Elopement in Children with Autism

Seven-year-old Xavion Young of Texas City, outside of Houston, disappeared on January 6 when he managed to unlock a back door while his mother was in the bathroom. His body was found the next day in a nearby retention pond. No doubt you have read about stories like Xavion’s many times. Elopement is a common problem among individuals with autism, and in some cases, the results are tragic.

Elopement involves leaving a designated area without permission. This can include running away from a parent when out at a park or store, escaping from a home when a caregiver is distracted, or running away from school. Nearly 50% of individuals with ASD have attempted to or have successfully eloped from a known adult.

The leading cause of death in children with autism spectrum disorder is drowning. In many cases, drowning secondary to elopement is a preventable tragedy. As in Xavion’s case, locks are advised but don’t always work, so it is necessary to address the root causes of wandering to prevent the next tragedy from occurring.

Nearly 50% of individuals with ASD have attempted to or have successfully eloped from a known adult.

Families often focus on trying to prevent wandering with gates, locks, and alarms. While these efforts are advisable and do help prevent some instances of elopement, you must identify the reasons why an individual is eloping in order to design an effective intervention. Behavior analysts can help families by focusing on function-based interventions designed to prevent the behavior.

Functional assessment of elopement and children with autism

Functional assessment is used to address many behavior issues and can also be applied to elopement and children with autism. As in the case of any behavior, we need to collect and evaluate data within the context of the display of the behavior in order to understand why it occurs. Behavior analysts refer to the “why” of the behavior as the “function.” In a review of the assessment and treatment of elopement, Dr. Megan Boyle and Dr. Reesha Adamson of Missouri State University found that the most common functions for elopement are:

• To get away from a place, activity, or person (escape)
• To obtain access to an item, activity, or person
• To engage in an intrinsically pleasurable activity, such as running
• To gain attention

Of course, there are challenges to conducting a functional assessment of elopement. It can be difficult to predict and observe, and setting up conditions to test to see if elopement will happen could be dangerous.

One way to identify predictors of elopement is to look at what is going on before it occurs. By reviewing the antecedents to previous incidences of elopement, interventionists and families may gain a clue as to what the individual is seeking or trying to escape. Was the person required to do something they didn’t want to do? Have they been denied something that they like and might be going somewhere they think they can find it? These observations may help you understand the individual’s motivation.

Functional communication training to help prevent elopement by children with autism

Some research has shown that an effective way to address elopement in children with autism is through functional communication training. As explained in the article Functional Communication Training: A Review and Practical Guide:

Functional communication training (FCT) is a differential reinforcement (DR) procedure in which an individual is taught an alternative response that results in the same class of reinforcement identified as maintaining problem behavior. Problem behavior is typically placed on extinction (i.e., reinforcement no longer follows problem behavior).

The results of the functional assessment will guide practitioners and families to an intervention linked to why the elopement is occurring. Here are some ideas:

If the function is attention

Make sure that the individual is receiving the amount and kind of attention they prefer in the environment from which they have eloped in the past. Give them non-contingent attention for just being there and attention for participation. Use visual supports to teach the individual how to request attention without elopement. Ensure that they receive attention from a preferred person when they use the visual support. Avoid reprimands or lectures, as such negative attention may only reinforce the elopement. It’s important that they receive positive attention for being present and following routines.

If the function is escape

If you can identify antecedents to elopement, change the environment to the greatest extent possible to prevent elopement. Teach the individual how to request a break and reinforce them for asking for a break without eloping. If the elopement occurs anyway, retrieve the individual and return them to the task or environment they are trying to escape. You may need to shorten the task and offer a break. Reinforce compliance with getting back to task. Do not punish the individual, such as berating them or putting them in time-out, as that reinforces the elopement. You want that person to want to remain in the environment.

If the behavior is automatically maintained

“Automatically maintained” means the behavior itself is the function – e.g., the individual finds running enjoyable. Many individuals with autism engage in behaviors related to automatic reinforcement. If this is the function for the individual’s elopement, enrich their environment to decrease the motivation to elope. Add more functionally equivalent activities into the environment. For example, you may give a student who elopes for the joy of running regular opportunities to go to the gym or a track and run.

If the function is access to tangibles

Schedule times when the individual can access the desired area or item. Teach the individual how to request the item or area. Communicate to them when they can have the item, and make sure they get it when you tell them they will get it, no matter what. Whatever you do, do not allow an elopement to continue – “Well, he’s already outside. We might as well let him stay out there.”

Elopement is a serious problem facing the autism community. Loved ones and clinicians can help keep individuals safe by:

• Monitoring and using locks and surveillance equipment
• Using GPS devices for those prone to wander
• Teaching the individual to get their needs met

The bottom line for decreasing the likelihood of elopement is to teach individuals the skills they need to get what they want in the environments that they are in at the time. If you do what you can to make the environment comfortable and teach the person how to ask for what they want, the chances for elopement will decrease.