The Causes and Treatment of Middle Child Syndrome

Ariel L. Lawson
University of Cincinnati

Middle Child Syndrome (MCS) has been around for hundreds of years but has just
recently begun to garner critical attention from researchers. Historians have found evidence to
suggest Middle Child Syndrome was first noticed among European royal families in the
16th century. King Henry VIII was described as "a lovely child, always willing to help, however,
the second son acted out of turn regularly to get attention" by his governess. While MCS has
been a widespread issue throughout history, it isn't until this century that researchers have
begun to understand its serious nature. It is estimated that nearly 25% of all children are
suffering from MCS (Middle Child Society of America, 2005). However, this number is likely
skewed due to the debate over what constitutes a middle child.
Middle children in the United States have become immediately recognizable to
clinicians due to the very distinct traits they exhibit. A person with Middle Child Syndrome can
most often be identified by the following features:
1. Systematic attention seeking
2. Pathological people pleasing
3. Uncontrollable anger towards nothing
4. Pathetically low self-esteem
5. Random invisibility

Clinical Features of Middle Child Syndrome

This paper will center around treatment efforts for Middle Child Syndrome, but the
features mentioned above deserve clarification for those not yet familiar with the seriousness
of MCS.

Systematic Attention Seeking

As middle children tend to feel left out or overlooked, they often act out to get
attention from parents and other authority figures. Middle children ages one to twelve may
throw exasperated temper tantrums when feeling ignored. As middle children get older, their
attention-seeking behavior becomes more rebellious. Teenage middle children are more likely
to deliberately disobey their parental figures and intentionally start arguments with their
siblings. Tantrums and rebellious behavior can continue well into adulthood (My Mom, 2022).

Pathological People Pleasing

Commonly referred to as 'brown-nosing', people-pleasing is an easily identifiable trait of

Those with MCS often experience intense erratic bursts of anger directed at nothing and
no one in particular. A recent study conducted by Drama Queen Labs asked sufferers where
their anger stems from. An overwhelming number of subjects reported, “the world just doesn’t
understand my pain.”

Pathetically Low Self-Esteem

Middle Child Syndrome creates a lack of self-esteem and the need for constant
validation. This can have more serious side effects, but it is most often viewed—simply—as
being whiny.

Random Invisibility

Those with Middle Child Syndrome often report feeling invisible. This phenomenon
most often occurs in the presence of an older or younger sibling. Sufferers also report
repeatedly being left in malls, grocery stores, hospitals, locked cars, etc. because no one can
see or hear them.

Causes of Middle Child Syndrome

Now that we have a better understanding of what Middle Child Syndrome looks like, we
can dive deeper into the causes. There is much controversy surrounding the true causes of
MCS. Recent years have shown an uptick in theories and models, but the most popular ones are
reviewed below.

Psychological Model

For many years, MCS was believed to be a genetic disorder. Biologists hypothesized MCS
was passed down genetically, but preliminary research overwhelming determined it was not.
Findings showed middle children born to parents who were not middle children still had MCS.
However, the lack of a genetic component was solidified when research revealed MCS was also
prevalent among those who were adopted into families with three or more siblings. It was then
determined to be a psychological issue.
There are far too many psychologically-based theories to review here, but one of the
more well-known models is Tanner’s “warped sense of reality”. The model suggests the cause
of MCS are the strong delusions sufferers have about events in their life. Others have equated
MCS to mass hysteria and concluded it simply doesn’t exist (Legion of American First-Borns,
2004).
Birth Order Model

There is much agreement that birth order is a major cause of MCS as every middle child
ever has experienced one or more symptoms. It is widely accepted that first-born and last-born
siblings are unable to contract MCS. Evidence suggesting those born first or last can have MCS
has always been disproved and often shown to be biased as it is typically conducted by first-
and last-born siblings jealous of their middle sibling’s success (B. Spears, 2021). However,
experts have been in a long-standing feud over the definition of a middle child.
Along with anthropologists, psychologists argue that anyone not born first or last in a
set of three or more siblings is a middle child, and therefore, at risk of MCS (J. Duggar(s), 2008).
However, mathematicians claim it is impossible to have more than one middle or median in a
set of numbers and the same applies to sets of siblings (M. Cyrus, 1994). Not wanting to
alienate any potential middle children, this review accepts the psychologist’s perspective.

Parental Model

The Parental Model is quite popular among those with MCS. This model suggests
parents are the main cause of Middle Child Syndrome. Experts theorize that parents treat their
middle children drastically different from their first and last born (J. Jonas, 1992). Several
studies revealed parents do not express as much love and attention to their middle children.
When middle children notice the difference in treatment, they begin to develop symptoms of
MCS. A note of interest about the research: data showed parents with MCS worked to give their
children equal amounts of love and attention. Middle children in those families still exhibited
symptoms but those symptoms were not as severe (S. J. Parker, 2009).

Treatments for Middle Child Syndrome

Extensive efforts have been made to find a treatment for Middle Child Syndrome.
Decades of research and analysis have generated several treatment options, but none seem to
have a lasting effect. Psychologists originally believed people would grow out of MCS and would
be able to function as a normal person by age twenty-five (when the brain is thought to be fully
developed). Unfortunately, research has shown that symptoms do not subside with adulthood.
The following, taken from the Journal of Middle Child Psychology, is a typical example of how
symptoms can alter during adulthood.

Miley C., age 29, is an extreme case of MCS. Miley’s symptoms intensified as she moved
through adolescence. Her need to people please became so apparent that her family nicknamed
her ‘Smiley Miley.’ By age 14, Miley was so desperate for attention she consciously took on an
alternate persona. Trying to stand out as much as possible, Miley would put on a blonde wig and
excessively bedazzled clothing and claim she was an international pop star named ‘Hannah
Montana.’ Miley kept up this alternate personality until age 18.
Her parents believed Miley’s symptoms were finally beginning to lessen: Miley stated she no
longer needed to be Hannah because she had her parent’s attention. This concern and attention
for Miley were short-lived as her parents shifted their focus to Miley’s two younger siblings. Not
able to cope with the lack of attention, Miley pursued a career as an actual pop star. Her early
songs reflected the severity of her symptoms: “Can’t Be Tamed,” “On My Own,” “Wrecking Ball,”
 and “Scars.” Miley dealt with the ups and downs of her symptoms throughout her 20s. When
symptoms flared, Miley would act out in an extreme manner. Miley was suffering from a
particularly difficult flare-up in 2013 when she broke into the MTV Video Music Awards and
overtook another artist’s performance. When symptoms were mild, Miley was able to have a
successful romantic relationship and even showed strong promise as a singer/songwriter.

Other proposed treatments have not been effective in alleviating MCS symptoms.
Middle children who run away tend to see an increase in the severity of symptoms. This is often
because no one seems to notice they are gone. Some have attempted to put themselves up for
adoption and request the family not to have any children. While this particular course of
treatment has some merit, it ends up being more harmful to a middle child’s self-esteem as
they are returned 97% of the time (Adopt-A-Middle-Child-USA, 2009). The most successful
treatment option currently is for middle children to move in with their spinster aunt.
Traditionally, spinster aunts provide the love and attention middle children are
desperately seeking from their parents. Middle children who move in with their spinster aunt
are 50% more likely to effectively cope with MCS symptoms (Spinsters Against Adopting
Dependents, 2013). Woefully, not all middle children have a spinster aunt, but recent studies
have shown spinster God Mothers could be a suitable substitution.
The current outlook for Middle Child Syndrome is not promising. At this point, middle
children will continue suffering until adequate treatment can be identified.