ASD assessment and Safeguarding challenges

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ASD assessment and Safeguarding challenges

• Dr Rachel Brooks

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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

3
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 childs 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.
• Working together definition

• Be healthy
• Stay safe
• Enjoy and achieve
• Make a positive contribution
• Achieve economic wellbeing
• Every child matters

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How likely are we to meet Safeguarding issues?

• Population risks of child abuse and neglect
• 9
• Gilbert et al Lancet vol 373 issue 9657 Jan 2009
  68-81

• Physical abuse
• Sexual abuse
• Emotional abuse
• Neglect

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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

• Children with ASD?
• Association between disability and child abuse
• ASD no greater risk
• Greatest risk
• Psychological and emotional problems
• Learning difficulties
• Spencer 2005 Pediatrics vol 116 609-613

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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

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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

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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

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Safeguarding within the assessment process

• 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

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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

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Challenging behaviour 2

• Frustration leading to physical abuse

• Pushed into shower fully clothed
• Hit with stick

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3

• 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

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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

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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?

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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