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.

Here is a straightforward post from Seattle Children’s on elopement. Cathy Rice, now director of Emory Autism Center and previously at the CDC, has published two papers on elopement.

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 in children with certain conditions can be challenging to research in a real-world context due to the high stakes involved; the consequences of not intervening can be catastrophic. For instance, Call recounted an incident involving a child whose fascination with balloons was so intense it affected his awareness of property values and safety. The child’s impulse to elope was triggered twice, each time leading to near-tragic accidents with vehicles, once because a colorful balloon display at a local real estate had irresistibly caught his attention. This highlights the critical need for vigilant supervision and safety strategies in such cases.

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.”