Over one-quarter of parents of children with autism spectrum disorder (ASD) report that their children have wandered or eloped from them in the previous year.1 Currently, the prevalence of ASD is estimated at 1 in 59 children, and it is 4 times higher in boys than girls.2 Within this population, safety concerns are prominent and are fundamental priorities for care. These behaviors impact children and families who experience other neurodevelopmental differences, including developmental delays, intellectual disabilities, genetic syndromes, emotional disorders, and behavioral disorders. Primary care providers (PCPs) are on the front lines to address these concerns, yet resources are limited and difficult to access.
Defining elopement and wandering
Elopement has been more clearly defined as leaving a designated supervised area without permission.2,3 The concept of wandering, however, has not been clearly delineated from elopement. In clinical practice, elopement is a term used to describe behaviors that occur impulsively and quickly, such as running or bolting from caregivers or contained supervised areas. In contrast, wandering is a more unfocused behavior. For example, it may consist of straying from a designated supervised area away from the sight of a caregiver.
Although elopement and wandering are common and serious problems for families of children who have ASD, there is limited research on this subject and few treatments have been shown to successfully prevent or reduce these behaviors.
Of all the interventions studied, many have small sample sizes (1 to 3 participants) and, therefore, cannot be generalized to the larger population.4 The dearth of research is an important opportunity to prioritize the research agenda to align with family priorities and clinical practice guidelines. Primary care clinicians are often asked how to respond to these behaviors. It is an issue that leaves families, educators, and clinicians feeling helpless, but this does not need to be the case. In fact, there are practical ways clinicians and families can work together to decrease elopement and wandering.
In children with ASD, elopement risk increases with severity of symptoms.1 Studies have shown that approximately 50% of caregivers of children with ASD eloped at least once after age 4 years. Approximately 25% of individuals with developmental disabilities and 35% of individuals with co-occurring intellectual disabilities have eloped within in the last year.1,3
In some circumstances, elopement and wandering behaviors do not cause imminent harm, such as when a curious child wanders to the next aisle in the grocery store or is attracted to an enticing activity or event nearby. However, current research has highlighted the overwhelming amount of children placed in situations where elopement and wandering result in imminent harm or accidental death. These situations may include when a child exits the family home and wanders to a nearby water source, walks into traffic, or strays in public spaces with potentially predatory strangers. As such, these behaviors do increase the likelihood of childhood trauma, injury, and death, as well as subsequent familial distress.
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