HJAR Mar/Apr 2025

AUTISM CARE 26 MAR / APR 2025 I  HEALTHCARE JOURNAL OF ARKANSAS a common fearlessness and decreased awareness of potential dangers, increase the risk of accidental injury. Oral sensory exploration through mouthing and chew- ing nonfood items may also place them at increased risk of accidental ingestion of toxic substances or choking. Additionally, a large percentage of children with autism have delays with cognition and language, which can limit understanding of potential dangers and instruction from others or their ability to communicate when there is trou- ble. Children with autism are often highly emotionally and physically reactive under stress, which can lead to fleeing, elopement or other impulsive behaviors that could endanger them. Decreased awareness and/ or attention to environmental surroundings can also lead to increased risk of injury or death. What Can Be Done to Increase Safety of Children with Autism? Around the Home A big part of ensuring safety at home includes reducing risk by securing the envi- ronment. Exits must be secured with dual locks or electronic locks that are not eas- ily reached or opened by the child. Many children with autism are surprisingly skilled with figuring out locks. Door alarms may be placed to alert family members when an external door is opened. Similarly, windows must be secured with locks and alarms or covered with boards or plastic if needed. When possible, fencing around the perim- eter of the home provides an added pro- tection for those who do exit the home and for children enjoying outdoor play. All chemicals should be kept in a locked garage or other utility area. Furniture must be anchored, fireplaces blocked, stairs gated, and bumpers or covers placed on sharp edges or corners around the home. When in the Community Wandering, elopement, or getting lost are primary safety risks when outside of the home. One large study found that 49% of children over the age of 4 had tried to elope at least once, with 26% of themmiss- ing long enough to cause concern, plac- ing them at substantial risk for drowning (24%) and traffic injury (65%). 7 Preventative measures are essential, including discussing expectations and plans before leaving the house. For new environments, it is helpful to have adults set limits around the perimeter by walking around the area with the child and outlining boundaries and/or mark- ing them with visual cues or signs. Some children will require closer supervision, regardless of visual and verbal cues. Some children may even need a secure bracelet or backpack that connects the child to the caregiver to prevent elopement when on outings. Caregivers must watch for signs of distress or overwhelm that may trigger running or a desire to escape. ID bracelets, shoe tags, temporary tattoos, or electronic tracking devices can be additional layers of protection and identification, should the child be separated from the caregiver. Trav- eling with a child with autism also requires preparation and includes ensuring appro- priate car seat or seatbelt use. Some children may need a specialized car seat, such as one that provides five-point harness beyond the younger years, as well as special adaptations that prevent them from unbuckling on their own. Caregivers should start early with teaching proper use of sidewalks and talk- ing about and role playing what to do if lost. AroundWater Drowning is a leading cause of accidental death in children with autism, and research has found they are 160 times more likely to die from drowning than the general popula- tion. 8 Children with autism are often drawn to water, as they find the multisensory expe- rience of water calming and enjoyable. Most drowning incidents occur when a child has wandered and occur near the home in the afternoon. 6 Thus, safety strategies to prevent wandering or elopement should be top pri- ority. Nearby ponds, lakes, rivers, pools, and ditches all pose a risk. Use of fencing, pool covers, physical proximity to the caregiver, and close supervision at all times around water help to reduce risk. Tubs, buckets, sinks, or other containers should not be left with water, and children should be moni- tored closely at all times around bodies of water, big or small. Given the increased risk, life-saving water safety training and swim lessons should be recommended and con- sidered by all families. Caregivers can talk with the child’s physician and search online to find more information about programs in Arkansas with specially trained swim coaches with added certifications for work- ing with children with autism. Safety Training Needs Many studies have demonstrated effec- tiveness of behavioral strategies in teach- ing safety skills to children with autism and developmental delay. 9,10 Functional behav- ioral analysis (FBA) is an assessment pro- cess performed by a trained clinician that is used to identify the underlying cause of a specific behavior so that appropriate plans can be made to address it. Applied behavioral analysis (ABA), functional com- munication training (FCT), and other evi- dence-based behavioral training programs can help shape behaviors of individuals with autism, teach them effective ways to communicate what they want and need, and train them in a variety of safety skills. These therapies are available in Arkansas but can be challenging for some families to obtain, as qualification requires multi- ple steps, multiple providers, and specific and sometimes lengthy paperwork to be submitted. Resources and trained provid- ers are scarce in some areas of our state as well. The Arkansas Department of Human Services, division of Children’s Special Services, provides case management and