World Drowning Prevention Day: The Risk to Autistic Youth

Today, July 25th, is World Drowning Prevention Day.

When parents are told their child is autistic, it would make sense if the consulting professional provided very useful information. Feedback beyond what they feel the child will or won’t achieve in terms of developmental milestones, academics, and independence.

It is rare that, “As an autistic child, they’re significantly more likely to drown than an allistic child. Here’s how to prevent that,” is ever raised by health professionals. But it should be. It really, really should be.

Drowning is the leading cause of accidental death in children, with autistic children at significantly higher risk than their allistic peers. Drowning accounts for almost 50% of accidental deaths in autistic children. Autistic kids are around 160 times more likely to drown than non-autistic children.

One hundred and sixty times more likely. Let that sink in.

There are a number of primary reasons that contribute to this including wandering, differences with generalisation and skill transfer, and interest in water.

Water

It is often reported that autistic kids have either a love or hate relationship with water. They’re either the kind of kid who would spend all day doing water play, every opportunity getting in a pool, as long as possible in the bath or shower… Or they hate bath time, are distressed at swimming lessons, and are potentially even water phobic.

While there isn’t a proven reason for the attraction to water some theories behind this include:

• Its gentle sensory input when swimming, a little like a weighted blanket or hug. The feeling of weightlessness
• The patterns in its behaviour, such as waves and ripples; the way light reflects off it; visual sensory input
• The ability to manipulate and control it without any risk of hurting or damaging the water
• That many autistic people report finding nature and natural areas less taxing

WANDERING

Approximately 50% of autistic children have a propensity to “wander”. To leave the safety of adult supervision, or confines of a safe space such as a home or playground, without asking or advising.

While, much like attraction to water, there is no specific reason that autistic kids might be more inclined to wander, factors may include:

• Lack of acceptance, or understanding, of social norms such as asking permission, saying goodbye, or authority.

Autistic children in school are somewhat notorious for finding it hard to adapt to the authority of teachers– some teachers more than others. This is not because they’re evil little ragamuffins, as some teachers would have it, but because their natural state is to assume equanimity.
– NeuroClastic https://neuroclastic.com/autism-and-responding-to-authority/

• Difficulties with impulse control
• Hyperfocus and/or hyperfixation on goals, plans, or items (ie, leaving the house because they had been reading about a train and decided to go for a walk to the train station to see a real one)
• Generalisation. Not necessarily perceiving a difference between the acceptability for them to choose to walk from their room to the bathroom because they wanted to wash their hands – without permission – but being expected to ask permission to walk from their room to the park because they wanted to play on the swings
• Escaping sensory overwhelm, attempting to seek comfort, trying to self-soothe by looking for dopamine hits or calming input

While the majority of wandering children return, or are returned, safely, a study conducted in 2017 indicated almost 25% of wandering events by children under the age of 15 resulted in death. Of these, studies have shown that over 90% of deaths in autistic people aged 14 and under, who do not survive wandering episodes, are due to drowning.

Skills

Difficulties in skill transfer is a relatively common autistic trait. The act of being able to do something in one context, but not being able – or not recognising that they ought to – do it in a different situation. This lack of instinctive skill transference is often called generalisation.

It is one of the many reasons that repetitious and drilled learning of skills is not ideal for autistic children. Giving multiple contexts, variations, minor tweaks, and differences, when learning a skill, allows autistic children to recognise that the same skill can be applied in different situations. Or even that the skill itself can be modified to suit the context.

In the context of drowning, this can lead to a complacency in supervising adults. If they know their child swims well at swimming lessons, they might briefly take their eye off their child when they’re swimming at a friend’s house.

And bodies of water encountered when wandering are even more risky. If an autistic child can swim, but has only ever swum in a swimming pool, they might not apply any of their swimming or safety skills should they fall into a lake.

DROWNING PREVENTION

There are many steps that can be taken to decrease the risk of drowning. Most are the same as would be applied to any child, though in application to autistic children may need to be utilised for longer (or permanently).

Swimming

Swimming lessons, including practicing swimming and water safety skills in a variety of contexts and locations, with different supervising and supporting adults

Safety

Active observation. When watching a child in a swimming pool, actively watching. Not reading, not looking at someone else while you’re chatting to them. Definitely not “quickly doing something”. Never assuming you’ll hear your child struggle if something goes wrong. Always ensure one specific adult is given (and has verbally acknowledged) the responsibility of watching a child.

General safety. Never leave containers of water in an area your child can access unsupervised. This includes running baths without being present, having clothes soaking in the laundry tub, leaving paddling pools filled, etc. You will be aware of your own child’s gravitation to water, and likelihood to wander; if they meet one or both of these, lock external, bathroom, and laundry doors.

Meet safety legislation if you own a pool, in terms of fencing and gate security. If you live in an area where this isn’t a factor, look into the legislation in place in other areas and apply it to yourself. If your neighbours have a pool, don’t rely on them to always do the right thing and never make mistakes; ensure your own yard fence and gate is secure, particularly ensuring your child can’t use furniture or trees to clear the fence.

Wandering

If your child is a wanderer, and is generally able to learn new skills and information, discuss with them why wandering isn’t a good idea. Talk about strategies when they want to wander, whether that’s to escape overwhelm or stress, or because they have a plan to enact. Discuss means that include compromise – “If you let me know where you want to go, I will do my best to meet that need as soon as possible.” – rather than “You must not do it.” 

Obviously, wanderers should be even more closely supervised and monitored than the average child. Many children who have been killed or injured during a wandering episode have been able to wander when their responsible adult took a phonecall, went to the toilet, or was helping another child in their care.

Window and doors can be secured with:

• locks that can’t be easily manipulated, or need a code or key
• window and door alarms
• window and door sensors, much like old-school shop bells that chime as you enter and leave, simply to draw your attention to anyone arriving or leaving

It can be a good idea to get kids prone to wandering to wear a GPS device such as a watch or piece of jewellery, so you’re easily able to find them if they wander.

Ensure your child is actively with you when someone else leaves. Similarly, when two adults are present, lay claim or give responsibility; don’t leave any opportunity for one adult to assume the other was watching them.

If, after discussion and strategising, close supervision, and increased security, you are still experiencing issues with wandering, an occupational therapist may be able to offer professional support.

Education

It is not feasible to expect one person to be solely responsible for 24/7 observation of another human for decades. As the primary carer, it can feel that this is a requirement in order to guarantee your child’s safety. However, clear education of others around these risks and safety needs can allow you some respite.

If your child is a wanderer, have a very clear expectation and process in place with any babysitters, educators, grandparents, or anyone else responsible for your child. Ensure they have personal access to any GPS tracking systems, so they’re not dependent on you for actively locating your child to begin.

Around a quarter of autistic child drowning deaths occur when the child is in the care of someone other than their parent. While this is not indicative of a problem itself (what percentage of autistic kids right this minute are currently in the care of someone other than their parent? My guess is that it would likely be well over 25%, given how many attend school, are provided with care, utilised respite workers, etc), it is a factor to ensure you’re covering.

Where to Seek Assistance

There are a number of organisations directly addressing the different needs of autistic children both in terms of learning to swim, and water safety in general.

Please contact your local swim school and ask them if they have anyone specifically trained in teaching autistic kids, what their approach is, or if they can recommend anyone in this area.

If you live, or have access to, the upper areas of Sydney, I am happy to provide recommendations directly. Just ask!