HJAR Mar/Apr 2025

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2025 25 especially those with intellectual disability. Wandering was linked to nearly 74% of fatal drowning incidents overall and was associ- ated with 90% of fatal drownings for those under 14 years. Other related safety con- cerns include elopement, pica, and lack of understanding of potential dangers. Several of the characteristics inher- ent to autism can place these children at increased safety risk. Many children with autism enjoy and prefer engaging in solitary activities, and they love to explore, climb, and jump. Many children with autism are also drawn to water, vehicles, and wheels. These preferred activities, paired with Statistic System from 1999-2014 showed a documented 1,067 deaths in persons with autism, with a mean age of death of 36 years, and a mean age of death due to injury of 29 years. 6 Twenty-seven percent of deaths were due to injury, 40% of which occurred in their own homes or in residen- tial placements. Increased accidental injury deaths were especially prominent for chil- dren under 15 years, with this group being 40 times more likely to die of accidental injury. Drowning (46%), suffocation, and asphyxiation together accounted for 79% of accidental deaths, with the risk of drown- ing highest for young children with autism, Ensuring physical safety of children with autism is a critical challenge that must be addressed. Although most individuals with autism live long lives, research has shown higher mortality rates for individuals with autism spectrum disorder, with a risk of premature death two to 10 times higher than the general population. 1,2 Much of the increased risk is related to comorbid con- ditions that are often seen in those with autism, including conditions such as epi- lepsy, ADHD, and depressive disorders. 3,4,5 Also related to the increased risk are unin- tentional as well as intentional injuries. 1,2,6 A review of data from the National Vital least two of the foods presented are a child’s preferred food. Incorporating the child into food preparation can expose them to vari- ous smells and textures as well as learning how specific foods are made to hopefully increase their interest in these foods. Using a preferred food and slowly changing the texture, shape, and consistency can be one strategy to fade in new foods. Conclusion It is often said that raising children takes a village. It is vital for caregivers to under- stand that they are not alone in their jour- ney of treating sleep and feeding difficul- ties with children with autism spectrum disorder. Allowing children to have access to research-supported therapy services can help to intervene on these challenges as well as support caregivers through these challenges. Autism Speaks has great toolkits for caregivers to access for sleep and feed- ing difficulties. Children with autism have brains that view the world in a way differ- ently than the majority of the population, however, this does not change the need for them to be supported and cared for with the best available services possible. It is vital that our policies and legislation continue to support access to services for this patient population and their caregivers. n inappropriate to the developmental level of the child and are not a culturally supported or socially normative practice. 4 When encountering a child with pica behaviors, it is very important to rule out any nutritional deficiencies. Remaining calm and limiting access to substances commonly consumed can be one method to intervene for these behaviors. Implementing a consistent schedule and routine for mealtimes is just as beneficial for children with autism. Again, a diagnos- tic feature of autism is the insistence on sameness and need for routine. Addition- ally, it is helpful to avoid as much distrac- tion as possible; however, some children do benefit from distraction at mealtimes. As a general rule, instead of eliminating screens altogether, parents can pause the electronic device if they notice their child not eating for several minutes. The screen can be resumed once the child puts a bite of food in their mouth. Praising children during a meal while ignoring inappropri- ate mealtime behaviors (e.g., throwing food, complaining about the food) can help chil- dren to understand the behavioral expec- tations and increase the positive mealtime behaviors. Consider the quantity and type of food presented on the child’s plate. Present three different food groups, ensuring that at excessive or extreme than the neurotypi- cal child. Introducing new foods to children with autismmay be difficult as this not only breaks a routine, but it may also lead to an increase in challenging behaviors. One diag- nostic feature of autism is the insistence of sameness and ritualistic behaviors, which may explain why children with autism eat a food that is a specific shape, color, or tex- ture. 5 These ritualistic behaviors also con- tribute to the child’s rigidity with the specific foods that they will eat. Caregivers often feel extreme guilt with their child’s eating issues given that feeding is seen as a “nor- mal”developmental milestone. Feeding dif- ficulties may also impact the parent-child relationship during mealtimes as well as after mealtimes. Many children with autism spectrum dis- order experience other gastrointestinal dis- orders such as constipation and abdominal pain. This often becomes a vicious cycle for children where they eat a limited number of foods causing difficulties with their gastro- intestinal systems, which then causes food selectivity and decreased appetite. One commonly associated eating differ- ence in children with autism is pica. Pica is defined as the persistent eating of nonnutri- tive or nonfood substances over at least a one-month period. Pica behaviors are also Understanding Safety Risks in Autism: How to Protect Vulnerable Children Elizabeth Pulliam, PsyD, and Chayla Slaton, PhD