What are adaptive behaviors, and why did you study adaptive behavior and injury risk?
Adaptive behaviors are skills we learn to function independently. This includes communicating with other people, following directions, completing tasks and personal grooming. They vary with age, and a delay is when someone isn’t at the level one would expect for their age.
It matters, because adaptive behavior also includes recognizing and avoiding danger, while making appropriate decisions when confronted with a new situation.
What were the findings around adaptive behavior and injuries in autistic children?
Overall, there did seem to be some increased risk for having had a serious injury among autistic children ages 3 to 5 – with some caveats. Children with normal adaptive function but a significant early learning delay were more likely to have had an injury.
We speculate that it's because of that discrepancy, that parents may overestimate their child's ability to respond to dangerous situations if their adaptive behavior is normal, even though they have significant early learning delay. But we’ll need to do more research in this area to see if that misjudging of their child’s abilities is part of the explanation.
You also looked at how wandering might lead to injuries. What is wandering and what did you find?
Autistic children are three to four times more likely to wander – typically defined as a tendency to leave the safety of a responsible person's care or a safe area. We found that wandering was associated with greater injury risk for autistic children with significant early learning delays.
You were part of a study that looked at self-harm among autistic children and adults. Were autistic people and children more likely to visit the emergency room due to self-harm?
Significantly more likely. Self-injuries are extremely common in autism. We found that autistic children and adults were about 65% more likely to have had an emergency department visit for self-harm compared to a studied group of children and adults without autism or intellectual disabilities or attention deficit hyperactivity disorder (ADHD).
Additionally, an autistic child or adult who also had ADHD or intellectual disability was at even higher risk of self-harm – nearly twice as likely to visit an emergency department.
Why is self-harm a common issue among autistic people?
There are some theories about that; we don’t know 100%.
Autistic children often have challenges in social communication. If they're having difficulty communicating, they may become frustrated, and this may be a way for them to communicate that they don't like something.
There also may be sensory stimulation issues. People with autism are very sensitive to sensory input, but they also sometimes self-stimulate to try to feel more comfortable in a challenging environment. This can involve things like self-hitting or biting, without actually meaning to hurt themselves.
That said, self-harm and suicide are highly correlated and self-harm is one of the strongest predictors of suicide attempts.
One of the results showed that poisoning was a leading mechanism for self-harm. Do you know why that is and why that was so high in the results?
Many autistic people also have other mental health conditions like depression and anxiety and will take medication for those conditions. We did a study about three or four years ago looking at people (not autistic people specifically) who were prescribed psychotropic drugs, and they were clearly more likely to use those drugs in a suicide attempt. I think that some of this might be related to that.
You also studied adverse childhood experiences. What are they?
Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood. They can include: experiencing or witnessing violence, abuse or neglect; growing up in a household with someone who has mental health challenges or drug or alcohol problems; experiencing parental loss or absence; discrimination; and enduring food insecurity or financial insecurity.
These types of experiences can disrupt healthy brain and social development and then can lead to unhealthy behaviors in the child and other risks as they grow up. Exposure to ACEs increases the risk of smoking, alcohol and substance use, injury, teen pregnancy, obesity, diabetes, depression, suicide and lots of other problems.
There’s been extensive research on ACEs over the last few decades. Growing up with these traumatic events is really damaging to children.
Why are autistic children more at risk with ACEs?
There’s increased sensitivity to the effects of ACEs for autistic kids. For example, ACEs can create unstable environments – which are at odds with how many autistic children need routine and structure. The same goes for emotional processing and social interactions and communication. ACEs can impact each of those negatively.
A big challenge is income insufficiency. More than half of autistic children live in low-income households. This can be further strained by the high cost of healthcare therapy, and the impact on a parent's ability to work when they have an autistic child. There can be difficulties getting assistance because of the underfunded and fragmented systems of care we have. Financial uncertainty can lead to homelessness, food insufficiency and other negative consequences of poverty.
What were some of the other results from the survey that you would like to highlight?
Autistic teens are significantly more likely to experience one or more ACEs than non-autistic teens, especially income insufficiency and parents that were separated or who had died.
We found that about half of the teens in our survey actually had experienced at least one ACE, but autistic teens were significantly more likely to have experienced at least one compared to non-autistic teens. It was about 60% in autistic teens and about 40% in non-autistic teens.
Experiencing two or more ACEs, again, was higher in autistic teens, more than a quarter of autistic teens – compared to one in five for non-autistic teens.
Given each of these three studies – how can parents, families, caregivers and friends help autistic children around safety?
Overall, I think it comes down to being open to adapting to help, enhancing safety around the house and recognizing the needs of their individual child.
For wandering, this could look like:
- Window guards or locks, alarms and pool fencing
- Close supervision with behavioral aides or other additional caregivers
- Electronic tracking devices could be discussed to detect wandering children before they encounter danger
For self-injurious behavior:
- Working on teaching their child to communicate, whether through words, sign language or assistive device
- Providing choices to their child so they can make their preferences known
- Identifying situations that are triggers for self-injury so it's easier to avoid them
- Offering positive reinforcement for their child when they do communicate needs via means other than self-injuring
- Seeking out professional behavioral therapy if necessary
Finally for ACES, it’ll come down to broader and comprehensive school and community interventions. We should look at strengthening economic supports, providing access to enrichment programs and high-quality care, parent skill training programs, social training and youth mentoring. Taken together, these could help reduce ACES and their consequences.
