Saturday, July 20, 2013

Reducing the risk of elopement or wandering



The issue of elopement and autism is very common. According to www.nationalautismassociation.org, nearly half, or 49% of all children  with autism will attempt to elope from a safe or known environment.

In 2009, 2010, and 2011, accidental drowning accounted for 91% total U.S. deaths reported in children with an ASD ages 14 and younger subsequent to wandering and elopement.
32% of parents reported a “close call” with a possible drowning.  
62% of families of children who elope were prevented from attending/enjoying activities outside the home due to fear of wandering
40% of parents had suffered sleep disruption due to fear of elopement
Half of families with elopers report that they had never received advice or guidance about elopement from a professional
Only 14% had received guidance from their pediatrician or another physician
 
Sources:
Interactive Autism Network Research Report: Elopement  and Wandering (2011)
National Autism Association, Lethal Outcomes in ASD and Wandering (2012)


We hear about it on the news, or read it in the paper or online. It is difficult to know what motivates someone with autism to wander from home, and to go away from people when lost, instead of towards people. What makes this critical for autistics, is that they may not respond when called, they have little sense of danger, and they may be non verbal. Lack of public information also makes this critical. Most people do not know how to communicate effectively with children who have autism. If an unfamiliar adult tried to ask your child safety information such as 'Where are your parents?' Would your child respond?
 
Many parents report their child gravitates towards water, so nearby lakes, ponds, and creeks may continue to be a desired destination.  Too, someone with ASD is likely aware when attention has shifted away from them, and will take the opportunity to slip out quickly in order to reach a desired area or item of interest.  Family gatherings or other events may give a false impressions of “all eyes on” someone with ASD.  However, heavy distractions can present opportunities to leave unnoticed.  Visiting relatives or episodes of distress also may increase the risk for wandering.  This holds true in warmer months when persons with ASD are more likely to play outside or attend summer or day camps.


Just like any behavior, there are many different ways you can reduce the risk of your child wandering from home, or bolting away from you when out in public.
Three main techniques used by an ABA therapist are:


Reducing Risk
Antecedent Interventions
Consequence Intervention


Reducing risk: Before going out in public, explain to your child where you are going. Use simple language, and talk about your expectations for their behavior. Teach your child to respond to their name, (verbally or non verbal). Provide praise for staying near you in public. Plan the outing in advance, know where the exits are, if its a crowded location, or near a busy street, bring another adult with you to help catch the child in case they attempt to elope. Consider getting an ID badge or bracelet for your child, and carry a recent photo ID of your child at all times. If your child is verbal, teach them to respond to safety questions such as "What's your full name? What is your phone number and address?"


Antecedent Interventions:
This would involve changing the triggers that precede elopement. Some children wander away when they see an interesting object. Some children may wander away because its loud and crowded, and they are seeking a quiet place. Pay attention to how your child acts before they attempt to elope, such as covering their ears, walking slowly behind you, staring intently at items or objects. Get to your child's level, and ask if they need to take a break. If the child is non verbal, you can teach them to hand you a break card, and when they do, they can have a supervised break. Teach the child to request a supervised break, instead of just wandering off.
Once you have identified the triggers, teach your child replacement behaviors.  If they wander in the middle of the night, teach them to stay in bed when they cannot sleep.  If they wander outside, teach them that they need permission first.  Use picture cards if your child is non verbal.  Put the picture card away at night, to signify that going outside at night is not an option.


Consequence Intervention:
This would involve changing the way you react to your child wandering away, or attempting to do so. Once you determine why they elope, whether its to gain attention, or to escape, do not give them the response they are seeking. If the child bolts at the grocery store because you are striking up a conversation with another shopper, then do not provide huge amounts of attention for their elopement behavior. Go get the child with minimal eye contact and language, and bring them back to where the cart is. You also want to be sure to teach them how to get your attention appropriately. You can teach your child to request your attention, such as tapping you, or saying your name. Practice appropriate behaviors for bring in public, and staying near an adult. Use praise and encouragement.
Other ways to reduce risks of wandering:


Secure your home. Consider contacting a professional locksmith, security company, or home improvement professional to promote safety and prevention in your home.  This may require installing dead bolt locks that require keys for both sides, a home security system, inexpensive battery operated alarms on doors and windows, hook and eye locks above child’s reach, and adhering printable STOP signs on doors, windows and other exits such as gates.


Tracking devices such as Project Lifesaver or LoJack SafetyNet services.  Various GPS tracking systems are also available.  


ID bracelets that include your name, telephone number, and other vital information.  They may also state that your child has autism and is non verbal, if applicable.  If your child will not wear a bracelet or necklace, consider a temporary tattoo with your contact information.  You can use a Sharpie or other marker, and seal with liquid bandage for a temporary tattoo.


Alert your neighbors.  It is recommended that caregivers plan a brief visit with neighbors to introduce their loved one, or provide a photograph.  Decide what information to present to neighbors; like attractions or fears, sensory issues or meltdown triggers.  


Alert first responders.  Provide key information before an incident occurs may improve response.  Favorite song, toy, or character, important phone numbers, favorite attractions and locations, likes, dislikes, fears, triggers, and de-escalation techniques, method of communication, whether verbal or nonverbal, uses sign language, picture boards or written words. Map and address guide to nearby properties with water sources and dangerous locations highlighted.
In Corpus Christi, Robin Palmer Blue is a board certified behavior analyst (BCBA) specializing in Applied Behavior Analysis, and a Music Therapist at Therapy Connections.
Sources for this article, and others that may be of help:
www.missingkids.com 1-800-THE-LOST
www.autismalert.org