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4.17 Children With Disabilities


Aiming High for Disabled Children: Transforming Services for disabled children and their families (UK guidance) (DCSF 2008)

Practice Guidance for Children with Disabilities


This chapter was slightly updated in August 2013 in regard to the new Practice Guidance for Children with Disabilities.


  1. Introduction
  2. Factors Associated with Significant Harm to a Child with Disabilities
  3. Medical and Health Issues
  4. Assessment
  5. Best Practice Guidance

1. Introduction

1.1 There is evidence that children with disabilities are significantly more likely to be abused than children without disabilities. Research has shown (Sullivan & Knutson, ‘The association between child maltreatment and disabilities in a hospital based epidemiological study’ Child Abuse and Neglect, 22, pp271-288) that children with disabilities are approximately four times more likely to be abused than children without disabilities yet there is evidence that they are less likely to be protected by our child protection system. This should always be taken into account when deciding how to respond to concerns. 

2. Factors Associated with Significant Harm to a Child with Disabilities


The Significant Harm Threshold for children with disabilities will have been met when:

  • There is clear evidence of abuse;
  • Needs have previously been identified and parents/carers have not been willing to work with services to change their parenting behaviour within the required time frame.
2.2 See also Referral to Social Services Procedure.

The following should be taken into account when making a decision about whether to refer concerns to Social Services:

  • Children with disabilities demonstrate the same signs and indicators as children without disabilities. However, these may sometimes be confused with factors associated with the child’s impairment. Where any of the following exist a referral should be made and assessment commenced by Social Services, in order to understand the situation and needs of the child:
    • Challenging behaviour;
    • Sexualised behaviour;
    • Low self-esteem / sadness / passivity / emotional withdrawal;
    • Self-harm – including such behaviours as head banging / biting / scratching;
    • Recurrent injuries;
    • Denial of necessary equipment by parents or carers;
    • Invasive procedures against the child’s will;
    • Failure to follow medical advice / give the child required medication;
    • An escalation in requests for short break / respite care;
    • Exaggeration of a child’s impairment, e.g. Insisting on treatment/medical intervention not deemed appropriate by professionals (issues relating to fabricated illness may be relevant in this situation – see Fabricated or Induced Illness Procedure).
2.4 The parental factors associated with abuse are also just as likely to be present in families with children with disabilities. It is very important that children with disabilities are not blamed for parental factors such as Domestic Abuse, substance misuse and parental ill health leading to the appropriate action not being taken. Parental factors should be taken into account in decision making about potential harm in the same way as they are for children without disabilities. See also Domestic Abuse Procedure, Parents with Drug or Alcohol Misuse Procedure and Parents with Mental Ill Health Procedure.

3. Medical and Health Issues


The potential to abuse or neglect children through medical or health issues is greater than with children who are not as reliant on specific health needs being met. Main areas of concern that should be considered during Section 46 Enquiries are:

  • The misuse of medication, for example:
    • To restrict liberty;
    • To control emotion and behaviour;
    • To impair physical and emotional capacity to resist abuse.
  • The neglect of health needs, for example:
    • Poor equipment adaptations and aids, which may result in harm;
    • Tampering with equipment to restrict liberty;
    • Basic health care needs not being met;
    • Denying or restricting access to food and nourishment.
3.2 Experiences such as these can inhibit a child’s ability to reach their full potential and can also affect their ability to resist abusive behaviours towards them, making them more vulnerable to further abuse.

4. Assessment


Take time to gather information you require in order to understand the context of the concern, the nature of the child’s needs and the risks to the child’s welfare:

  • More time may be needed to gather information and you are likely to have to seek information from more people than in the case of a child without disabilities;
  • It will be useful to gather information from:
    • Carers – there may be carers additional to those usually involved with a non-child with disabilities;
    • Health professionals – as well as those routinely contacted during enquiries;  
    • Find out whether the child is in regular contact with the: 
      • School nurse;
      • Community/district nurse;
      • Physiotherapist;
      • Occupational therapist;
      • Dietician;
      • Speech and language therapist;
      • Clinical psychologist;
      • Psychiatrist;
      • Complementary Health workers.
    • Education and schools – thought should be given as to the wide range of people who may be in contact with a child with disabilities including:
      • Special educational needs co-ordinators or inclusion co-ordinator;
      • Classroom/lunchtime assistants;
      • Transport drivers and escorts;
      • Volunteers;
      • Peripatetic teachers.

5. Best Practice Guidance


A child with disabilities is more likely to receive care from a number of adults and this is a risk factor in itself:

  • This means Section 46 Enquiries may be more complex. There may be more adults to be interviewed and more potential perpetrators. These difficulties need thorough consideration at the Strategy Discussion to ensure all risk factors are identified and contamination of evidence is avoided.

Recognise that you may need to seek specialist advice and information in order to make judgements about whether a child is suffering Significant Harm and what action should follow: 

  • Examples of Significant Harm which may arise for children with disabilities may fall outside your previous experience, for example:
    • Failure to meet the communication needs of a hearing impaired child to the point where their development is impaired;
    • Misuse of medication;
    • Being denied mobility, communication and other equipment;
    • Being denied access to medical treatment including, for example, parents not agreeing to a gastrostomy where the child is receiving inadequate nutrition and/or oral eating is unsafe.

A failure to recognise children with disabilities’ human rights can lead to abusive situations and practices:

  • Basic human rights include issues relating to food nutrition, appropriate levels of discipline or sanctions, finances, hygiene, physical comfort, social interaction, sexuality, liberty and sleep. These basic rights can be abused either through ignorance, lack of appropriate resources or support or with intention to cause harm. Whether abuse of rights is unintentional or not, is unacceptable or not, it is not acceptable for this to go unchallenged as it does not promote children’s welfare or safety. Moreover, when human rights are denied children are vulnerable to further types of abuse.
5.4 Abuse of rights and poor practice can become pervasive in institutions and poor care practices can have more significant consequences for some children with disabilities than for children without disabilities. Poor care practices that for a child without may affect their development, might be life threatening for a child with disabilities.

If someone tells you that a child’s injury or behaviour is a normal part of their disability make sure you verify this opinion:

  • A previous occurrence should not automatically act as a verification of ‘normality’ and it may be necessary to seek medical or other specialist advice.

Take care to address any barriers to communicating with a child with disabilities:

  • Children with disabilities may have different communication needs. They may use other communication systems such as British Sign Language, symbols or hand gestures (e.g. Makaton, Rebus). The child might have very limited communication with only a hand or sign movement that indicates yes and another to indicate no. This does not mean that the child cannot understand or is not able to communicate what has happened to them;
  • If a parent or professional tells you that a child cannot communicate, explore further what they mean. Ask - how do they know when the child is in pain? Hungry? Hot/cold? Or does not like something? This will inform you how the child communicates;
  • For some children their only way of communicating with you will be through changes in their behaviour. It is very important, therefore, to maximise the use of observation and reports from those in contact with the child. For example, where a child’s response to personal care changes suddenly, or where they express fear or aversion to a particular carer;
  • If it is possible that there will be a criminal prosecution always consider whether an intermediary should be used at an early stage in the enquiries.

Do not think that because a child has a different ability to understand the world that they will not be affected by being harmed or neglected:

  • Abuse and neglect are as harmful for all children, including children with disabilities. Best practice based on research evidence recognises that the impact of abuse on children’s psychological, emotional and physical health should always be addressed, regardless of whether at the time they understood what was happening to them. This should be applied to all children, including those with cognitive impairments.