Abuse of Disabled Children

Research suggests that disabled children are at particular risk of abuse, and that the presence of multiple disabilities appears to increase the risk of both abuse and neglect (see Standards 5, 7 and 8 of the National Framework for Children, Young People and Maternity Services).

Disabled children are more vulnerable to abuse because they may:

• Have fewer outside contacts than other children;
• Receive intimate personal care, so increasing the risk of exposure to abusive behaviour;
• Have an impaired capacity to resist abuse;
• Have communication difficulties that make it harder to tell others of their concerns;
• Be more vulnerable to bullying, intimidation and abuse by both adults and peers.

Looked after disabled children are not only vulnerable to the same factors that exist for all children living away from home but are particularly susceptible to possible abuse because of their additional dependency on residential and hospital staff for day to day physical needs.

See also Section 8, Safeguarding Disabled Children: Practice Guidance.

Safeguards for disabled children are essentially the same as for non-disabled children. These should include:

• Making it common practice to help disabled children make their wishes and feelings known;
• Ensuring disabled children get appropriate personal education;
• Ensuring disabled children have appropriate means of raising their concerns with a range of adults;
• An explicit commitment by all providers of services to disabled children to their safety and welfare;
• Close contact with families, and a culture of openness;
• Guidelines and training for staff on all aspects of good practice (including intimate care, anti-bullying strategies and sexuality).

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, in accordance with the Referrals Procedure. The same thresholds for action must apply. Where there are safeguarding concerns about a disabled child, there is a need for greater awareness of the possible indicators of abuse and/or neglect as the situation is often more complex. It is crucial that the disability is not allowed to mask or deter the need for an appropriate investigation of child protection concerns.

See also: Section 8, Safeguarding Disabled Children: Practice Guidance.

The following are some indicators of possible abuse or neglect:

• A bruise in a site that might not be of concern on an ambulant child, such the shin, might be a concern on a non-mobile child
• Not getting enough help with feeding leading to malnourishment
• Poor toileting arrangements
• Lack of stimulation
• Unjustified and/or excessive use of restraint
• Rough handling, extreme behaviour modification e.g. deprivation of liquid, medication, food or clothing
• Unwillingness to try to learn a child's means of communication
• Ill-fitting equipment e.g. calipers, sleep boards, inappropriate splinting, misappropriation of a child's finances
• Invasive procedures which are unnecessary or are carried out against the child's will

If insufficient time is given for a child with restricted arm and hand movement to have an adequate lunch, the child could experience hunger or dehydration. The impact of such an experience is repeated over a number of days could be considerable.

Removing batteries out of an electric wheelchair to restrict liberty solely for the convenience of staff might equate to a non-disabled child being locked in a room or having their legs tied.

Professionals may be reluctant to act on concerns because of a number of factors that include:

• Over identifying with the child's parents/carers and being reluctant to accept that abuse or neglect is taking or 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
• Behaviour, including sexually harmful behaviour or self-injury, may be indicative of Abuse
• Being aware that certain health/medical complications may influence the way symptoms present or are interpreted. For example some particular conditions cause spontaneous bruising or fragile bones, causing fractures to be more frequent

Those in Children's Social Care who are likely to receive initial contacts and/or referrals concerning disabled children should have received appropriate training to equip them with the knowledge and awareness to assess the risk of harm to the child and know what action to take.

Assessment should be undertaken by professionals who are both experienced and competent in child protection work, with additional input from those professionals who have knowledge and expertise of working with disabled children.

A good question when assessing a disabled child is: Would I consider that option if the child were not disabled?

See also: Section 8, Safeguarding Disabled Children: Practice Guidance.

Special attention should be paid to disabled children's communication needs and every effort made to find out their wishes and feelings. Throughout any Initial Assessment and Core Assessment process, including a Section 47 Enquiry, all service providers must ensure that they communicate clearly with the disabled child and the family and with one another as there is likely to be a greater number of services and staff involved than for a non-disabled child. All steps must be taken to avoid confusion so that the welfare and protection of the child remains the focus.

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.

The following questions should be asked when a referral is received concerning a disabled child:

• What is the disability, special need or impairment that affects the child? Ask for a description of the disability or impairment
• Make sure that you spell the description of an impairment correctly
• 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 s/he is unhappy?
• Has the disability or condition been medically diagnosed?

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

At the Strategy Discussion, consideration should be given to appoint a support worker to consider any complex issues arising from the disability. If a facilitator or interpreter is required, he or she should be involved when planning the investigation.

Where 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.

Practitioners should be advised to refer to the appendices of the government's guidance for a list of helpful resources and more detailed assessments tool and research literature.

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. Each child should be assessed carefully and supported where relevant to participate in the criminal justice system when this is in their interests as set out in Achieving Best Evidence which includes comprehensive guidance on planning and conducting interviews with children and a specific section about interviewing disabled children.

Participation in all forms of meetings such as Child Protection Conferences and Core Groups must be encouraged and facilitated and take into account any issues about access.

The full range of service providers and carers must be represented at all meetings.

Click here to view Safeguarding Disabled Children: Practice Guidance.