Identifying Parents with Cognitive Difficulties: How Child Welfare Services Enable Timely and Appropriate Support

Abstract

Parents with cognitive difficulties are consistently overrepresented in child welfare proceedings, yet such difficulties in themselves are poor predictors of parenting capacity. Research shows that many parents succeed when provided with tailored support, making identification crucial for understanding parental capacity and whether interventions are adapted to individual needs. In this study, cognitive difficulties are understood broadly, encompassing challenges with memory, learning, information processing, and executive functioning, whether linked to formal diagnoses or arising from psychosocial strain. Families in contact with child welfare services often present with multiple and overlapping concerns, such as poverty, trauma, or diffuse forms of neglect, which can obscure or mimic cognitive difficulties. While previous studies have documented prevalence and outcomes, little is known about how professionals identify such difficulties in everyday practice. This study addresses this gap through qualitative interviews with 15 professionals from the Norwegian Child Welfare Service, which were analyzed thematically using an inductive approach. The analysis identified three themes: identification shaped by definitions, identification through relational insights, and identification through patterns of response. Identification rarely followed formal or standardized procedures. Instead, it unfolded gradually through accumulated observations, relational engagement, and professional reflection. The findings highlight how the absence of systematic routines and the delays that result from trial-and-error approaches shape opportunities for adequate support and influence assessments of both parental capacity and the child’s situation.

1. Introduction

This study aims to explore how parents with cognitive difficulties are identified when they come into contact with child welfare services. Research indicates that these parents are overrepresented in child protection proceedings (Cleaver and Nicholson 2007; Llewellyn et al. 2003; Tøssebro et al. 2017) and that suspected or confirmed difficulties are documented in a notable proportion of cases leading to child removal or court-ordered supervision (McConnell et al. 2011). At the same time, studies show that cognitive difficulties alone are not strong predictors of parenting capacity and that many parents succeed in their caregiving role when provided with appropriate support (Coren et al. 2011; Feldman 2002; Feldman and Aunos 2020; Gaskin et al. 2012; Wade et al. 2008). This makes identification crucial, as it shapes how parental capacity is perceived and whether interventions are adapted to individual needs (Norlin and Randell 2022). Here, parental capacity refers to the ability to provide sufficiently good care over time, and should not be confused with parental ability, which relates to short-term caregiving under specific conditions (Conley 2003).

Families seldom come into contact with child welfare services for a single reason. Reports typically describe a combination of concerns related to the child’s development, parental caregiving, and broader family or environmental conditions. Children from low-income families are consistently overrepresented (Drange et al. 2021; Kojan and Storhaug 2021), and similar patterns are found among parents who themselves received child welfare support during childhood (Kojan and Storhaug 2021). Histories of maltreatment and trauma, including PTSD-related symptoms such as emotional detachment, restricted affect, and reduced responsiveness, are also common (De Bellis and Keshavan 2003; De Bellis 2001). Parental substance abuse and mental health problems are frequently reported, but rarely in isolation. Many families also struggle with high levels of conflict, neglect, or physical abuse (Kojan and Storhaug 2021). In addition, more diffuse concerns, such as emotional unavailability or emotional neglect, have gained increasing attention in recent years (Drange et al. 2021; Kojan and Storhaug 2021). These challenges are often interconnected and reflect long-standing strain and instability in the caregiving environment (Madigan et al. 2025). Such complexity may conceal or interact with cognitive difficulties, and recognition of these challenges is crucial to shaping support and interventions (Coren et al. 2011; Feldman and Aunos 2020; Norlin and Randell 2022). This study asks: How do professionals identify parents with cognitive difficulties within child protection services?

1.1. Identifying Parents with Cognitive Difficulties

According to Norlin and Randell (2022), parental capacity is one of the main aspects assessed by child welfare workers during their interactions with families. Evaluating a parent’s ability to meet their child’s needs typically involves what is referred to as a parental capacity assessment. In this process, identifying cognitive challenges becomes both important and demanding, as it shapes how parental capacity is understood and whether support can be appropriately tailored (Norlin and Randell 2022). Parents with cognitive difficulties represent a diverse group, ranging from those with mild learning disabilities to more complex impairments (Booth et al. 2005a, 2005b; Llewellyn et al. 2010). Cognitive function refers to a set of brain-based skills needed for tasks of varying difficulty (Angevaren et al. 2008), including perception, learning, memory, reasoning, and problem-solving. In child protection practice, identifying such difficulties requires both careful judgment and ethical sensitivity (McConnell and Llewellyn 2002; Sigurjónsdóttir and Rice 2017). Recommendations emphasize the importance of comprehensive assessments that address physical and mental health, parental stress, parenting style, and everyday caregiving skills (Aunos et al. 2008).

Cognitive difficulties can affect parents’ ability to process information, follow complex instructions, or engage in long-term planning, factors that influence parenting capacity and shape interactions with child protection professionals (Cleaver and Nicholson 2007; Feldman 2002). Professionals often become aware of such challenges through repeated interactions and everyday observations. However, how this information is interpreted depends on theoretical frameworks, professional biases, institutional guidelines, and the quality of professional–parent relationships. Identification may therefore hinge on professionals’ interpretations of parents’ communication and follow-up, shaped by institutional expectations, structural time constraints, and personal experiences (McConnell et al. 2011; Sigurjónsdóttir and Rice 2017). Reduced cognitive and executive function appears in many neurodevelopmental conditions, such as Tourette syndrome, fetal alcohol syndrome, ADHD, and autism (Carlson et al. 2013). However, cognitive difficulties are not always clinically defined. They may also emerge as consequences of long-standing psychosocial strain or adverse life circumstances (Feldman and Aunos 2020; McConnell and Llewellyn 2002). As a result, difficulties often go unrecognized, especially when parents develop compensatory strategies, mask their struggles, or when assessments rely primarily on professional discretion (Booth et al. 2005a, 2005b; Llewellyn et al. 2010).

In such cases, professional discretion functions as a form of situated judgment under conditions of uncertainty (Lipsky 1980; Molander 2016). According to Lipsky (1980), child welfare workers act as street-level bureaucrats who must navigate tensions between institutional rules, limited resources, and family needs. Molander (2016) similarly argues that discretion is shaped by normative and institutional constraints, while also enabling flexible responses to individual situations. In the absence of formal procedures, discretion becomes a central mechanism through which cognitive difficulties are either recognized or overlooked, depending on how parental behaviors are interpreted, prioritized, and made legible in professional practice (Booth et al. 2005a, 2005b; Norlin and Randell 2022).

1.2. Previous Research

Previous research on parents with cognitive difficulties has focused primarily on two subgroups: those with intellectual disabilities (ID) and those described as having cognitive impairment (CI), a broader category encompassing various learning and neurodevelopmental conditions (Booth et al. 2005a, 2005b; Llewellyn et al. 2010; Tøssebro et al. 2014). This body of work also includes the development and use of instruments designed to assess parents with intellectual disabilities, such as Family Environment Resources and Disability Inventory (FERDI; McConnell et al. 2021), the Structured Assessment of Parenting in Intellectual Disability (SAPID; Zeitlin et al. 2020), and tools informed by social information processing models (Azar et al. 2012), and program evaluations such as the Parenting Young Children intervention (McHugh and Starke 2020). While these categories differ in scope and diagnostic clarity, both highlight enduring cognitive challenges that may affect parenting, including difficulties with learning, reasoning, memory, and problem-solving (Booth et al. 2005a, 2005b; Feldman 2002).

A recurring theme in this research is the tension between prevalence and predictive value. On the one hand, nonrecognition has been identified as a barrier to providing inclusive services (McConnell et al. 2021). On the other hand, studies show that mild intellectual disability and borderline intellectual functioning are poor predictors of parenting capacity or risk of maltreatment (Budd and Greenspan 1984; Dowdney and Skuse 1993; IASSID Special Interest Research Group on Parents and Parenting with Intellectual Disabilities 2008; Lightfoot et al. 2011; McConnell et al. 2021). Despite this, parents with intellectual disabilities remain markedly overrepresented in out-of-home care proceedings across high-income countries, with estimates suggesting that up to 20% of children entering care are removed from such parents (Booth et al. 2005a; McConnell et al. 2011, 2021; Tøssebro et al. 2017). This overrepresentation has been linked to systemic barriers and limited access to appropriate services (Aunos and Feldman 2007; Aunos and Pacheco 2013; Booth et al. 2005b; Feldman and Tahir 2016; Koolen et al. 2020; Slayter and Jensen 2019), placing parents at a systematic disadvantage in retaining custody (Booth et al. 2005a, 2005b; McConnell et al. 2021).

Less attention has been given to how cognitive difficulties are actually identified in practice. Many parents lack a formal diagnosis, and difficulties may instead emerge from or be reinforced by long-standing psychosocial strain and challenging life circumstances. Cognitive difficulties are therefore not to be understood as static, but rather as varying across time and context (Feldman and Aunos 2020; McConnell and Llewellyn 2002). Existing studies indicate that recognition often occurs only after concerns about parenting arise (McConnell and Llewellyn 2002; Sigurjónsdóttir and Rice 2017), typically late in the child protection process, which limits opportunities for preventive intervention (Booth et al. 2005a, 2005b; McConnell et al. 2011). In some cases, delayed recognition may lead to children being placed in public care, and parents report feelings of insecurity and inadequacy when tailored support has been lacking (Adolfsson et al. 2023). Assessments of potential future risk also remain contested, as current functioning does not necessarily predict future caregiving capacity (Choate and Engstrom 2014). Research further indicates that assessing parental capacity in these situations is complex, as cognitive difficulties are often situational rather than diagnostic and can fluctuate across different contexts. Social workers tend to assess capacity in relation to the child’s needs, which may obscure or delay recognition of underlying challenges (Norlin and Randell 2022). Parents with cognitive difficulties are also less likely to be referred to family preservation services, even when support needs are acknowledged (Slayter and Jensen 2019). One explanation is that professionals may conflate cognitive difficulties with static or irreparable parenting deficits (Booth et al. 2005a, 2005b), particularly when poverty, trauma, or poor health are interpreted as evidence of incapacity (Feldman and Aunos 2010; Sigurjónsdóttir and Rice 2017). While these studies highlight key challenges for parents and professionals, limited research has examined how processes of identification unfold in child protection practice.

2. Method

The study employed an exploratory, interpretive qualitative design aimed at understanding how professionals identify parents experiencing cognitive challenges within the context of child welfare practice. This approach aligns with the interpretivist and constructivist paradigms that underpin qualitative inquiry (Creswell and Poth 2018; Denzin and Lincoln 2011; Gonzalez and Forister 2020). It is based on qualitative interviews with 15 professionals employed in municipal child welfare services in Norway. Participants were recruited through an open invitation distributed to several child welfare services. The invitation described the purpose of the study and specified that participation required experience from cases involving parents with cognitive difficulties. This criterion ensured that the sample included professionals who had direct and recent experience with the study phenomenon. The recruitment aimed to achieve variation in geographic location (from rural areas to large cities), municipality size, and organizational models. All participants who volunteered were women, reflecting the typical gender composition of the child welfare workforce in Norway. They were experienced in family support, supervision, and counseling, and most held casework responsibilities at the time of the interview. Their professional background was in social work, primarily as child welfare workers or social workers, with some also having experience from early childhood education or interdisciplinary services.

All participants held a bachelor’s degree in child welfare, social work, or a related field. Several had completed master’s degrees or postgraduate training in areas such as family therapy, child development, mental health and substance use, trauma-informed care, or minority perspectives. Many were also certified in evidence-based parenting programs, including Marte Meo, Circle of Security – Parenting (COS-P), International Child Development Program (ICDP), and Parent Management Training–Oregon Model (PMTO). All had also completed training in the Parenting Young Children (PYC) program, a structured, evidence-informed approach developed for work with parents with cognitive difficulties. Their professional background provided them with both theoretical insight and practical experience concerning how cognitive challenges may influence parenting capacity and the conditions for change and adaptation in guidance processes.

2.1. Data Collection and Analysis

Semi-structured interviews were conducted using a short thematic guide designed to promote reflection and elaboration. This approach was considered well suited to exploring professionals’ interpretive reasoning and experience-based knowledge, as it allowed participants to elaborate on their practices and perspectives while maintaining a clear focus on the study’s topic (Brinkmann and Kvale 2014; Rubin and Rubin 2012). The guide consisted of a few open questions that invited participants to reflect on their own experiences and describe situations from practice. Its open structure ensured that the conversations remained focused while allowing participants to elaborate freely on aspects they considered relevant. It encouraged participants to describe how, in their everyday work and contact with children and families, they identify and assess parents with cognitive difficulties. Follow-up questions were used to probe for concrete examples, clarify meanings, and capture the reasoning behind professional judgments. All interviews were conducted by the authors, digitally with both audio and video, to ensure accessibility for participants across different regions and to accommodate their work schedules. The digital format allowed for interaction comparable to in-person interviews and was well-suited to participants’ professional routines. Each interview lasted between 60 and 90 minutes, with a median duration of approximately 70 minutes. All interviews were recorded with consent, transcribed verbatim, and anonymized prior to analysis.

The transcripts were then analyzed thematically, following an inductive approach inspired by Braun and Clarke (2021). This approach was chosen because it provides a flexible yet systematic framework for identifying and interpreting patterns of meaning across participants’ accounts and is particularly suited to exploring experiential and interpretive processes in professional practice. The transcripts were read repeatedly to ensure familiarity, and initial codes were generated through an open and iterative process. Coding was conducted collaboratively to enhance reflexivity and consistency. As the analysis developed, attention moved between data extracts, codes, and potential patterns of meaning. Through this iterative process, related codes were brought together and organized into initial candidate themes that captured shared meanings across the dataset. These candidate themes were reviewed and refined through discussion and comparison until three overarching themes were developed, each representing a distinct but interconnected pattern of meaning in how professionals described the identification of parents with cognitive difficulties: (1) Identification shaped by definitions; (2) Identification through relational insights; (3) Identification through patterns of response. Only patterns that appeared across several interviews were retained and developed further; single or idiosyncratic accounts were considered in relation to the broader material but were not included as separate themes.

2.2. Ethical Considerations

The study was registered and pre-approved by SIKT (Norwegian Agency for Shared Services in Education and Research; no. 551902) and conducted in line with the guidelines of the Norwegian National Research Ethics Committee (NESH). Participation was voluntary, and all participants received written and verbal information about the project, including details on confidentiality, the secure handling of data, and their right to withdraw at any time. All participants provided written informed consent prior to the interviews. Participants were asked to reflect on their professional experiences in general terms, and the interviews were conducted with care to avoid disclosing identifiable information about third parties. Data were handled and stored in accordance with the General Data Protection Regulation (GDPR) as implemented in the Norwegian Personal Data Act, and followed SIKT’s approved data management protocol for research projects. The reporting of methods and findings adheres to the Standards for Reporting Qualitative Research (SRQR; O’Brien et al. 2014).

3. Results

Across the dataset, participants’ descriptions were largely consistent in how cognitive difficulties were recognised and interpreted in child welfare practice. Although the sample included professionals from services located in municipalities of different sizes, organisational models, and geographic regions, the analysis did not reveal systematic differences in their accounts. The following presentation, therefore, focuses on the main patterns of meaning identified across all interviews.

Three overarching themes capture how professionals described the identification of parents with cognitive difficulties in their everyday work: (1) Identification shaped by definitions, (2) Identification through relational insights, and (3) Identification through patterns of response. These themes represent different yet interconnected dimensions of the identification process, moving from how cognitive difficulties are conceptually framed and defined, to how recognition develops through professionals’ relational engagement and practice with families, and finally to how understanding is reinforced through accumulated observation and experience over time.

3.1. Identification Shaped by Definitions

The first theme identified through the analysis shows how professionals’ understanding of cognitive difficulties developed over time. Rather than relying on formal assessments or diagnostic categories, they described a broader, more functional and relational approach, where difficulties became visible through parents’ everyday responsibilities and interactions with support. Across the interviews, informants emphasized that cognitive difficulties were not perceived as fixed traits, but as something that became noticeable over time, through repeated interactions and in response to how parents handled the everyday demands of caregiving.

Many informants reflected how their initial assumptions had linked cognitive difficulties to low intellectual capacity or developmental disability. Over time, this view had expanded to a broader range of functional problems related to memory, stress regulation, or executive functioning:

Previously, when I thought of cognitive difficulties, it was very easy to think someone was in the lower range, almost approaching a kind of intellectual impairment. However, now I am more likely to think about PTSD, or a sort of temporary cognitive reduction, based on their life situation.

[Informant 1; PTSD refers here to post-traumatic stress disorder]

It is not necessary for a present diagnosis. If they cannot manage to follow routines or structure their everyday life, then we must take that seriously, even if they seem very resourceful on the surface.

[Informant 12]

These reflections illustrate how the term itself has evolved in practice, from a narrow clinical label to a broader category that helps professionals identify when parents struggle to process, retain, or generalize care and support. Some explicitly described cognitive difficulties as a kind of ‘umbrella’ concept used to capture a diverse range of functional limitations. This expansion also included those with a foreign language, who often faced additional cognitive strain in trying to follow up digital communication or school requirements in a second language.

Several informants describe how they became concerned when repeated efforts at supervision and support failed to yield meaningful changes in parental behavior. Even when parents appeared motivated and cooperative, the same issues often returned again and again:

They nod and agree with everything. However, you returned, and nothing has changed. It is as if they cannot translate our discussion into action.

[Informant 4]

It is not that they do not want to, but they are unable to hold onto what we have said. We can go through the same thing over and over again, and it is like starting from scratch each time.

[Informant 13]

These patterns raised questions not about opposition or attitude, but more about profound difficulties with learning, memory, or transfer. When verbal agreements were not followed through with concrete change, informants began to suspect that the challenges were due to information processing rather than a lack of motivation. In some cases, this realization came gradually, after multiple failed interventions.

Several informants pointed out that stress, trauma, and chaos in daily life could either mask or mimic cognitive difficulties. Even resourceful parents might struggle to organize their time, remember conversations, or implement advice when overwhelmed:

It is not always the case that they are cognitively weak. It can be everything else they carry, the chaos, the trauma, all the things happening at once. Moreover, that makes it hard to absorb anything new.

[Informant 9]

They might come across as very competent in a meeting. However, when we are at their home, it is a different story; there is no follow-through. Things are not in place. Then you start to understand what is happening.

[Informant 5]

I have worked with several parents who were depressed or struggling mentally. Moreover, when stress builds up, cognitive functions such as memory, learning, and even basic planning are impaired. It is like they are underwater.

[Informant 14]

These insights support a context-sensitive approach to identification. What might first appear as a low cognitive capacity could reflect a state of overload or emotional hypo-regulation. Informants described a need to weigh and consider whether the observed difficulties were persistent or temporary, and to tailor their interpretation accordingly. In some cases, they noted that even those with strong verbal skills were very concrete or literal in practice, a trait that only became apparent through persistent work.

The identification of cognitive difficulties was rarely a sudden occurrence, as described by many informants. Instead, it was something they came to understand through a slow process, ongoing collaboration, repeated home visits, and consistent comparison between intention and outcome:

At first, it was not easy to spot. It is something you would grow into after working with them over time. You start to feel that something is not settling the way it should.

[Informant 10]

It is not one conversation that tells you. It is a fact that you are not getting any development over time. That is when you start to connect the dots.

[Informant 6]

This emphasizes that identification was not a technical judgment, but a relational and cumulative one. Informants relied on their accessibility to the parent, as well as the repeated interactions that allowed them to test assumptions and observe patterns over time. According to several informants, the identification of cognitive difficulties was rarely based on a single exploration, as it emerged when the usual strategies failed.

In addition to describing cognitive difficulties in terms of executive function and daily parental management, several informants also reflected on how the situation itself, particularly in contact with child protection, could temporarily affect a parent’s cognitive capacity. Some reflected on how contact with child welfare services may lead to increased stress and anxiety, which could interfere with how parents processed and retained information:

Even if people are not cognitively impaired when they come to a meeting with us in child welfare, they become that way because they are so anxious sitting in front of us.

[Informant 14]

Just by meeting us, they often go into survival mode […] That is when guidance is ineffective.

[Informant 13]

These reflections led some informants to suggest that cognitive strain should be expected, at least to some extent, in parents who are involved with child protective services. They described how the life situations that bring families into contact with the system are often so conflicted that reduced ability to process, memorize, or act on information is likely, even at the first encounter. However, they also noted that this understanding was rarely reflected in practice. According to their accounts, expectations and assessments of cognitive functioning were still usually based on other indicators, such as verbal ability, educational background, presentation in meetings, or prior documentation.

3.2. Identification Through Relational Insights

The second theme identified through the analysis highlights how relational insights shaped recognition of cognitive difficulties. Instead of emerging from formal assessments or single observations, insight developed gradually through relationships built over time, across settings, and through repeated encounters with families. Familiarity and proximity to families gave professionals access to details that might otherwise go unnoticed: a lack of change, a pattern of confusion, or an unexpected inconsistency between what was said and what was done. These were not de-contextual conclusions but responses to interactions that developed relations and allowed for expanded observations:

Concerns do not arise from a single issue; instead, they stem from multiple issues. It is when you have been in contact for a while and you get a feeling that something is not connecting the way it should.

[Informant 6]

If I have worked with them a bit, I start to see patterns. Forgetting things, repeating the same questions, or not following up after they seemed to understand.

[Informant 11]

In this context, patterns refer to gradual recognition that develops through relational familiarity, rather than to systematic behavioural regularities emphasized in more formal observations. These patterns became more noticeable in the context of relational work, where professionals had the opportunity to communicate with parents over time and in various situations. What emerged was often subtle: repeated misunderstandings, trouble recalling previous conversations, or signs that verbal agreements were not being translated into practical skills. There was not much emphasis on diagnostics, but instead on directing attention to what did not change and reflecting on why the change did not occur.

Several informants describe how parental handling can differ distinctly between structured, formal meetings and informal settings. While many parents presented as articulate and cooperative during office appointments, their struggles often became more apparent in everyday environments, especially during home visits:

At the office, they get along well. However, when we visit them at home, nothing is in place. No routines. No follow-up. That is when it starts to make more sense.

[Informant 4]

When I am in their home, I notice things I miss in meetings. Like how easily they lose track of what we have talked about, or how tasks we agreed on have not begun.

[Informant 15]

This contrast made home visits a key element in the identification process. It allowed professionals to move beyond verbal impressions and observe how parents functioned in their everyday lives, without the need for structure or prompting. Difficulties that were hidden in conversation often surfaced in the chaos or stillness of the home, such as missing routines, forgotten plans, or overwhelming environments. For many, these encounters confirmed what they already suspected but had been unable to verify.

Several of the informants also highlight how their identification was influenced by their parents’ responses to their supervision and support over time. Several informants explained it was after multiple rounds of supervision, often customized and recurrent, that the possibility of cognitive difficulties became a relevant consideration. The absence of change in response to guidance was therefore interpreted not as a lack of motivation, but as an observation that initiated professional reflection on whether cognitive difficulties might be present. When repeated supervision and tailored guidance did not lead to visible change, professionals began to reflect on whether learning or processing challenges might be contributing to the persistent difficulties observed:

We explain things again and again, but it does not seem to sink in. Moreover, that is when I stop thinking it is just stress or a misunderstanding; something else is going on.

[Informant 10]

We try different approaches, give reminders, and make it more accessible. However, when we still do not see progress, it is as if something is getting in the way of learning.

[Informant 14]

In these cases, it was not the presence of a particular symptom that led to identification, but the absence of expected development. Professionals described how they observed for change, and when it did not appear, they began to adjust their interpretation. Rather than attributing difficulties to defiance or attitude, they considered whether the parent might be facing cognitive challenges that had not been obvious initially.

Finally, many informants described how this process of identification was rarely due to one individual’s perception. Knowledge often emerged through dialogue with colleagues, where comprehension was tested, shared, and refined. Observation of a parent alone offered solely one perspective, but discussing those observations in a team helped clarify whether concerns were shared and whether the situation should be understood as indicating possible cognitive difficulties:

You cannot always see this. However, when we start talking, things like: Have you also noticed this? That is when it becomes clearer. We put the pieces of the picture together.

[Informant 2]

It is reassuring to hear that others have had similar experiences. Then it is not just your concern, but it becomes something we can work from.

[Informant 7]

As such, the analysis indicates that team discussions served as both confirmation and correction in the interpretive process. Informants’ descriptions suggest that comparing experiences reduced the risk of bias and helped them distinguish between individual uncertainty and a more systemic concern. In this way, identification was not a matter of individual expert judgment, but a collective process grounded in relational experience, practical insight, and shared reflection.

3.3. Identification Through Patterns of Response

The third theme identified through the analysis relates to patterns in parents’ communication and behaviour across encounters. Whereas relational continuity and familiarity provided the basis for recognition in ongoing collaboration, this theme focuses on how professionals interpreted the consistency, tone, and content of parents’ responses over time. Cognitive difficulties were recognised not through single incidents, but through accumulated observations of how parents engaged with follow-up and guidance across situations.

For several informants, parental communication difficulties were not just occasional barriers but part of a holistic pattern. When verbal guidance had to be simplified, rephrased, or repeated without noticeable change, some began to consider whether the parent might be facing underlying cognitive difficulties:

We sometimes have to repeat ourselves again and again. Say the same thing in different ways. Simplify it.

[Informant 13]

You also need to simplify things and make them more comprehensible. Moreover, even if people are not cognitively impaired, they can come across that way in meetings with us, simply because they are so anxious.

[Informant 14]

While repetition and clarification were expected in some situations, especially under stress, informants noted that when patterns persisted despite sustained efforts at support, they began to wonder whether something more fundamental might be at issue.

In some cases, parents responded well during meetings and appeared to follow the conversation. However, informants observed that later follow-through was lacking:

Many [parents] learn to say the right things, but nothing really happens.

[Informant 12]

One indication for me is when a family or a parent has received guidance, but nothing moves forward. There is no change.

[Informant 13]

These descriptions point to a discrepancy between verbal engagement and practical follow-up. When this pattern continued across multiple encounters, informants began to interpret it as a possible sign of cognitive difficulties rather than a lack of motivation or reluctance.

Certain features of communication were also seen as relevant. Some informants described how their attention was drawn to very concrete and literal interpretations, or how information had to be broken down repeatedly without apparent retention:

They [parents with cognitive difficulties] are also very concrete and literal. More so than others.

[Informant 5]

You almost have to show it. Not only verbalize it.

[Informant 10]

In these situations, informants did not initially interpret the difficulties as cognitive in nature. Still, over time, as the same struggles repeated across contexts and despite various explanatory attempts, they came to contemplate this idea more seriously:

They reply “oh yes”, but then they forget the next time.

[Informant 8]

You see that nothing really changes, and they struggle, for instance, with memory. […] Then you go deeper, and that is when you realize, no, they are struggling in those areas.

[Informant 1]

Rather than an early conclusion, informants described a slow process of realization. The continued absence of change, despite explanations and supervision, contributed to a growing suspicion that the issue might relate to information processing.

When speaking to parents, some informants chose to avoid technical or diagnostic terms. They focused instead on describing situations and challenges in everyday terms, with the intent to preserve the necessary relationship:

We do not say cognitive difficulties. We discussed what is challenging and what might make things easier.

[Informant 6]

If you say something like ‘cognitive challenges’, people tend to shut down. You lose them. It is better to discuss the struggles they face in their everyday lives.

[Informant 12]

This process of identification did not reflect a diagnostic approach, but rather emerged through parental interactions over time. Informants described becoming attentive to repeated signs of confusion, lack of follow-through, and concrete communication styles. In summary, identification through patterns of response reflected a gradual and cumulative process, where repeated observations of communication and follow-up shaped professionals’ interpretations of cognitive difficulties.

4. Discussion

This study examined how child welfare professionals identify parents with cognitive difficulties. The findings suggest that identification often occurs without a formal or standardized process, instead developing gradually through experience-based interpretation, practical engagement, and relational observation. None of the informants mentioned using formal tools or structured assessment routines; instead, they relied on accumulated insight from everyday interaction and reflection. These informal and relational observations were considered crucial for understanding parental functioning. However, they often occurred late in the process and were not supported by frameworks that could facilitate earlier recognition. The issue, therefore, is not the value of informal insight but the lack of structures that enable such insight to inform early assessments. This raises two critical questions: first, how the absence of systematic identification routines affects consistency and equity in support, and second, how delayed identification shapes the use of time in ways that influence assessments of both parental capacity and the child’s situation. Both aspects relate to the child protection system’s responsibility to provide assistance, care, and protection at the right time.

First, the findings indicate a notable absence of systematic routines for identifying cognitive difficulties in child protection. Informants described how recognition typically occurred informally, based on accumulated relational knowledge, observation, or professional intuition. While experiential judgment is a well-documented and necessary aspect of welfare work (Molander 2016; Lipsky 1980), the lack of shared tools or structured procedures makes identification highly dependent on the practitioner’s competence, interpretive framework, and available time (McConnell et al. 2011; Norlin and Randell 2022). Although all participants had relevant experience with parents facing cognitive difficulties, this experience did not appear to lead to earlier or more systematic identification. Their descriptions suggest that identification remained a gradual and interpretive process, shaped by the same temporal and organisational constraints that characterise child welfare practice more broadly. This indicates that experience alone was insufficient to overcome the structural and procedural limitations described across the findings. Previous studies confirm that decisions are shaped by discretion, local routines, and varying thresholds for concern (Booth et al. 2005a, 2005b; Bredal et al. 2023; Kojan and Storhaug 2021; Sigurjónsdóttir and Rice 2017), resulting in fragmented practices where similar cases may be followed up in markedly different ways. Without systematic identification, parents risk receiving standard rather than tailored support. Techniques such as visual aids, structured routines, modeling, and reinforcement, which have been documented as effective for parents with cognitive difficulties (Aunos et al. 2008; Feldman 2002), may be overlooked or introduced too late. This is consistent with research showing that delayed adjustment reduces the effectiveness of interventions and may reinforce perceptions of non-compliance (Cleaver and Nicholson 2007; Coren et al. 2011). Informants described cases where parents appeared engaged and responsive in conversations, but showed little progress in practice. In the absence of structured assessment, such situations were not consistently evaluated as signs of cognitive struggle but often interpreted as a lack of effort or motivation. Similar findings are reported elsewhere (Norlin and Randell 2022; Sigurjónsdóttir and Rice 2017). As a result, explanatory models tended to emphasize psychological or attitudinal explanations, while structural or cognitive factors remained underexplored. The reactive nature of identification also influenced how professionals evaluated parental progress. In the absence of formal procedures, identification often occurred late, typically after repeated signs of stagnation or non-compliance (Booth et al. 2005a; McConnell et al. 2011). This increases the risk of misinterpretation, reinforcing explanations that frame limited progress as resistance rather than possible cognitive difficulties. Several scholars emphasize the importance of early and structured assessment to ensure equity and reduce reliance on intuition alone (Cleaver and Nicholson 2007; Norlin and Randell 2022). Observation guidelines, screening instruments, or customized communication frameworks could support more timely and consistent identification, while shifting professional attention toward cognitive accessibility and learning needs.

Second, delayed identification also affects how time is used in child protection interventions. Informants described how cognitive difficulties were often considered only after conventional supervision had been attempted without results. Although well-intended, this trial-and-error approach consumed critical time and often led professionals to question parents’ motivation or capacity for change (McConnell et al. 2011; Norlin and Randell 2022). Persistent non-compliance often raised doubts about parents’ ability to benefit from support; however, rather than triggering consideration of cognitive factors, the lack of progress was frequently interpreted as resistance or a relational breakdown (Cleaver and Nicholson 2007; Sigurjónsdóttir and Rice 2017). From a theoretical perspective, time is not only a practical constraint but also a structuring condition for professional judgment (Molander 2016). As Lipsky (1980) argued, limited time and institutional demands in frontline services do not merely restrict discretion; they shape how it is exercised. In this context, the gradual emergence of concerns reflects not only professional caution but also organizational logics that prioritize visible outcomes within short intervention windows. Delayed identification thus becomes more than a missed opportunity; it reflects how institutional timeframes hinder the recognition of needs that unfold slowly or subtly. Over time, this can contribute to exhaustion or ‘change fatigue’ for both professionals and parents exposed to strategies that do not meet their needs (Booth et al. 2005b; Slayter and Jensen 2019; Wade et al. 2008). Such dynamics may lower expectations, reduce persistence, and narrow the perceived window for improvement. In a system where interventions are time-bound and outcome-driven, these processes influence judgments about whether the child can wait for change to occur (Coren et al. 2011; Koolen et al. 2020). The analysis indicated that when progress was not observed within a given timeframe, professionals tended to shift their focus toward securing stability for the child through alternative care decisions. Judgments about parental change potential were also shaped by normative expectations of responsiveness, such as initiative, verbal engagement, and timely implementation of guidance, indicators that may not capture the learning needs of parents with cognitive difficulties (Feldman 2002; Gaskin et al. 2012). When time is spent applying standard approaches and a lack of progress is attributed to compliance or resistance, the underlying mismatch between support strategies and parental capacity may remain invisible. Time is, therefore, not only a neutral resource but an active element in how need, capacity, and urgency are constructed. When cognitive difficulties remain unidentified, the time available for meaningful support is not simply reduced; it is spent in ways that shape professional judgments and limit the scope for tailored intervention (Feldman 2002; McConnell and Llewellyn 2002; Slayter and Jensen 2019; Wade et al. 2008). This reinforces the importance of early identification, not merely as a technical tool but as a structural condition for equitable decision-making. Such decisions are shaped by institutional logics and constrained by limited time and resources (Cleaver and Nicholson 2007; Lipsky 1980; Molander 2016; Norlin and Randell 2022).

5. Conclusions

Taken together, the findings illustrate how both procedural gaps and temporal dynamics shape the scope for adequate identification and assessment. When cognitive difficulties are not addressed through systematic routines and when standard approaches consume time without progress, support may appear active but remain misaligned. The findings underscore the need to develop and implement more systematic approaches for early identification of cognitive challenges, supported by policy and training initiatives that strengthen professional judgment and promote consistent recognition across services. In practice, this requires clearer procedural guidelines for assessment, consistent tools for documenting concerns, and training that enables professionals to recognize and respond to cognitive difficulties at an early stage.

While the study provides new insight into how professionals describe the identification of parents with cognitive difficulties in child welfare practice, some limitations should be noted. The findings are based on a small, purposive sample and reflect the perspectives of professionals. Although participants represented variation in organisational models, municipality size, and geographic location, the analysis did not reveal systematic contextual differences, and the results should therefore be understood as describing shared professional reasoning rather than locally specific practices. Further research could expand on these findings by incorporating multiple perspectives, examining longitudinal developments, and investigating how organisational conditions and professional training impact recognition and support over time.