Research In Action

A patient's family recently shared with me how challenging it could be to take their autistic child shopping because their child would often try and dart out in the parking lot or in intersections unless holding their parent's hand. Another family reported how excited they were that their child with ADHD had learned to ride her bike independently but expressed concerns about feeling comfortable with her riding in their neighborhood without an adult. These and other similar stories remind me of the increased vigilance and concerns among families of children with neurodevelopmental differences as they travel within their communities. 

Factors Increasing Risk for Road Traffic Injury

Data on road traffic injuries among children with neurodevelopmental disabilities is limited, though we know that their risk of unintentional injury overall is significantly elevated when compared to the general population. In a study of adults on the autism spectrum, more than half reported difficulty with crossing the street independently. Autism spectrum disorders, ADHD, and other neurodevelopmental differences may be associated with some behaviors or conditions that could elevate risk of a road traffic injury, including:

• impulsivity, leading to running into busy streets, or crossing an intersection without looking for cars
• communication challenges, which may make it harder to understand safety directions
• differences in engagement and/or strong or intense interests which may distract or shift attention away from important safety observations
• elopement, or wandering, which can be more than 3 times more likely among autistic children or those with ADHD
• medical conditions that may in and of themselves impact safety awareness, such as hearing loss, vision differences, or neuromuscular conditions (e.g. cerebral palsy) 

Virtual Reality As a Teaching Tool

Researchers have evaluated the use of virtual reality (VR) technology as a training tool to teach autistic children and teens road safety skills. VR may offer an opportunity for safe practice, while maintaining a level of reality that may help to facilitate generalization in the natural environment. 

• In one study, six autistic children used a desktop VR environment for teaching street-crossing skills; participants practiced crossing the virtual street and progressed through stages with increasing difficulty, such as the number of cars traveling at faster speeds. Autistic participants demonstrated improvements in street-crossing skills in the VR environment, but only half of them showed improvement in protected street-crossing settings. 
• In another study, three participants used an immersive headset VR tool to learn how to identify whether it is safe to cross the street. After the training protocol, all 3 participants reached mastery goals for safety in both the VR and natural environment.

What Clinicians Can Offer

When discussing road safety teaching with families of autistic children or with other neurodevelopmental differences, I typically share the following tips:

• use visual supports such as images, symbols (e.g. stop sign or a thumbs up), and/or photographs to help communicate effectively and efficiently
• use social stories (short descriptions of a particular situation or event which should include information about what a child should expect in that situation) to help children learn new skills 
• consider enlisting the help of behavioral therapists to help include road safety goals as part of a behavioral plan 
• practice and role-play in safe environments to build up new skills and habits 

Other interventions, such as medications to reduce impulsivity, may be warranted in certain situations where children are at more acute risk for dangerous road safety behaviors. 

Access a road safety guide for parents, including age specific goals for safety learning, here.