Safe And Sound: Training Occupational Therapists To Enhance Autism Safety And Support

Editor’s note: This text-based course is a transcript of the webinar, Safe And Sound: Training Occupational Therapists To Enhance Autism Safety And Support, presented by Tara Warwick, MS, OTR/L.

Learning Outcomes

• After this course, participants will be able to recognize common safety challenges faced by autistic individuals in homes and communities.
• After this course, participants will be able to identify the process for evaluating specific safety concerns related to autistic individuals, such as wandering, sensory sensitivities, and self-injurious behaviors, to enhance overall safety and well-being.
• After this course, participants will be able to identify potential preventive measures, personalized safety plans, and strategies for providing essential support to autistic individuals and their families.

Introduction

Several years ago, I became interested in safety for children with autism. At the time, I was working closely with schools and families of children with autism. About five years ago, after providing training at a particular school, one of the young students sadly passed away months later after wandering from home and drowning. This tragedy highlighted that safety for children with autism was an overlooked area that needs more focus. Since then, I have researched and presented extensively on this topic, aiming to increase awareness and prevent future incidents. Along with colleagues, I started a nonprofit in Oklahoma that provides families with resources and grants related to safety. Today, I am grateful for the opportunity to share more information with you about this important issue. Promoting the safety of children with autism continues to be a priority in my work.

Padlet Resources

If time permits, at the end of this training, I will review the Padlet page (QR code in handout), which contains relevant resources and materials from today's presentation. Padlet is an excellent platform for organizing information, and this page will remain available indefinitely as a reference. Please feel free to access it anytime after today's session to retrieve helpful information and recommendations covered here. My goal is to provide you with an ongoing tool to support your work with children with autism.

Why Do We Need This?

• Roughly half of children with ASD attempt to elope from a safe environment.
• More than 1/3 of children with ASD who elope are rarely able to communicate their name, address, or phone number
• Wandering ranked among the most stressful ASD behaviors by over 58% of parents
• 40% of parents suffered sleep disruption due to fear of elopement
• Half of families reported they never had any guidance on elopement from a professional

It is critical that we prioritize addressing safety for children with autism. The statistics related to wandering and elopement behaviors are alarming. Nearly 50% of children with autism will attempt to wander or elope from safe environments. Of those children who do wander, more than a third are often unable to communicate basic personal information like their name, address, or phone number if they become lost. For parents, wandering is an incredibly stressful behavior, ranking among the most anxiety-provoking autism behaviors overall. It disrupts sleep and causes constant worry. Yet despite this, 50% of families report never receiving any guidance from professionals on the risks of elopement and how to prevent it. As providers, we have a responsibility to be proactive and address safety with families rather than overlooking this critical topic. My goal today is to make this a priority by equipping you with strategies and resources to help keep children with autism safe. The risks are too great not to act.

Autism Facts

• 1 in 36, boys 4x more likely than girls (CDD, 2020)
• Most are diagnosed after age 4, though autism can be reliably diagnosed as early as age 2.
• 31% of children with ASD have an intellectual disability, 25% are in the borderline range (IQ 71–85), and 44% have IQ scores in the average to above average range (i.e., IQ >85).

It is helpful to review some basic autism facts as they relate to safety concerns. 1 in 36 children are diagnosed with autism, with boys being diagnosed at 4 times the rate of girls. However, testing biases may skew these gender ratios so the true numbers are unclear. Most children are not diagnosed until after age 4, but using validated tools and a team approach enables reliable diagnosis as early as age 2. In terms of cognitive abilities, 31% of children with autism have an intellectual disability. Another 25% have borderline IQ scores, while 44% have average to above average IQs, over 85. Understanding these baseline statistics provides useful context when addressing safety skills and risks for this population. Even children with average cognitive abilities can face elopement risks. This highlights the importance of safety training for all individuals with autism, regardless of IQ. Being aware of the basic epidemiology and cognitive profiles will equip us to better serve families and children on the spectrum.

• Affects all ethnic and socioeconomic groups.
• Minority groups tend to be diagnosed later and less often.
• Early intervention affords the best opportunity to support healthy development and deliver benefits across the lifespan.
• There is no medical detection for autism.
• Social communication & restricted, repetitive behaviors

Autism affects all ethnic and socioeconomic groups, though minority groups tend to be diagnosed later and less frequently. I see this discrepancy firsthand in my work in Oklahoma City, where minority families often struggle to access diagnostic and intervention services. Unequal access to early diagnosis and support is likely an issue nationwide. We know that early intervention is key, as it enables healthy development and delivers lifelong benefits when started young. Learning fundamental social, communication, and safety skills early sets a strong trajectory. 

Currently, there are no medical tests to detect autism. Diagnosis relies on expert evaluation of developmental history and direct observation of social communication and restricted, repetitive behaviors. Skilled providers observe behaviors and administer validated tools to assess symptoms accurately. Standardized assessment is key, as autism manifests through challenges in social communication and interaction, as well as restrictive, repetitive patterns of behavior. 

When considering safety risks, it is clear how these core symptoms could make it difficult for children to stay safe. Difficulties with communication, social skills, restricted interests, and repetitive behaviors may all play a role in elopement and injury risks. A thorough understanding of the core features of autism informs our approach to promoting safety.

Social Communication

• Difficulty understanding what others are thinking and feeling.
• Understanding nonverbal cues – facial expressions, gestures, body language.
• Understanding another person’s perspective.
• Difficulty regulating emotions.
• Difficulty communicating needs to others

There are several core challenges in autism that increase safety risks and make children more vulnerable.

Difficulty understanding others' perspectives means children may not realize when they have wandered into an unsafe situation. They struggle to put themselves in someone else's shoes and understand that others will worry if they elope. Reading facial expressions, body language, and nonverbal cues is also challenging. This makes it hard to discern strangers' intentions, elevating the risks of being taken advantage of. 

Problems regulating emotions can also lead to impulsive, unsafe actions. Children can become overwhelmed and instinctively bolt or flee safe environments during emotional dysregulation. Difficulty communicating compound these risks. Up to a third of children cannot communicate basic personal information like their name or address if lost. They also struggle to express their feelings, needs, and wants to others.

Taken together, these social, communication, and behavioral challenges inherent to autism increase injury risks and make it difficult for children to stay safe without adequate support. Being attuned to how their symptoms impact safety is key to promoting skills-building and preventative strategies. My aim is to increase your awareness of these connections so you can better serve families.

Restricted, Repetitive Behaviors

• Self-stimulatory behavior – hand flapping, rocking, jumping, twirling, etc.
• Rigidity – insist on consistency in the environment.
• Restricted range of activities – line toys up for hours, throw items, etc.
• Intense interests and obsessions
  • Items – fans, dinosaurs, television shows, etc.
  • Interests – history, space, numbers, etc.

In addition to social and communication challenges, restricted, repetitive behaviors inherent to autism can also impact safety. Children may exhibit repetitive self-stimulatory behaviors like hand flapping, rocking or jumping, especially when stressed or dysregulated. Rigid insistence on consistency and routine is common, causing distress when environments change unexpectedly. This rigidity can lead to impulsive, unsafe actions when overwhelmed.

Restricted ranges of interest and intense preoccupations or obsessions are also seen. Children may become consumed by thoughts of specific items or topics, unable to focus on anything else. I've seen children leave safe spaces to seek out objects of obsession, putting themselves at risk. For example, a child may see something of interest while riding in a car or bus and later impulsively leave home unsupervised to find it. Their obsessive thinking overrides safety considerations.

Being attuned to how repetitive behaviors and restricted interests influence actions helps us promote safety skills. Accommodating needs for consistency while expanding interests and flexibility are important. My goal is to increase your understanding of how core autism features like rigidity and obsession contribute to elopement risks so you can better support families.

What You May See

• Limited or no eye contact
• Unusual response to sensory information
  • Hands over ears
  • Rock back and forth
  • Scream or run away
  • Make noises
• Limited communication or unusual use of language
  • May not be able to answer simple questions
  • May repeat what you ask
  • May use sign language or electronic device

Several behavioral characteristics common in autism can also lead to misperceptions and unsafe situations when interacting with first responders or the community. For example, limited eye contact is typical but can appear suspicious to those unfamiliar with autism. Sensory sensitivities mean loud sirens, lights, and crowds may overwhelm children, triggering fight-or-flight reactions like screaming or bolting. Their attempts to self-regulate are often misinterpreted. 

Communication is also frequently atypical. As mentioned, many children cannot answer basic questions or personal details when stressed. They may echo others' words rather than respond appropriately. Some rely on sign language or devices to communicate, which community members may not understand. 

My goal is to increase awareness so you can help educate families and first responders about these autism behaviors. The more we advocate, the better-equipped communities will be to interpret behaviors accurately and support individuals and families. Rather than expecting children on the spectrum to change, our role is to drive understanding, compassion, and safe spaces. I aim to provide you with strategies and resources to fulfill this advocacy role and create safer, more inclusive environments.

Associated Medical Conditions

• 30-60% ADHD
• More than half have one or more chronic sleep problems
• Anxiety disorders - 11-40% of teens
• Depression – 7% of children, 26% of adults
• 8x more likely to suffer from GI disorders

Several co-occurring medical conditions commonly intersect with autism and influence safety risks. High rates of ADHD are seen, with 30-60% of children with autism also having this diagnosis. Over 50% experience chronic sleep problems as well, which can significantly increase the risks of nighttime wandering and elopement. Anxiety disorders are also very prevalent, affecting 11-40% of teens on the spectrum. Depression follows in adulthood, with 7-26% of adults affected. Children with autism are also 8 times more likely to suffer from GI disorders compared to neurotypical peers. 

Conditions like ADHD, disrupted sleep, anxiety, depression, and GI issues often exacerbate autism symptoms and contribute to unsafe behaviors. Lack of quality sleep and high anxiety, in particular, lead to increased impulsivity and flight risks for many children. Being attuned to each child's medical profile provides a clearer picture of the intersecting challenges that may be influencing safety. My goal is to equip you with an understanding of these associated conditions so you can better promote tailored accommodations, coping strategies, and skills training to meet each child's needs. Please let me know if this overview on medical factors like sleep, anxiety, and GI issues is helpful for considering risks and supports in your own practice.

• As many as 1/3 have epilepsy
• 4-35% also have schizophrenia (general pop. 1.1%)
• 1/3 (2-5 year olds) are overweight & 16% obese
• Only approved medications Risperidone and Aripiprazole

Approximately one-third of children are affected by epilepsy, a statistic that surpasses my initial expectations. What's particularly astonishing is the prevalence of schizophrenia among individuals aged four to 35, which stands at a significantly higher rate than the general population's 1.1%. In the case of young children aged two to five, a concerning one-third are classified as overweight, with an additional 16% falling into the obese category. As of now, these are the sole sanctioned medications available for these conditions.

Associated Challenges

• An estimated 25-30% do not communicate with words or limited words.
• Nearly half wander or bolt from safety.  
• Nearly 2/3 between the ages of 6 and 15 have been bullied. 
• Nearly 28% of 8-year-olds have self-injurious behaviors. Head banging, arm biting, and skin scratching are among the most common. 

Furthermore, we encounter additional challenges associated with these statistics. An estimated 25 to 30% of these children face difficulties in communication, a topic we have previously discussed. It's noteworthy that nearly half of them tend to wander, and an alarming two-thirds have experienced bullying, a figure that indeed strikes me as remarkably high.

Moreover, approximately 28% of eight-year-olds exhibit self-injurious behaviors such as headbanging, arm biting, and skin scratching. This raises concerns about the safety of these children in their environments. A pertinent question from the chat box emerges: "What if parents have unrealistic goals for their child?" This is indeed a complex issue. While it is essential to support parents in their aspirations for their children, it is equally vital to establish a relationship with families that doesn't diminish their hopes. The key lies in helping them discern what is realistic in terms of safety and understanding where the child currently stands, along with identifying the necessary steps to ensure their safety within their surroundings.

• Drowning remains a leading cause of death for children with autism and accounts for approximately 90 percent of deaths associated with wandering or bolting by those aged 14 and younger. 
  • Wandering or bolting
  • Attraction to water
  • Lack of experience (putting off swim lessons)
  • Lack of training

The gravity of this situation struck me profoundly as well. Drowning continues to stand as a dire threat to the lives of children with autism, constituting a staggering 90% of fatalities associated with wandering and bolting by the age of 14 or younger. It is truly disheartening to acknowledge that 90% of such tragic incidents involve drowning when children elope, exemplified tragically by the case of a young boy in Oklahoma several years ago. In his pursuit of water, he escaped from what should have been a secure environment, ultimately succumbing to this heart-wrenching situation.

A significant number of children with autism exhibit sensory needs that draw them to water, intensifying the need for preventive measures. The factors contributing to this risk are multifaceted. It may include a lack of swimming experience, possibly stemming from the unavailability of trained instructors, or behavioral challenges that hindered their participation in swim lessons. Moreover, it could be attributed to a lack of training and awareness among individuals in the immediate vicinity of the child with autism, which could inadvertently lead to such tragic outcomes.

The statistics surrounding this issue are indeed deeply concerning, emphasizing the urgency of raising awareness and implementing comprehensive safety measures within the autism community.

Top Safety Risks for Autistic Individuals

• Wandering or eloping from safety
• Pica
• Drowning
• Household toxins
• Misunderstand related to communication difficulty

There are several safety risks associated with autistic individuals that require careful consideration and discussion when working with their families. These top risks encompass wandering or eloping from safety, pica (the ingestion of non-food items), drowning, exposure to household toxins, and the potential for misunderstanding due to communication difficulties.

When engaging with families, it becomes crucial to initiate conversations surrounding these various risks to determine if a child may be vulnerable to any of these challenges. These dialogues serve as a means to assess and address potential hazards and ensure the safety and well-being of the child.

Notably, household toxins may not always be the most apparent risk, but it is one that deserves attention and awareness. Your experience with the young girl who inadvertently ingested medication serves as a poignant reminder of the potential dangers posed by household toxins. Regrettably, this risk is real, and it underscores the necessity of safeguarding autistic individuals against exposure to poisonous substances.

Evaluating Safety

• Schedule a time to meet with families
• Include goals in your plan of care and/or IEP goals
• Address at regular times during the year (IEP Meeting, before winter break, before summer break, after summer break)

The importance of evaluating safety when working with children, especially those with autism, cannot be overstated. Here are several essential considerations and strategies for addressing safety concerns:

It's crucial to allocate specific times for meetings with families to delve into safety issues. For children in school, incorporating these discussions into Individualized Education Plan (IEP) meetings is a strategic approach. Stressing the significance of these conversations and their relevance to both home and school environments is vital.

Recognize that safety concerns at home can extend to the school environment and vice versa. Collaborative efforts with families and school teams can lead to the creation of a unified safety plan that comprehensively covers all aspects of the child's life.

The inclusion of safety-related goals in the child's plan of care or IEP is crucial. These goals should be tailored to address specific safety needs and concerns. Whether you operate in an outpatient or school setting, framing safety goals as medically necessary can provide a strong rationale for their inclusion.

Consistently make safety a prominent topic throughout the year. Consider weaving discussions about safety plans into IEP meetings and diligently documenting them in progress notes. Prioritizing safety discussions before extended breaks or significant changes in routine is a prudent approach, as these periods can heighten the risk for safety-related issues.

When evaluating elopement or wandering behavior, it is essential to delve into its root cause. Some children may engage in elopement due to sensory-seeking behaviors, driven by the desire for specific sensory experiences or as a means to alleviate sensory overload. Others may elope out of safety concerns. Discerning the underlying motivation behind elopement can inform tailored interventions that effectively address the issue.

For children whose elopement is linked to sensory needs, creating sensory-friendly spaces or teaching them how to request sensory breaks can be beneficial. In cases where elopement relates to task avoidance, the focus should be on developing coping strategies and assisting the child in managing overwhelming situations.

Depending on the child's age and capabilities, it is essential to impart safety skills. These may encompass communication skills, the ability to recognize and avoid hazards, and adherence to safety rules.

To promote safety, structured breaks should be introduced. These breaks can provide children with autism with a designated and safe environment to decompress and regain control when sensory overload or anxiety arises.

By incorporating these strategies and maintaining a steadfast commitment to safety, professionals can help ensure the well-being of children with autism in various settings.

Safety Plan Checklist

• Does the person with autism tend to wander, run away, or get lost in a crowd?
• Have the home, school, and community activities been evaluated for safety? Have preventative measures been put into place in each of these areas?
• Does the person ALWAYS wear identification with a contact number listed?
• Has the family let neighbors/community know about the child with autism?
• Are safety skills included in the Individual Education Program in your school district?
• Have you or the family contacted your local 911 call centers?

When considering a safety plan checklist and engaging in discussions with families, it's essential to pose thought-provoking questions, as seen above, that address various aspects of safety.

Engaging in these discussions and addressing these critical questions can aid in the development of a comprehensive safety plan tailored to the specific needs of the individual with autism. It also fosters proactive collaboration between families, educators, and the community to enhance safety and well-being.

The Why of Wandering

• Goal-directed wandering
• Bolting/Fleeing
• Other: nighttime wandering, disorientation, boredom, transition/confusion

Exploring the underlying reasons behind wandering behavior is crucial when developing a safety plan and collaborating with families. Here's how you can guide families through this process. Encourage families to reflect on the circumstances surrounding the last instance of wandering. Ask them to describe what was happening before and after the episode. Inquire whether they believe the individual had a specific goal in mind when they wandered. Were they seeking something specific, such as a toy, access to water, or a neighbor's house? Discuss the possibility of the behavior being a form of elopement in response to feeling overwhelmed. Did the individual flee from a situation they perceived as unsafe or excessively stimulating? Explore whether the wandering tends to occur during nighttime and if it is possibly related to disorientation or confusion. Consider whether wandering might be a result of boredom or restlessness when the individual does not have a structured activity or task to engage in. Investigate if wandering tends to happen during transitions, especially when there is a deviation from the usual routine or when unfamiliar people are present.

By delving into the various motivations behind the wandering behavior, families and professionals can gain valuable insights that can inform the development of effective strategies and interventions to enhance safety and address the specific needs of the individual with autism. This comprehensive understanding of the "whys" can lead to more targeted support and preventive measures.

Dangers of Wandering

• Drowning
• Hit by vehicle
• Falling
• Dehydration
• Hypothermia
• Abduction
• Victimization
• Assault

The dangers linked to wandering among individuals with autism are numerous and present significant safety concerns. These risks encompass various potential hazards, such as drowning, which remains a substantial danger, particularly when individuals with autism are attracted to water. Additionally, there is the risk of vehicle accidents and falls when they wander near roads or unfamiliar areas, which can result in injuries. Extended periods of wandering can lead to dehydration, and exposure to extreme weather conditions may result in hypothermia.

Moreover, wandering individuals may become vulnerable to abduction by strangers and may also be at risk of victimization, including physical assault and bullying. It's important to recognize that these safety concerns extend to both younger children and older teens or young adults with autism. Older individuals may face additional challenges due to their physical appearance and behaviors, which can be misunderstood by others.

Addressing these concerns requires collaboration among professionals, therapists, families, and the community as a whole. Developing comprehensive safety plans, raising awareness in the community, and providing support and resources are essential steps toward reducing the risks associated with wandering and ensuring the safety and well-being of individuals with autism.

Prevent-Educate-Respond

Now, I want to go over the prevent, educate, and respond model. 

Prevention

• Install Home Safeguards
• Secure Personal Safeguards
• Create Community Awareness
• Remain Hypervigilant

Some prevention strategies we are going to review are installing home safeguards, securing personal safeguards, creating community awareness, and then remaining hypervigilant.

Install Home Safeguards

• Fire Marshall does not have jurisdiction over your private residence, per Cleveland County Fire Marshall
• Safety question:
• Can the child get out in case of fire?
• Can somebody get into the room in case of fire?

Regarding personal safeguards, it's crucial to consider the balance between safety and accessibility, particularly within the confines of a private residence. An important aspect, as highlighted during my assistance with a family's home modification, pertains to the jurisdiction of the fire marshal, which can vary by location, such as in Cleveland County.

It's advisable to check with the local fire marshal or relevant authorities to understand their regulations and guidelines. The primary concern revolves around whether the child can safely exit the premises in case of a fire emergency and whether someone can access the child's room in such situations. 

In some cases, families have installed additional locks on doors to prevent nighttime elopement. However, they must ensure that these measures do not compromise the child's ability to exit during a fire or impede emergency access. Striking the right balance between addressing the risk of wandering and fire safety is paramount, and consulting with local authorities can provide valuable insights and guidance in making informed decisions.

Areas to Address.

• Install secure locks (exterior doors)
• Door/window chimes
• Use baby monitors or webcams
• Visual prompts (stop signs)
• Keep garage door opener out of reach
• Secure gates
• Fence for yard
• Protection for beds

When discussing safety considerations with families, it's essential to explore various practical measures: Begin by ensuring that the home has secure locks on exterior doors to prevent unauthorized exits. Some individuals may benefit from simple chimes or alarms on doors and windows. These cost-effective devices can serve as cues for both the child and caregivers. There are affordable options available for monitoring, such as baby monitors or webcams. These modern technologies have become more accessible, allowing families to monitor their child's room effectively. These devices can be set to detect even slight movements, providing alerts when necessary. Consider using visual cues like stop signs, especially if the individual tends to use a specific exit. These prompts can serve as reminders and enhance safety. Keep garage door openers out of reach to prevent access to potentially hazardous areas. Evaluate the protection of backyard fences, including the possibility of adding exterior locks to keep individuals from wandering outside the yard. For younger children, protective measures like bed tents can enhance safety at night. Engage in conversations with families to determine if such measures would benefit their child, particularly for nighttime safety.

By discussing these considerations with families, you can help them make informed decisions to create a safer environment for their child with autism.

Examples.

• 2-Sensory Indoor Door and Window Sensory (12.97 at Lowes)
• Doorknob Protectors
• Adhesive Mag Lock
• Multi Use Latches
• First Alert Pods
• Guardian Lock
• 1-2-3 Door
• Bed Tent
• Safety Sleeper

Here are various examples of safety measures, some of which are also available on the Padlet. Indoor door sensors are cost-effective and can be easily obtained from stores like Lowe's. They provide alerts when doors are opened, helping caregivers monitor exits. Doorknob protectors can be used to prevent individuals from easily opening doors and exiting. Families can install adhesive magnetic locks on cabinets, particularly those containing medication or other potentially dangerous items. These locks use magnets to secure cabinets. Various types of latches are available to secure doors and prevent unauthorized exits. First Alert pods are portable devices that are useful for vacations. Caregivers can keep them with them, and if the individual wanders beyond a certain distance, an alert is triggered. A Guardian lock is suitable for use in hotel rooms, helping families secure the room and prevent elopement, especially at night. A 1-2-3 Door is a device that functions as a half door, providing a barrier while allowing visibility and airflow. Bed tents and safety sleepers can enhance nighttime safety, especially for younger children.

Secure Personal Safeguards

• Wearable identification
• Temporary tattoos (special occasions and outings)
• Non-emergency 911 to flag your child with autism and their information.

When it comes to securing personal safeguards for a child with autism, there are several options to consider. These safeguards are designed to ensure that essential information and identification are readily available, especially during outings or emergencies.

One option is wearable identification, which includes items like wristbands, necklaces, or pinned identifiers on clothing or shoes. The goal is to find a form of identification that the child is comfortable wearing and can keep on them.

Temporary tattoos can also be a practical choice, particularly for special occasions and outings. These temporary tattoos can display vital information about the child and serve as an additional safety measure.

Additionally, some 911 systems offer non-emergency options that allow parents or caregivers to provide essential details about the child with autism. This information can be crucial for emergency responders in understanding the child's specific needs and circumstances.

Examples.

• Alert Me Band
• Keep Me Safe ID
• If I Need Help
• Tattoos with a Purpose
• Safety Tat

There are various options and brands available for personal safeguards designed to assist individuals with autism. While these brands may have different names, they generally serve the same purpose. Some examples include the Alert Me Band, Keep Me Safe ID, If I Need Help, Tattoos with a Purpose, and Safety Tat.

Families and caregivers interested in these personal safeguard solutions can explore these brands to find the one that aligns best with their specific requirements. These safeguards are typically affordable and reusable, making them practical choices for enhancing safety.

GPS Tracking Technology Considerations.

• Battery life
• Water resistance
• Waterproof
• Removable
• Perimeter notification available
• Cellular service
• Involve trained emergency response personnel
• Help desk available
• Costs and monthly fees
• Field testing

When exploring GPS tracking devices as a safety measure, it's important to consider various factors with families. One crucial aspect is the device's battery life, as it determines how long the device stays charged and remains effective during use. Additionally, it's essential to inquire whether the device is water-resistant or waterproof, as this feature can be crucial in various situations.

Another key consideration is the device's removability. Discuss with the family whether the individual can easily remove the device or if it can be comfortably worn to ensure consistent tracking. Understanding the range or perimeter within which the device operates is also important to track the individual's movements effectively.

The type of connectivity the device relies on is a critical factor. Determine whether the device requires cellular service or operates via Bluetooth, as this can impact both its functionality and cost. Additionally, inquire about any available support, such as trained professionals or a help desk associated with the device, as this can be vital in emergencies.

Finally, it's essential to discuss any associated fees, including the initial cost and ongoing subscription or service fees. By addressing these questions and considerations, families can make informed decisions about GPS tracking devices to enhance the safety of individuals with autism.

Examples.

• Amber Alert GPS
• Angel Sense
• ICE4Autism
• Project Lifesaver

There are various options and resources available for GPS tracking and safety devices to enhance the security of individuals with autism. For example, the Amber Alert system is widely recognized for child abduction alerts, which can also be used for tracking purposes to ensure the safety of individuals.

Angel Sense offers a specialized GPS and voice-monitoring device designed for children with special needs, including autism. ICE4Autism is an app-based solution that provides real-time location tracking and safety alerts for individuals with autism.

Project Lifesaver is a program designed to assist in the rapid location of individuals who may wander or become lost, often involving wearable transmitters. Additionally, Air Tags, small and affordable tracking devices, can be creatively incorporated into wearable items like anklets or accessories shaped like characters. This ensures that individuals carry them without noticing, making them a great way to enhance safety.

Create Community Awareness

• Alert the school and bus drivers
• Complete alert form for local police (current photo and unique characteristics)
• Alert trusted neighbors
• Introduce them to your child
• 911 – Non-emergency flag

Creating community awareness is a vital aspect of ensuring the safety of individuals with autism. This involves several key actions. One essential step is to always be mindful of who is with the child, especially during transportation, such as school bus drivers and school staff. It's important to ensure that these individuals are well-informed about the child's condition and any safety protocols that need to be followed.

Additionally, families should be encouraged to complete alert forms provided by their local police departments. Resources available on websites like Autism Speaks can guide families in providing essential information to law enforcement, which can be crucial in emergency situations.

Another important aspect is informing trusted neighbors about the child's condition and the possibility of wandering. Introducing the child to neighbors allows them to become familiar with one another, which can be especially helpful in case the child ever needs assistance or goes missing.

Exploring the use of non-emergency 911 systems to flag information related to a child with autism is also a valuable strategy. This can help first responders better understand the child's needs and respond appropriately in emergencies.

Contact First Responders.

• Contact your local police station and other first responders
• Provide them with the form and any additional information relevant to your child
• Introduce the child to first responders

Contacting first responders and providing them with essential information is a critical step in ensuring the safety of individuals with autism. Families can utilize first responder forms, which are often available on websites like Autism Speaks (as listed on the Padlet), to communicate important details about their child's condition and specific needs.

Additionally, introducing the child to first responders can be beneficial in helping them become more familiar with the child. This familiarity can contribute to a sense of safety and better understanding should any emergency situations arise.

Alert Trusted Neighbors.

• Introduce the child to the neighbors
• Use the form as a guide for important information
• Create an All About Me Form
• Likes/Attractions/Favorite Things
• Triggers/Dislikes/Fears
• If lost, it may likely be found at
• How to calm him
  • few words
  • visual supports
  • things they like

When communicating with neighbors to create a network of support and awareness, assisting families in developing an "All About Me Form" can be immensely helpful. This form should include various details about the child, such as their likes, interests, favorite activities, and what they are attracted to. It's also important to note their dislikes and any fears they may have.

In case the child ever goes missing, the form should specify where they can most likely be found and provide guidance on how to calm them if necessary. Additionally, it includes instructions on how to interact with the child, what to say or not say, and how to communicate using minimal words. These details can help neighbors feel more prepared to assist the child in various situations.

Remain Hypervigilant

• High alert during warmer months, holidays, vacations, camping trips, transition periods, outdoor gatherings, new home or school, visiting unfamiliar settings, public outings
• Initiate a “tag, you’re it” system during family gatherings and transitions.

Remaining vigilant and maintaining awareness is crucial when it comes to ensuring the safety of children with autism. Families should be reminded not to become complacent and to stay vigilant, especially during certain periods of the year or specific situations.

Warmer months, holidays, vacations, camping trips, transitions, outdoor gatherings, visits to unfamiliar places, and public outings are all instances where elopement risk can be elevated. Families should be particularly cautious during these times.

One effective approach is the "tag, you're it" system, which involves using a lanyard to indicate who is responsible for watching the child at any given moment. This system helps ensure that someone is always keeping an eye on the child, especially in crowded or busy settings.

Additionally, educating families about potential triggers for wandering is essential. Understanding what might prompt a child to wander can help caregivers take preventive measures to keep the child safe.

Education

How can we educate and give the child some skills to avoid elopement and wandering?

Identify Triggers/Teach Self-help

• What could trigger wandering (loud noises, bright lights, fear)?
  • Teach other ways for your child to respond
  • Noise-canceling headphones
• Teach Self-Help
  • Calming techniques
  • Asking for a break

Teaching children with autism about their triggers for wandering is an essential part of their safety education. By identifying what factors may prompt wandering, families and caregivers can take preventive measures. Triggers could include loud noises, bright lights, fear, or crowded environments.

It's also important to teach these children alternative ways to respond when they start feeling overwhelmed. For example, they can be taught to ask for a break, go to a designated safe area, or use a specific gesture to indicate their distress. Noise-canceling headphones can help them block out overwhelming sounds.

Providing calming techniques is another helpful strategy. Deep breathing exercises, sensory activities, or offering choices for self-soothing can be effective in managing stress and preventing wandering.

The 5-Point Scale, in Figure 1, is a valuable tool for children to understand and communicate their emotional states, ranging from calm (1) to highly stressed (5). This scale can be a useful visual aid in helping children recognize and express their feelings.

Figure 1. The 5-Point Scale.

Using the 5-Point Scale as a tool to help children with autism communicate their emotional states and stress levels is an effective strategy. It allows them to express their feelings and needs before reaching a crisis point where they might bolt or run away. Incorporating this skill into their IEP or outpatient therapy goals can be highly beneficial. It empowers children to self-regulate their emotions and behaviors, reducing the risk of wandering or elopement and promoting their overall well-being.

Break Area

• Identify a place/area across all locations
• Make sure activities are there that are calm
• Explain to others
• Limit interaction and talking
• Practice, practice, practice!
• Respect the child’s need for a break
• Give time and personal space

Creating designated break areas, even if they are simple and not elaborate sensory rooms, can be incredibly helpful for individuals with autism. These safe spaces provide them with a designated area to retreat to when they become overwhelmed or anxious. It's important to communicate with families about the importance of these break areas and how to set them up effectively, ensuring that they are calming and sensory-friendly for the individual. This proactive approach can help prevent elopement or wandering by giving the individual a place to self-regulate and de-escalate.

Calming Activities

Creating a break area and setting clear boundaries around it is crucial for the success of this strategy. It involves not only physical preparation but also educating everyone in the individual's environment about its purpose and the need to respect their space when they use it. Practicing this with the individual when they are calm and not in a moment of distress is an excellent way to ensure they understand how to utilize the break area effectively. Providing calming activities and sensory tools in the area can further assist in self-regulation and stress reduction.

• Drinking a glass of water
• Deep breathing
• Stretching
• Jumping jacks
• Drawing
• Reading
• Taking a bath (if possible) or putting their hands in cool water
• Putting a cool, wet cloth on the forehead
• Playing with a sensory-type toy

Using ice-cold water as a strategy to help individuals, both children and adults, manage their emotions and calm down is supported by research. It can be a simple yet effective technique to consider when someone is feeling upset or overwhelmed. Additionally, there are various other activities and techniques, such as deep breathing, stretching, engaging in physical activities like jumping jacks, or using sensory toys, that can serve as valuable tools to help individuals self-regulate and manage their stress or anxiety effectively. These strategies can be tailored to the specific needs and preferences of the child or individual.

Teach Safety Skills

• Enroll in swim lessons
  • 91% of reported wandering-related deaths in children with autism due to drowning (2009-2011)
• Social Stories about safety
• Answering personal identification questions
• Dial 911
• Identify a “safe” person

Prioritizing swim lessons is crucial, especially considering that drowning is a significant risk for children who tend to wander or elope. Finding a qualified swim instructor is ideal, but occupational therapists can also contribute by breaking down swim skills into manageable steps and providing safety guidance. Additionally, using social stories can be a helpful tool to educate children about water safety. These stories can effectively convey important information and behavioral expectations related to swimming and water-related activities.

Tips for Swim Lessons

• Information to instruct the child includes:
  • Communication
  • Behaviors
  • Visuals used
  • Medical precautions
  • Bath? Washing hair?
  • Specific likes and dislikes
  • Motivation
• Flexible teaching styles – firm/playful, nurturing/calm, energetic/engaging
• Build Trust

When enrolling a child with autism in swim lessons, it's essential to provide the instructor with pertinent information about the child's communication style, behaviors, any necessary visuals, and any medical considerations. Knowing how the child responds to bathing and hair washing can also be valuable information. 

Additionally, assisting families in finding a swim instructor who employs a flexible teaching approach, combining firmness with playfulness, nurturing with calming, and energy with engagement, is crucial. Building trust with the instructor is a vital initial step, especially if the child is apprehensive about getting into the water. Building this trust can help create a positive and effective learning environment.

Swimming- Routines and Rituals

• Use a systematic, consistent approach with clear instructions
• Always ask permission before entering the bath, pool, or any body of water
• Swim Skills vs Play Time – Why is Play important?
  • Engage with instructor
  • Interact with instructor
  • Motivation
  • Padlet Videos

Establishing a consistent and systematic approach with clear instructions is essential when teaching children with autism how to handle water-related activities. Creating routines and rituals helps them feel secure and understand what to expect.

Encourage the practice of asking for permission before entering any body of water, whether it's a bath, pool, or another water source. Differentiating between swim time and playtime is important, as it helps children engage with their instructor, interact meaningfully, and stay motivated to learn.

Utilizing social stories can be an effective strategy to teach children about water safety, including the importance of not leaving home without adult supervision and what to do when they want to leave. These stories can help reinforce safety concepts in a way that's accessible and understandable for children with autism.

Social Stories

• Examples:
  • Leaving home without adult supervision
  • When you are lost
  • Playing in water
  • Going into unfamiliar houses/cars
  • When approached by a first responder

Social stories can also be valuable tools for teaching children with autism what to do in various situations, such as when they're lost, playing in the water, entering unfamiliar houses or cars, or when approached by a first responder. These stories provide clear and visual guidance on how to respond appropriately in different scenarios, helping children understand and remember the necessary steps to stay safe.

Goal Example- Safety Skills

• By the end of six months, the child with autism will independently demonstrate appropriate safety skills in at least three different settings, including home, school, and public spaces, as evidenced by consistently following safety guidelines and demonstrating an understanding of potential risks and appropriate responses in at least 80% of observed situations.

Here are a couple of different goal examples on safety skills. 

Goal Example- Safe Person

• Within a three-month period, the child with autism will be able to consistently identify at least three safe persons in their environment, as demonstrated by pointing them out, using verbal cues, or displaying a visual representation with an accuracy rate of at least 80% during structured identification tasks across different settings, such as home, school, and community.

Here is another one identifying a safe person in the community.

Objective Examples- Water Safety

1. Will demonstrate understanding of water safety rules and guidelines by independently reciting at least five key water safety rules.
2. Will display appropriate behavior and responses to water-related situations, such as showing awareness of potential dangers, recognizing lifeguards or designated supervisors, and correctly identifying and using safety equipment (e.g., life jackets) in at least 80% of observed scenarios.

These are objective examples of goals for water safety.

Respond

The last section is about how to respond.

• Always call 911 immediately – law enforcement should treat each case as “critical”
• Provide Autism Elopement Form
• Search water first
• Community response (missingkids.org/aware)
  • Stop
  • Seek Assistance
  • Stay

In case a child with autism escapes, it's crucial to act promptly and follow specific steps. The first step is to call 911 immediately, treating every elopement case as critical. It's important to contact emergency services right away.

Next, provide the autism elopement form to the first responders. This form can be found in the Autism Speaks safety resources, which are available on the Padlet. The form contains essential information about the child and their specific needs, helping the responders better understand the situation.

Additionally, it's vital to prioritize searching near bodies of water when a child goes missing. Children with autism are often attracted to water, which poses a significant drowning risk. Therefore, always begin the search near bodies of water to address this immediate danger.

Finally, a community response strategy is essential. Remember the mantra: "Stop, Seek assistance, Stay." If a child with autism escapes, stop any ongoing activities immediately. Seek assistance by calling 911 and informing authorities about the situation. Stay at the location where the child was last seen until they are found and returned to safety.

Acting swiftly and efficiently is crucial in ensuring the child's safety when they elope.

Re-Evaluate the Plan

• Child medical, behavioral, and communication updates
• Home and community safety updates
  • Family re-locate
  • New neighbors
  • New community activities family interested in

Reevaluating the safety plan on a regular basis is essential to ensure its continued effectiveness. Rather than waiting for a crisis, it's prudent to schedule routine safety reviews. Consider evaluating the plan at specific intervals, such as every nine weeks, at the end of a semester, or before breaks.

During these reviews, look for any necessary updates or modifications. Assess whether there have been changes in the child's medical condition, behavior, or communication abilities that require adjustments in the plan. Additionally, consider changes in the home environment or community. Have there been any relocations, new neighbors, or alterations to community activities? These changes may necessitate updates to the safety plan to ensure the child's security in new settings.

It's important to note that many families might not realize that they can seek help from professionals like occupational therapists regarding safety plans. Often, they may believe they have to handle it on their own. Therefore, initiating the conversation about safety and offering support as professionals is a crucial step in keeping children with autism safe. By proactively addressing safety concerns and periodically reviewing and updating safety plans, we can help prevent potentially dangerous situations and ensure the well-being of these children.

Review of Padlet Resources

The Padlet is open for you as long as you need it. If there are any resources that you want to share on there, I think you should be able to add them.

Summary

• Get involved with families about safety, make it a priority in your plan of care
• Help families create a safety plan
• Re-evaluate the plan
• Help create overall community awareness

Your emphasis on making safety a priority and actively involving families in creating and maintaining safety plans for children with autism is incredibly important. Collaborating with families to address environmental factors, personal safeguards, skill development, and community awareness can significantly enhance the safety and well-being of these children.

Your approach of reevaluating the safety plan regularly and ensuring that everyone in the child's community is educated and aware of how to support them is essential. By working together with families and providing guidance and resources, professionals like you can make a meaningful difference in the lives of children with autism and help create a safer environment for them.

If you or anyone else has further questions or needs additional information on this topic or related matters, please don't hesitate to ask. Your dedication to this field and the safety of these children is truly commendable.

Questions and Answers

What are your thoughts on utilizing CBD oils to reduce harmful behaviors and reduce anxiety?
I think that every family should talk to their physician about using CBD oils because it varies from case to case. Some families have found success, while others haven't. I don't have a strong bias one way or the other.

What would you recommend for a classroom with multiple students who elope, where additional locks, gates, and doors are not allowed?
This is a great question. First, I would want to understand why these students are eloping. Is it because the classroom is overwhelming for them? If so, we should consider modifying the classroom environment to make it less overwhelming. When students have enjoyable and successful experiences in the classroom, they're less likely to want to elope. I would also examine whether specific times of the day or lack of routine and structure trigger elopement. Creating more routines and structure during those times might help.

Are there any favorite books on safety?
I don't have specific recommendations for children's books on safety, but Autism Speaks and the National Autism Association offer excellent resources on safety. If anyone else has favorite books, please share them.

Would wobble cushions help children who need stimulation but tend to wander?
Whether wobble cushions help depends on the underlying reasons for wandering. If a child is wandering because they seek more movement, wobble cushions might be beneficial. However, if wandering is driven by being overwhelmed, wobble cushions may not be the best solution. It's essential to match interventions with the specific reasons behind the elopement behavior.

References