Safety in the Home

Most parents and caregivers would view safety as a significant concern regarding their children in the home environment. Modifications such as placing gates in stairwells and doorways, covering electrical outlets, and using childproof locks on cabinets are some of the things many parents do to ensure safety. In response to these concerns the Autism Society of America has partnered with law enforcement and a preparedness consultant to create Disaster Preparedness Tips and a Safe and Sound packet. The packet contains an Emergency Decal that can be placed on your door or automobile window and a companion piece called the "Personal Information Record".

For parents of "typical" children, such safety precautions are usually necessary for the first few years of childhood, after which the child develops, matures and no longer requires the use of modifications. However, for parents of children on the autism spectrum, it is sometimes a different story. There are a myriad of additional issues to consider when addressing the safety of the individual with autism, the family members, and the home environment - often throughout the life of the individual with ASD.

Consider the many behaviors an individual with autism may engage in that could be unsafe: climbing, throwing, breaking, jumping, peeling, cutting, pulling down, throwing utensils, plates and cups, sweeping items off surfaces, dumping drawers and bins, and climbing out of or breaking windows. Or consider what can happen when natural curiosity and household appliances converge: putting items in appliances, flushing things, touching burners, turning hot faucets, inserting items into electrical sockets, chewing on wires, and crawling in a washer or dryer. Finally, consider the potential dangers that can result from playing with matches, lighters or fire.

Often children with autism who display such behavioral concerns do not understand the ramifications of their actions, which, at best, can be bothersome and, at worst, can be devastatingly tragic. Therefore, it becomes incumbent upon the caregivers in the home to provide both a safe environment and ways to teach their children to be safe.

There are several environmental and safety modifications that can be made in the home as well as steps that can be taken to prevent unsafe or inappropriate behaviors. The following suggestions have been found to be helpful in preventing dangerous behaviors and ensuring a safer environment. The suggestions range from using locks for security or limiting access to the individual to labeling every functional item and area in the home with photographs or symbols to assist in communication.

Sometimes parents balk (initially) at the idea of having to place locks on doors or cabinets, having to place alarms outside a child's bedroom, or having to label the house with photos or cards. They often say: "This is not a classroom." However, your home is indeed a natural learning environment, just like a classroom.

Establish priority areas for modification. Modify the most important areas first - such as the individual's bedroom, bathroom, leisure areas, kitchen, and back yard - since these are the primary areas of interaction for many children. When getting started, think about the room(s) in which the child spends the most time; for some children it would be a recreation/ family room, for other children it might be the bedroom or kitchen. In addition, consider the behaviors to be modified and the relationship of those behaviors to the environment Behavior modification works to alter an individuals behavior through positive and negative reinforcement. Remember that behaviors always serve some purpose, and in order to alter a particular behavior it must first be understood. If the individual likes to put things in the toilet or run hot water in the bath, modifications should begin in the bathroom. If the child runs out of the house, modifications should begin with securing exterior doors with locks.

Arrange the furniture appropriately. Arrange the furniture in a way that "makes sense" for the activities the individual is expected to do. That is, if the individual will be doing "seated" activities, ensure that there are clear table surfaces and appropriate chairs. If the child frequently runs out of a room via a predictable path, arrange the furniture and close doors so that he or she is unable to escape. Limit the need for excessive movement and/or transition. Move furniture away from shelves or places where the child may climb. Keep furniture surfaces clear (if the individual is a "sweeper") and place items out of reach on shelves, in bins, or locked away. In addition, use gates or barriers to provide safety from falling down steps or to limit access to certain areas in the home.

Use locks where appropriate. It is important to place locks on exterior doors that provide entry or departure to and from the home. For individuals who run away or leave the home without supervision (also referred to as "elopement"), having locks on the doors can prevent them from leaving. Place locks on interior doors and cabinets where the individual should not have free access.

Some parents feel more secure when their child is locked into his or her bedroom at night to prevent "in the middle of the night" wandering. If you choose to put locks on the doors, use locks that you are able to open such as a lock with a keyhole/key, a hook-and-eye lock, or a slide-bolt. Some parents place the lock key above the door frame of the room to have quick and easy access. If a button-knob lock is used on the outside of the door, make sure that the child does not lock you into the room with him or her. It is imperative that you have immediate access to any room where the door is locked in the event of fire, or other emergency.

Regarding locks on cabinets and drawers, use safety locks (often plastic devices) to secure items that may be unsafe for the individual. Many parents place these locks on bathroom and kitchen cabinets to prevent access to items in the cabinets.

Safeguard your windows. If the child likes to climb out of windows, place locks on them. Hardware stores carry special locks for just this purpose. If the child breaks glass or pounds windows, replace the glass panes with Plexiglas to prevent injury. Some parents have had to also place wooden boards over windows to prevent injury or elopement.

Make electrical outlets, appliances safe. Cover or remove electrical outlets and access to electrical appliances. Use plastic knob covers {also available at hardware stores) for doors, faucets, ovens, and stove burners. Lock the door to the room or rooms with the washer or dryer, appliances or power tools to limit access. Ensure that all wiring for appliances and electronics is concealed in a way that the child cannot play with the wires. Individuals on the autism spectrum often have a curious interest in how things work but that can be coupled with a pervasive "unawareness" of dangerous situations - a potentially powerful combination when it comes to electrical materials.

Lock dangerous items away. Secure items that are dangerous if ingested, such as detergents, chemicals, cleaning supplies, pesticides, medications, and small items that a child may mouth or chew, It is easy for an individual with autism to confuse a bottle of yellow cleaning fluid with juice based upon appearance, or to pour / spill liquids out of any bottle (some of which may be poisonous or toxic), and pills that look like candy can easily be eaten by mistake. Place such items out of reach or in cabinets with locks. Keep the Poison Control phone number in a permanent place that is clearly in view.

Secure items/materials that are dangerous or unsafe if used without supervision, such as sharp objects/ utensils (scissors, knives, razor blades). When unsupervised, many children like to cut things (clothing, curtains, wires, books, etc.) into pieces with scissors or knives. If necessary, use scissors that have blunted ends (child-safety scissors), and be sure to provide supervision when involved in cutting activities. In addition, secure items that need to be limited (i.e., candy, Nintendo, lighters, matches, TV, DVD player, toilet tank covers) with a lock or ties.
Label everyday items. Place visual labels (symbols, photos, words, textures) on functional items, rooms, cabinets, drawers, bins, closets, and anything that has relevance for the child. By labeling the environment, a child with ASD may better understand what is expected and may be less likely to engage in undesirable behaviors. In addition, if the child understands the function of an item, piece of furniture, etc., he/she is more likely to use it for its intended purpose. For example, by placing visual labels on the bed for sleeping, the child may be less likely to view the bed as a trampoline. By placing labels on drawers and closets, it may reduce power struggles over being asked to put things away because the child will know where to put them.

Organize everyday items. Organize functional items in see-through plastic bins/boxes with visual labels (symbols, photos, words, textures) so the child can see and use the receptacles. Place the bins on shelves or in places that the child can easily see and access. Once again, the more organization, order and structure in the environment, the more likely it will reduce the frustration level of a child on the autism spectrum and the less likely he or she will be to engage in appropriate behaviors.

Institute appropriate seating. Ensuring that the individual is seated properly at a table or work station can help prevent behavioral concerns, such as throwing objects, knocking over furniture, self-stimulatory behaviors, and acts of aggression. For example, some children need to be seated in chairs with arms or a wrap-around style desk when doing work. Others may need to be seated in a place where they cannot easily escape from the table, such as against the wall or in a corner. In addition, a proper sitting posture (body at a right angle and feet flat on the floor) will help facilitate good learning and/or eating behaviors.

Use visual signs. Use dividers, tape boundaries, and signs as needed for setting expectations and limits. For example, the use of STOP signs on doors, drawers, furniture, and appliances has helped some children understand that these items/ areas are off limits. For children who climb on high surfaces or enter areas that they should not, STOP signs will let them know that what they are doing is dangerous. Using color tape to designate boundaries on carpets, floors, or walls can help to visually remind the child where their bodies need to remain.

Secure eating utensils and place settings. When using utensils during mealtimes, consider tying utensils to nylon string and attaching them to the chair or leg of the table, this way if the child throws the utensils, they will remain attached to the string. There have been children who have "unintentionally" thrown forks across the table and injured other family members. If the child throws or sweeps plates, bowls, and cups, secure them with adhesive Velcro and attach them to a secure placement. Use plastic or rubber plates, bowls, and cups to prevent shattering of breakable items.

Safeguard bath items/toys. Consider keeping bath toys in a bag/bin away from the tub and unavailable until bathing/hair washing are competed. This will help the child focus on bathing and prevent power struggles while in the tub. You do not want a child flailing around while in a slippery bathtub since he or she or you could be injured. When the child is finished bathing/hair washing, you can then give access to tub toys. Keep bath items (soap, washcloth, shampoo, sponges, etc.) together in a plastic bin or rubber bag and accessible. Replace open-lip bottles with pump so the child will not empty or ingest the contents.

Remember fire safety. Regarding fire safety, it is important to have lighters and matches out of reach or locked up. Place safety covers over gas stoves and oven knobs so that a child cannot turn them on. Always supervise children closely when there is an active fire in the fireplace or when there is a barbecue with open flames. Many community fire departments can provide stickers (called tot finders) for bedroom windows of children, so that in the event of a fire, the firefighters can locate a child's bedroom quickly. While it may be difficult to teach an individual on the autism spectrum about the dangerous nature of fire, it may be possible to teach him or her about how to behave when it comes to fire safety.

Developing social stories (with photographs, pictures, words) about smoke detectors, fire drills, fire alarms, touching fire, etc., and reading the stories to the child on a regular basis, is the place to begin. [A social story is a short, personalized story that explains the subtle cues in social situations and breaks down a situation or task into easy-to-follow steps.] In addition to social stories, the use of visual (photos, pictures) rules can assist the child in understanding what they are not supposed to do and/ or what they are expected to do. For example, "no touching the oven burners" with a photograph of the over burners with a bright red "no" symbol or STOP sign over the photograph may visually depict the rule for the child.

Consider identification options. It is important that your child has proper identification in the event that he or she runs away or gets lost and is unable to communicate effectively. Once a child with ASD becomes mobile, he/she may decide to walk out of the home without supervision. Children on the autism spectrum often like to be outside and in motion, so leaving the home to play outside is common. Once outside of the home, the child is then vulnerable and may be unable to get home or communicate where they live.

If the child will tolerate wearing a medical ID bracelet or necklace, get one (they can be found your local drug store). However, many children with autism do not like to wear jewelry, so the next best option is to place iron-on labels into each garment. Some children can be taught to carry and provide an identification card from a wallet or fanny pack and can learn to show their identification cards if they are not able to verbalize the information to another person. Some parents have also used specially designed tracking devises, perimeter systems, or service dogs for children on the spectrum who are known to elope.

Introduce Intervention Techniques to Teach Safety. In addition to the physical modifications to your home, you will want to introduce behavior modification techniques to teach your child how to be safe and act appropriately. There are a myriad of augmentative behavioral interventions that can be employed to do this. Examples of these interventions would be:

• social stories
  
• activity schedules
  
• visual rules
• signs / charts
  
• peer and adult modeling
  
• reinforcement for safe and appropriate behavior
  
• consistent consequences for unsafe or inappropriate behavior
  

Once general safety, good judgment, competence and understanding of what is expected can be demonstrated, many of the environmental modifications can be faded over time. Introducing the home modifications and intervention techniques mentioned above will not only help to keep your child and your family out of harms way, they will also help ensure that your child is ready and able to learn and, ultimately, better able to reach his or her full potential.

Resources Most of the items and products (safety knobs for appliances, locks, etc.) mentioned above, can be purchased from hardware stores, department stores, and children's stores in your community. You can also contact your fire department to see whether they have locator stickers or other materials to foster fire safety.

ASA