OARacle Newsletter

All parents worry about their children’s safety, especially when the family is out of the house for any reason, from a walk in the neighborhood to a 4^th of July parade. Parents of children with autism may experience heightened anxiety and concerns due to their child’s lack of expressive and receptive language, focused interests, and social awareness. A child with autism, for example, might not experience a sense of danger if approached by a stranger. An autistic adolescent who is interested in cars and knows all the makes and models might rush to quickly cross a street to take a closer look at a cool parked sports car, while ignoring community safety rules such as looking both ways before crossing the street.

Instruction and Practice of Skills

Teaching children with autism safety skills can help mitigate risks. A child, for example, can practice sharing their parents’ name, address, and phone number in case they wander off or become lost in the community. Parents can teach their children how to cross the street safely. Behavioral skills training can be used to teach these and other skills. Behavioral skills training consists of the following:

• Identify the skill.
• Break the skill down into its specific steps.
• Identify a place free of distractions to practice.
• Determine a reasonable length of time to practice based on your child’s attention span.
• Identify a reward to be earned for practicing the targeted skill.
• Demonstrate each step of the skill and then ask your child to perform the skill.
• Provide praise for steps performed correctly.
• Continue to practice the skill until your child can do the skill quickly and smoothly.
• Have your child practice the skill in various places in the community. Practice the skill periodically to reinforce it.

Pre-teaching

Children in general, particularly children with autism, often benefit from pre-teaching. Pre-teaching involves highlighting parental behavioral expectations or what is likely to happen before engaging in community-based activity. For example, a child who loves going to their favorite fast-food restaurant might immediately bolt for the restaurant’s front door, not watching or attending to vehicles nearby, due to the excitement of arriving at their favorite place to eat. Or a child might wander off in the grocery store to go to the cookie aisle. In situations such as these, pre-teaching can be useful. Pre-teaching is designed to increase predictability and expectations, thus decreasing impulsive behavior that might result in safety concerns. These are the steps for pre-teaching:

• Decide how you will pre-teach based on how your child learns. Is talking to your child about the expectation enough? Do you need to use a visual that explains the steps of the activity?
• Identify the steps your child is expected to follow. For example, after the car is parked, walk into the restaurant holding dad’s hand; look at the menu; order; sit; and wait for the food to be ready.
• Provide praise for following the steps. Use a reward if necessary, for example, getting dessert if all the steps are followed.

Safety Awareness

If you have safety concerns about your child, it is particularly important to be aware of the environment around them. When first arriving at a place (for example, the mall or a park for a picnic), scan for safety concerns such as:

• Nearby bodies of water
• Busy roads
• Open doors, hallways, or other routes a child might wander down
• Unfamiliar areas
• The presence of items that your child might have a high interest in, such as a dog or squirrel, Legos, or candy

Regularly scan your surroundings to identify potential risks and take proactive steps to ensure your child’s safety (e.g., have them hold your hand, maintain closer proximity to them)

Rewarding Safe Behaviors

For some children, the strategies above may not be enough. If this is the case, parents should consider rewarding either the absence of a behavior—not bolting away from the family group, for example—or a positive behavior—communicating that they want to go and look at something, for example. These are some tips for using rewards:

• Rewards are the most powerful when access to them is limited.
• Initially, a reward should be fairly easy for the child to earn; then it should be slowly made more difficult to earn.
• The rule for earning the reward should be made as clear as possible. The use of pre-teaching (see description above) and visual supports may be useful.
• The reward should never be provided if the child does not meet the expectation.

If these recommendations are not successful or if your child has several near misses, consider seeking support from a board-certified behavior analyst (BCBA). Behavior analysts have expertise in helping to refine and adjust these strategies to make them more effective.

David B. McAdam, Ph.D., BCBA-D, is an associate professor of pediatrics and education at the University of Rochester. At the Warner School of Education and Human Development, he is the director of the master’s degree program in behavior analysis. At the University of Rochester School of Medicine, he provides behavioral consultation to persons with intellectual and developmental disabilities in schools and other community-based settings in the Community Consultation Program