(56) Autism

How do I make my home safe for my autistic child?

The following suggestions have been found to be helpful in preventing certain types of behaviours and ensuring a safer environment. The suggestions range from using locks for security or limiting access to the individual to labelling every functional item and area in the home with photographs or symbols to assist in communication.

After you have identified all the risks in the home, separate each room into one of three categories:

1. Safe

2. Needs modification

3. No access allowed

Safe rooms are those rooms where the child can spend time with little risk to their safety. Rooms that require modification are rooms where furniture may need to be removed or replaced, electrical outlets covered, or locks put on doors and cabinets. Rooms labelled “no access allowed” are those rooms that contain things that can harm the child, but cannot be modified easily. For example, young autistic children have been known to be injured when climbing into washing machines or dryers. If you have a laundry room, it may be easier to put a lock on the door than to design a way to block access to the washer and dryer. The same could be said for basements filled with power tools or painting supplies.

Modify the most important areas first. Not every parent can afford a complete home security makeover. Therefore, parents should identify those areas where the child spends the most time and work to secure them first. For example, the child’s bedroom, bathroom, den, kitchen, and backyard are all good places to start because these are the primary areas of interaction for many children with autism.

Get the right furniture. Autistic kids can be hard on furniture. They enjoy jumping and climbing; leaping from one piece of furniture to the next. Therefore, high dressers may pose a fall injury, glass-topped coffee tables may be shattered, and sharp edges on end tables can cut and bruise active children. Furniture that poses an immediate risk to the child should be removed from the room. When choosing new furniture for a room that your autistic child will spend a lot of time in (such as their bedroom or playroom), look for soft durable chairs (for example, beanbag chairs), desks and tables with rounded edges, low beds, book cases that can be affixed to the walls, and so forth.

Use locks, fences, and gates 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, 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, such as cabinets that contain medications or cleaning supplies. Foldable gates can be used to deny access to stairwells or other rooms. Keep in mind that although these gates may be appropriate for small toddlers, as your child gets older and stronger, they may not provide an effective barrier. Enclosing the front or backyard with a fence can provide a safe haven for your child to play. If you have a pool, use a cover over the pool and lock it.

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 place wooden boards over windows to prevent injury or elopement.

Use alarms when appropriate. Some autistic kids seem to enjoy escaping from the house unnoticed. They slip out of doors or windows and even open locks as they get older. Putting alarms on doors and windows can alert parents of their child’s attempts at escape. This may be safer than putting up too many barriers that may prevent appropriate escape during a house fire. These needn’t be expensive, integrated security systems. Local electronic stores sell inexpensive, yet very effective, alarms for individual doors and windows. Make electrical outlets and appliances safe. Cover or remove electrical outlets and access to electrical appliances. Use plastic knob covers for doors, faucets, ovens, and stove burners. Ensure that all wiring for appliances and electronics is concealed in a way that the child cannot play with the wires or bite or cut them. Heavy items such as televisions, VCRs, or computers should not be stored in high places, so that a child could pull them down on his- or herself.

Lock dangerous items away. Make sure toxic substances are secured in a locked cabinet. These substances include detergents, caustic chemicals, cleaning supplies, pesticides, medications, and small items that a child may mouth or chew. Sharp tools and kitchen implements should lock away (if practical) or placed out of sight and out of easy reach if they are regularly used. Rather than have these items all over the house in places that are convenient to the chores they are used for, it may be safer to store them in one place, such as a closet or cabinet that can be securely locked. For items such as kitchen knives or sharp scissors, locks can be placed on individual kitchen cabinets or drawers.

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 the child cannot turn them on. Always supervise the children closely when there is an active fire in the fireplace or when there is a barbeque with open flames. Many community fire departments can provide stickers (often called tot finders) for bedroom windows of children. These are invaluable in the event of a fire so that firefighters can locate a child’s bedroom quickly. Although it may be difficult to teach an individual with autism or PDD about the dangerous nature of fire, it may be possible to teach them about how to behave when it comes to fire safety.Be careful with firearms in the house. Autistic children will not readily learn gun safety. No guns should be accessible in nightstands, on top of dressers, and the like. All firearms should be locked in a gun safe, unseen and inaccessible to children in the house.

Consider identification options. Autistic children have a tendency to wander, to lag behind groups, to get lost, and sometimes escape from their own home. If your child has proper identification, it is easier for others to help them return home. This is especially true if your child is unable to communicate effectively. If your child will tolerate wearing a medical ID bracelet or necklace, get one (they can be found at your local drug store or ordered on the Internet). However, many children with autism do not like to wear jewellery, so the next best option is to place iron-on labels into each garment. Some children can be taught to carry an identification card in their wallet, purse, fanny pack, or knapsack. Children can be taught to show their identification cards when asked by adults.

How do I change my child’s behaviours to reduce the risk of accident or injury?

Risks in and out of the home cannot be effectively eliminated; for example, it is impossible to abolish hot cooking pots on the stove, sharp knives in the utensil drawer, or the traffic on busy streets. In these cases, teaching children about the dangers and ways to avoid them is important. Developing social stories about smoke detectors, fire drills, fire alarms, touching fire, talking to strangers, and so forth is the place to begin. (A social story is a short, personalised story that explains the subtle cues in social situations and breaks down a situation or task into easy-to-follow steps.) These stories need not be long or complex, and they should be repeated often, especially in potentially risky situations. For example, when Mum is cooking on the stove, she may tell the story to her child of a boy who burned his hand when he touched the flame or the hot pan. These stories can be embellished with songs, rhymes, or funny faces. However, if repeated often enough, the child will learn to avoid the dangerous situation.In addition to social stories, the use of visual (photos or 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 oven burners with a bright red “no” symbol or STOP sign over the photograph may visually depict the rule for the child.

The behaviour of the child is not the only behaviour that must change. Parents used to caring for typical children will notice the supervising takes a lot more effort. The parents or guardians of autistic children need to be more vigilant because autistic children tend to be more persistent in their actions and are not deterred by obvious dangers or chastened by stern lectures.

Children with autism may need extra precautions to stay safe in your home. However, it is important to find a balance between keeping your child secure and making your home a prison. You should keep in mind that locks should not be so secure that they prevent anyone from leaving the house during an emergency such as a fire. Vigilance is an important virtue in the parents of autistic children.Vigilance requires more effort and can induce more stress.

Where do autistic people usually live?

In general, autistic people have the same living options as people with other disabilities. Their living arrangements are matched with the individual’s needs, capabilities, and the finances of their family. It is important for parents to understand that, unlike educational services, the federal and state governments have no obligation to provide their child with a place to live. Therefore, parents must consider today where they’d like their child to live in the future and begin making plans years before the child will require those arrangements. In the past, autistic children were likely to be placed in an institution.

Today, except in rare instances, autistic children live with their parents.

Autistic adults, however, have more options. These options include:

Family home. Parents or interested and involved siblings can provide a home and care for their autistic family member. If the parents have no typical children to care for their child after they die, they can arrange for a caretaker or companion to live with their child in the home.

State-run mental health facility. This is an option for autistic adults with severe intellectual or behavioural impairment who require continual care and supervision. Although the trend in recent decades has been to avoid placing persons with disabilities into long-term care institutions, this alternative is still available when necessary. Unlike many of the institutions years ago, today’s facilities view residents as individuals with human needs and offer opportunities for recreation and simple but meaningful work.

Group home. A group home is a single-family residential structure designed or adapted for occupancy by unrelated developmentally disabled persons. The structure provides long-term housing and support services that are residential in nature. The residents typically participate in daily tasks and are often free to come and go on a voluntary basis. A group home might have four permanent residents with two staff members for most of

the waking hours and one staff member while the residents sleep. A group home can be owned and funded by the state, a charitable organisation, or a family.

Assisted living facility. Assisted living refers to a residential care facility that provides housing, support services, and at times, health care for a group of unrelated developmentally disabled people. Typically, these people are not able to live independently but do not need the level of care that an institution offers. The assisted living situation can be tailored to the needs of the individuals; for example, two autistic people could share an apartment and be visited daily by a representative of social services. An assisted living facility can be owned and operated by the state, a charitable organisation, or a family.

Autistic kids can be hard on furniture.

The behaviour of the child is not the only behaviour that must change.