5.12 Abuse of Disabled Children

1. Introduction

However, research has found that disabled children are three to four times more likely to be abused and neglected than non-disabled children (Jones et al 2012; Sullivan & Knutson 2000). They are also more likely to experience multiple types and occurrences of abuse (Sullivan and Knutson 2000). Disabled children can be abused and neglected in ways that other children cannot, and they have additional needs and face both additional and specific risks and barriers to their protection. These include:

• Attitudes and assumptions such as a reluctance to believe disabled children are abused, minimising the impact of abuse and attributing indicators of abuse to a child's impairment without an exploration of possible causes or reasons underlying these;
• Barriers to the provision of support services that lead to the disabled child and their family being isolated;
• Impairment-related factors such as dependency on a number of carers for personal assistance, impaired capacity to resist/avoid abuse, communication impairments and an inability of the child to understand what is happening or to seek help;
• A skills gap such as an inability to communicate with the disabled child and respond to their individual needs in a child protection context, or inappropriate application of thresholds.[1]

[1] NSPCC (2016) Safeguarding Disabled Children in England.

2. Risk Factors

Disabled children may be particularly vulnerable for a number of reasons:

• It is known that families of disabled children often experience high levels of unmet need, isolation and stress as a result of a range of social, economic and environmental factors (Institute of Education, 2013);
• Evidence suggests that disabled children are more likely to be neglected than other children, but that this is less likely to be recognised or acted upon (Spencer et al, 2005 and Sullivan and Knutson, 2000);
• There can be a tendency to allow a standard of care that would not be acceptable for a child without a disability;
• As disabled children are more dependent on their parents/carers than other children for every aspect of day-to-day care, they are even less likely than other children to understand or reveal that their parents/carers are harming them;
• A parent/carer's ‘explanation' for a child's symptoms may be less likely to be explored, e.g. a child's developmental delay may be explained as part of their impairment, whereas it may be due to neglect or poor parenting. Poor growth or thinness may be an aspect of the child's impairment, but could also mean that the child is kept light for carrying purposes;
• Personal care may be undertaken in isolation, possibly provided by a number of carers. This may increase the opportunity for abusive behaviour and also make it more difficult to set appropriate boundaries for safe caring;
• Sometimes, the practical care may be adequate but there is an emotional rejection of the child which is either not recognised or ‘excused' because of the additional pressure on the parents/carers;
• Impaired capacity as a result of physical or learning disability to understand what is happening or resist/avoid abuse;
• Difficulty in communicating what is happening;
• Increased vulnerability to bullying and intimidation, including online;
• Being more vulnerable than other children to abuse by their peers;
• Inadequate training in safe care provided for those caring for disabled children;
• Reluctance to believe that abuse of disabled children is possible;
• Lack of access to the ordinary opportunities and experiences enjoyed by other children of a similar age;
• Possible increased vulnerability to grooming behaviour, including online – this is particularly applicable to children with learning disabilities or those with autistic spectrum conditions who may find it more difficult to understand social boundaries or healthy relationships. In relation to sexual exploitation, research by the NSPCC suggests that whilst young people with learning disabilities share many of the same vulnerabilities as those faced by all young people, they also face additional barriers, including a lack of information and access to information about sex and relationships, and false perceptions that young people with learning disabilities do not have the same needs and desires to have a relationship as all young people.[1]

[1] Franklin, A, Raws, P and Smeaton, E (2015) Unprotected, overprotected: meeting the needs of young people with learning disabilities who experience, or are at risk of, sexual exploitation.

3. Indications of Abuse / Neglect

In addition to the universal indicators of abuse / neglect, it is important to consider additional indicators and vulnerabilities for disabled children. All professionals who come into contact with children and young people with disabilities are in a position to identify indicators that the child may be suffering or may be at risk of significant harm. A child or young person's disability should always be considered when considering whether significant harm might be indicated. For example a bruise in a site that might not be of concern on an ambulant child or young person, such as the shin, might be of concern on a non-mobile child or young person.

Other particular issues relating to disabled children and young people that may also lead to a risk of being abused or exploited include:

• Force feeding or inappropriate feeding;
• Personal care needs may not be met adequately;
• Unnecessary physical restraint or rough handling (for more information, see Reducing the need for restraint and restrictive intervention);
• Extreme behaviour modification including the deprivation of clothing, medication or food, limiting movement, restricting freedom by locking doors;
• Misuse of medication, sedation, heavy tranquillisation or denial of medical treatment;
• Invasive procedures which are unnecessary or carried out against their will;
• Ill-fitting equipment, e.g. callipers, sleep boards which may cause injury or pain, inappropriate splinting.

4. Attitudes towards Disabled Children

Attitudes in society and among professionals working with children can lead to a view that abuse of disabled children does not happen or that disabled children are in some way less harmed by abuse. This in turn undermines the safeguarding of disabled children.

Negative approaches can lead to discrimination and, in turn, may guide professionals to be less likely to act on their concerns. Reasons for this include:

• Over identifying with the child's parents/carers and being reluctant to accept that abuse or neglect is taking place/has taken place, or seeing it as being attributable to the stress and difficulties of caring for a disabled child;
• A lack of knowledge about the impact of disability on the child;
• A lack of knowledge about the child, e.g. not knowing the child's usual behaviour;
• Not being able to understand the child's method of communication;
• Confusing behaviours that may indicate the child is being abused with those associated with the child's disability;
• Denial of the child's sexuality;
• Not realising that behaviour, including sexually harmful behaviour or self-injury, may be indicative of abuse;
• Not being aware that certain health/medical complications may influence the way symptoms present or are interpreted, for example some conditions cause spontaneous bruising or fragile bones, causing fractures to be more frequent.

(Murray and Osborne, 2009; Ofsted, 2009, 2012; Stalker and McArthur 2012; Stalker et al. 2010).

5. Safeguarding Disabled Children and Responding to Concerns

Safeguards for disabled children are essentially the same as for non-disabled children, but in addition should include:

• Identifying the capacity of disabled children and their families to help themselves wherever possible;
• Ensuring that those caring for and working with disabled children understand how to provide safe care to a high standard, and are aware of the particular risks of harm for individual children;
• Enabling disabled children to participate in decisions about their care and treatment;
• Ensuring that disabled children receive appropriate personal, health and social education, including sex education;
• Providing effective opportunities and communication systems for disabled children to help them raise their concerns;
• Service providers working in partnership with parents/carers in an open and honest way;
• Ensuring that children are engaged in therapeutic support appropriate to their understanding following abuse.

Children who are living away from home may be particularly vulnerable, e.g. those in residential care homes, residential schools and healthcare settings.

When children are placed in an emergency situation, all medical consents/needs and method of communication need to be clearly documented and provided to the setting.

Where there are safeguarding concerns in relation to a disabled child, they must receive the same level of protection from harm as any other child. Any professional who has a safeguarding concern about a disabled child, should follow the usual procedure for responding to concerns of abuse and neglect.

Where there are concerns about the welfare of a disabled child, these should be acted on in exactly the same way as with a non-disabled child; the same thresholds for action must apply. For further information please see Knowsley MASH (Multi-Agency Referral Form). If there is an immediate safeguarding concern outside office hours the Out of hours the Emergency Duty Team should be contacted.

When making a referral to Children's Social Care or Early Help, it is useful to consider the answers to the following questions:

• What is the disability, special need or impairment that affects the child (a description of the disability or impairment)?
• How does the disability or impairment affect the child on a day-to-day basis?
• How does the child communicate? If someone says the child cannot communicate, simply ask the question: ‘How does the child indicate he or she wants something?'
• How does the child show she/he is unhappy?
• Has the disability or condition been medically diagnosed?

For a new referral, where the threshold has been met, a strategy meeting will take please and the Multi Agency Safeguarding Hub will liaise with the appropriate teams to determine who commence a Section 47 Investigation under the Children Act 1989 or child and family assessment if required.

If the child or young person already has a Social Worker, the Social Worker will take the lead.

Extra resources may be necessary, especially where the child has speech, language and communication needs. For example, it may be necessary to obtain an assessment from a teacher and speech and language specialist as to the best way of working with the child. The child's preferred method of communication must be given the utmost priority (Taylor et al, 2014).

The number of carers involved with the child should be established, as well as where the care is provided and when.

If a facilitator or interpreter is required, they should be involved when planning the investigation. Where there is an interview with the disabled child, consideration should be given to whether any additional equipment or facilities are required, and whether someone with specialist skills in the child's preferred method of communication should be involved. All those involved in an investigation must ensure that they communicate clearly with the disabled child and the family, as well as with each other, as there are likely to a greater number of professionals involved.

Assumptions should not be made about the inability of a disabled child to give credible evidence, or participate in, the court process. In every case the best interests of that disabled child should be considered (see Achieving Best Evidence in Criminal Proceedings - Guidance on Interviewing Victims and Witnesses, the use of Special Measures and the Provision of Pre-trial Therapy).