How to deal with Elopement habits in Autism patients?
While there are many behaviors that can create unease in parents and caregivers, elopement might be the one behavior that worries them the most. It is a behavior that is both unpredictable and predictable, yet, it still appears to come out of nowhere.
It is a delicate dance because chasing after somebody who is eloping can cause them to elope more. The alternative, not going after the person, is really only possible in a contained situation. Even then there’s various safety concerns.
One time I was going after an eloping student. I tried to keep my distance because that seemed to make them want to get away more. I was following them and, while trying to find other places to elope and explore, they ended up putting their hands through a glass window. So the question becomes what is an effective way to combat elopement where the person eloping gets the sensory stimulation they seek and the people caring for them can keep them safe?
At times, elopement may look like a person is simply trying to leave a designated area or be defiant. While it’s true that elopement can be a way to escape, most of the time, this actually isn’t the situation. In a lot of cases, the person eloping is trying to tell us something. Perhaps they want to go outside and explore? If they are at school and they bolt from the classroom, maybe they need to use the bathroom? No matter what the cause of the elopement may be, it is always helpful to show the eloping person ways to better communicate what they need. This could be done verbally or visually and is beneficial to both the person eloping and the person providing care. It will also help in making sure that the person eloping is in the safest environment they can be in.
Oftentimes when we work (or care for) people with Autism, much of what we do with them centers around reinforcement. First they are going to do something and then they’ll get an item that they desire. This allows them to work on waiting skills, as well as build up tolerance for not getting immediate access to a desired item.
However, in trying to work on eloping so that the behavior can be made functional (and thus reduce the amount of times that it occurs), it might be a good idea to try a strategy of non-contingent reinforcement. A colleague was recently telling me about a client who would elope out of the home and down a busy street which posed a severe risk to their safety. When they eloped, the family would immediately hop in the car and go pick them up.
Overtime, my colleague and her team determined that the behavior was most likely to occur during down time. This was seen as basically when the client got bored of doing a specific thing. The colleague realized that the overall function of the eloping was access to car rides.
My colleague, her RBT staff and the family worked on building more choices and preferred activities for entertainment during down time. The only issue with this was that this took time so they had to put something in place to keep the client safe in the meantime. To do this, they determined that elopement occurred, on average, every hour or so, and so the family took him for a short car ride every hour as a part of their daily schedule.
They saw an immediate drop in elopement because it was much easier to just wait for a car ride than run out of the house and down the street for one. With this type of intervention my colleague explained that they did not need to also include extinction (no longer providing car rides if/when they did elope) which is not possible when there are safety concerns like this. In this instance, safety was such a concern that it was necessary to establish an immediate reinforcer, so that the need/desire to elope could be countered with something positive even though going for rides every hour wouldn’t be sustainable forever.
However, the client built up their leisure skills, and as we practice in Applied Behavior Analysis (ABA), the reinforcer of taking out the client for hourly car rides was able to be stretched out. Eventually, they only had to take the person out only 1-2 times a day or as needed for other activities.
This was a solid example of how effective a strategy such as non-contingent reinforcement can be. It was able to satisfy the client’s need for a car ride, they were able to work on the ever important skill of communicating their needs, and this strategy was the cornerstone of making the client safer at home and in community.