Drowning and ASD. Why and what can be done?
Drowning is the leading cause of death among children with Autism Spectrum Disorder (ASD) (University of the Sciences in Philadelphia, 2014). According to the National Autism Association, accidental drowning accounted for approximately 90% of total (U.S.) deaths reported in children with ASD ages 14 and younger in 2009 to 2011, subsequent to wandering. Statistics in Australia cannot be found, however it is hypothesised that the percentages would be comparable.
As of last month, further statistics have come to light (American Journal of Public Health), outlining that;
- Drowning accounts for 46% of all injury deaths among children with autism, which translates to 160 times the chance of dying from drowning compared to other children.
- Individuals 14 years and younger are 40 times more likely to die from injury than the general paediatric population.
Why?
- Wandering
Wandering is the tendency for an individual to try to leave the safety of a responsible person’s care or a safe area, which has the potential to result in potential harm or injury. It is often referred to as absconding, elopement or fleeing.
It is not uncommon for individuals with ASD to become overstimulated with crowds, noises and a range of other stimuli, hence escaping this by retreating to another environment. Many individuals with ASD gravitate towards bodies of water because they associate water with alleviating many of their sensory needs. Research indicates that nearly 50% of children with ASD attempt to escape from a safe environment, which is a rate nearly four times higher than children without autism. 58% of parents of ASD children report wandering/elopement as the most stressful of ASD behaviours (National Autism Association).
In addition to drowning, wandering brings with it other high risk factors, including but not limited to exposure to the elements; dehydration; falls; hypothermia; traffic Injuries; encounters with strangers; and encounters with law enforcement.
- Difficulties with Generalisation
Generalisation refers to ability to transfer skills and information learned in one setting, to other settings, people and activities. 68% of the individuals with ASD who represent the 91% figure above, died in a nearby pond, lake, creek or river. So although many individuals with ASD may have had swimming lessons and developed swimming skills in pools in the past, they may experience difficulties in generalising this skill across different environments (lakes for instance).
- Lack of specialised services
Many swimming teachers may have undertaken additional training in ‘special needs’ however until recently, there has been a severe lack of specialised training specific to ASD and swimming. There is a need for teachers to understand the ways in which individuals with ASD process information and acquire new skill sets, so the classes can be individualised and tailored to the strengths of the individual. There is also a need to incorporate components of water safety into the lessons.
- Difficulties with perceiving danger
The risk of drowning increases with the individual’s ASD severity. Many individuals with ASD have difficulties with anticipating danger and judging risk, which is exacerbated if they also have an intellectual disability.
- Lack of awareness
The data also showed that only 50% of parents of children with ASD have received advice about wandering prevention from a professional. Sadly, many in our community are unaware that wandering is even an issue or that drowning is such a high risk factor for individuals with ASD.
What can be done?
Talk
Your interest in this blog and the issue as a whole, is a start. As with most things, awareness and education is key. From 2009 to 2011, 23% of children who died following a wandering incident were in the care of someone other than a parent. Talk with those around you and educate them on the risks.
Wandering/drowning is most likely to occur under the following settings:
- During warming months
- Visits to non-home settings, such as a friend’s house or when on holidays
- During family gatherings
- During times of stress or escalation, which may cause the individual to flee or wander
Take extra precautions and plan accordingly. Family gatherings or other events may give a false impression of high supervision, which is often not the case.
Preventative and Reactive Resources
Autism Swim have brought together a range of clinical specialists in creating the Wandering and Drowning Prevention toolkit - http://autismswim.com.au/product/wandering-drowning-prevention-toolkit/
This is inclusive of a range of preventative and reactive resources in relation to wandering including emergency plan templates, individual identification aids, checklists and signage; and it’s free. The more awareness that is raised, the higher the likelihood that governments will respond.
Enrol your child in specialised swimming lessons
Enable your child to have the best opportunity possible to learn water safety and acquire swimming skill sets. Enrol them in specialised swimming lessons, being run by Autism Swim Approved Instructors.
Positive Behaviour Support
If your child has a propensity to wander, consider Positive Behaviour Support to ameliorate this. Behaviour Specialists will undertake an assessment of the behaviour and design associated strategies and programs. An Occupational Therapist may also be able to assist
If you have a question or comment, or would like to share your story, please email us at hello@autismswim.com.au
Erika Gleeson
Clinical Director
Autism Swim / www.autismswim.com.au
Additional references:
((Lethal Outcomes In Autism Spectrum Disorders (ASD) Wandering/Elopement; Lori McIlwain, Wendy Fournier Jan 2012)