05/06/2026
I've been doing reports to support special education needs for over 5 years. And over that time I've gradually watched something shift. Not just individual disagreements or difficult cases. A pattern. Increased hostility, distortion, deflection, delay, refusal to acknowledge evidence that is right in front of them. I think some of what I've witnessed raises serious questions about institutional harm, and in some cases may need to be examined through safeguarding and professional standards frameworks. And I think the reason it continues is because professionals are scattered, scared, and isolated enough that each case looks like a one-off.
So I want to name what I think is actually happening.
Independent reports are being critiqued behind the scenes by statutory professionals who in many cases have not assessed the child, not spoken to the family, and are not transparently accountable for how their comments are used. Those critiques are then used to delay, reduce or deny provision. In some cases, families appear to have no idea this is happening. They submitted a report to evidence their child's needs. They did not give informed consent for highly sensitive clinical information to be circulated to unknown professionals for behind-the-scenes review. You cannot consent to a process you do not know exists.
And if that critique is unsigned, undated, carries no letterhead, no registration number, no declaration of whether the reviewer has ever seen the child, then what exactly is it? It carries the weight of professional authority with none of the responsibility of professional accountability. That should concern every single person in this field.
Now. I want to ask a question I think we avoid.
When a professional agrees to critique a report for a child they have never assessed, what is driving that decision? Is it genuine clinical concern? Professional obligation? Pressure from a commissioner or manager? Protection of a service model or a budget line? I can't answer that. But I think we need to start asking it. Because some professionals decline this role entirely. They recognise it as outside appropriate scope and they say no. Which means it is not simply what the system requires. It means a choice is being made. And where there is a choice, there is accountability.
The scope question matters too. Regardless of someone's expertise or training, it is not okay to critique another autonomous HCPC professional's clinical report. When this happened to me, I sought advice from RCOT. The advice I received was clear. No one should be judging another autonomous HCPC professional's clinical opinion. If you disagree with the findings, the appropriate route is to complete your own assessment, gather your own evidence, and reach your own conclusions. That is professional accountability. That is how standards work. What you cannot do is substitute an opinion formed at a desk, without ever seeing the child, for evidence that was built through direct clinical contact.
Independent professionals sign their reports. They declare their registration. They evidence their reasoning openly. When the process happening alongside that is unsigned, undisclosed and unaccountable, that asymmetry raises serious ethical questions.
And we also need to ask whether what a statutory professional is really commenting on is the limits of what their own service is commissioned to provide. Because those are not the same thing. A narrow commissioned service cannot redefine the boundaries of a child's need. A service that is not commissioned to assess masking, burnout, sensory trauma, demand avoidance or relational safety cannot declare those needs outside professional remit. It can only declare them outside its own model.
There is also something we need to be honest about when it comes to why professionals comply with processes that do not serve children. Most people go into these roles because they want to help. That part is real. And then they land inside a culture that has its own logic, its own language, its own version of what responsible practice looks like. Nobody tells them explicitly to protect the budget over the child. They do not need to. It is absorbed. Through what colleagues do. Through what managers say. Through what goes unchallenged in team meetings. Through the framing that gets handed down until it stops feeling like a directive and starts feeling like professional common sense.
If you have never navigated these systems as a parent, as a disabled person, as someone the system got wrong, you may have no reason to question any of that. The harm is not visible to you. You are not living it. And systems, whether deliberately or not, rely on that gap.
And then there is the question of how people make sense of what they are doing. Nobody sustains a career by telling themselves they are causing harm. So the story shifts. Protecting the budget becomes protecting the public purse. Refusing provision becomes clinical rigour. Critiquing an independent report becomes quality assurance. The language does the work of making it feel defensible. And most of the time, the person using that language genuinely believes it.
That is not an excuse. But it is how it works. And understanding how it works matters if we are ever going to change it.
This is where the double empathy problem becomes relevant beyond autism. You can only truly understand a system's harm if you have moved through it as someone it was designed to marginalise. That is a call to listen harder to the people who have that experience, including neurodivergent professionals, including families, including children, whose accounts are too often dismissed as subjective at exactly the moment they are most accurate.
Because lived experience is not weak evidence. In complex neurodivergent, trauma-informed and sensory presentations, it is often the evidence that explains the functional reality that a short assessment cannot capture. A child who masks in clinic, complies for an unfamiliar adult, looks fine in school and is suicidal at home is presenting consistently. They are showing you exactly how much it costs them to hold it together in environments that are unsafe. If we remove that account from the evidence base, we delete the child.
And clinical practice can and does move ahead of published research. Experienced clinicians working in specialist areas see longitudinal patterns before research catches up. That is recognising that professional judgement, pattern recognition, observation and functional impact are part of the evidence base. The absence of extensive research does not mean a clinical pattern does not exist. But we also need to be honest about why that research gap exists in the first place. The presentations we are talking about, autistic burnout, PDA profiles, sensory trauma, school-induced distress, shutdown, chronic invalidation, these are often unsuitable for the methodologies considered gold standard. RCTs require clean criteria, homogeneous populations, controllable variables. The children we are describing do not fit that mould. Which means the most complex, most affected, most underserved presentations are also the least likely to generate the kind of research that the system then demands before it will act. The absence of evidence may sometimes tell us as much about the limits of the research infrastructure as it does about the clinical reality.
There is a public purse argument and it deserves to be made properly. Families self-fund independent assessments because statutory services cannot assess quickly enough, deeply enough, or in ways that capture actual functional need. They have in many cases already saved the public purse. So when scarce statutory clinical hours are then spent critiquing, undermining or duplicating that assessment while other children sit on waiting lists, that is cost transfer. To families. To schools. To CAMHS. To tribunals. To the child's mental health and education. But the cost does not stop there. A child who does not get the right support at the right time does not disappear from public spending. They grow up. They reach adult mental health services, adult social care, welfare systems, housing support, employment services, emergency healthcare, criminal justice.
And it is not only the child. Parents fighting for appropriate support frequently exit the workforce, develop their own mental and physical health conditions, require their own NHS input, face relationship breakdown, and become reliant on the very welfare systems the LA claimed to be protecting.
The cost of unmet childhood need is not absorbed. It is deferred, multiplied, and distributed across every public system that child and their family will ever encounter, across their entire lifetime. Protecting one budget line in one financial year is not public purse protection. It may be one of the most expensive decisions a system can make, paid for slowly, by everyone, over decades.
And for neurodivergent professionals specifically, hidden critique processes, last minute challenges, unsigned opinions, absence of right of reply, adversarial communication, these do not land as administrative inconvenience. They land as hypervigilance, distress, cognitive load and trauma. Safe working conditions are not a privilege that stops applying when someone is self-employed or working in the private sector. And when the conduct itself, the lack of transparency, the exclusion, the professional undermining would raise questions about bullying, harassment or unsafe working practices in other contexts, we need to be honest about what it is.
A system with a legal duty to support disabled people cannot simultaneously create conditions that make it impossible for disabled professionals to work safely. That is not inconsistency. It is the system revealing exactly where disabled people sit in its priorities, whether they are five years old or forty five, whether they are the child in the report or the professional who wrote it.
For many of us, independent practice is the only way to remain in the profession without becoming too unwell to serve the children who need us. Undermining that route does not only harm us. It harms every child who depends on that specialist work. And, ironically, the public purse too.
I am expected to practise to professional standards.
I am entitled to be treated through professional standards.
Speaking up about systemic practice feels risky. Most of us know that. We have seen what can happen to people who raise their heads above the parapet, and that fear is one of the main reasons this pattern has been allowed to continue. Silence is an effective tool of a system that benefits from it.
What is the cost of staying quiet. Each case stays isolated. The pattern stays invisible. And the practice continues because there is no collective body of evidence large enough to demand a response.
The SEND wall is getting higher, and I know others are feeling it too.
Routes that used to exist are being closed down, narrowed, or made almost impossible to navigate. Whether that is deliberate or structural, the effect is the same: children are waiting longer, families are fighting harder, and it is becoming increasingly difficult to get anything meaningful through.
Professionals across OT, SLT, EP, psychology, advocacy, education and SEND law need to start documenting this collectively. Disciplined, detailed, cross-disciplinary evidence that maps this pattern nationally and is too broad to be dismissed as individual grievance.
A local authority has asked an NHS SLT to critique my report and once again, they have said I am talking outside my remit. Why? because I discuss the effects of trauma in my report and say the child needs a trauma-informed approach. Apparently trauma has nothing to do with language and communication!!!!
One of the biggest misunderstandings is the belief that trauma only affects behaviour. It doesn't. Trauma affects communication. I cannot do my job properly without a good working knowledge of trauma.
When a child feels unsafe, threatened, misunderstood or overwhelmed, the brain prioritises survival over learning. The parts of the brain responsible for language, problem-solving, emotional regulation and flexible thinking become much harder to access.
This means a child may:
🔹 Hear your words but struggle to process what they mean.
🔹 Know the answer but be unable to find the words.
🔹 Say "I don't know" because they genuinely can't explain.
🔹 Become more literal in their understanding.
🔹 Struggle to follow instructions they could manage perfectly yesterday.
🔹 Shut down, melt down or lose speech altogether.
Ironically, the moment we most want a child to communicate is often the moment they are least able to do so. For autistic children, this can be even more pronounced. Anxiety, sensory overload, social uncertainty and previous experiences of being misunderstood all add to the cognitive load. A child may appear oppositional, rude, avoidant or disengaged when in reality their nervous system is simply overwhelmed.
Trauma isn't always one dramatic event. Sometimes trauma is years of being blamed for a disability nobody recognised, as the boy I was writing about. Sometimes it's constantly being told you're overreacting. Sometimes it's being punished for behaviours that were actually signs of distress. Sometimes it's spending every day trying desperately to fit into an environment that doesn't understand you.
The question we should ask isn't "What's wrong with this child?"
It's "What has happened to this child, and what is their nervous system trying to tell us?"
Communication can only flourish when children feel safe.
Safety before speech. Every time.
I have written back to say I am in a privileged position of having a great deal of experience and training in trauma so I am obviously coming from a different angle to someone with less experience and training.
