Transcript ASD assessment and Safeguarding challenges

ASD assessment and
Safeguarding challenges
Dr Rachel Brooks
Safeguarding challenges
• What do we mean by safeguarding ?
• Why safeguarding should be part of our
assessment.
• What particular issues arise in children with
social and communication disorders
Case history
• 11 year old child diagnosed with severe
autism
• Serious incidents of DA 2006 and 2008 resulting in
MARAC process
The Multi Agency Risk Assessment Conference is a formal
conference, convened in response to all cases of domestic
violence where the risk is identified as “high”. The purpose is for
agencies to share information to identify those at a high level of
risk of serious harm and construct management plan to provide
professional support to all those at risk, including children in
families
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Serious case review
• Further incident of DA 2010: mother wishing to
separate from husband and moved into hotel with
child. Other child remained with father
• Mother disengaging from support services. School
attendance deteriorating
• Police called to hotel and found child’s body: mother
said she had strangled him and attempted to take
her own life
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Safeguarding
• ‘the process of protecting
children from abuse and
neglect, preventing
impairment of their health
and development, and
ensuring they are growing
up in circumstances
consistent with the
provision of safe and
effective care that enables
children to have optimum
life chances and enter
adulthood successfully.’
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Be healthy
Stay safe
Enjoy and achieve
Make a positive
contribution
• Achieve economic wellbeing
Working together definition
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Every child matters
How likely are we to meet
Safeguarding issues?
• Population risks of child
abuse and neglect
• Physical abuse
• Sexual abuse
9%
• Emotional abuse
• Neglect
Gilbert et al Lancet vol 373 issue
9657 Jan 2009 68-81
How likely are we to meet safeguarding
issues in the ASD population?
• Cumulative risks to disabled
children
31%
• 8% of sample had a
disability
• 25% of all maltreated
children had a disability
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Children with ASD?
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Association between disability and
child abuse
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ASD – no greater risk
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Greatest risk
– Psychological and emotional
problems
– Learning difficulties
Spencer 2005 Pediatrics vol 116 609613
Why are children with ASD be
vulnerable ?
• Poverty
• Mental health problems
• Low educational
achievement
• Alcohol and drug
misuse
• Inter personal violence
Gilbert et al 2009 see previous slide
• Communication
• Social naivety
• Multiple carers and
settings
• Challenging behaviour
Autistic phenocopy
• Result of gross
emotional and physical
neglect
• ‘Rumanian orphans’
• After adoption
presentation gradually
changed and were left
with conduct disorder
• Girl aged 12
• History of gross neglect and
violence in infancy
• ?? Also physical abuse
• LDs
• Social naivety
• Some routines and rituals
• ADOS not typical of ASD
• Functionally autistic in
classroom
Autistic Phenocopy?
• Boy asylum seeker
• Early abuse and domestic violence
• Full multidisciplinary assessment as a young
child gave a diagnosis of ASD
• Settled in safe environment ASD symptoms
faded away
• Now has diagnosis of Specific Language Delay
Safeguarding within the assessment
process
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Developmental assessment
Hearing test
Physical examination
ASD specific history
Play assessment
SLT assessment
OT assessment
School observation
Blood tests
Cognitive assessment
Repeat appointments
Second opinions
Etc.etc.
• Childs problems and
parents frustrations
catalogued in presence
of child
• Child excluded from
understanding their
own diagnosis
• Diagnostic labelling as
an end in itself
Challenging behaviour 1
• Challenging behaviour
can be a predisposing
factor or a result of
abuse.
• Frustration leading to
emotional abuse
• Boy aged 13
• Very ritual bound and
parents struggling to
help him with
transitions
• Frightening objects
used to move him on
• Support staff condoning
the scary object use
Challenging behaviour 2
• Frustration leading to
physical abuse
• Pushed into shower
fully clothed
• Hit with stick
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• Fear leading to physical
abuse
• Boy with LDs , 12 hits
his mum and she hits
back to protect herself
• Boy 16 high functioning
Autism hits his mum,
mums new partner
intervenes to protect
and hits him
Restraint
• Lack of training and
skills in managing ASD
and challenging
behaviour leading to
unacceptable restraint
• 4 person hold on a 10
year old girl with ASD
and LDs
Sexual abuse
• Children may act out
what they have seen or
experienced
• How do you tell the
difference?
• 12 year old boy normal
IQ with ASD suspended
from school for sexual
advances to girls in
school
• History of inappropriate
video material being
viewed and available to
children at home
• Was there more than
this?
Investigating safeguarding concerns
• Referrals should be made as per guidance
• Children and YP with ASD are most likely of all
to tell what they believe is the truth
• It maybe an opportunity to rethink levels of
support to a family
• But the focus needs to be the well-being of
the child