Elopement Behaviors: A Real Danger

Elopement or running away behaviors are certainly at the top of the list of most serious behaviors that must be eliminated from the range of behaviors that a student with special needs experiences in school. I have had several families where elopement has been a frequent and tortuous experience. While some have been injured fortunately none have died. For students with autism there is a great propensity to elope from school supervision and put themselves in danger. According to a study just published in Pediatrics on elopement behaviors, 49% of parents reported that their child had attempted to elope at least once. Of these children, 65% had a “close call” with traffic whereas another 24% were at risk of drowning. Children who elope leave their homes (74%), stores (40%), and schools (29%). Researchers were able to compare the rate at which children with an autism spectrum disorder eloped compared with that of their typical siblings. Between ages 4 and 7 (4 being the developmental age when children can be expected to not wander off), 46% of children with an autism spectrum disorder eloped compared to 11% of their siblings. And between ages 8 and 11, 27% of children on the spectrum wandered compared with just 1% of their siblings.

Children with more severe forms of autism were more likely to wander than those affected to a lesser degree. According to parents (2) children wander because they enjoy exploring (54%), are attempting to get to a favorite place (36%), are avoiding demands or experiencing anxiety (33%), are pursing a special topic (31%), or are experiencing sensory overload (27%). Parents are right to be concerned about elopement behaviors, which can result in tragedy. A 2008 Danish study (2) surprisingly indicated that the mortality rate among those on the autism spectrum is twice that of the general population. An earlier 2001 California study suggest that these increased death rates may be in large part due to accidental drowning. Children who wander are for whatever reason attracted toward water. A study done by the National Autism Association found that from 2009 through 2011, the deaths of 20 of 22 autistic children who eloped were caused by accidental drowning. The study authors stressed that this number is based on media reports only and is unlikely to indicate the full scale of the problem. Not surprisingly, 56% of parents report that dealing with elopement behaviors is the most stressful part of raising a child with autism. And fears of elopement are literally causing parents to lose sleep (43%) or alter their activities (62%).

Even though half of parents report that they receive no guidance in managing these behaviors, there is help out there. First, the Centers for Disease Control in October 2011 approved a new diagnostic code: V40.31 Wandering in Diseases Classified Elsewhere. The hope is that the existence of this code will enable caregivers to receive insurance coverage for safety equipment as well as fortify their arguments for accommodations and safety-related requests for children while at school.  Additional help is available online. AWAARE (Autism Wandering and Elopement Initiative) (4) has prepared “tool kits” for first-responders, which are designed to be given to first-responders before an emergency occurs. The goal of the tool kit is to educate first-responders on elopement behaviors and present effective ways to interact with children with autism, of whom one third will be unable to communicate their name, address or phone number. The kit also educates first responders on the unique risks and attractions that water and traffic pose to children with autism. Since an amber alert is inappropriate for an autistic child who has wandered off rather than been abducted, AWAARE recommends the institution of a reverse 911 system, where individuals in the geographic area in which the child has disappeared can be rapidly notified to be on the lookout for the child.

Additional recommendations for caregivers include the use of tracking devices (similar to those used for patients with Alzheimer’s), ID bracelets, swim lessons for the child (never a complete guarantee of safety), use of social stories, locks in the home, and judicious use of “stop” signs at doors to deter wandering. In one instance of a child I represented the use of a wide strip of yellow electrical tape on the floor of the threshold of the classroom coupled with a social story about elopement significantly improved and eventually eliminated the dangerous behavior. The authors of the Pediatrics study argue that their findings demonstrate the need to find more effective interventions to prevent elopement behaviors, support parents better, as well as educate therapists, schools, and first responders about the risks posed by children who wander. In school the staff needs to feel empowered that they can address this behaviors effectively through planning, staffing and equipment (e.g. locks and walkie-talkies). As to planning a good and ongoing FBA and dynamic BIP are absolutely essential to begin elimination of elopement behaviors. Parents of children with autism who are prone to wandering behavior will probably never be able to truly relax their vigilance or let their guards down, which is clearly not only a safety issue for the child but also a quality of life issue for the child’s family. But with increased awareness of this problem and better education, and concrete steps, as detailed above, can be taken to ensure the safety of these children.