Abuse of Children with Disabilities

Children with a disability are children first and foremost and deserving of the same rights and protection as other children. By definition, any child with a disability should also be considered as a child in need (Section 17 Childrens Act 1989). It is also important to see the child in the context of the whole family and community supports that are present.

The available UK evidence on the extent of abuse among children with disabilities suggests that children with disabilities are at increased risk of abuse, and that the presence of multiple disabilities appears to increase the risk of both abuse and neglect (See NSPCC Learning ‘We have the right to be safe’: Protecting disabled children from abuse (nspcc.org.uk)).

Research also indicates that as well as being the least protected, disabled children are also the least consulted in routine assessments.

The West Yorkshire Consortium seeks to address and challenge these practices by affirming its understanding of the issues facing disabled children and its commitment to removing the barriers that prevent children with disabilities from accessing their rights.

It is recognised that SEND statutory guidance covers children or young people aged 0-25 however this guidance relates to children under the age of 18. Professionals should be cognisant of how they manage transitions to adult services as children turn 18. At this point adult safeguarding procedures should be followed (Please see SEND Code of Practice - 0 – 25 2024 page 52 for Adult Social Care responsibilities).

A child could be considered to be disabled if he or she has significant problems with communication, comprehension, vision, hearing or physical functioning. (Section 17 (11) Children and Families Act 2014).

Many factors can make a disabled child more vulnerable to abuse than a non-disabled child of the same age. Safeguarding children with disabilities demands a greater awareness of their vulnerability, individuality and particular needs.

Children with disabilities may be especially vulnerable to abuse for a number of reasons. Some children with disabilities may:

• Be isolated and have limited contact with others;
• Receive intimate care which may involve a number of carers, this may increase the risk of exposure to abusive behaviour and make it more difficult to set and maintain physical boundaries;
• May have reduced ability due to physical or communication needs to challenge or protect against abuse;
• Have communication difficulties that may make them less able to tell others what is happening;
• Be inhibited about complaining for fear of losing services and/or are not aware services are abusive;
• Be especially vulnerable to bullying and intimidation and may be less able to recognise these issues;
• Be more vulnerable to abuse by their peers.

Additional factors which increase vulnerability to abuse, or neglect may be:

• The child's dependence on carers could result in the child having a problem in recognising what is abuse. The child may have little privacy, a poor body image or low self-esteem;
• Carers and staff may lack the ability to communicate effectively with the child and may not be trained appropriately to meet the needs of the child;
• A lack of continuity in multi-disciplinary working which may lead to an increased risk that behavioural changes may go unnoticed;
• Lack of access to 'keep safe' strategies available to others;
• Children with disabilities living away from home and community are not seen daily by others outside of the organisation they live in. In poorly managed settings children are particularly vulnerable to over-medication, poor feeding regimes, poor toileting arrangements as well as issues around control of challenging behaviours, lack of stimulations and emotional support;
• Parents'/carers' own needs and ways of coping may conflict with the needs of the child. Pressure on family carers with limited support can be a risk factor for children with disabilities;
• Some adult abusers may target disabled children in the belief that they are less likely to be detected. Evidence indicates that a child with disabilities is less likely to be seen as a reliable witness when they do disclose;
• Signs and indicators can be incorrectly attributed to disability; Such as normalisation of overuse of restraint. Issues around abuse as well as mental health issues may not be seen due to the focus on the child’s disability. An autistic child for example may mask if they were in pain;
• Children with disabilities are less likely to be consulted in matters affecting them and as a result may feel they have no choice about their care. Attitudes and discrimination can mean that only disability is seen rather than the full picture. Children with disabilities must be responded to as individuals with their own specific needs, feelings, thoughts and opinions;
• Services do not have the knowledge and expertise to support and meet the needs of a child with disabilities.

Concerns about the welfare of a child with a disability should be acted upon in the same way as any other child in accordance with the Referrals Procedure. The same thresholds for action apply.

Expertise and resources in both safeguarding and promoting the welfare of children and in working with disability have to be brought together to ensure that children with disabilities receive the same levels of protection from harm as other children. Other specialist workers or teams may become involved in the assessment process in accordance with local arrangements.

Parents/carers are relied upon (whether family or paid carers) as a source of information about children with disabilities and to interpret and explain behaviour or symptoms. Professional staff can potentially feel out of their depth in terms of knowledge of a disabled child's impairment, where the familiar developmental milestones may not apply. Professionals should be conscious of a increased possibility of disguised compliance for children who have disabilities.

Parents/carers will need to be challenged in the same way as carers of children without disabilities.

Where there are communication impairments or learning difficulties, particular attention should be paid to the communications needs of the child to ascertain the child's perception of events and his or her wishes and feelings.

All professionals should be aware of non-verbal communication systems and should contact suitable interpreters, advocates, and facilitators or consider other communication aids.

Agencies must not make assumptions about the inability of a child with a disability to give credible evidence or information to professionals in safeguarding processes, or to withstand the rigours of the Court process.

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 in Criminal Proceedings: Guidance on interviewing victims and witnesses, and guidance on using special measures (Ministry of Justice) which includes comprehensive guidance on planning and conducting interviews with children and a specific section about interviewing children with disabilities.

Intermediary support can be provided if a child with a disability needs support with communication at court or in a tribunal hearing.

Please see Government website around how to access an intermediary service - HMCTS intermediary services (GOV.UK).

Participation in all forms of meetings such as Child Protection Conferences and Core Groups must be encouraged and facilitated. The use of specialist advocates and communication support/aids should be considered.

The indicators for abuse and neglect among children with disabilities are the same as they are for the wider population, however the child's reaction or response may be less overt. Where children are observed to have bruising or other injuries it is important to consider all the possibilities, and not to assume that it is a result of their disability.

Similarly, when children with disabilities display behaviours that would cause concern in other children it is important not to make assumptions about any connection with their disability and consider that other traumatic incidents may be a causational factor.

Where a child is unable to tell someone of their abuse, they may convey anxiety or distress in some other way, for example behaviour and/or symptoms. Carers and staff must be alert to this and be aware of the possibility that behaviour that challenges may be caused by something other than the disability. Particular attention must be paid to changes in behaviour, mood and/or symptoms which may indicate distress. Effective multi-agency/multi-disciplinary information sharing is essential, particularly where the child accesses several different environments such as school, residential home, respite care etc.

In addition to the universal indicators of abuse/neglect listed in the Recognising Abuse and Neglect Procedure, examples of specific abuse of children with disabilities may include:

• Force feeding;
• Unjustified or excessive physical restraint;
• Rough handling;
• Extreme behaviour modification including the witholding of liquid, medication, food or clothing;
• Misuse of medication, sedation, heavy tranquillisation;
• Invasive procedures against the child's will;
• Refusal to allow procedures that are needed eg blood tests, immunisations, tube feeds;
• Not being brought to appointments or not collecting prescriptions;
• Denying access to health or educational professionals visiting the home;
• Neglect of personal care needs;
• Deliberate failure to follow medically recommended regimes or misapplication of medication;
• Non-compliance with programmes or regimes;
• Failure to address ill-fitting or poorly maintained equipment which may cause injury or pain;
• Misappropriation/misuse of a child's finances, leading to the child’s needs not being met;
• Being denied access to education, play and leisure opportunities;
• Not having their holistic developmental needs as children recognised or met due to excessive focus on disability.

The UK Social Work Practice in Safeguarding Disabled Children and Young People report (UK Social Work Practice in Safeguarding Disabled Children and Young People - What Works for Children's Social Care) details some of the reasons why disabled children and young people are at greater risk and the reasons why, including where gaps and blockages in provision exist.

Safeguards for children with disabilities are essentially the same as for children without disabilities. Where there are concerns about the welfare of a disabled child, their emerging vulnerabilities and needs should be assessed and met in the same way as with any other child.

Parents/carers will need to be challenged in the same way as carers of children without disabilities. Reluctance to challenge can also be referred to as the ‘halo’ effect. While professionals should feel compassion for the parent/carer(s) they shouldn’t tolerate inadequate / poor parenting that would not be accepted from the parent(s) of a non-disabled child. Safeguarding action should not be delayed because the parent/carer or service is seen to be “doing their best”.

Throughout any Assessment (see Single Assessment Procedure), including a Section 47 Enquiry, all service providers must ensure that they communicate clearly with the child with the disability and the parents/carers and with all professionals involved with the child as there is likely to be a greater number of services and practitioners involved than for a children without disabilities. All steps must be taken to avoid confusion so that the welfare and protection of the child remains the focus. Where there are communication impairments or learning difficulties, particular attention should be paid to the communications needs of the child to ascertain the child's perception of events and their wishes and feelings. As with all assessments the voice and lived experience of the child is key and professionals need to be conscious that obtaining this may be more challenging with children who have disabilities.

Safeguarding measures should:

• Make it common practice to empower children with disabilities to make their wishes and feelings known in respect of their care and treatment;
• Ensure that children with disabilities receive appropriate personal, health and social education (including sex education);
• Make sure all reasonable efforts are made to ensure that children with disabilities know how to raise concerns and give them access to a range of adults with whom they can communicate. This could mean using interpreters and facilitators who are skilled in using the child's preferred method of communication;
• Recognise and utilise key sources of support including staff in schools such as support workers, friends and family members where appropriate;
• Ensure that there is an explicit commitment, with clear assurance and governance structures in place to aid understanding of children with disabilities's safety and welfare among all providers of services used by children with disabilities;
• Develop the safe support services that families want, and a culture of openness and joint working with parents and carers on the part of services;
• Ensure that guidance on good practice is in place and being followed in relation to: intimate care, including consideration of the number of people undertaking that care; working with children of the opposite sex; managing behaviour that challenges families and services; issues around consent to treatment; anti-bullying and inclusion strategies; sexuality and safe sexual behaviour among young people; monitoring and challenging placement arrangements for young people living away from home.

Ofsted thematic inspection: Protecting Disabled Children

Safeguarding Disabled Children: Practice Guidance

Safeguarding children with disabilities in residential settings (GOV.UK)

Safeguarding children and young people - policy and procedure