According to www.nationalautismassociation.org nearly half (49%) of all children with Autism will attempt to elope from a safe or known environment. 

All children may wander away from adult supervision at one time or another. What makes this issue so much more critical for children with Autism is they may not respond to their name, they may have a low sense of danger, and they may be nonverbal. Lack of public information also makes this issue so critical. Most people don't know how to effectively communicate with children who have Autism. If an unknown adult tried to get safety information from your child (such as "Where are your parents?") would your child respond? Or would your child walk away?


 For this post, the word Elopement describes:

  • The individual leaves or wanders away from the home, or from a known adult while out in public.


Elopement isn’t always the individual running away from you at full speed. I have had clients who hide from me in public settings, try to get into other peoples cars, or refuse to hold my hand in public because they want to wander. 

The issue of elopement & Autism is very serious. All you have to do is read the newspaper or watch the evening news to hear about children, adolescents, and adults with Autism wandering away from home and being gone for hours or even days. Sometimes these stories have tragic endings.
It can be hard to know what is motivating individuals with Autism to wander away from home. Also, a child with Autism is more likely to go away from people if they get lost, than towards people like a NT child would.

Just like any other behavior there are many different ways you can reduce the risk of your child wandering away from the house, or bolting away from you when you are out in public.

I explain these terms in my For Related Professionals post, but for any behavior you want to manage you can intervene on the Antecedent or the Consequence.  
Antecedent means what happens before the behavior. Consequence means what happens after the behavior. The approach that will work best will depend on the individual who is eloping and their particular motives for wandering away. I suggest you try as many of these recommendations as you can, and then end up with a few solid techniques.
This is such a serious topic that I want to emphasize that elopement should be extinguished using a comprehensive behavior plan that addresses prevention strategies as well as consequence strategies. In other words, how will we prevent wandering? As well as, how will we find the child if they successfully escape?

The suggestions included in this post do not negate the need to conduct a full FBA to deal with consistent, ongoing elopement attempts. A FBA will help reveal the reason why elopement behavior is persisting.

The main techniques I will address are: Reducing Risk, Antecedent Interventions, and Consequence Interventions.

Dealing with Elopement in Public

Reducing Risk- Before you go out in public with your child, explain to them where you are going. Use simple language at their cognitive level and talk about your expectations for their behavior. Explain that they need to stay with you, and may need to hold your hand. I have had parents tell me "My child just wont hold my hand". Well... it isn't optional. State your expectation for behavior, and tie it to reinforcement. For example "You need to hold my hand in the store, and then you can have Ipad". Teach the child to respond to their name (verbally or nonverbally), and provide praise for them staying near you in public. Plan the outing in advance, know where the exits are, roughly how crowded it will be, if its near a busy street, etc. If possible take another adult with you to help catch the child if they attempt to elope. Consider getting an ID badge or bracelet for your child, and carry a recent photo ID of your child with you at all times. If the child is verbal, teach them to respond to safety questions such as “What’s your name”, “What’s your phone number”, and “What’s your address”.

Antecedent Interventions- This would involve changing the triggers that precede the child eloping. Some individuals wander away when they see an interesting object. Some children wander away because it’s 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 ears, walking very slowly behind you, staring intently at items or objects, etc. Be on the alert so you can step in when you see a trigger. Get on your child’s level and ask them if they need to take a break. If the child is verbal they can learn to request a break. If the child is nonverbal you can teach them to hand you a break card, and when they do they can have a supervised break. Particularly in public settings like festivals, malls, or outdoor concerts, children with Autism may elope to escape from noise and large crowds.

Consequence Interventions- This would involve changing the way you react to your child wandering away, or attempting to wander away. Some children may wander away to gain your attention. Other children may wander away to escape you. It will vary. Once you determine why they are eloping, be sure not to give them the response they are seeking. If your child bolts at the grocery store because you strike 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 show them how to get your attention appropriately. You can teach them to request your attention appropriately, such as tapping your shoulder.




Dealing with Elopement in the Home


Reducing Risk- Modify the home environment to make it safer. Install heavy duty deadbolt locks on the doors and windows. Install an alarm in the home, or consider security cameras. Consider placing bells or motion detectors on all doors. Talk to neighbors and explain that you have a child who wanders, and may not respond to their name. Make sure close neighbors have your contact information and a photo of your child, so if your child ever wanders into their yard they can call you immediately. If there are many people in the home (such as for a party) have at least 2 people keeping an eye on the child. Write and post house rules, and one of the rules should be that the child cannot go outside without permission. Teach the child to respond to their name (verbally or nonverbally), and provide praise when they respond. Practice going into another room and calling the child, and provide reinforcement when they come find you.


Antecedent Interventions- This would involve changing the triggers that precede the child eloping. Start determining the triggers for the child attempting to elope. Many children display wandering behavior in the middle of the night if they can’t sleep. Other children wander away from home if they see something interesting outside, such as the ice cream truck driving by. 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 can’t sleep. If they wander outside to explore interesting items teach them that they need permission first. If the child is verbal they can request permission to go outside. If the child is nonverbal, you can make an “Outside” picture card. When the child brings you the picture card, they are allowed to go outside (with supervision). Put the picture card away or cover it up at night, to signify that going outside at night is not an option.


Consequence Interventions- This would involve changing the way you react to your child wandering away, or attempting to wander away. When you see the child bolt, and you catch up with them, what is your reaction? Do you yell, become angry, cry, give a lecture? If the behavior is happening regularly, your reaction may be feeding the behavior. If you yell at your child every time they begin to wander away, then that child is wandering to get your attention. Try reducing the attention you provide for elopement, and give MORE attention for when the child is near you and within your sight. Use specific praise such as “Good job playing on the front porch”. If the child steps off the porch, or tries to bolt into the street, get them back safely with minimal eye contact or language and place them on the front porch. Practice appropriate behaviors for being outside and staying near an adult using praise and reinforcement.



Resources-

Below is a list of resources and safety tools that can be used with individuals with Autism who elope or are at risk to elope.

http://www.autismsafety.org/wandering.php 12 Ways to Prevent & Respond to ASD Wandering

http://www.projectlifesaver.org Wrist bands with transmitters

http://www.americanmedical-id.com Identification bracelets

http://www.radioshack.com/home/index.jsp Purchase surveillance cameras

http://www.homesecuritystore.com Fingerprint detection locks

http://policeandautism.cjb.net/avoiding.html  How to alert police that you are raising a child who elopes (article written by a police officer)

http://www.awaare.org/docs/FWEP.pdf  Sample of a Family Wandering Emergency Plan

https://www.safetynetbylojack.com   Safety Net by Lo-Jack

http://www.amberalertgps.com  Amber Alert GPS

http://www.specialtyalarms.com  Child Specialty Alarms


**Quick Tip: Teaching a child to respond to their name typically means they look at you when they hear their name.  If you want the child to come back to you when their name is called, you have to specifically teach that. For children who run towards the street, you can use a simple command such as "Stop" or "Freeze". If you yell out the child's name because they are running away from you, they may not understand they are supposed to halt. 







I love the movie "The Miracle Worker", but I didnt always love it. It used to be just another annoying movie that I was forced to watch probably hundreds of times in school. Every time I had a substitute teacher, they would reach for "The Miracle Worker" VHS and I would watch this movie with boredom yet again.
It wasnt until I started working in the field of ABA that I started to appreciate this movie. I watched this movie as an adult after I had started working with children with Autism, and it was like seeing the movie for the first time. I saw every great ABA therapist I had ever worked with reflected in Anne Sullivan. Theres great parallels between this movie and what a great ABA therapist (or a great teacher) does.
In a sense, we pull children kicking and screaming -sometimes literally- out of the enclosed world of Autism and into the world of ABA... Sometimes we have to pull family members and teachers kicking and screaming too.


We pull these children into eye contact, conversation, affection, and cooperative play, and out of averting their eyes, walking away from peers, tantrums, and self harming behavior. Its tough work that requires thick skin, and being able to be firm when everyone else wants to give in. It requires repetition, persistence, a mountain of patience, and optimism. When even the people closest to the child are telling you, "don't bother", "he wont learn that", "you're wasting your time", a great ABA therapist continues trying, and continues teaching.

There's too many great quotes from "The Miracle Worker" for me to pick one, so here are my favorites:

Anne Sullivan: Mrs. Keller, I don't think Helen's greatest handicap is deafness or blindness. I think it's your love and pity. All these years you've felt so sorry for her you've kept her like a pet. Well, even a dog you housebreak.

 James Keller: Sooner or later, we all give up, don't we? 
Anne Sullivan: Maybe you all do, but it's my idea of the original sin.
James Keller: What is?

Anne Sullivan: Giving up! 


Anne Sullivan:  It's less trouble to feel sorry for her than it is to teach her anything better. 

Anne Sullivan:  Pity for this tyrant? Is there anything she wants she doesn't get? I'll tell you what I pity... that the sun won't rise and set for her all her life, and every day you're telling her it will. What you and your pity do will destroy her, Captain Keller. 

Anne Sullivan:  [after a breakthrough with Helen] Now all I have to teach you is one word - everything.





Its time for Frequently Asked Questions part II :-)
Part I was pretty popular so I decided to do a part II of even more questions that people ask me all the time. 

So lets jump in...

FAQ Families:

  1. Will my child with Autism EVER talk/have friends/use a toilet/live independently, etc.? This is a very common question. The short answer is, no one can tell you definitively. The longer answer is with the correct recipe of intensive treatment, well qualified therapists, excellent parent education and training, and a commitment to consistency, any child with Autism can make great strides and permanently enhance their quality of life. Its good to think about and plan for the future, but parents please don’t drive yourself crazy with endless “What If” questions. Appropriate planning and consideration for the future is good, incessant worrying and anxiety is not.
  2. I think my child may be on the Spectrum, but I'm not sure…..she isn’t like those kids you see on TV who have Autism. Maybe she will outgrow it. Autism is not one –size- fits- all. These children will differ greatly from each other. Media portrayals of Autism can be very one dimensional sometimes. Several years ago, every person with Autism was “Rainman”. Now it seems every person with Autism is “Bill Gates”. The pendulum has swung from exaggerating all Autism as a severely debilitating condition, to exaggerating all Autism as just a quirky or odd personality. Do not let the media tell you what Autism looks like, because the reality is Autism can look like anyone. Look for red flags: communication, social interaction, play skills, eye contact, and joint attention deficits. If you have a hunch or gut feeling that something may be wrong, get an evaluation done. The sooner you get a diagnosis, the sooner you can get services.
  3. What causes Autism? This question is such a political hot topic right now. The very PC answer is that currently, it is unknown what the cause of Autism is. My non-PC answer is that in some cases Autism may be caused by genetic predispositions or heredity and in some cases Autism may happen after the child is born. Many parents feel that their child “became Autistic”. Other parents tell me that they always knew their child was a little “off” even from infancy. I think there are many causes for Autism, and not one smoking gun. What is more important is to focus on what to DO about your child with Autism and move out of the phase of searching for the cause.
  4. My main therapist will be unable to work for 6 weeks, and we are freaking out! Who will cover those sessions?  It is always preferable to have more than one ABA therapist, and this is a big reason why. When you have multiple therapists its easy to cover sessions that are missed due to illness, vacation, car trouble, etc. Another reason for multiple therapists is you don’t want your child to get too attached to being taught by the same person. However if you only employ one direct therapist in your home and that person needs to miss sessions for any reason, guess who the backup therapist is? YOU. In the therapists’ absence it’s the parents responsibility to step in and provide therapy. You should be so knowledgeable and comfortable with your child’s ABA programs that with minimal training from the therapist you could run a session in their absence.
  5. I worry that my child hates his therapy and dislikes the therapist. He cries when she comes to the house, and he runs away from her. Should I be worried? I actually had this situation happen to me, where I started working with a little boy who just…didn’t…like…me. I would show up at the home, he would burst into tears. Let’s just say the parents weren’t thrilled to see their child react this way. Eventually we had a lightbulb moment and realized that the child was very sensory sensitive and reacted strongly to my perfume. It gave him migraines. So what was happening?  He associated me with pain. If your child has a consistent negative reaction to therapy or to a particular therapist, that’s a problem. It is normal for your child to avoid therapy sometimes, or to occasionally appear upset when the therapist arrives. The key word there is occasionally. A consistent negative reaction could mean many things: the therapist isn’t properly paired with the child, the therapist has become aversive to the child, the child is struggling with transitioning into work-time, etc.
  6. Im overwhelmed by all these treatment options. Should I research each one and read more books before I implement anything? Early intervention is key when it comes to Autism treatment. Throw away the concept of “wait and see". Time is not your friend. The sooner you begin intensive treatment the better it will be for your child. Yes, the vast array of treatments for Autism is dizzying. So start simple. Focus on one deficit at a time. If your child has a poor gait and weak fine motor skills, get them into OT. If your child refuses to play with peers and has no interest in toys, look into Playdates or Social Skills Groups. As you learn more about various treatments and what your local school district offers (or what insurance will cover) then you can begin considering other options. Its important to start somewhere.
  7. What kind of expert (teacher, physician, psychologist) is the best source to tell me about my child? Doctors, pediatricians, developmental psychologists, nurses, teachers, behavior specialists….as a parent of a child with Autism you may find yourself in the middle of a revolving door of professionals. It’s important that you understand professionals are qualified in a certain area or domain. They may be experts in child development, behavior, or Autism, but who is the expert on your child? You are.


FAQ Therapists:

  1. My client completely ignores or is very aggressive with her siblings. I want to help the parents with this but Im not sure what to tell them. I discuss in my social skills post how to teach children with Autism to interact with toys or other people. It is very common to work with a child who will interact with, or be in close proximity to adults yet will cry, scream, or aggress if a child gets too close to them. Many parents feel especially hurt that their child won’t interact with his/her siblings. From the child’s perspective, their siblings are not special. Their siblings are just annoying, unpredictable, short people who happen to live with them. Social skills need to be explicitly taught, and part of your therapy sessions should include bringing the siblings together for structured interactions.
  2. I know Im supposed to provide parent education, but Im not sure how OR The parents don’t want my help/feedback. Parent education at its core is simply involving the parents in the therapeutic process. You want to include the parents as part of the treatment team, even if you have to convince them why this is important. Your goal with parent education is to inform, educate, and provide feedback. The parents should know what programs you are teaching, what reinforcers are effective, what strengths the child has, etc. You may come across a family that seems uninterested or apathetic about parent education. Your response to this will vary depending on where you work. If you work for a company, parent involvement is often required and parents resistant to feedback are dropped as clients. If you work for yourself, you need to decide how you want to handle an apathetic client. If you aren’t careful some families may start to view your services as glorified babysitting, not therapy. You need to clarify that you are a professional providing a service and you need parent involvement to be successful. If the family is consistently apathetic, you may have to stop providing services to that family.
  3. My client hates change. Should I accommodate that or should I intentionally change things so he can get used to it? Resistance to change and a rigidity of interests are characteristics of Autism. It is to be expected. As part of the therapy process, yes, you need to start exposing the child to a varied routine so they can learn to accommodate change. This should be done gradually and in increments. Its also important to use visual cues such as a picture schedule posted on the wall. You can change the pictures every so often to signify to the child that the routine will be different. Expect that the child may be agitated or confused by the change in routine, but over time and with consistency these reactions should minimize.
  4. What's a Certified ABA Therapist? You might have heard someone refer to themselves as a certified ABA Therapist and wondered what that meant. There is no nationally recognized certification for ABA therapists other than board certification. Board certification comes at 3 levels: BCaBA for Bachelor Degree holders, BCBA for Master Degree holders, and BCBA-D for Doctorate Degree holders. When someone says they are certified in ABA this could mean almost anything. One person could hold an ABA certification due to taking graduate level coursework in Applied Behavior Analysis, but someone else could say they hold an ABA certification if they only attended a 2 day workshop on basic behavior theory.  For more information go to http://www.bacb.com.
  5. My client acts so much worse around his parents than he does with me. Why is that? This is a very common question.  This doesn’t always occur for the reasons you may think. Its true that in some situations the parents may be inconsistent or lack follow-through on discipline. Beyond that, sometimes the child hasn’t generalized yet that they must listen to many adults and not just the therapist. For many children with Autism the parents are a safe haven. The parents serve as comforters, providers of food, love, hugs, kisses, and may be the only people the child feels fully comfortable with. Sometimes what looks like bad behavior can be a special parent-child bond.
  6. My supervisor is unavailable, unhelpful, or makes me feel stupid for asking questions. What should I do? I love answering questions like these, because I have been in that position. I have had great, bad, and indifferent supervisors. When I was a new therapist it made me feel very uncomfortable to tell a supervisor they weren’t doing a good job. So I understand how hard it is to have that awkward conversation. I suggest talking to your supervisor 1:1 about the issue and providing concrete examples about the areas you feel are lacking. Make “I” statements instead of “You” statements, such as “I feel unprepared when I’m given no background information about a child I am working with” instead of “You need to stop sending me out to see clients without giving me their intake file first”. Focus on what you want to see improve, and explain what you need to benefit from training. If you don’t feel comfortable asking your supervisor questions, venting after a really bad session, or making programming suggestions, then that’s a problem. No matter your experience level your supervisor should be open to your ideas.
  7. What do parents look for when hiring ABA therapists? What’s most important to them?  I have helped many families interview and hire in home ABA therapists, and I do think there are a few things all families have in common when hiring a therapist:
    • The family wants you to enjoy your job- Even if you have minimal experience or training, clear passion can make a great impression on a family
    •  The family wants you to show up when you say you will- Be on time for work, call if you are going to be late, and don’t end sessions early
    •  The family wants you to be competent- All families want to see that you know your stuff. They want to see that you are knowledgeable and have expertise, which is why they are hiring you in the first place
    •  The family wants you to see their child as a child first and a diagnosis second- Don’t view their child as a list of deficits and weaknesses, or a problem to be fixed
    • The family wants you to be loving and kind- Parents love being around people who love their children











"I am not a teacher, but an awakener"   Robert Frost, American poet, 1874-1963



Beyond just being a cute TV show about new parents, the phrase “Up All Night” can also describe the lives of many parents raising children with Autism. Sleep issues are a common concern I hear from families, and they usually have been dealing with significant sleep issues for years.

Sleep issues could include getting the child to sleep in their own bed, getting them to fall asleep, getting them to stay asleep, or night roaming. These sleep issues can range from annoying to pretty serious. I also know of some parents who take turns sleeping in shifts so that someone is always awake.

For a stressed-out family dealing with behavioral, medical, educational, and social issues, a consistent lack of sleep makes a bad situation worse. I know of households where the parents regularly get 2-4 hours of sleep per night, because their child with Autism may not go to bed until 1am. Or the child goes to bed at 8pm, but is wide awake at 11pm and jumping off of furniture. A parent once made a comment to me that she felt like she had a perpetual infant, because her 7 year old son only slept 2-3 hours a night.

Everyone deserves a good night’s sleep. That includes you, and that includes your child. Many severe behavioral problems in children can be confounded by a lack of sufficient sleep. If you are dealing with significant sleep issues, know that you are not alone. This is a common issue within the Autism community. Here are a few general tips before tackling sleep problems:

  • As with any behavioral intervention, before you begin tackling this problem be fully prepared for a difficult process. Especially if you have an older child (over 6), these sleep issues have likely been present for quite some time. They won’t be fixed overnight.
  • Be a wary consumer when dealing with homeopathic methods such as Epsom salt baths, brushing therapy, and melatonin to induce sleep. These methods are not always empirically supported, so use them at your own risk and take careful data so you know whether an intervention is effective or not.
  • Both parents/caregivers need to be on board before correcting sleep problems. If Dad decides to start teaching the little one to sleep in her own bed, it is imperative that Mom is also on board. To have one parent enforcing rules and one parent allowing leeway will confuse the child and could make the behavior worse.
  • Do not begin addressing sleep issues during times of upheaval such as a family move, right before the start of a new school year, or if the child is ill.
  • Like many behavioral interventions, you may see sleep issues worsen before they improve. If this happens it is important you do not back off or stop the intervention. Doing so will likely make the behaviors more persistent and harder to change.
  • Children need to learn to go to sleep on their own. If you have a young child it is fine to sing and cuddle them until they fall asleep. However, at some point you need to begin removing yourself from the bedtime routine so the child can learn to fall asleep without you. When children climb into their parent’s bed in the middle of the night, wander around the house at 4am, or have difficulty calming down enough to fall asleep, it is because they haven’t learned the skill of going to sleep on their own. The child wakes up in the middle of the night and goes looking for Mom or Dad because they need their “prop” to go back to sleep.
  •  If your child is preschool age you also need to think about napping at school. In most preschools, children are expected to lay down at a specific time everyday and fall asleep within a few minutes. Don’t let your child be at a disadvantage in the classroom because they are used to having a 45 minute bedtime routine filled with songs, stories, hugs, and cuddles. Most preschool classrooms will not accommodate the lengthy bedtime routines that your child may require.










 "Discipline your son, and he will give you rest; he will give delight to your heart". Proverbs 29:17
Copyright T. Meadows 2011. All original content on this blog is protected by copyright. Powered by Blogger.
Back to Top