This is the second of a 2-part series for families dealing with pica or elopement. In this post, we’ll cover the following information on elopement:

  • Presentation and prevalence
  • What makes elopement so challenging to treat
  • Common, evidence-based treatments to consider
  • Tips for parents to begin a treatment plan

Elopement

Presentation and prevalence

Elopement occurs when a child runs or wanders from a safe, supervised environment. A 2012 study found (via parent survey) that 49% of the study children with autism eloped after the age of 4 and of these, 53% were away from supervision long enough to be considered missing. In contrast, parents reported that 13% of the study’s unaffected siblings had eloped after the age of 4. Statistical analyses showed that the children with autism who were more severely impacted by autism (lower intellectual and communication abilities) were more likely to elope than those who were more mildly affected by autism.

What makes elopement so challenging to treat? 

Like pica, there is less research on elopement than other problem behaviors exhibited by those with autism. Often, elopement is lumped into a category of “challenging behavior” and not studied independently.

However, research has confirmed that, like some other difficult behaviors, elopement is often goal-oriented.

That is, children engage in elopement for a purpose, or because it serves a function. For example, a child may run away from something (being asked to complete a task) or run to something (toy in the toy store). With this knowledge, we look for tools from the field of behavior analysis.

One such tool that we want to use, prior to choosing an intervention, is functional assessment. A functional assessment (FA) allows us to formulate hypotheses about why the behavior occurs.

The most pertinent pieces of information we are looking for are:

  • What happens just before the behavior occurs?
  • What happens immediately after the behavior occurs?

In many cases, gathering this information about challenging behaviors is not difficult for parents to do. Observation can yield durable information including data that is very reliable. However, in the case of potentially dangerous behavior such as elopement, it may not be an option to observe circumstances, when the situation requires immediate action – such as stopping a child from stepping into the street.

Therefore, indirect methods of assessment can be used. These include parent or caregiver interviews, rating scales and checklists. These tools are helpful and can lead us in the right direction for identifying an effective treatment.

Common, evidence-based treatments to consider

Per a 2009 review of the literature on elopement in people with developmental disabilities, a wide variety of interventions can be successful in reducing the rate of elopement.

The common thread among successful interventions for elopement is the selection of function-based treatments. For example, if the goal of elopement is identified as gaining access to a preferred activity – running out of the house to the backyard in order to swing – then a good intervention might include functional communication training (FCT) to request access to swings, or at least, a highly-valued substitution for swinging. This could be supplemented with visual schedules and practice of “waiting” skills, e.g., “You can swing after the timer sounds.” The timer would have the time durations increased in a systematic manner.

If the purpose of your child’s elopement is to escape activities he dislikes, such as doing homework, a function-based treatment might include teaching your child to request a break from homework or to ask for assistance with it. This is another way to use FCT. In this case FCT would be supplemented with increasing tolerance of demands, e.g. a break comes after completion of one academic task, and then next week the break comes after completion of two academic tasks.

Tips for parents to jump-start a treatment plan for elopement

  • Consider recruiting a behavior analyst to work with your family, especially if your child elopes often or elopes in dangerous situations (e.g., high traffic areas or after dark).
  • Make a plan for gathering information about the behavior. If possible, observe your child engaging in elopement and record what happens immediately before the behavior and what usually happens after the behavior. Safety is always priority so ask for help in gathering information while keeping your child safe.
  • Ask other caregivers about the behavior. If your child engages in elopement at school, with a babysitter or with another caregiver, interview those people for information about what happens before and after the behavior.
  • Look for patterns in the information you’ve gathered. Does the behavior tend to happen at a certain time of day? Does elopement only occur when your child wants something or when your child is doing something she dislikes? Use this information to create a hypothesis for the purpose of your child’s behavior.
  • Consider how you can track the frequency of the behavior. Using measurement will help you track progress and make good decisions regarding continuing or ceasing your intervention approach. You can tally the frequency of the behavior on your calendar or find a data-tracking app for your phone.

This is the 2nd part of a 2-part series on difficult behaviors to treat. In the case of both behaviors featured, elopement and pica, assessment can be challenging because it may be dangerous to allow the behavior to occur for the purpose of observation. Prevention strategies are recommended until a provider can help with implementing a function-based treatment. For more information on elopement, please see Autism Speaks resources.

References 

Anderson, C. Law, J. K., Danieles, A., Rice, C., Mandell, D. S., Hagopian, L. & Law, P. A. (2012). Occurrence and family impact of elopement in children with autism spectrum disorders. Pediatrics, 130, 870-877.

Lang, R., Davis, T., O’Reilly, M., Machalicek, W., Rispoli, M., Sigafoos, J., Lancioni, G. & Regester, A. (2010). Functional analysis and treatment of elopement across two school settings.  Journal of Applied Behavior Analysis, 43, 113-118. 

Lang, R., Rispoli, M.J., Machalicek, W., White, P.J., Kang, S., Pierce, N., et al. (2009). Treatment of elopement in individuals with developmental disabilities: A systemic review. Research in Developmental Disabilities, 30, 670-681.

O’Neill, R.E., Horner, R. H., Albin, R. W., Sprague, J. R., Storey, K., & Newton, J. S. (1997). Functional Assessment and Program Development for Problem Behavior. Pacific Grove, CA: Brooks/Cole Publishing.