Safety issues are more important than any other issues. When a child is placing himself in danger by ignoring automobile traffic, eating inedibles or harming himself through self-injurious behavior, immediate action is required. Self-injury is often a symptom of a painful condition. Tooth pain can produce head-banging or head-slapping as the child struggles to "make it go away." Some children are drawn to dangerous behavior because it is physically exciting to jump from heights, or to go closer to the cars that are zooming by on the street. Each situation is different. It is important to try to understand what is motivating the child to engage in the dangerous behavior. If it is known what the child is seeking, it may be possible to provide it safely, and the child’s need for the dangerous behavior disappears. Several intervention principles are noteworthy in addressing safety issues:
Every child who is at-risk of a safety problem (nonverbal, cognitively impaired, communication disorder, etc) should be identified by their parent to law enforcement and other first-responder authorities. The child should be acquainted with these people and their uniforms so that the child is less likely to flee from such persons in emergencies. Special programs like the Premise Alert program in Pennsylvania are especially helpful in getting necessary safety information to 911 systems and should be a part of every child’s treatment plan, when safety issues are involved.
Environmental modification is necessary – never trust the conscientiousness of any adult caretaker as the sole means of preventing elopement (running away) or access to dangerous objects, chemicals or places. The placement of "childproof" locks is effective only until the child figures out how to open them, which is inevitable in most cases. Alarms are necessary to detect opened doors and windows, when elopement is a concern.
Repeated practice, with various adult caretakers in a variety of settings, is a prerequisite to acquiring strong safety habits. Children who learn safety skills in the home, at school, in the daycare setting, at Grandma’s house and in different stores are much safer than children who learn "safety skills" in a special education classroom, no matter how often those skills are taught.
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