Children with disabilities

Adults, including professionals caring for and/or assessing a child's needs, may concentrate on the child’s special needs and overlook signs and symptoms which may suggest that the child is being maltreated. Often, signs indicating maltreatment may be attributed to the disability.

Children with disabilities

Disabled children have exactly the same human rights to be safe from abuse and neglect, and to be protected from harm and achieve positive outcomes as non disabled children. Disabled children do however require additional action. This is because they experience greater vulnerability as a result of negative attitudes about disabled children and unequal access to services and resources, and because they may have additional needs relating to physical, sensory, cognitive and /or communication impairments. Evidence from research confirms that disabled children are particularly vulnerable to abuse and /or neglect.

Why are disabled children more vulnerable to abuse?

  • Attitudes and assumptions within society and amongst those working with children can lead to a view that abuse does not happen to disabled children

  • A reluctance to challenge carers has been found together with a sense of empathy amongst practitioners with parents and foster parents who are felt to be under considerable stress

  • 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.

  • Communication barriers mean that many disabled children including deaf children have difficulty reporting worries, concerns or abuse. Some disabled children do not have access to the appropriate language to be able to disclose abuse; some will lack access to methods of communication and/or to people who understand their means of communication. Disabled children and young people are sometimes assumed not to be reliable witnesses.

  • Lack of participation and choice in decision making can disempower disabled children and make them more vulnerable to harm as can a failure to consult with and listen to disabled children about their experiences.

  • Factors associated with impairments can lead to greater vulnerability to abuse. Behaviours indicative of abuse such as self harm and repetitive behaviours may be construed as part of a child’s impairment or health condition.

  • Isolation from other children and adults means that many disabled children struggle to tell others about their experiences making it easier for abuse and neglect to remain hidden.

  • Double discrimination faces many disabled children from black and minority ethnic groups and refugee and asylum seeking children. They can experience additional difficulties and challenges in accessing and receiving services and often those they do receive are not sensitive to their culture and language or relevant to their needs.

  • Spending greater periods of time away from home, particularly in residential settings is a risk factor for abuse.

  • Lack of training and about safeguarding disabled children can result in professionals not recognising the signs of abuse or neglect. 

Disabled children and young people should be seen as children first. Having a disability should not and must not mask or deter an appropriate enquiry where there are child protection concerns.

Considerations

Safeguarding disabled children’s welfare is everybody’s responsibility and given that evidence shows that disabled children are more vulnerable to abuse than non-disabled children it is important to be mindful of the following:

  • Many disabled children are at an increased likelihood of being socially isolated with fewer contacts than non-disabled children

  • Their dependency on parents and multiple carers for practical assistance in daily living, including intimate personal care, increases their risk of exposure to abusive behaviour

  • They have an impaired capacity to resist or avoid abuse

  • They may have speech, language and communication needs which may make it difficult to tell others what is happening

  • Child with learning difficulties may not be able to sequence events when telling someone
  • They often do not have access to someone they can trust to disclose that they have been abused

  • They are especially vulnerable to bullying and intimidation

  • 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

  • Over identification with parents/carers, attributing the abuse or neglect to the pressures of caring for a disabled child.
  • Additional stress of having a disabled child on parent/carer.
  • Child with learning difficulties may not be able to understand usual safety rules such as, ‘don’t get into stranger’s cars or, ‘don’t accept food from strangers.’
  • Being ‘on the receiving end of care’ increases passivity and a feeling of not having choice or control, so child less likely to speak out about what has happened
  • Negative ‘messages’ in society about disability lead disabled people to feel of less value and thus less likely to speak out about any harm they experience.
  • Barriers in society – ‘it doesn’t happen’
  • Pattern of harm, statistically disabled children are more likely to be subject to emotional harm or neglect so there may not be ‘one disclosure’ but rather the need to put the ‘pieces of the jigsaw’ together. Individuals noticing these ‘pieces of the bigger picture’ may wrongly assume they are too small to pass on.
  • Reasons for non-attendance at school can be easily accepted.

Assessment 

Good assessments support professionals to understand whether a child has needs relating to their care or disability and/ or is suffering, or likely to suffer, significant harm. The assessment needs to give a picture of what is normal/typical behaviour for the child/young person to enable us to pick up and clarify when they are behaving in ways that are not typical/ out of character for them. The specific needs of disabled children should be given sufficient recognition and priority in the assessment process. When undertaking an assessment (and considering whether significant harm, might be indicated) professionals should always take into account the nature of the child’s disability. The following are some indications of possible abuse or neglect:

  • A bruise in a site that might not be of concern on an ambulant child such as the shin, might be of 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 and learn a child’s means of communication;

  • Ill fitting equipment e.g sleep boards, inappropriate splinting, misappropriation of a child’s finances

  • Invasive procedures which are unnecessary or are carried out against the child’s will.

Professionals may find it more difficult to attribute indicators of abuse or neglect, or be reluctant to act on concerns in relation to disabled children because of a number of factors, which they may not be consciously aware of. These could 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

  • 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.

It is important that professionals working with disabled children are alert to the above indicators of abuse and take them into account, where appropriate, if they have concerns about the welfare of a disabled child. As professionals we need to consider any issues or concerns raised and if they would be acceptable for any child and if not they need to take action.

Initial contact and referral

Where a professional has concerns that a disabled child may be being abused or neglected, they should make a referral to children’s social care as soon as possible. It is important to include as much information as possible within the referral, including details of the child’s disability and what it means to them as an individual.

Children with disabilities are subject to the same child protection procedures as non-disabled children. It is important for professionals to consider all the indicators above to ensure that assumptions are not being made.

Useful guidance 

Further information can be found in the practice guidance in relation to working with children with disabilities:

https://www.gov.uk/government/publications/safeguarding-disabled-children-practice-guidance