1. Road safety
- Maintaining safety as a pedestrian involves a complex combination of skills, including judgement, predicting the actions of others, planning and making quick decisions. These are difficult skills to acquire if the child/young person has executive functioning difficulties.
- Road safety involves processing multiple sources of information simultaneously which can be difficult for many autistic people. He/she needs to be aware of others on the footpath, traffic on the road and rules when crossing the road.
- A child with auditory processing difficulties may not respond to the adult’s instruction to “Stop” or “Wait” at the side of a road because he/she does not register or understand the verbal instruction.
- Individuals who are sensitive to sensory input may feel overwhelmed by the large amounts of sensory input (e.g. noises from traffic, others talking, planes overhead, bright sunlight, movement of traffic and people, wind blowing the trees, different colours, various smells, and other people walking close to them). This may cause anxiety and sensory overload and so the child/young person may not be able to think clearly to make safe decisions about crossing the road etc.
- The child/young person may be very distracted by the surrounding stimuli, affecting concentration. In particular, he/she may be distracted by a favourite interest e.g. makes of car, road signs. Losing concentration when walking on a footpath or crossing a road can then risk personal safety. For example, the child may see a favourite make of car and suddenly run across the road to examine it more closely.
- Some children and young people with autism are impulsive, and so may act before thinking actions through. For example, he/she may see a shop of interest on the other side of the road and suddenly cross the road without checking oncoming traffic.
- Road safety involves anticipating the unpredictable actions of others e.g. a car not stopping at a zebra crossing, a car turning on to a side street without indicating. This unpredictability and understanding the actions of others can be difficult for someone with autism.
- Road safety will often demand flexible thinking and problem solving e.g. what to do if the footpath is blocked, what to do if the pedestrian crossing is not working.
- Teach road safety from a young age but start on quiet roads.
Scenarios could be set up in empty car parks or the school playground to teach and practise road safety rules.
- Present road safety rules in a visual form which is meaningful for the child/young person e.g. use photos, symbols or words. Go over these rules frequently, and especially just before going out on a road.
- Parents and caregivers can carry a visual symbol for “Stop” and present this to the child when approaching a road to cross.
- Wearing ear defenders or headphones will reduce anxiety caused by noisy traffic and unpredictable road noises so it may be useful for some children and young people. Remember, however, that this may mean they won’t hear a car coming behind them or a warning car horn and so they will need to be taught to be extra vigilant and look around them at all times.
- Carrying a backpack with a little weight in it may help to reduce anxiety and sensory overload, thus allowing the individual to stay calm on the road and reduce impulsive reactions.
- Present problem scenarios to the child/young person and devise solutions to these e.g. what to do if a car is blocking the footpath, what to do if there is no pedestrian crossing.
- Crossing the Road
- Sensory Processing Resource – Travelling to and from school
- Executive functioning difficulties will create challenges when learning to drive. The young person will need to be able to make quick decisions while processing multiple pieces of information on the road.
- Motor planning is often an area of difficulty for individuals with autism. Driving is a complex sequence of simultaneous motor actions and so it may take some people with autism longer to master these skills.
- Driving can be overwhelming due to the high levels of sensory stimuli to be processed. Some young people with autism may feel overloaded by the amounts of different visual input and auditory input.
- Driving requires the ability to think flexibly as unpredictable occurrences will frequently take place and road/traffic conditions are always changing. The actions of other drivers are unpredictable and this may require fast and flexible thinking.
- The young person should discuss his/her intention to learn to drive with the GP or paediatrician. They will be able to advise if there are any difficulties/deficits which need to be considered and which the young person may need to state to DVLNI (Northern Ireland) or NDLS (Republic of Ireland). This might include difficulties with perception, executive functions, sensory processing or motor planning/control.
- Some computer programmes can be introduced at an earlier age to teach skills such as fast reaction times, processing multiple sources of visual input, sequencing and controlling a steering wheel.
- When learning to drive the young person should start in quiet locations away from other traffic e.g. an empty car park. This will allow them to master control of the car before the additional challenge of negotiating traffic.
- Discuss problems which may arise and possible solutions e.g. the car breaks down, traffic lights are not working, emergency vehicle needs to overtake, road is closed.
- Explain to the young person that many drivers will break rules and how to deal with this.
- Reduce the amount of sensory input/distractions in the car e.g. turn off the radio, remove any unnecessary objects (e.g. items hanging from the mirror, books, cups, discarded items), remove car scents etc.
- Find a driving instructor who has experience in teaching people with autism or special needs.
- It would be beneficial to inform the driving instructor of the autism diagnosis and specific difficulties which may affect driving. The young person or caregiver could tell the driving instructor to keep verbal instructions short and clear.
3. Drugs and alcohol
- Many autistic people report that alcohol and some recreational drugs help to reduce the anxiety associated with their autism.
- In particular, alcohol has been reported by some autistic people to lessen their social anxiety and helps them to relax in social situations. They then find it easier to interact with others.
- The difficulty with using alcohol and drugs as a means to reduce anxiety is that some individuals can become dependent on these, and in some cases, an addiction may develop.
- Some individuals with autism may not understand the risks to their physical and emotional wellbeing if they take excessive amounts of alcohol.
- Additionally, some individuals with autism may not be aware of the risks associated with recreational drugs. They may also not be aware of the risks associated with ‘legal highs’ as they may make the assumption that ‘legal’ means ‘safe’.
- Young autistic people who are having difficulties making friends due to deficits in social communication might take alcohol and drugs in order to fit in with their peers and be accepted into a social circle.
- Some individuals with autism have also reported that alcohol helps to numb some of the overwhelming sensory sensitivities they experience.
- Addiction may also be an increased risk in autism due to the drive for repetition.
- Education about drugs and alcohol is essential.
They need to be made aware of both the immediate risks to health and also the long-term risks to physical and emotional health.
- Educating young people with autism about drugs and alcohol may require the use of more visual teaching strategies and social stories. The approach should be individualised to suit the learning style of the young person.
For example, if he/she is interested in Science, a more scientific approach can be taken in which the effects of different chemicals on the body can be examined. Other young people may be confused by too much detail and instead need clear visual rules about the use of drugs and alcohol. They may benefit from ‘visual mapping’ showing what can happen if you choose to take a drug or alcohol substance.
- It is important to clarify both the health and legal risks of excessive use of alcohol and drugs.
- Using visual supports to show safe levels of alcohol intake will be useful for some young adults with autism and they may respond positively to these visual rules.
- If a young person is using alcohol or drugs as a means of reducing anxiety, intervention should focus on other anxiety management strategies. A Cognitive Behavioural Approach (CBT), tailored for the unique needs of the individual with autism, is often recommended. The National Autistic Society – Counselling
- • If a parent or professional is concerned that a young person may have developed a dependency on drugs or alcohol, referral should be made to the Child and Adolescent Mental Health Service (CAMHS).
4. Safety at home
- Safety at home issues are the same for individuals with autism as they are for any child. However, the risks may persist longer into development for a child with autism, and so strategies in the home may have to be kept for a more prolonged period e.g. use of stair gates, socket covers, locks.
- Impulsive behaviours increase the risk of harm and injury. Some children and young people with autism do not link consequences to actions, or do not think through each step of an activity to consider the potential risks. When they see something that is of interest to them, they may act impulsively to get it e.g. a child may see a toy placed on a high shelf and climb to get it without pausing to think of safety or alternative solutions, such as asking an adult to reach it.
- Some children and young people may place themselves at risk when trying to ‘escape’ something they dislike e.g. climbing out of a window to escape from a noisy/busy party in the house; crawling into a cupboard or behind a unit to escape the noise of the vacuum cleaner.
- The child/young person may not easily generalise risks e.g. he/she may have had an injury on a ‘hot’ kettle but not generalised this to understand that other ‘hot’ appliances (oven, iron etc) will also cause injury.
- Individuals who crave sensory input often enjoy activities such as climbing and running, and the instinct to engage in these sensory activities often outweighs the risk to personal safety for them.
- Individuals with receptive language difficulties may not process and retain verbal safety information, and others may not be able to read and understand the safety information on labels.
- Preventative measures may be required for younger children and those with an intellectual disability. These measures may include locks on doors and windows and cupboards, alarms, socket covers, furniture fixed to walls etc.
- It is also important to educate children and young people so they can start recognising risks and hazards for themselves and know what action to take. This can start with simple recognition of items which may be hot, sharp etc and can then move on to more advanced skills such as what to do in the case of a fire.
- Label items to warn child/young person of potential hazards e.g. “stop”, “hot”, “sharp”, “poisonous” and “Don’t touch”. Use photo, symbol or word, depending on the child’s level of understanding.
- Label items which could be hot (e.g. kettle, iron, oven)
- Label cupboards and drawers which contain sharp items (e.g. knives, tools, scissors)
- Label items which could be poisonous (e.g. household cleaners, medicines).
- A colour coding system could also be applied e.g.
Red = Do not touch
Amber = be cautions before touching
Green = safe item
- Use social narratives or visual mapping systems to show consequences for actions e.g. what happens if you touch something hot, what happens if you swallow non-edible items.
- Use social narratives or visual instructions to show what to do in different scenarios e.g. what to do if there is a fire in the house, what to do if you burn yourself.
- Display emergency numbers beside the telephone in the house or on the child’s mobile phone i.e. numbers of family members and emergency services.
5. Asking for help
- Many autistic children and young people do not have the social awareness to understand that other people are sources of help.
- If an individual is object-focused, he/she may not have yet developed an awareness of people in their environment and identified them as sources of help. They may not have yet developed the communicative intent to request help.
- Individuals with expressive communication difficulties may not know how to ask for help from others.
- Some individuals may know how to ask for help if there is someone near them but they may not know how to access help if there are no familiar people nearby e.g. if lost on a street or if there is an emergency when he/she is at home alone.
- The child/young person may not be aware of all sources of assistance and to access it e.g. pastoral care coordinator at school, customer services in a shop, different types of emergency services.
- Parents and professionals can observe a child and be alert to times when they need assistance.
- The adult should then intervene with a “Help” card, encourage the child to hand this over and then give the assistance required. This helps the child to make the link that other people can be sources of help. This can be taught in numerous natural scenarios, such as a child not being able to find a toy or part of a jigsaw, child not being able to open a food packet of bottle of water, child not being able to open a locked door.
- Ensure the child/young person has constant access to a visual “Help” card. Tip to Remember: even if the child/young person can verbally request help when calm, they may lose this ability in a stressful situation or when anxious.
- Educate the child/young person about different sources of help, when to use them and how to access them e.g. have a chart listing different ‘helpers’, when to use them and how to contact them. This may include a teacher in school, the pastoral care coordinator, parent/caregiver, emergency services etc.
- Identify possible scenarios when the individual may require assistance and educate them about what to do in these scenarios and how to get help e.g. what to do if lost, what to do if you can’t find an item in a shop, what to do if you are late for a bus, what to do if you feel unwell. Social narratives or simple visual sequences can help in teaching actions in different scenarios.
- Ensure the child/young person has access to important phone numbers at home or on his/her mobile e.g. parent’s phone number, other family member, emergency services.
- If the child/young person has expressive language difficulties, ensure they know how to request assistance using visual methods, such as a help card or being able to send a text message.
6. Safety in social situations
- The risks in social situations are the same for young people with autism as they are for all children and young people. However, the social communication and executive functioning difficulties associated with autism can further compromise their safety.
- Some children and young people with autism may have difficulty discriminating between ‘strangers’ and ‘safe people’, especially if it is not immediately clear e.g. is a shop assistant a stranger or can he/she be approached for help? Is a police officer a stranger or can he/she be approached for help?
- Many autistic young people are socially isolated and may be so keen to make friends that they form inappropriate friendships with people who may manipulate them and lead them into trouble.
- The child or young person with autism may be so object-focused that this takes over any awareness of personal safety. If the young person, for example, has a strong interest in dogs, they may start interacting and walking with a dog owner, even though that person is a stranger.
- Many autistic young people often prefer solitude and so may often go out alone and walk along streets alone. This then increases the risk to their personal safety.
- Executive functioning difficulties may mean that the young person does not adequately plan social meetings, and may be late to meet friends or go to the wrong meeting place. The young person is then alone and may be unsure of how to get home or ask for help.
- Establish a set of clear rules with the young person to improve their personal safety. Rules may include:
- Do not go out alone. Always walk with a friend or family member.
- Send regular text messages to parent to let them know where you are and that you are safe (e.g. every 30 minutes).
- If you get lost or become separated from friend(s), phone parent immediately.
- Avoid walking in areas which have no street lights.
- Always inform parent where you are going, who you will be with and what time to expect you home.
- Use visual supports to assist the young person in discriminating between strangers and people who can help.
- It is impossible to think of every person they may come across but try to compile a list of people who can be safely approached for help e.g.
- School patrol person
- Dinner lady
- Police man
- Fire man
- Bus driver
- Shop keeper
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