Elopement may sound cute, because the word evokes a starry-eyed couple running away to get married. Elopement also refers to when a child runs or wanders from a safe, supervised environment. It can be a worrisome concern among the parents and caregivers of children with autism spectrum disorder and/or intellectual disability.
This May, Nathan Call, director of Severe Behavior Programs at Marcus Autism Center, and colleagues published a retrospective review of their behavioral treatments for elopement, extending back to 2003. This is a companion to their 2015 analysis of treatment for pica, the ingestion of inedible substances. Call is also assistant professor of pediatrics at Emory University School of Medicine.
He summarized their approach by saying: “Individualizing treatment based upon the reason each child elopes seems to work very well.” The paper makes it clear that the reasons for a child eloping were a mixed bag: for some it was “access to preferred tangible items,” for others it was access to attention or other reasons.
Elopement can be difficult to study scientifically because the consequences of just letting it happen may be disastrous. In an interview, Call described one child who was attracted by balloons. He eloped so readily that he had been struck by cars twice, one time because he was drawn to a balloon display at a nearby apartment complex.
The 11 children in the review were ages 5 to 12, and 7 had a diagnosis of autism spectrum disorder – others had Down syndrome or intellectual disability.
The individual treatments varied in efficacy from 51 percent to 100 percent reduction of elopement, with a mean of 86 percent. The behavior specialists used treatment methods such as DRO (differential reinforcement of other behavior) and DRA (differential reinforcement of alternative behavior).
The difference is pretty technical, Call explained:
“In DRA the child receives reinforcement for doing something specific, like asking to go somewhere instead of running to it. In DRO the child receives reinforcement for going some period of time without eloping. DRO is used more with automatically maintained behaviors because usually there isn’t some specific reinforcer that can be reinforced, as in DRA.”