3.1 Abuse of Disabled Children: Guidance

Disabled children are children first and foremost, and are therefore subject to all Working Together guidance and to other Buckinghamshire Safeguarding Children Partnership (BSCP) policies, procedures and guidance. Disabled children have the same rights as non-disabled children to be protected from harm and abuse.

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

Various definitions of disability are used across agencies and professionals. Whatever definition of ‘disabled’ is used, the key issues are the impact of abuse or neglect on a child’s health and development, and how best to safeguard and promote the child’s welfare.

This guidance is relevant to children and young people who have physical, sensory and learning disabilities, as well as children and young people with autistic spectrum conditions (ASC) and attention deficit hyperactivity disorder (ADHD).

Guidance emphasises the critical importance of communication with disabled children. This includes recognising that all children communicate preferences if they are asked in the right way by people who understand their needs and have the skills to listen to them (Marchant and Page, 1992).

The participation and involvement of children and young people in decision-making about their own welfare and in the services they receive is a legal requirement under the Children Act (1989 Section 1(3)). However, it is known that for disabled children, this is less likely to happen.

In order for disabled children to participate in decisions about their safety and welfare, it is essential that resources and time are made available to allow their voice to be heard. Many disabled children or young people need alternative or additional means of communication to understand and to express themselves. The best practice for disabled children is for a worker with appropriate communication skills to be allocated.

All reports that are written about a disabled child or young person should include their views, wishes and feelings, and how they have been ascertained.

Professionals must identify barriers to accessing services and aim to make information available to disabled children and young people, and their parents and carers. This information should take account of the child or young person’s impairment, as well as the child or young person’s and parents’ preferred formats.

“Dependency on a wide network of carers and other adults is the everyday experience of some disabled children in order that their medical and intimate care needs such as bathing and toileting can be met. The large number of adults involved and the nature of the care needs both increase the risk of exposure to abusive behaviour and make it more difficult to set and maintain physical boundaries. Some disabled children grow up to accept damaging, demeaning or over restricting treatment from others because they have never known anything more positive. There is also the possibility that disabled children may be schooled into accepting others having access to their bodies.” (Safeguarding Disabled Children Practice Guidance DFEE 2009.)

The Children and Families Act (2014) places a duty on local authorities to promote children’s wellbeing as it relates to:

• physical and mental health, and emotional well-being
• protection from abuse and neglect
• control by them over their day-to-day lives
• participation in education, training or recreation
• social and economic well-being
• domestic, family and personal relationships
• the contribution made by them to society.

Disabled children are included in this duty and in order to assess their needs, the Children and Families Act (2014, Section 37), expects that local authorities will produce and maintain an education, health and care plan to coordinate a child’s needs.

It is important that agencies provide coordinated services and support around a child and family at the earliest stage to effectively safeguard and promote the welfare of disabled children and to prevent deteriorating outcomes.

Disabled children are likely to have poorer outcomes across a range of indicators, including low educational attainment, poorer access to health services, poorer health outcomes and more difficult transition to adulthood. They are more likely to suffer family break-up and are significantly over-represented in the populations of Looked After Children and young offenders.

Where disabled children are Looked After, they are more likely to be placed in residential care rather than family settings, which in turn increases their vulnerability to abuse.

Families with disabled children are more likely to experience poverty and children with special educational needs are more likely to be excluded from school (Miller and Brown, 2014).

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.

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.

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).

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.

Multi-agency protocols for times of transition must include a communication strategy and young people must be supported to participate in the development of their transition plans, particularly in their transition to adulthood.

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.

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?

Where the threshold has been met, First Response will liaise with the appropriate teams to determine who will commence a Section 47 Investigation under the Children Act 1989.

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. At the Strategy Discussion, consideration should be given to appointing a support worker to consider any complex issues arising from the disability.

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.

Article 5 of the Human Rights Act states that ‘everyone has the right to liberty and security of person. No one shall be deprived of his or her liberty [unless] in accordance with a procedure prescribed in law’.

High levels of supervision and restrictions imposed due to a child's disability or behaviours could in some instances be considered a deprivation of liberty (and therefore abusive).

Local authorities must consider whether any children in need or Looked After Children are being deprived of their liberty, but are not able to provide consent to a deprivation of liberty on behalf of a child or young person.

Where children are not looked after, parents can give consent for deprivation of liberty if it falls within the zone of parental responsibility under the age of 16 years. Deprivation of liberty can also be lawful if warranted under statute (Section 25 of the Children Act, secure accommodation provisions).

For a young person aged 16-17, currently only the Court of Protection can authorise a Deprivation of Liberty, as parents or the Local Authority cannot consent to a confinement.

However, where a child is Looked After, different considerations apply even where the parents consent to deprivation of liberty. Their consent may be adequate where the child is accommodated under Section 20, but where the child is the subject of an interim care order or a care order, it is unlikely a parent could consent and nor can the local authority. This means that where there is a deprivation of liberty the local authority will usually need to seek leave of the High Court to make an order for the deprivation of the child’s liberty.

Whilst deprivation of liberty has been a key part of adult safeguarding for many years, this is a complex and developing area in terms of child safeguarding practice. Professionals working in Children’s Social Care should ensure that appropriate legal advice is sought where is possible that any child or young person may be deprived of their liberty. Further information is available in The Application of Deprivation of Liberty Safeguards (DoLs) in Children’s Services (January 2016).

There are special measures for safeguarding disabled children during criminal proceedings. The following issues need to be considered: 

• Agencies should not make assumptions about the inability of a disabled child to give credible evidence. Each child should be assessed carefully and supported to participate in the criminal justice process when this is in their best interests and in the interests of justice.
• Witnesses aged under 18 are automatically eligible for assistance with giving their evidence under Section 16(2) of the Youth Justice and Criminal Evidence Act 1999 (Updated in March 2011– Ministry of Justice guidance on interviewing victims and witnesses, and guidance on using special measures).
• Other special measures may include clearing the public gallery in sexual offence cases and those involving intimidation. Screens around the witness box may be provided so witnesses do not see the defendant, and video-recorded evidence via video links could do away with the necessity for the young person to be in court at all (Ministry of Justice, Achieving Best Evidence 2011 - includes comprehensive guidance on planning and conducting interviews with children).
• Intermediaries and aids to communication may be required to facilitate good communication.

The Buckinghamshire Safeguarding Children Partnership provides multi-agency safeguarding training including specific training on protecting disabled children. Details can be found on the training section of the BSCP website.