Increasing a Child’s Ability to Remain with an Adult in the

Community/Decrease Elopement

Paula M. Santos, Psy.D., BCBA-D Clinical Director

Assessment, Consultation & Treatment

Research/History • Lethal Outcomes in Autism Spectrum

Disorders- cases from 2009 to 2011: – Accidental drowning accounted for 91% of deaths;

68% died in nearby body of water, 23% under care if someone other than a parent

– Higher incidence rates in females than males

• 2011 included in diagnostic codes: – V40.31 Wandering in Diseases Classified

Elsewhere

• 2012 survey in the Journal of the American Academy of Pediatrics (Interactive Autism Network & Kennedy Krieger Foundation) – First major comprehensive study on children with

autism and wandering – 1218 families with children with autism as well as

their siblings without autism – Children with ASD are eight times more likely to

elope between the ages of 7 and 10 than their typically-developing sibling

Effects of Wandering on Family • Wandering was ranked among the most stressful

autism behaviors by 58% of parents of children who elope

• 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 they had never received advice or guidance about elopement from a professional- 19% had received such support from a psychologist or mental health professional, 14% from pediatrician or physician

Severity of Elopement • More than one third of children who elope are

never or rarely able to communicate their name, address, or phone number verbally or by writing/typing

• Wandering increased with the severity of autism • 65% of parents reported their child was in danger

or had a “close call” with a traffic injury • 32% of parents report a “close call” with a

possible drowning • 26% of those who had eloped were missing long

enough to cause concern

Reasons Parents Identified Children Elope

• Top 5 reasons parents felt children eloped: – Enjoys exploring (54%) – Heads for a favorite place (36%) – Escapes demands/anxieties (33%) – Pursues special topic of interest (31%) – Escapes sensory discomfort (27%)

• 67% of parents of children who elope said they saw no seasonal pattern (that it didn’t occur more during the summer)

Approach/Intervention for Elopement

• Identifying reason(s) for elopement – Prevention including Teaching – Intervening when elopement occurs

Reasons for Elopement • Gain Access

– Preferred items and activities (e.g., water, playground, animals, food, toys, nighttime waking)

– Sensory input (e.g., enjoys running, distracted and unaware)

• Escape or Avoid – Non-preferred items and activities (e.g., shopping,

walking and exercise) – Non-preferred sensory stimuli (e.g., noises,

crowds, bright lights)

Setting Events that Make Elopement More Likely

• Holidays • Family gatherings- parties, outdoor activities • Camping and hiking outings • Vacation homes, other’s homes • When move to a new home • Following changes to home related to

weather (screen doors, AC units, etc.) • Classroom transitions • Stressful situations when escalation triggers

surface

How to Identify the Reason(s) for Elopement

• Look for patterns: – What is consistently going on in the environment

your child elopes from? – What does your child gravitate toward when they

elope?

Prevention

• Things to do all the time to prevent elopement from occurring or reoccurring

• Things to do to decrease serious risks should

your child succeed in eloping

Secure Your Home • Battery operated alarms on doors • Placing doorknobs, deadbolts, hook and eye

locks, etc. above child’s reach • Child gates • Fencing in the yard

Introductions to Relevant People • Neighbors

– Identify those neighbors who your child may be more likely to seek out (e.g., pools, pets, toys)

– Provide contact information- name, phone number, let them know about child’s interests in their yard/home

– Discuss possible prevention strategies

• First Responders- Police, Fire Department – Provide photo and contact information – Provide information on tracking device, interests,

etc.

Tracking Devices • Global Positioning Systems (GPS) • Network Assisted GPS (A-GPS) • Radio Frequency (RF) • Uplink Time Difference of Arrival (U-TDOA) Consider: – Battery life – Cell signal/service – Water resistant/water efficacy – Can it be removed by the child easily – Does device/system require trained emergency

response personnel

Child Identification • ID Bracelets/Necklace/Anklet:

– Medical ID bracelets – Shoe lace tags – ID can include diagnosis of autism, non-verbal,

etc.

• Safety cards • Teach child safety information:

– Name – Parent/guardian’s names – Parent/guardian’s cellphone number

Temporary Child Identification

• Label inside of clothing, backpack, etc. • Wrist bands • Temporary tattoos • Check-in with registration desk/safety desk:

– Leave picture ID card with safety contact information

Address Sensory Needs • Attempt to control for sensory input that is

aversive and/or provide sensory conditions that are desired: – Headphones – Sun glasses – Dim or turn off lights – Increased physical activity – Access to preferred items (i.e., water, animals)

Address Sensory Needs

• Scheduled access or on-going methods: – Consider effects of satiation and deprivation

•When deprived of something an individual usually has a higher desire or need for something

•When satiated of something, an individual usually has a lowered desire or need for something

Create Clear Expectations & Rules • Simple consistent rules:

– Staying in the home, stay with adults – Rules regarding preferred items/activities (e.g.,

when/where ok to play chase, etc.) – Review these rules continuously – Emphasize these rules in high probability situations – Reward child for following rules- when they don’t

elope in high probability situations (be sure to specify what the reward is for)

• Visuals to illustrate and reiterate rules and expectations

• Social Stories

Teach Communication • Communicate to:

– Gain access – Escape or avoid

• Modality of communication: – Must be effective- both quick and easy

• Incorporate into your services: – IEP goals – In home services – Speech and language services

Teach Communication & Compliance with Rules

• Create and capture teaching opportunities: – The more you teach up communication and

tolerance the more likely your child will use them when the elopement situation naturally arises

– Purposely go to high probability areas, and expose to specific stimuli repeatedly to practice

– Anticipate child wanting to gain access or escape/avoid: • Prompt them to communicate, and reward

communication • Review rules, and reward compliance

Questions Paula M. Santos, Psy.D., BCBA-D Licensed Clinical Psychologist & Board Certified Behavior Analyst

drsantos@actpsychology.com www.actpsychology.com

(626)824.0982