Differential Reinforcement with and without Blocking as Treatments for Elopement

Background: Elopement, or leaving caregiver supervision without consent, is a problem behavior with potentially dangerous consequences for individuals with autism (Matson & Rivet, 2008). Blocking attempts to elope is a common treatment component, (Piazza et al., 1997) but it can be particularly difficult for caregivers to anticipate the behavior and quickly restrain the eloping individual. Given that blocking some individuals’ elopement may be impractical or even impossible to implement, a direct comparison of treatments that do and do not include blocking would seem worthwhile. This study evaluated the role of blocking in treating the elopement of an individual diagnosed with autism.

Objectives: The purpose of this study was to evaluate the use of blocking in the treatment of elopement by utilizing a differential reinforcement of other behavior (DRO) treatment with and without blocking.

Methods: It was hypothesized that failure to block elopement would result in degradations in treatment effectiveness. Therefore, a treatment evaluation was conducted using a reversal design to compare the occurrence of elopement during baseline and two treatment conditions consisting of a resetting differential reinforcement of other behavior (DRO) with and without blocking respectively. All sessions were conducted in two adjacent therapy rooms (referred to as Room A and Room B). Furniture blocked the hallway to prevent egress from Room A to anywhere other than Room B (or vice versa). A previous functional analysis had demonstrated that the participant eloped to gain access to preferred items. Therefore, prior to each session, the participant was provided with 2 min of access to preferred items in Room B, after which he was removed to Room A, which contained no preferred items. Elopement was defined as passing the plane of the doorway of Room A. During baseline elopement resulted in 20 s of access to the preferred items. During the DRO with blocking the therapist provided 20 s access to a preferred activity in Room B contingent upon the absence of elopement for 30 s.  Attempts to elope were blocked by the therapist who obstructed the participant’s egress from the room by stepping into the doorway and/or used their hands to gently redirect his upper body (i.e., back, shoulders, arms, etc.) in the opposite direction. The DRO without blocking was identical to the DRO with blocking condition with the exception that 20 s of access to the preferred activity in Room B was delivered contingent upon elopement as well as the DRO contingency.

Results: During treatment the participant engaged in similarly elevated rates of elopement in baseline (M= 0.97 ) and DRO without blocking condition conditions (M= 0.98). However, decreased levels of elopement were observed in the DRO with blocking condition.

Conclusions: This study extended previous findings on the treatment of elopement by demonstrating that blocking may be a critical component of treatments for elopement for at least some individuals. This finding is potentially problematic given the nature of elopement, which can make blocking difficult to implement, and suggests that caregivers may need to be vigilant to block.