Elopement in Autism
Scheithauer defines elopement as any time that a child leaves supervision. This can include leaving the home, bolting away in public, getting lost in a store or mall, leaving a classroom, or running away in a hallway (3:30). The speaker explains that elopement is developmentally appropriate when it is not a habit and only occurs before age four. She cites research showing that nearly 50% of autistic children have eloped after the age of four and that 35% of autistic children with intellectual disabilities eloped in the last year (5:00). The presenter outlines a recent study where half of the caregivers with kids that eloped (n = ~1,500) reported that they were at risk of serious injury. Many children were avoiding public places, and over 40% of caregivers had no guidance on how to address it (5:45).
What the research says
Contemporary literature on the treatment of elopement emphasizes the importance of function-based strategies. Scheithauer underscores the importance of understanding why a child is eloping, which then allows families and practitioners to teach alternative and appropriate behaviors to get what the child needs. Function-based interventions also entail changing the environment to promote appropriate behavior and generalizing the behaviors to maintain changes across time (7:00). The presenter cites a literature review showing that 80% of studies on function-based interventions for elopement showed positive results. Similarly, a case series analysis showed that 9 out of 11 kids experienced a 70%-90% reduction in elopement (10:35). Scheithauer notes limitations in past research, including struggles to create individualized care plans, limited dissemination and large sample sizes, and the need for specialized training and clinical settings to implement the interventions (11:45).
Function-Based Elopement Treatment Manual
In light of these limitations in the literature, researchers developed the Function-Based Elopement Treatment (FBET) manual. This involves 2-hour weekly caregiver-mediated appointments that include scripting, templated protocols, troubleshooting tips, and ways to graph data. The goal of the program is to have parents practicing these skills between meetings (14:23). The presenter outlines what each of the 12 appointments entails, from functional analysis to safety considerations to a co-created individualized treatment plan (16:05). The FBET manual focuses on three categories of prevention:
Physical Prevention
Physical prevention strategies aim to slow or prevent elopement by installing locks or alarms on home doors and windows. The speaker provides examples of different locks caregivers may use (22:30). Outside the home, this includes increased supervision where possible and GPS trackers. Scheuthauer underscores the importance of making sure a child knows how to report their name, phone number, and address when asked. For non-speaking children, it’s best to have them wear identifying information on a bracelet, lanyard, or shoe tag – examples are provided (26:00).
Danger Reduction
The biggest danger to children who elope is often drowning. The speaker suggests swim safety training, especially if a child likes bodies of water. Teaching young children how to cross the road on their own is also imperative, as cars and busy streets present an equally great danger. Scheuthauer emphasizes that parents/caregivers can enlist help from teachers at school or therapists the child works with in teaching these skills (29:50).
Response Readiness
The presenter explains how incredibly stressful and scary it is when a child goes missing and emphasizes the need to plan for this possibility now. She provides examples of elopement emergency forms that include a current photo and key information for people looking for the child (e.g., sensory sensitivities, medical issues, special interests). Having this information prepared beforehand makes it easier to communicate with emergency services and keeps the caregiver from having to find and provide all that information in an extremely stressful moment (31:00).
Feasibility & Efficacy Clinical Trials
To test the feasibility of the FBET, Scheuthauer and her colleagues conducted a clinical trial that showed not only that families could be recruited for the treatment, but also that 91% of appointments were completed with high caregiver satisfaction (6.7 out of 7). Further, data shows that 92% of therapists followed guidelines and that a little under half of the treatment group improved in elopement tendencies and safety (18:24).
Following feasibility testing, researchers conducted an efficacy study in which 76 participants were randomly assigned to either FBET or a parent education program not directly focused on elopement (20:30). To begin, all parents completed a prevention checklist to record prevention strategies in the three categories outlined above. Safety outcomes showed that parents in the FBET had greater success implementing safety measures than those in the parent education group. As such, Scheuthauer asserts the need for clinicians to help create safety plans with families and to periodically check in on progress (35:00).
Assessment and Treatment Considerations
The presenter describes latency-based functional analysis, in which children are exposed to different situations to test how long it takes them to run away and identify the cause. Common causes include seeking attention, escaping something or someone, and not wanting to finish a task or leave where they are. She emphasizes how difficult it can be to assess this with elopement because it physically removes the child from the situation (36:00). The speaker highlights match testing, stating that testing elopement to get away from something shouldn’t be tested in the same context as elopement for attention (39:00).
Scheuthauer suggests setting clear rules and reminders for leaving home and setting boundaries with landmarks or other items (like jump ropes or furniture in a clinic) so the child understands what counts as elopement and what doesn’t (40:25). It is also important to consider sensory sensitivities, how these may play into elopement, and how to minimize the aversiveness of a situation (42:30). The speaker notes that FBET support doesn’t not work for everyone, especially if the root cause of elopement is related to anxiety or fear (42:30). She also emphasizes using a strength-based approach and building treatment plans with input from the child (45:00).
Treatment Plan Components
The presenter outlines components of impactful treatment plans, including labeled praise and large reinforcers for safe behavior. She tells viewers to start small with a lot of repetition. For example, the first step is to walk from the car to the store’s door, then back to the car. She provides example scenarios and reinforcers for instances in which a child elopes to the toy aisle in a store and for a child who elopes as they are leaving school because they want to go to the playground (46:20). Scheuthauer reiterates FBET treatment outcomes before the Q&A (52:15).
