AUTISM-RELATED WANDERING: The Facts from AOTA

What is wandering?

Wandering is the tendency to try to leave the safety of a responsible person’s care or a safe area, which can result in potential harm or injury. This might include running away from adults at school or in the neighborhood, leaving the classroom without permission, or leaving home when no one is looking. Wandering or bolting is considered common and short-lived in toddlers, but it may persist or reemerge in children and adults on the autistic spectrum. Children with Autism Spectrum Disorder (ASD) have challenges with social skills, communication and safety awareness. This makes wandering, also referred to as elopement, bolting, fleeing, running, a potentially dangerous behavior.

How common is wandering in children with ASD?

  • Nearly half of the children diagnosed with ASD wander at one time or another
  • Increased risks for wandering are associated with increased severity of ASD
  • More than a third of the children with ASD who wander/elope are never or rarely ever able to communicate their name, address, or phone number
  • Half of the families living with a child with ASD report they have never received advice or guidance about elopement from a professional
  • Accidental drowning accounts for approximately 90% of lethal outcomes

Wandering types:

Goal-directed wandering: wandering with the purpose of getting to, or away from, something

Bolting/Fleeing: the act of suddenly running, usually to quickly get away from something

What are the risks?

Drowning; dehydration; heat stroke; hypothermia; traffic injuries; falls; physical restraints; encounters with strangers; encounters with law enforcement

When does wandering happen?

  • Warmer months and holidays such as the Fourth of July
  • Outdoor activities such as camping, hiking or other gatherings
  • Visits to a new place,  such as a friend’s home or a vacation setting
  • Times of transition, such as when a family moves to a new home, a child goes to a new school or when renovations have been made to accommodate warmer weather especially window screens, window fans, A/C units and screen doors
  • Transitions from one classroom to another, or during other school-day transitions.
  • Times of stress or when escalation triggers arise (typically the child/adult will bolt)

How can an occupational therapist help?

  • Educating  first responders about autism, including sensory preferences and social challenges, to assist in search and rescue efforts
  • Providing families with resources to address safe routines such as The Big Red Safety Toolkit http://nationalautismassociation.org/docs/BigRedSafetyToolkit.pdf
  • Video-modeling to increase safety within the  community, such as adhering to street sign signals.
  • Designing safe school bus evacuations programs
  • Developing swimming programs for children with ASD through a partnership with departments of recreation
  • Addressing anxiety and impulse control through relaxation techniques, social stories and other strategies in order to prevent bolting
  • Offering activity and environmental surveillance on playgrounds to increase safe and accessible play for children of all abilities