How to spot the signs of abuse

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What are the indicators of abuse, how should we respond and how can we ensure that children will seek help? 

Research has consistently shown deaf and disabled children to be at increased risk of all forms of abuse.  Professionals, parents, carers and others working with, or caring for, deaf and disabled children all have a part to play in promoting safety and well-being, both in responding to concerns and in enabling children and young people to seek help if they need to do so.

Developing a culture of respect and empowerment and consulting with deaf and disabled children will contribute to an environment that promotes safeguarding and well-being. This article draws upon views expressed by deaf and disabled children within a range of consultations and activities carried out by, or on behalf of, the NSPCC over recent years.

A child focussed approach

Deaf and disabled children have the same basic needs and rights as any child. Maintaining a focus on the child’s emotional needs, experiences, wishes and feelings is a key factor in promoting the child’s physical and emotional health and well-being.

All children have a right to protection. However, different standards are often applied to the well-being of deaf and disabled children. There can be a failure to recognise or to act on concerns that would not be tolerated with non-disabled children. For Black and minority deaf and disabled children additional risks and barriers to recognition and action can exist. Barriers to recognition often relate to attitudes, assumptions, communication and a reluctance to challenge parents, carers or other professionals.

It is essential that indicators are not assumed to be the result of the child’s deafness or impairment or cultural and religious beliefs and practices. The right attitude and approach is crucial for avoiding possible misinterpretation and for ensuring that appropriate questions are asked and explanations sought. An explicit commitment to safeguarding from all individuals involved should make it easier to ask pertinent questions.

Recognising abuse

Deaf and disabled children can experience abuse in the same ways as all children and in ways additional to non-disabled children. Sometimes actions or inactions may not immediately be recognised as abuse. However, if persistent, they may have a cumulative and substantial effect over time and constitute abuse.

Children and young people often find it difficult to talk about abuse, and some deaf or disabled children may not be able to do so in a direct way; so, it is vital to be aware of possible indicators of abuse. Efforts should be made to seek to understand any underlying issues that may relate to a child’s mood or behaviour, in order to promote their well-being. When a child is unable to communicate directly then other sources of information, such as tracking mood or behaviour against, for example, time of day, routines, activities, presence of other people, diet or medication, may be considered. It is important to try to identify possible triggers for changes in mood or behaviour. Depending on the nature of the concerns or new information, it may be appropriate to involve other agencies, including social care.

Indicators of abuse should be considered in the light of the child’s development and context. It is important to note that indicators only serve as a guide, and the presence of one or more should not be taken as proof that abuse is occurring. If you have concerns, or you are not sure, it is essential that you seek advice and/or follow your agency’s child protection procedures.

Indicators of possible abuse should be available within child protection policies and procedures but are also available on NSPCC’s website (see below). Some of these are:

•    Physical abuse: bruises or injuries that are either unexplained or inconsistent with the explanation given or visible on the soft parts of the body where accidental injuries are unlikely. Delay in seeking medical treatment, multiple bruises in clusters, scalds with upward splash marks, cigarette burns and human bite marks. There may also be changes in a child’s behaviour, such as fear of parents being approached for an explanation, aggressive behaviour, flinching when approached or touched, reluctance to get changed or withdrawn behaviour. Disabled children may experience other forms of abuse such as the failure to provide medication or treatment for a child, forcing of treatment that is painful for the child or inappropriate use of physical restraint

•    Emotional abuse: This can show itself through developmental delay due to a failure to thrive and grow. However, children who appear well cared for may still be emotionally abused by being taunted, put down or belittled. They may lack love, affection or attention and be denied opportunities for play and social interaction. Indicators can include sulking, hair twisting, rocking, being unable to play, fear of making mistakes, speech disorders and self-harm. For deaf or disabled children, emotional abuse could also include lack of communication, consistent failure to seek their views, unrealistic expectations and blaming the child for their impairment and for related difficulties

•    Sexual abuse: Usually, it is the child’s behaviour that may cause you to become concerned, although physical signs can also be present. It is not easy for children to tell about abuse and, if they do, it is important they are listened to and taken seriously. Physical signs of sexual abuse can include pain or itching in the genital area, bruising or bleeding near the genital area, sexually transmitted infection, vaginal discharge or infection, stomach pains, discomfort when walking or sitting down. Abuse can also show itself in sudden and unexplained changes in behaviour, fear of being left with a specific person or persons, nightmares, running away from home, sexual knowledge beyond the child’s developmental level, bed-wetting, eating problems, self-harm, talking about secrets and acting in a sexually explicit way

•    Neglect: This can have lasting and damaging effects on children. Signs may include, constant hunger, being constantly dirty or “smelly”, loss of weight or being constantly underweight, and inappropriate clothing for the conditions. The child may complain of being tired all the time, have few friends, talk about being left alone or unsupervised or the parent/carer may fail to seek medical assistance/appointments

Neglect of a deaf or disabled child can include, failure to respond to the child’s treatment, dietary or care needs or to provide adequate supervision or stimulation, failure to adapt to a child’s communication method and failure to remove potential hazards which a child may not be aware of or may not be able to avoid.

Empowering deaf and disabled children

A commitment to safeguarding requires an approach that values and empowers children and young people, promotes a culture of respect for others and addresses concerns at an early stage.

Involving children and young people
Involving children and young people in the development of policies, practices and activities will help ensure that these are inclusive, effective and responsive to all issues of concern. Providing opportunities for children and young people to have a say over matters affecting them and other young people will help promote an inclusive and respectful culture, in which they will be more aware of the needs of others and school staff will be more aware of their needs and experiences.  School councils, peer support groups, “Have Your Say” days and other extra curricula activities can all make a contribution.

Personal safety skills

Personal safety skills work undertaken by the NSPCC with deaf children (Safe 2009) has highlighted the common lack of awareness and vocabulary around very basic areas such as feelings, relationships and safety. A recent consultation undertaken by Triangle for the NSPCC with 22 children and young people with learning difficulties found that, although most children could say something about rules of staying safe, most were preoccupied with strangers. Most could talk about safe places and people they knew, but they mostly viewed these as either always or never safe. They had difficulty knowing how to deal with unfamiliar places and people who are not always safe/unsafe.

It is essential that deaf and disabled children receive personal safety skills training and learn how to seek help if they need to. Materials and methods should respond to the specific learning needs of individual children, and learning should be continually reinforced. Deaf children and children with learning disabilities are likely to require a range of visual materials that they can relate to, including information delivered by deaf or disabled young people, and learning methods may include role plays and exercises using a range of examples. Deaf and disabled children also need accessible information to support their learning, through mediums such as audio, easy read with illustrations or British Sign Language.

Opportunities for seeking help

Many deaf and disabled children have talked about communication as a barrier to seeking help and have sometimes told us of their fears of the possible repercussions if they say something. Comments have included: “Information is often not accessible or is in places that are too public, so you can be seen looking at it”. “It can be difficult to say something in private [e.g.] if you need someone to help you to communicate”.

Fear of possible repercussions for speaking out is very real for some deaf and disabled children, and can be particularly so for children in residential schools. A safe environment should provide confidential access to a range of sources of help. Opportunities to communicate with a range of school staff and others such as counsellors and advocates will increase opportunities for seeking help.

Barriers to seeking help can be emotional, practical and attitudinal. Adults need to take time to communicate effectively and to listen without making assumptions. Disabled children have told us that they are more likely to go to someone for help if they believe that person will listen and do something about it.

Further information

David Miller and Yasmin Kovic are from the  NSPCC:
www.nspcc.org.uk

Article first published in SEN Magazine issue 42: September/October 2009.

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