CHAPTER 11
Ensuring Safety
All children have accidents and injuries. The occasional hurt or “owie,” broken bone, bump, fall, cut, or scrape is part of growing up. This is true for all children, but children with autism and related conditions are probably at increased risk for injuries and accidents. This happens for several reasons. An understanding of important safety concepts (such as that hot things are dangerous) can come later than for most children. In addition, children on the autism spectrum may be more impulsive. Younger children with autism, in particular, seem to have an unusual combination of poor judgment and good motor ability. Other children with autism spectrum disorders (such as Asperger’s disorder) may have poor judgment and poor motor ability. Either situation can lead to trouble. The unusual sensory interests sometimes seen in autism and related conditions can also be a problem. For example, the autistic child may not mind the taste of something that most of us would find bitter or might be interested in something vibrating or twirling, like the wings of a bee or the twirling blades of a fan. Children with autism can also surprise you. The child who is otherwise fearful of new things or situations may seem driven to explore a new construction site, or the child who is otherwise afraid of the water may be preoccupied with a neighbor’s swimming pool. Likewise, the child who is usually fearful of things and has been once stung by a bee may not seem to learn from that particular experience. For all these reasons, you should take extra care in trying to prevent problems before they happen. In this chapter, we consider some of the issues involved in being sure children on the autism spectrum are safe. This chapter includes some general information on safety and focuses on issues specifically related to children with pervasive developmental disorder (PDD). It is not meant to be an exhaustive discussion of all aspects of safety in children. There are many good books devoted entirely to that topic. Several are mentioned in the reading list at the end of this chapter. As you will see, we divide this chapter into several sections on safety at home, safety at school, and safety in the community. There may be points in each section that are relevant to the others. Keep in mind that the child’s level of development, as well as her size, will greatly influence what she will find enticing and appealing and the kinds of problem situations that can arise.
ACCIDENTS AND INJURIES
• Injuries are the leading cause of death in children and adolescents in the United States.
• Fatal injuries are just the tip of the iceberg: For every fatal injury, another 18 children end up in the hospital and over 200 are treated in the emergency department.
• The good news (and sad news) is that most of these injuries are preventable.
• Available data suggest that children with autism are at increased risk for serious injury and even death due to accidents such as drowning and suffocation.
GENERAL HOUSEHOLD SAFETY
An ounce of prevention is worth a pound of cure. Take sensible precautions as you would for any child. This is especially true for younger children with autism, who have a knack for finding dangerous situations or places. Even for normally developing youngsters, you cannot always anticipate what they will get into. Many children with autism or PDD will require safety supervision longer than other children. Their judgment about which places are safe and what might be hot or sharp may not be as good as you would like. As children on the autism spectrum get older and consequently larger and stronger, you may need to rethink what will keep them safe. For example, an older child may be able to undo a standard plastic outlet cover but not yet realize the dangers of poking something into the outlet. Screw-on covers that are harder to remove may be helpful. LectraLock (
http://lectralock.com/residential.htm) is a company that provides ideas and products for this kind of safety. Many children with autism, particularly young children, are not safe unless someone is watching them all the time. The ways to provide a safe environment vary with the child’s age and surroundings. For younger children and for many older children with PDD, you will need to either: (1) have someone keep an eye on them constantly, (2) take them along when you need to leave the room briefly, or (3) have a safe area where they can be left alone briefly without any risk of harm. A crib or playpen may be a safe place for a younger child. The child’s bedroom can be a safe and secure place to leave him briefly if he can’t get out on his own. Keep in mind that you want to teach safety; this means modeling the behavior you want, reminding the child about safety through regular and routine discussion and reminders, and so forth.
Safety steps to take include covering electrical sockets; locking cabinets that contain poisonous cleaning supplies and paints; putting in door latches and stair gates; and storing knives, scissors, and other sharp objects out of reach. Check for the obvious hazards—things like open stairwells, areas where the child could easily fall, sharp objects protruding from walls or floors, and so on. Be sure windows are secured and that the child cannot fall out of them. Use window guards on windows, particularly for rooms on the second story and higher. And, of course, if there are any guns in the home, be sure they are unloaded and locked away out of all children’s reach. The absolute safest way to avoid gun accidents is not to have guns in the house.
You also want to keep the home safe from fire or poisonous gases. Matches, flammable materials, candles, and electrical cords can all be dangerous in the hands of a child. You should have a smoke detector and a carbon monoxide detector, as well as a working fire extinguisher on each floor of the home. Be sure the child cannot turn on the stove herself. Also be sure that the furnace or any wood-burning stove or other heaters are working properly. Know what number to call in your area if you have a fire emergency. In many places, it is 911.
IMPORTANT NUMBERS TO POST ON THE PHONE
• 911 or local police and fire department numbers
• Pediatrician’s name and phone number
• Local hospital’s emergency departments number
• Poison Control Center number: 800-222-1222
In addition to the more general safety precautions, go room to room with an eye for potential safety hazards relative to the child with an ASD. For example, what looks colorful and interesting? What would be tempting to pull at? Are the fans or things that spin within the child’s reach? Something that looks unappealing and unappetizing to you may look delicious to the child. This is even more of a problem when some medications may look and, indeed, even taste like desirable candies.
Overall, the kitchen and bathrooms are probably the most dangerous areas in the home. Take a particularly careful look at these rooms and remove dangerous objects that the child could get hurt with, and block access to places where he could get injured.
Like other children, those on the autism spectrum tend to spend most of their time in their bedroom, so be sure it is a safe place. Depending on the child, it may be best to keep the room sparsely furnished (this may help with sleep at night as well; see Chapter 17). Take a careful look for things that can be a source of danger, for example, a bookcase that can be pulled to a window or over on a child. You can use an intercom to alert you when she is leaving the room, especially at night. Another option that can work nicely is to use a Dutch door; you can then lock shut the bottom half of the door and keep the top half open so you can either see or hear the child. If the child with autism shares a room with an older sibling, be sure that none of the older child’s belongings present a safety hazard. If the autistic child shares a room with a younger child, be sure that she doesn’t allow the younger child to get into trouble such as by opening a gate or door and letting the younger child out of the room without a parent’s knowing about it.
Falls, such as down the stairs or out a window, are mostly a problem for younger children, but some older kids with autism may misjudge a distance or a height and have an unexpected accident. If the child likes to move chairs around and climb, be sure that he can’t climb onto a windowsill and then fall out of the window. Make sure all windows have screens that can’t be easily dislodged. You may need to block the space in front of windows if the child is a good climber. Gates can be used to protect children from falling down stairs. You may need to fasten the gate to the wall if it is at the top of a staircase. Pressure gates may give way if a bigger child pushes into it.
Poisoning
Poisonings can occur at any age. Harmful household cleaners and detergents as well as medications, both prescription and nonprescription, and paints and solvents are common sources of poisonings. Cosmetic products and household plants can also be poisonous if eaten.
COMMON HOUSEHOLD POISONS
Kitchen • Dishwasher detergents
• Drain cleaners
• Ammonia
• Oven cleaners
• Glass cleaners
Bathroom • Medicines (over-the-counter and prescription)
• Toilet bowel cleaners
• Thermometers containing mercury
• Deodorizers
Basement or Garage • Automotive materials
• Antifreeze
• Windshield cleaner/deicer
• Insect killers
• Glues
• Paints
• Paint thinner/remover
• Kerosene
• Brake fluid
• Gasoline
• Rat/mouse poison
• Lighter fluids/charcoal starter
Other Areas • Alcohol
• Cigarettes
• Furniture polish
• Moth balls/cakes
To guard against poisoning:
• Keep prescription (and nonprescription) medicines in safe and secure spots with child-resistant caps. (Be aware, however, that even child-resistant caps are not 100% effective.)
• Be aware that unfinished alcoholic drinks are potentially dangerous if they are consumed by younger children.
• Keep in mind that even a medication or vitamin that you regularly give to the child can be harmful if the child decides to feed herself too many of them.
• Keep poisons in places where the child can’t reach them. This can be different places at different ages. Child-resistant latches on cabinets offer some protection, as do child-resistant bottles, but don’t underestimate the child’s ability to get into things! Substances that are quite poisonous should be kept under lock and key.
• Keep things in their original containers so you know what they are.
• For children who can understand its meaning, use bright colored stickers to indicate which substances may be harmful. Mr. Yuk stickers have been used successfully for this purpose by many parents. These stickers can be procured from the Pittsburgh Poison Center at the Children’s Hospital of Pittsburgh (
http://chp.edu/CHP/mryuk).
POISONOUS OR TOXIC FLOWERS AND PLANTS
Common House Plants and Flowers • Philodendron
• Dumbcane
• Peace lily
• Amaryllis
• Foxglove
• Monkshood
• Lilly of the valley
• Aloe
• Caladium
• Elephant ear
• Narcissus
• Daffodil
• Oleander
• Larkspur
• Poinsettia
• Chrysanthemum
Wild Flowers and Plants • Nightshade (various varieties)
• Henbane
• Hemlock
• Morning glory
• Mountain laurel
• Mistletoe
• Jimson weed
• Hellebore
• Buttercup
• Castor bean
• Rhododendron
• English holly
Note: This is just a partial list.
At home (and also at school) the Poison Control Center number should be posted near the phone or school nurse’s office. (The national number—which can put you in touch with the local center—is 800-222-1222). When you call the Poison Control Center, you should have some basic information:
• Your name and phone number
• The child’s name and age
• The child’s weight
• The name of the product or plant or whatever the child ingested, the amount you think she ingested, and when it was ingested
It is also important to recognize the warning signs that the child may have gotten into something. These include finding open containers of medicines or cleaning supplies near the child or stains on the child’s clothing, or the child’s suddenly becoming sick (vomiting, seizures, abdominal pain, etc.). If the child is sick, call 911 first, then poison control. Be especially careful when you have visitors who bring medications or cigarettes with them, or when you go to other people’s homes who do not have young children and therefore have not child-proofed their homes.
Mouthing can be a serious problem for young children and even older children with autism spectrum disorders (ASDs). If the child likes to explore objects with his mouth, you should be sure that lead-based paint was not used at home or in school on walls or toys or even cribs. Lead-based paint has not been used for indoor paint in this country since the end of the 1970s, but some people still live in houses with old paint, or it may persist in the soil outside the house. You may need to avoid toys with small pieces past the usual recommended age of 3 years if the child likes to mouth things.
Wandering
Wandering can be a problem at home as well as at school and in the community. Children who wander put themselves at risk. If this happens at home, there are several steps parents can take. Special locks for outside doors make it harder, hopefully impossible, for the child to open the outside door on her own. Some people use deadbolt locks; some use a regular lock or a hook-and-eye-type lock very high up on the door (well out of the child’s reach). Another choice is to put alarms on the windows or doors that go off when they are opened, alerting parents to a child’s trying to leave the house. One web site that provides such products is Radio Shack (
www.radioshack.com).
If the child has a tendency to wander, help her learn to wear a MedicAlert bracelet. The bracelet can have the child’s name, parents’ names, and cell phone number and can even state that the child has autism or ASD. We have seen one instance where the child’s tendency to bolt/wander was so severe that her parents obtained a special helper dog that went with the child everywhere. The child and dog were basically tied together and the dog was trained that when the child started to bolt, he (a massive dog) would just sit! Other options are increasingly available (e.g., global positioning systems). We talk more about wandering later on when discussing safety issues in the community.
Another area that deserves consideration is the yard outside the home. Swimming pools are an obvious hazard and need to be surrounded by secure gates and fences as well as alarms that go off if a child goes through them or gets into the water. Even without a pool, a yard can be the source of many dangers. Be sure the child can’t get out of the yard on his own and that he can’t find any poisonous plants to ingest. Walk around the yard periodically and see what might look inviting to a child of different ages.
SAFETY AT SCHOOL
Safety issues at school are somewhat different than at home. Some hazards are less frequent than at home, but other issues are more common and more complicated to deal with. Having other students around leads to potential difficulties, and areas where typically developing children are less supervised (recess, gym, even cafeteria) may be much more likely to surface as trouble spots for children on the autism spectrum. As we noted previously, teaching safety is important and an awareness of potential safety concerns is important in preventing problems. In this section we discuss some of the problems that can arise in the school itself. The following section (on safety in the community) discusses auto and bus safety concerns as well as water safety.
Staff Preparedness
As with other activities, planning is important to prevent accidents and injuries, but because some emergencies may happen, it is critical to have staff trained and ready to cope if necessary. Teachers should all be trained in basic safety issues and simple first aid. In situations where there are potential danger areas (e.g., if there is a pool at school or if there is access to potentially toxic materials), children should never be left unsupervised. For children on the autism spectrum, adequate supervision is always appropriate. In contrast to typical children, those on the autism spectrum may need more, not less supervision on playgrounds, recess, and similar activities; failure to be aware of this often leads to trouble.
Teachers and school staff should establish rules and routines to prevent accidents and have an important role in teaching basic safety concepts that can be generalized to home and community settings. They should also rehearse what to do in the event of an illness or emergency.
Teaching Safety Concepts
As the child gets older and acquires more language, parents and school staff should make a point of teaching safety concepts. You can use picture schedules and visual cues to help children who are just learning language. Topics to teach include what things are dangerous (hot objects, electrical outlets), how to cross the street, and, as children get older, the appropriate use of household items that have some potential for being dangerous (electrical appliances).
Keep in mind that there is some (relatively slight) potential for “overdoing” this teaching—that is, you could end up making the child frightened of certain situations if you make them sound too dangerous. Focus on concepts important for the child’s safety in the real world. Use explicit teaching at whatever level is appropriate to the child. If a situation makes you very anxious or frightened, think about having someone else work on this with the child (or work with you first) so that your own anxiety is not part of what the child learns.
Teach generalization of safety concepts; don’t, for example, let the child learn to cross the street only in one spot! Given the tendency of children with autism toward rigidity, you should work very specifically on generalization and “teaching the big picture.” There are some important exceptions to the rule—one child we know with Asperger’s would stop in midstreet if the “don’t walk” sign came up, obviously putting him at more danger because of his literal response to being taught about safe crossing!
Outdoor Activities and the Playground
Going to the playground at recess or after school can be a great way for the child to get exercise and meet other children. Even when more interactive play is a challenge, the opportunity to be in a new environment and play alongside other children is important. In outside areas, look for worn play equipment that is unsteady or ready to break, sharp edges, or exposed nails/screws. Keep safety in mind, particularly when you look at play equipment. For example, if the child is a fearless climber, you might want to limit the height of playground structures so she won’t be tempted to jump. Be sure there are no poisonous plants in the playground or backyard. Even when an area is fenced in, keep in mind the potential for the child’s getting out. Never assume that the child can’t get out of a fenced area! Be aware that items like swings, slides, and seesaws may be a particular source of danger, given problems in social awareness, organization, and judgment. There are guidelines for playgrounds relative to Americans With Disabilities Act (ADA) standards. As we noted in the chapter on medical conditions, having a one-page medical summary and/or permission for emergency treatment for the child is helpful. The school nurse can take an active role in this process; this helps him or her get to know the child and family and be more helpful in actual emergency situations.
Many children receiving special education services who are out of the mainstream classroom for parts of the day are included with the rest of the class for recess and gym. Unfortunately, these times (when typically developing children need the least supervision) are just the times when children on the autism spectrum may need the most attention! Difficulties in peer interaction, communication, and play may prevent the child from being included. For younger and more cognitively impaired children, this is even more likely to occur. For the more able children, there is significant potential for teasing and social ostracism. This means that, depending on the child’s levels of ability, the teacher may want to be proactive in preventing problems. Fortunately, a number of good resources are available (see the reading list for this chapter as well as for Chapter 7). For younger children, use of an assigned peer buddy during recess can be helpful. A similar procedure can be used with older and more able children, for example, giving the child on the autism spectrum a task he can engage in with an assigned peer during recess. As we have discussed elsewhere in the book, teaching social and play skills is critical. Dealing with the typically developing students is also important; various resources, including videos and reading materials, can be used to help avoid bullying and teasing. Similarly, teaching the more able school-aged or adolescent student about responses to teasing, understanding humor, and similarly sophisticated social skills can be important.
Classroom Safety
As at home, it is good to take a look at school or day care facilities for obvious dangers in the building itself. Often, difficulties will arise around times of transition—always a stressful time for the child on the autism spectrum. Have plans in place for dealing with emergencies. The fire drill may be a source of great anxiety and lead to disorganization in the child with ASD. Have a plan in advance that can be rehearsed with the child; practice this often enough that it feels routine to the child. For more able children, you can teach routines of what to do and have the child practice; for less able children, take appropriate steps so that, for example, in case of an evacuation, the child is assigned to a responsible adult. In some parts of the country, storm drills such as for tornados may occur, and practicing for these situations may also be helpful.
Establishing classroom rules will lend a sense of structure to the child with ASD, and it can also help prevent accidents and injuries. As on the playground, the rules must be tailored to the situation, environment, and students. Once rules for the classroom are clear, they should be used and applied consistently. As part of lesson planning, teachers should consider risk and safety issues. The teacher should also look at the classroom for safety issues, including availability of scissors or other sharp materials, electrical appliances or shock hazards, cleaning supplies or other materials that may be poisonous, and so forth. Art materials should be nontoxic.
Field trips represent special opportunities for encouraging generalization of skills. They also present some risk, particularly for children on the autism spectrum who may become upset with new situations or changes in the environment. It is important that teachers plan appropriately for community activities and field trips by obtaining parental permission, having a plan in place for monitoring students, being prepared to deal with emergencies, and so forth.
In some cases, children will have known medical problems, for example, allergies or seizures. Teachers should be prepared to cope with these problems if they arise. For children with severe allergies, training in the use of the EpiPen is appropriate; this pen can be lifesaving if a child has a severe allergic reaction.
Aggression
Aggression in school can be a major problem and present many challenges for teachers and school staff. Aggression may be directed against other children, the staff, or against the self (self-injurious behaviors). Unfortunately, aggressive behavior of any type tends to “energize” similar responses in those observing it, including staff. It is important to train staff to be as calm and collected as possible, rather than inadvertently contributing to further escalation.
Verbal aggression can be an issue in more able children on the autism spectrum. This can include name calling, swearing, threats, and so forth. At times, this may have been provoked by teasing or bullying or similar behavior from other students; at other times, it may arise as the person on the autism spectrum misinterprets a comment or joke. Verbal aggression can go on to escalate into physical aggression and fighting. If possible, interrupting the verbal aggression is important by removing the parties from each other and redirecting them. When possible, try to understand what went on and help the child develop alternative responses—thus making this a learning experience for some or all concerned. Giving the child something new to focus on is helpful.
Physical aggression can be difficult to manage. This can range from hitting, biting, and kicking to self-injurious behaviors. For children who have problems with physical aggression, it is important to have a behavioral plan in place in advance. Alertness to signs of an impending blow-up can often prevent escalation. As with verbal aggression, remaining calm helps. Physical restraining should be done only when there are no other alternatives and/or in situations where risk of injury is extreme. If there are some children who will possibly need restraint, this should be planned for ahead of time. There should be explicit plans that everyone involved knows about in advance so that no one will be hurt or surprised by the actions that are taken.
Although self-injurious behavior is relatively uncommon, when it occurs, it may be so severe that it can cause significant physical injury or may interfere significantly with the child’s educational program. Self-injury is most common among children with the most significant degree of developmental delays and seems to increase around adolescence as well as during times of stress. As with aggressive behavior, careful observation may help clarify what sets the behavior off and what warning signs to look for, for example, temper tantrums that escalate to more challenging behaviors.
Self-injurious behaviors can range from repeated scratching and gouging of the skin and eyes, to self-inflicted bites and occasionally to severe head banging—sometimes severe enough to break bones. Sometimes, self-injuries are connected to a medical problem. For example, among adolescents, self-injury may start only when the wisdom teeth cause difficulties, or sometimes nonverbal children may start to bang their ear because they have a painful ear infection. Various methods, including medicines, protective equipment, and behavioral interventions can be used to control self-injury. Often, multiple methods are used together. When these methods are used, parents, doctors, school personnel, and others need to be involved so that everyone works together in a coordinated way in the child’s best interest.
COMMUNITY SAFETY
Wandering/Running/Bolting
As discussed in the section on general household safety, some children on the autism spectrum have trouble with running away/bolting from caregivers. Sometimes this takes the form of impulsive running/darting away, at other times it can seem more premeditated. These times are, as you might expect, times when the child is in the most danger, for example, darting into a street, jumping from a car onto a highway, or jumping in front of a train (sadly, all examples of cases we knew). As always, there is a balance between wanting to encourage appropriate adaptive skills and maintaining safety. For children for whom this is known to be a problem, it is important to maintain constant adult supervision, with the child always visible to the teacher, staff member, or parent and with continued observation of the area. A behavioral plan for dealing with the behavior should be developed. Sometimes a loud noise or loudly spoken instruction will interrupt the behavior and do the trick in terms of stopping the behavior. Use physical intervention if appropriate to ensure safety. In community situations, continuous visual contact is important and assistance should be obtained when needed. Running/bolting should not be ignored given the seriousness of such behavior; however, try not to make the “chase” into part of a game that inadvertently reinforces the behavior. We give some examples of dealing with running/bolting in Chapter 14.
Auto and Bus Safety
Many children are hurt each year in car accidents. You can minimize the chances of injury by following National Highway Traffic Safety Administration recommendations (
www.nhtsa.dot.gov). They suggest using the child safety locks on the back doors of the car to keep kids from opening the doors from the inside. They also recommend that parents use a window lock to prevent children from being able to open the windows themselves. And, most important, they recommend that children under 12 sit in the back in age-appropriate safety restraints. That means infants from birth to at least 20 pounds and 1 year of age need to be rear facing in a car seat appropriate for their weight. Children from 1 to approximately 4 years old should be in a safety seat facing forward. Older and larger children (starting at 40 pounds) can be in a booster seat and there are now safety seats that can be used for children up to 60 to 80 pounds.
In deciding when to switch the older child to a seat belt, the National Highway Traffic Safety Administration web site advises, “Use vehicle lap and shoulder belt for children who have outgrown a booster seat and can sit with his or her back straight against the vehicle seat back cushion, with knees bent over the vehicle’s seat edge, without slouching, and feet on the floor (approximately 4"90’).” Recently, there has been a move to keep children in booster seats longer and until they are bigger. This is thought to be safer than switching to a regular seatbelt at age 4 years. Some states now require a booster seat until the child is through the sixth year and 60 pounds. Many local fire and police departments provide a free inspection to be sure that you have the car seat or booster seat installed properly.
If the child does not like being restrained, you will need to be sure that he cannot undo the safety belts or restraints. You may want to have another person sit next to him in the back seat to keep him safely buckled up. There are also some products available that can make it harder for the child to unbuckle his seat belt. Several products that may be helpful are available from E-Z-ON (
www.ezonpro.com). If the child gets out of his car seat or seat belt, be prepared (as soon as you can do so safely) to make a point of pulling over and stopping the car so you can get him back into the car seat or seat belt.
If the child has a hard time in the car in general, you may be able to make the trip more enjoyable with toys to play with or a DVD player or TV to watch.
If the child rides in a bus or van to school, be sure someone supervises her getting properly seated before the ride home. Some children with ASDs need an aide on the bus to be sure they don’t undo the safety restraint and get out of their seat.
Water Safety
Some parents may find that their child enjoys being in the water, and that this has a calming effect on him. However, you need to be careful that the child is never left alone in or near the water, not even briefly. This is especially true of any child with seizures. Drowning can occur at home in the bath or outside in a pool, even a small child’s pool. Drowning is one of the more frequent causes of accidental death in autism. So if the school uses an inflatable pool for younger children in the summer, it’s safest to empty it each time the class is finished with it for the day. If you have a larger pool at home, you need adequate gates, locks, and covers to keep the child from trying to swim on his own. As we discussed earlier in the household section, a safety alarm that lets you know when something, or someone, has hit the surface of the pool is a worthwhile investment. Teach good safety around the pool—no running, no diving into shallow parts of the pool. Also keep in mind that if you have a pool, you’ll also have pool chemicals around, which are probably poisonous and need to be inaccessible to the child.
It is a very good idea to have the child learn to swim. She is less likely to drown if she knows how to swim. Furthermore, swimming is a great sport—it provides good exercise, offers opportunities to learn some self-care skills (such as changing clothes), and can be a good way to meet other children and adults in a more controlled and less threatening situation. Its repetitive and somewhat isolative aspects can be a source of pleasure to children on the autism spectrum, and unlike team sports (which are highly social), swimming can be a sport you can do in the presence of other people but one that is not very social.
SUMMARY
In this chapter, we talked about some of the steps you can take to help the child be safe at home, at school, and in the community. Prevention is nine-tenths of the battle here. Go through the home, classroom, and playground with an eye for potential danger spots for the child. If the child is small, get down to her level on the floor and take a look around (the world can look quite different). Keep in mind the child’s special interests and abilities as you are childproofing the environment. Help others in the household and at school be aware of safety issues. Some new approaches are using computers and virtual reality simulations to teach safety skills. These approaches are just emerging but hold considerable potential for highly focused, repetitive teaching and their use of less complicated learning environments may make it easier for the child with ASD to learn.
Because you can’t prevent all injuries or accidents, you should be prepared to deal with them effectively. Post poison control and other important numbers near the telephone. Read a book on first aid and take a first aid course that includes cardiopulmonary resuscitation (CPR) training. Putting together a first aid kit to have at home or to take along on family trips may be helpful. Finally, keep in mind that issues of safety can change for children over time as they become older. Periodically, take a look at the environment to be sure it is still as safe as possible for the child. There is a child autism safety web site (
www.MyPreciousKid.com) that is very helpful. It includes suggestions for products that may help keep the child safe, including ID tags, locators, door alarms, and other products.
■ READING LIST
Boyd, B. (2003). Parenting a child with Asperger syndrome: 200 tips and strategies. Philadelphia: Jessica Kingsley.
Chavelle, R. M., Strauss, D. J., & Picket, J. (2001). Causes of death in autism. Journal of Autism and Developmental Disorders, 31, 569-576.
Cook, J., & Hartman, C. (2008). My mouth is a volcano! Chattanooga, TN: National Center for Youth Issues.
Dubin, N. (2007). Asperger syndrome and bullying: Strategies and solutions. London: Jessica Kingsley.
Fancher, V. K. (1991). Safe kids: A complete child-safety handbook and resource guide for parents. New York: Wiley.
Jagoda, A. (2004). Good housekeeping family first aid book (rev. ed.). New York, NY: Hearst.
Kim, Y. S., & Leventhal, B. (2008). Bullying and suicide: A review. International Journal of Adolescent Medicine and Health, 20(2), 133-154.
Ludwig, T. (2006). Just kidding. Berkeley, CA: Tricycle Press.
Ludwig, T., & Manning, M. J. (2006). Sorry! Berkeley, CA: Tricycle Press.
Marotz, L. R., Cross, M. Z., & Rush, J. M. (2005). Health, safety, and nutrition for the young child (6th ed.). Clifton Park, NY: Thompson Delmar.
Naylor, P. R. (1994). King of the playground. New York: Aladdin Paperbacks.
Reich, J. B. (2007). Babyproofing bible: The exceedingly thorough guide to keeping your child safe from crib to kitchen to car to yard. Beverly, MA: Fair Winds Press.
Rodgers, G. C., Jr., & Matyunas, N. J. (1994). Handbook of common poisonings in children (3rd ed.) Elk Grove Village, IL: American Academy of Pediatrics.
Shaw, E. (2001). Keep kids safe: A parent’s guide to child safety. Appleton, WI: Quality Life Resources.
Shore, K. (2001). Keeping kids safe. New York: Prentice Hall.
Strickland, D. C., McAllister, D., Coles, C. D., & Osborne, S. (2007). An evolution of virtual reality training designs for children with autism and fetal alcohol spectrum disorders. Topics in Language Disorders, 27(3), 226-241.
Unintentional injuries in children. 2000. The Future of Children (a publication of the Packard Foundation), 10,
www.futureofchildren.org.
■ QUESTIONS AND ANSWERS
1.
When David was first diagnosed, the doctor did several lab studies. These all came back normal except for his lead level, which was slightly elevated. It was not high enough to treat, but the doctor has followed it since that time and we have been careful to keep an eye on what he puts in his mouth. Why does this happen? Lead poisoning is an important health problem in children. Several studies have suggested that children with autism may be more likely to have higher lead levels. This is usually because they may like to put nonfood items in their mouths or may be more likely to lick things than children without developmental difficulties (normally developing toddlers also may be at greater risk for lead poisoning). The worry here is not that the lead level caused the autism but that higher lead levels may contribute, over time, to other developmental difficulties (e.g., inattention). Periodic screening is thus important in autism (this can be done with a simple blood test), particularly if the child likes to put things in his mouth. Treatment can be indicated if the lead level is high, although here, as in much of the rest of medicine, an ounce of prevention is worth a pound of cure; parents should be alert to the problem, and particularly if the child has a high lead level, look for the sources of lead in the environment and remove them. These are most likely to be found in paint in old houses and, sadly, in toys from abroad.
2.
My son has no sense of danger and will go with anyone—is there any way to help him get a sense of appropriateness with strangers? The answer really depends on your child’s age and level of cognitive ability as well as his ability to communicate. For children who are verbal and have better cognitive abilities, there are some good children’s books that teach about safety. Some of the curricula developed for schools in teaching about use of personal space may also be appropriate. It will be important that your school know about, and work on, this issue.
3.
The company I work for is relocating and we have to move. Are there any precautions my wife and I should think about when looking for a new place to live? Our 4-year-old with ASD seems to be into everything! Keep in mind that for older homes (built before the mid-1970s), you should be sure the house (and grounds) are free from lead-based paints. There are companies that can test for this. As you think about a house, keep safety in mind; for example, are you on a busy street or a quiet one? Are there danger areas (pools, cliffs, highways) nearby? Are there things that might particularly attract your child and be dangerous?
4.
I teach a second-grade class (along with another teacher and a paraprofessional), and we have a child with autism who is included for most of the day. Are there any special times of the day that accidents are more likely to happen? Are there any things we can do to make the classroom safe? Transitions are characteristically stressful times for children on the autism spectrum, and the most likely times for children to have all kinds of difficulties, including injuries. So keep a special eye on the child at these times. Take a careful look at the classroom for obvious and less obvious safety hazards. Depending on the level of ability of the child, this may take a different form—are there poisons, sharp objects, dangerous materials?
5.
Our 6-year-old likes to eat everything. A friend told me we should keep a bottle of ipecac syrup in the house in case he eats something he shouldn’t. When should we use this? Basically, you shouldn’t. Call poison control (or 911 if your child is in obvious distress). Doctors now feel that the dangers in using ipecac outweigh the risks.
6.
There is a student with Asperger’s in my home room in junior high. He gets very preoccupied with the fire drills and will be anxious for weeks and weeks after they happen. Is there anything I can do to make him less anxious? The anxiety likely stems from various sources; you can try to sort out some or all of these and do as much as you can to address them ahead of time. Practice even when there is no drill. Have a clear set of directions for the student so he knows exactly what do to. Giving him a very specific job may also help. If he is afraid of the noise, seat him as far away as you can from the source of the sound. Doing a project on firefighters or fire prevention may also help (although there is some potential that he will end up learning a lot about this!).
7.
My 8-year-old with autism has a tendency to wander. As it happens so does my elderly grandfather—for him my parents have found a GPS tracking device. Are there similar things that can be used for children with autism? Also, my husband wants to get a dog—are they any good for helping children with autism?