Wandering Among Preschool Children with and without Autism Spectrum Disorder: Occurrence and Association with Injuries

Background: Research suggests that children with autism spectrum disorder (ASD) may wander from safe environments, which places them at increased risk of sustaining injuries. Wandering is moving about from place to place with or without a fixed plan. Wandering is most often studied in samples of children 48 months and older since it is common among toddlers learning to explore their environment and assert independence.

Objectives: The objectives of this study were to:

1. Compare the occurrence of wandering among children 48 months and older in three study groups: ASD, other (non-ASD) developmental delay (DD), and population comparison (POP); and
2. Assess the association between wandering and injuries in each of the three study groups.

Methods: Participants were children 48 months and older enrolled in the Study to Explore Early Development Phase-1 (SEED1). SEED1 is a multisite, community-based study of preschool children designed to investigate the development and risk factors of ASD. The Social Communication Questionnaire (SCQ) assessed symptoms of ASD for all children upon study enrollment. Those with an SCQ score of 11 or higher or a previous diagnosis of ASD received a comprehensive evaluation that consisted of the Mullen Scales of Early Learning (MSEL) and Autism Diagnostic Observation Schedule (ADOS). Parents were interviewed with the Autism Diagnostic Interview – Revised (ADI-R). Results of the ADOS and ADI-R determined ASD status. All other children received a limited developmental evaluation that consisted of only the MSEL.

We examined two injury outcomes. For all children, parents responded during a telephone interview whether their child ever had an injury that required medical attention (yes/no). Parents also completed the Child Behavior Checklist (CBCL), which included items on the frequency of their child getting hurt or being accident-prone (never or sometimes/often) and the frequency of wandering (never/sometimes or often). Attention deficit/hyperactivity (ADHD) problems (yes/no) also was determined from the CBCL; intellectual disability (ID, yes/no) was determined from the MSEL. Associations were assessed for each study group between wandering and being hurt/accident-prone and sustaining an injury that required medical attention. Regression models included ADHD risk, child sex, ID, and maternal education as potential confounders.

Results: The analytic sample included 2,215 children: 610 ASD, 842 DD, and 763 POP. There were significant differences in parental report of wandering based on study classification (χ²=354.82, p<.001): 57.9% of children with ASD wandered compared to 25.1% of children with other DDs and 12.1% of POP group children. Children reported to wander were more likely than those reported not to wander to get hurt or be accident-prone (ASD odds ratio (OR)=1.55 (1.01,2.25); DD OR=2.51 (1.71,3.68); POP OR=2.52 (1.51,4.22). However, wandering was not associated with injuries that required medical attention in any study group.

Conclusions: Children with ASD wander significantly more than other children do in the SEED1 sample. Parent-reported wandering was associated with getting hurt or being accident-prone but not with sustaining an injury that required medical attention. Future research could explore the antecedents and consequences of wandering in children with ASD and influence on family functioning and child health outcomes.