavioral dysfunctions often lie at their core. The lack of awareness makes the issue even harder to recognize and address.

Doctors, psychologists, speech therapists, educators, teachers, and social workers are on the front lines in working with children who present such symptoms, but they are rarely trained to recognize parental behavior that not only fails to support recovery but actively impedes it. This includes refusal to cooperate, maintaining the child’s pathological condition, sabotaging therapy, or covert abuse disguised as over-caring.

It is crucial that all professionals working with children be trained not only in therapeutic techniques but also in identifying pathological parental behaviors. Parents themselves must be made aware that their role is critical, and that refusal to engage in personal change often leads to the chronic persistence of the child’s difficulties. Without joint, informed collaboration among all involved parties, recovery is unlikely to occur.

Timely recognition of these risks is critical. Increasing sensitivity and competence on this subject is an essential step toward creating an environment in which children have a real chance for development, healing, and a life free from abuse—even when that abuse is disguised as care.

Conclusion
The present study contributes a novel perspective to the growing literature on Munchausen Syndrome by Proxy (MSBP), extending its conceptual boundaries by examining parental behaviors within the context of screen addiction. While classic MSBP cases are typically characterized by medically fabricated symptoms and overt physical interventions, this report highlights a subtler, yet equally damaging, form of abuse: the chronic screen overstimulation of children by caregivers, resulting in developmental arrest and neuroregulatory dysfunction. The inclusion of screen addiction and delayed developmental profiles as potential markers of abusive caregiving behavior is, to our knowledge, unprecedented in the clinical literature.

The analysis of 162 clinical cases reveals an alarming pattern of parental behavior marked by persistent screen exposure, denial of harm, resistance to therapeutic recommendations, and ultimately, sabotage of the child’s recovery process. Although these behaviors often occur under the guise of care, they conform to the core psychological motives outlined in MSBP literature, including the caregiver’s unconscious or conscious drive to maintain the child in a dependent, symptomatic state in order to secure social attention, validation, and emotional gratification. Unlike traditional MSBP, the harmful behaviors observed in this sample are rarely recognized as abuse by medical or therapeutic professionals due to their normalization in broader societal contexts.

Another distinctive aspect of this study is the integration of psychophysiological profiling of the caregivers—a methodological innovation in the field. The use of HRV, skin conductance, and other autonomic measures allowed for an objective assessment of caregiver stress regulation, emotional availability, and capacity for self-regulation. The data revealed consistent correlations between poor autonomic regulation in caregivers and low adherence to therapeutic interventions, high resistance to behavior change, and ultimately, therapeutic dropout.

Moreover, the study identifies a typology of parental sabotage behaviors—subtle, often socially acceptable acts that systematically undermine the therapeutic process. These range from minimizing reported screen use to selectively withholding key developmental information, failing to perform prescribed interventions, or abruptly discontinuing therapy during phases of critical developmental improvement. The observation that these behaviors often intensify at moments of potential recovery suggests a highly organized, though not necessarily conscious, psychological mechanism of maintaining the child in a state of dysfunction.

This work therefore calls for a reconceptualization of caregiver-mediated developmental disorders, particularly in the context of ambiguous or "unexplainable" diagnoses such as ASD and ADHD. It proposes that conditions may be iatrogenically maintained or even induced through screen addiction in parents, psychological enmeshment, and emotionally motivated caregiving pathologies. Such a perspective has implications for diagnostic practices, therapeutic frameworks, and child protection protocols.

The findings advocate for the integration of developmental trauma models with updated MSBP criteria to capture contemporary manifestations of caregiver abuse in the digital age. Furthermore, the outcomes challenge current assumptions regarding prognosis in neurodevelopmental disorders, highlighting the potential for recovery when screen exposure is eliminated and caregiving patterns are therapeutically restructured.

References

Abdurrachid, N., & Gama Marques, J. (2020). Munchausen Syndrome By Proxy (MSBP): a review regarding perpetrators of Factitious Disorder Imposed on Another (FDIA). CNS Spectrums, 1–28. doi:10.1017/s1092852920001741

Bools, C., Neale, B., & Meadow, R. (1994). Munchausen syndrome by proxy: A study of psychopathology. Child Abuse & Neglect, 18(9), 773–788. doi:10.1016/0145-2134(94)00044-1

Dobson, C., & Perry, B. (2010). The role of healthy relational interactions in buffering the impact of childhood trauma. In E. Gil (Ed.), Working with Children to Heal Interpersonal Trauma: The Power of Play (pp. 26–43). New York, N.Y: Guilford Press.

Jackson, A. L., Frederico, M., Cleak, H., & Perry, B. D. (2023). Interventions to Support Children’s Recovery From Neglect—A Systematic Review. Child Maltreatment, 29(4), 714-727. https://doi.org/10.1177/10775595231171617

Manolova V.R. and Vezenkov S.R. (2025) Screen Trauma – Specifics of the Disorder and Therapy in Adults and Children. Nootism 1(1), 37-51, ISSN 3033-1765 (print), ISSN 3033-1986 (on-line)

Meadow, R. (1977). MUNCHAUSEN SYNDROME BY PROXY THE HINTERLAND OF CHILD ABUSE. The Lancet, 310(8033), 343–345. doi:10.1016/s0140-6736(77)91497-0

Meadow, R. (1982). Munchausen syndrome by proxy. Archives of disease in childhood, 57(2), 92-98. doi: 10.1136/adc.57.2.92

Meadow, R. (1985). Management of Munchausen syndrome by proxy. Archives of Disease in Childhood, 60(4), 385–393. doi:10.1136/adc.60.4.385

Meadow, R. (1995). What is, and what is not, “Munchausen syndrome by proxy”? Archives of Disease in Childhood, 72(6), 534–538. doi:10.1136/adc.72.6.534

Perry, B., & Dobson, C. (2009). Surviving childhood trauma: the role of relationships in prevention of, and recovery from, trauma-related problems. Journal of CCYP, a division of British Association for Counseling and Psychotherapy, (March), 28–31.

Perry, B., & Szalavitz, M. (2007). The Boy Who Was Raised As A Dog: What Traumatized Children Can Teach Us About Loss, Love and Healing. Philadelphia, PA: Basic Books.

Petrova, S.N., Manolova V.R. and Vezenkov, S.R. (2025) Reintroducing Screens: Severe Regression and Symptom Aggravation in Children with ASD/Screen Addiction. Nootism 1(1), 59-65, ISSN 3033-1765 (print), ISSN 3033-1986 (on-line)

Rosenberg, D. A. (1987). Web of deceit: A literature review of Munchausen syndrome by proxy. Child Abuse & Neglect, 11(4), 547–563. doi:10.1016/0145-2134(87)90081-0

Rusinovska, B., Satora, M., Tybulchuk, B., Romanek, Z., Sekowska, M., Pyrka, Z. (2023). Overprotective mother or Munchausen syndrome by proxy? Characteristics of the disease based on a literature review. Medical Science, 17, 3. 11-18, DOI: 10.5604/01.3001.0053.8075

Sheridan, M. S. (2003). The deceit continues: an updated literature review of Munchausen Syndrome by Proxy. Child Abuse & Neglect, 27(4), 431–451. doi:10.1016/s0145-2134(03)00030-9

Sousa Filho, D. de, Kanomata, E. Y., Feldman, R. J., & Maluf Neto, A. (2017). Munchausen syndrome and Munchausen syndrome by proxy: a narrative review. Einstein (São Paulo), 15(4), 516–521. doi:10.1590/s1679-45082017md3746

Stefanova M.Ts., Manolova, V.R. and Vezenkov S.R. (2025) ADHD and Screen Addiction in Children Aged 3-9: Staged Recovery and Neurophysiological Markers. Nootism 1(1), 66-73, ISSN 3033-1765 (print), ISSN 3033-1986 (on-line)

Vezenkov, S.R. and Manolova V.R. (2025) Neurobiology of Autism/Early Screen Addiction Recovery. Nootism 1(1), 19-36, ISSN 3033-1765 (print), ISSN 3033-1986 (on-line)

Vezenkov, S.R., Manolova, V.R. (2025) Screen Addiction – Biomarkers, Developmental Damage and Recovery. Nootism 1(1), 6-18, ISSN 3033-1765 (print), ISSN 3033-1986 (on-line)

Yates, G., & Bass, C. (2017). The perpetrators of medical child abuse (Munchausen Syndrome by Proxy) – A systematic review of 796 cases. Child Abuse & Neglect, 72, 45–53. doi:10.1016/j.chiabu.2017.07.008

18.05.2025

issue02-May2025