Please help me raise safeguarding issue re ROGD teen autism assessment

[Cantunseeit]

Hello you lovely vipers. I'm a long(ish)-term lurker and parent of a ROGD teen. I rarely post much here but read everything! You are my sanity in a nutso world and I value your knowledge and straight-talking immensely.

Now I need your help please. My ROGD DD was referred by NHS to a private provider of autism assessments under the Right to Choose scheme as she was 17 and would have aged out of the NHS route way before getting anywhere near the top of the waiting list.

When her appointment came round I found that the personal details section of the profile questionnaire included questions about gender identity, pronouns and alternative names and she had gone to town with it all! As part of her assessment I had to do a three hour interview about DD's early childhood. All had to be done using opposite sex pronouns and her fake name because "policy".

I am really angry and want to raise this as a safeguarding issue. I've drafted a letter but I'm not happy with it - difficult when emotions running high. I'd love it to be much more forensic and hoping some of you experts can lend a hand.

I will paste the first draft into the next post and fingers crossed some co-creators will be along ... 🙏

Here's my first draft:

Safeguarding issue / complaint
My daughter was assessed for autism by [name of organisation] under the NHS’s Right To Choose scheme. As part of the pre-assessment data gathering, she was asked for her: gender identity, preferred pronouns and preferred name. This information has no bearing on whether or not she is autistic.

As my daughter is 17 she completed her own online profile and included an alternative name, gender identity and pronouns. The assessor insisted on using my daughter’s preferred name and opposite sex pronouns throughout the parental interview. She stated that it was [name of organisation]’s policy to do this and if she did not use them in the interview and in the subsequent report there would be repercussions.

This presents a safeguarding issue for vulnerable and suggestible young people by encouraging them to self-ID as the opposite sex without proper assessment and be affirmed in this by professionals. It also contradicts NHS England’s commitment to the Cass Review, which is clear about the significance of social transition: “Social transition may not be thought of as an intervention or treatment, because it is not something that happens in a healthcare setting and it is within the agency of an adolescent to do for themselves. However, in an NHS setting it is important to view it as an active intervention because it may have significant effects on the child or young person in terms of their psychological functioning and longer-term outcomes.” [1]

I believe this experience was to the detriment of my daughter who has no diagnosis of gender dysphoria and had never before been referred to with opposite sex pronouns by a professional. Furthermore, she has not changed her legal name – yet the assessment report will be for and about a person who does not legally exist.

The approach is also illogical for the parental interview as all questions related to my daughter’s early childhood, when she exclusively used her legal name and everyone used female pronouns for her. The cognitive dissonance created by the process will not have helped provide the information needed for the assessment.

As [name of org] was carrying out the assessment on behalf of the NHS I had expected that its practices would be consistent with the NHS. I will be bringing this to the attention of my GP practice who referred by and suggesting they cease further referrals until they have received confirmation that this practice has ended.

[1] Cass,
H. (2024). Independent review of gender identity services for children and
young people: Final report.
https://cass.independent-review.uk/home/publications/final-report/ (P. 158,
12.5)

Bloody hell - have you been in touch with Bayswater?

I think your letter is good - is it worth spelling it out further by saying something like "social transition is the first step towards medical transition which is irreversible and has been shown to cause physical and mental harm, especially when later regretted."

Your letter is good and Cass is the key documentation.

Whilst KCSIE is safeguarding specific in school settings, essentially it is repeating what Cass says and that appropriate clinical support is needed for gender questioning children. Keeping children safe in education - GOV.UK
However, your daughter, from the sounds of it, WASN'T gender questioning before this assessment, so this bit of KCSIE wouldn't apply to her.

However it also does talk about involving and including parents - which is safeguarding best practice - and I would probably point out that you were not given a choice or any input about whether or not you felt it was in your child's best interests and wellbeing to pretend she could change sex.

Was there an option to not answer the gender identity questions? If not it's enforced social transitioning - it's not just giving those as an option, it's actively suggesting children should have these things and when it's framed in that way it requires quite a high degree of critical thinking to not be carried along with it.

Given your daughter has never indicated any gender dysphoria at all before this I'd probably include a line such as 'Given my daughter has never shown any signs of gender dysphoria prior to completing this assessment and given there was no indication that the gender questions were optional nor that a lack of belief in gender was acceptable, it is difficult not to conclude that it is completing the assessment itself that has lead her to identify differently from her sex which is very troubling'

If you feel that's true of course. What does she say about it?

Honestly, you wait for years for assessment and then this happens - I don't know how you feel OP but I'd have no faith at all in any part of the assessment from people who don't see the obvious safeguarding problems for autistic children with enforced questions about gender identity.

A child or ADULT with autism would have an appropriate adult for a police interview.

It seems bizarre for there not to be a similar policy for medical appointments.

Good idea - I will build it in. Thank you

We did contact Bayswater when DD first announced she was in fact our DS several years ago but they never got back to us. Perhaps I should have another go.

Definitely try again. Good luck.

Prof Michelle Moore was describing this kind of thing as far back as 2018. I dread to think how many children have been led down this path due to this kind of thing.

Sorry OP, got confused (long day, end of half term) - so your child is gender questioning but without a diagnosis of gender dysphoria? Just ignore what i said - although the bit about parental involvement is in KCSIE and might be relevant.

Sorry, I wasn't clear in my set up. My DD definitely is / was gender questioning and the autism assessment was suggested as a helpful alternative route for her to explore why she felt different - she has several traits but not necessarily an open and shut case although several family members on the spectrum and it may be more difficult for us to spot as v used to these traits!

The first couple of years since she told us she was really a boy were pure hell - we've never affirmed and we've never used her new name or pronouns although she does use them at school (school changed without speaking to us - which turned out to be cock-up not conspiracy, which I think on balance could be worse in terms of irresponsibility). However in the last 18months there have been steady signs of desistance. That's probably why I am so furious that this has happened - although possibly an early warning that she was not necessarily moving away from the idea of being a transman but avoiding conflict at home? Sorry, oversharing now.

I don't think the questions were mandatory (she'd filled in her own profile and mine so by the time I saw it it was already a done deal). However, I can't see any need for those questions at all for this assessment. Possibly a "known as" name field but the rest is just gratuitous. There were loads of questionnaires and free-form answer boxes - it would be easy for anyone who wanted special treatment for their child to ask for it. No need for all to have to be exposed to this. Certainly no reason for me, as her parent to have to do the interview (just me and assessor) using new name and wrong pronouns. Obviously I didn't go along with this so it was a most bizarre conversation

Could you include this doctor’s speech? He gives concise and easy to understand reasons for the link between autism and gender ideology.

I think your proposed response is a good one, and the situation you describe sounds like the assessor is keener to show how terribly pro-gender they are instead of doing a professional DSM V assessment.

To answer some earlier points, the assessor needs to build rapport with the young person and so being aware of pronoun preferences can be helpful. During the assessment with the YP, only the truly captured would refer to the individual by anything other than "you" though.

The interview (ADIR or similar) with the parents to establish the background in childhood, would usually follow the parent's lead re names and pronouns.

Where there is a discrepancy between the child & parental naming/pronoun preferences. I would expect this to be acknowledged in the report and a way forward agreed, for example, Belle has asked to be known as Bob for this report. Belle was brought to assessment by their parents who continue to use Belle and use female pronouns.

It is preferable for people being assessed to be seen for at least part of the assessment without parents/carers however. It reduces parental influence on a child's answers and behaviours and provides space for safeguarding disclosures if appropriate. Parents reluctant to allow children to be seen alone can be a red flag, though is often anxiety (which in itself may be a reason for the child's traits).

Your letter is good; Cass really should be the end of it. I'm so angry on your behalf; all organisations working with young people ought to kiss Cass' feet and be grateful that they now have black on white guidance that spells out that social transition can be harmful.
Are you addressing the letter to your NHS Trust or to the organisation which provided the assessment? I'd go for both.
DD1(14) is autistic and this is easily in the top 5 of things which make me so afraid for her.

Your letter is good.

Not entirely your situation, but for 18+, NHS Service specification: Gender Identity Services for Adults (Appendix A) available at https://www.england.nhs.uk/publication/service-specification-gender-identity-services-for-adults-non-surgical-interventions/ says to explore co-morbidities (such as autism) first, prior to referral for gender dysphoria. It's bizarre to do two assessments at once, or assume/dream-up that gender dysphoria assessment is already done. What a mess.

Service specification for children was updated after Cass review, I've not read it in full but you may wish to have a look to see if your experience with this provider contradicts anything here: Service specification: national referral support service for specialist service for children and young people with gender incongruence

Good luck!

Just sending solidarity. I’m mum to autistic DS fortunately preteen and so far this hasn’t been something we’ve had to navigate but I do appreciate the complexities of parenting an ND child. We’re currently trying to sort through him having an ADHD assessment and trying to find someone who can expertly work through what is ASD vs what might be ADHD feels like a maze.

I think your letter is very good with salient points covered. I would address it to the head of the service and ask for a copy of their official policy on this. I would also ask in the letter if it is their policy to go against the recommendation of the Cass report how this supports what the NHS accepts as best practice? In what evidence is their approach based if not Cass? I think I would also reference reporting this to your ICB. The RTC pathway is complicated because it’s not a straightforward commissioning process which means your local ICB may not be the commissioned- it might be an ICB in a different area- but your ICB will (should) want to know about this.

Ultimately I would think about what you also want to have as the outcome of this for you and your dd. Do you want to re do the assessment with a different assessor? Continue on from where you are but do the rest with a different person or start the process with a different provider?

Thanks all. I'm going to wait for the final report to come in before taking any action. A long wait to get to this point so hopefully will at least end up with a conclusion to help DD move on - even if paperwork is all in the wrong name.

I will definitely also write to the NHS GP practice who made the referral and cc them in the letter to the provider.

In terms of desired outcome, I'd love to force some thought and dot joining to happen to ensure more weight is given to asking about pronouns and gender identity in future. It leads to really serious real world consequences for children and young people and it is really not kind at all. All the professionals I've come across so far (mostly at school) seem in complete denial about this.

It’s easy to be breezy about it when it's not your child's health and future at stake.

My advice would be not to accept paperwork in the wrong name, and to act now. It's very hard to get off the trans train, once you're on it. Ask them to correct the name because gender dysphoria assessment / diagnosis never happened and it is entirely inappropriate. With any complaints you make, request response in writing, which will mean their legal team will have be involved and basically it will be taken more seriously.

Schools think short term (about doing their lessons in peace) and deny the obvious and dangerous link between social transitioning and medicalisation, schools are not on your side.

You can join Bayswater, Our Duty and/or Free Speech Union for support.

Just to add, when you get the report, you may also wish to ask for copies of any school reports that were submitted for the assessment if you haven't already seen them.

I hope the assessment provides some answers for you.

You poor poor things. What a dreadful situation. But just to echo F1rstDo's response: if you can find a way, please do try to get the report in the right name. That diagnosis letter lasts a long long time, and will outlast this phase. Perhaps a way of tackling this for now is to get onto the assessors on Monday, and ask that the report be about your child's legal name. Save your brilliant letter for another day, just get the diagnosis letter in her name as on her birth certificate for now.
I'm outraged by the way you've been treated, but that diagnosis letter is gold dust and is the key to opening future doors.

My son was diagnosed twelve years ago, before any of this nonsense was on any of the paperwork, and is now at university. His diagnosis letter from primary school is still being trotted out. I don't know about what happens if names don't match but it's not a risk worth taking at this stage. Par example, I suspect my son is currently having difficulty because of telling university that he goes by a girl name, and I suspect that some Disabled Student's Allowance-related paperwork has gone awry as a result... I'm just biting my tongue and letting him learn the hard way: he's an adult, I've made it clear which bits of his admin I'm prepared to do, this is on him until he's prepared to ask for my help. God but it's hard letting him dig a hole though. 😬🤐

Good luck OP. Rooting for you. 💪

I've been thinking about your post and worrying that I am being naïve and wanted to check whether I've understood correctly (or just being paranoid).

DD was referred for an autism assessment and that is what the report should cover - AFAIK, the assessment / report will not cover anything else (not even ADHD which both DD's assessor and the one that asked me about early childhood presentation asked if she was also going to be assessed for). Are you saying that her answers on her profile questions set could trigger further intervention for gender questioning/dysmorphia without DD or I requesting it via GP?

I was concerned that paperwork would be in the wrong name and that including quite a lot of questions about alternative names, genders, pronouns etc was effectively grooming, particularly for potentially ND kids. Should I be more worried than I already am about implications for DD?

Sorry if I am indeed being paranoid (normal state for me for last three and a half years)

Referral to a gender clinic can’t happen without someone asking for it, but it is common for trans identified teens to ask for a referral without parental knowledge. A change of name will make it easier to do so because it evidences social transitioning. Also, as you noted by referring to Cass Review, change of name is a serious psychological intervention and not a neutral act. The benefits of social transitioning are not proven, and the risks are significant. You can DM me if it helps. You are not paranoid.

I didn’t realise when I typed the above that private messaging is temporarily disabled. www.mumsnet.com/talk/_chat/5281430-is-private-messaging-disabled-or-is-it-just-me

I don’t think a RTC provider can do a referral onto a gender clinic because it’s not within their scope.
As a general rule Secondary Care (ie non GPs) can and should organise onward referrals but only if the thing they are referring for is what the person was referred to them with. For example, a patient could be referred to a gynaecologist with pelvic pain. The gynaecologist assesses and thinks it’s not gynae related but could be a gastrointestinal problem causing the pain. They should then refer the patient to the gastroenterologist.
It’s a bit more complicated around who can do what when it’s RTC but I think even if they thought your DD difficulties were due to gender dysphoria not ASD they’re not part of the NHS in the same way as the NHS ASD service is so I don’t think they would refer on and TBH it’s hard enough getting hospitals to do the onward referrals when it is clear cut and straightforward!
The biggest issue you will have is sadly around your DD’s age as she’s likely to be given a lot of autonomy over her healthcare now even though technically she’s not yet an adult.