Behavior Development Solutions

Ask Cipani!

Elopement in School Setting: Mom says, "Don’t Restrain!"

Part 1

A behavior that I have struggled with lately is elopement. I work in a public-school district and several of our buildings are open-concept (meaning there are no doors and the rooms are divided with partitions only). One student in particular would run out of her classroom and run down the hallways. She ran into other classrooms and storage areas (none of these have doors). She would hide and if anyone chased her she would laugh and continue to run. If staff was within eye-sight but not chasing, she would up the ante to climbing walls and partitions to the ceiling or running out of the building into the parking lot. The building is two circles so it is nearly impossible to keep eyes on her unless she is being followed. The principal decided to sit in the doorway one day and she climbed out the window.

Child Eloping

There were several antecedents to the behavior including: being assigned work, being denied a preferred activity and conflicts with a peer. Consequences included being chased, being restrained, in-school suspension, out-of-school suspension, extended time in a 1:1 environment with a paraprofessional (excluded from classroom), and delaying/avoiding tasks.

The main struggle with this particular student is that she had a traumatic background and her mom insisted that her behavior is motivated by “fight or flight” and that any physical touch or seclusion could re-traumatize her. On the flip side the behavior was dangerous when the student is running unsupervised around the building. The mother threatened legal action if anyone was to put their hands on her child. We can restrain her if she is causing imminent danger to herself or others (going outside of the school-yard area would be imminent danger for a first grader). However, her mother is very against the restraining her and has made a police report against the school for restraining. Staff are very reluctant to restrain due to this. She was supposed to start attending an agency for her schooling where she would work 1:1 with a metal health specialist and eventually transition back to the school setting. The mental health worker quit after 2 days and the mental health clinic kicked her out after 6 days because she was too unsafe by eloping from their setting towards a very busy street.

The average rate of running is 1.35 times per day. However, the percentage on this one is not that beneficial because there are many days that she does not run at all. 13 of the last 20 days that she was in school she did not run. On the other 7 days she ran 4 or more times during that day. Usually if she is going to elope she does so before 10:30 and usually continues to do so several times throughout the day. If she is able to get into her routine successfully and does not elope before 10:30 she usually does not elope for the rest of the day.

She is a first-grade student. Her functioning level is a little difficult to quantify. For her initial eligibility report, the school testing found her below grade level in all areas. However, I have watched her with her mom and she is able to read above grade level and complete math very close to grade level. Her writing is definitely below grade level.

Any guidance on this would be appreciated! Please let me know if any additional information would be required for this scenario to be selected.


Part 2
Ennio’s Initial Response

Dear K.K.

Thank you for submitting such an interesting case, which is fraught with problems from program design issues to logistical and legal issues. Elopement by children/students/clients poses a severe management problem, in both school and home settings. Before I address the possible function of this particular case of elopement, it is necessary to direct the dialogue to the risk management (legal) issue in this case. Due to the nature of the individual’s age, an act of elopement jeopardizes the individual’s welfare. In your case presentation, you have pointed out that the child’s parent has encumbered your attempts to restrict and restrain the child unless she walks out of the school area. As you have delineated, this limitation on the school’s staff impedes your ability to keep the child safe. It should be plainly obvious that containing her before she gets close to the street is more proactive and responsible. Hence, I believe that any court (fair hearing) would see such proactive measures as serving the best interests of the child (if it comes to that). In fact, the child’s prior placement in a mental health agency was terminated because of the dangerous nature of such acts.

I have been involved in similar types of circumstances where an action I deem necessary from a clinical and/or safety standpoint is rejected by some party (parent, school personnel, etc.). When I am impeded in my program design by unwarranted and ill-advised restrictions, I go “on the written record.” In some written client permanent records (behavioral assessment, IEP, etc.), I indicate what my program design/plan would have been and why it is necessary. I then write what I believe will be the threat to safety or client welfare if my plan is denied. For example, “if we are not allowed to physically intervene prior to the child’s reaching the street curb, we assert that such a limitation jeopardizes her welfare. We are being handicapped in keeping her safe by not being allowed to intervene way before she is in proximity to the street. It is against our strong objection that some members of the team reject our appeal, and we deem that they have placed the child’s welfare in jeopardy1.”

Let me now address the “elephant in the room.” The contention that she will be re-traumatized if anyone restrains her seems preposterous and mis-guided. Question: when you did physically restrain her on the several occasions you alluded to, did she suffer an emotional breakdown subsequently? If the answer is “Yes, she had to be hospitalized,” I withdraw my reservation. If not, such “real life” evidence that a traumatic event does not occur when she is held should be conveyed to everyone.

I realize that the mother is acting in her daughter’s best interests as she views it at this point. Unfortunately she is being mis-directed and mis-informed by someone that any physical contact with another person (male/female) will “bring up” traumatic emotions and thoughts2. Further, such a process (if it actually occurred), is dangerous and should be avoided at all costs. Such unproven contentions and deleterious myths are rampant in mental health. The evidence from clinical research demonstrates that one of the most effective therapies for PTSD3 is exposure and response prevention. This therapy approach provides repeated exposure to the “fear-provoking” stimulus.

Let me now address each of your proposed antecedents, and their potential for serving as establishing operations (EOs) for elopement.

Hypothesis #1: Is it escape from tasks? 

You mentioned that one antecedent is when she is assigned a task/work. I would presume that you are suggesting the possibility of an escape function for elopement, i.e., that the act of elopement functions as escape from an assigned task(s). An escape function exists when an aversive establishing operation (aversive EO) is presented, and a behavior produces the termination of that EO. Many escape functions involve problem behaviors that abolish the aversive EO through the actions of staff, teachers etc. These are termed socially mediated escape functions. Let us assume for the moment that presentation of tasks/instruction serves as an aversive EO for elopement. In this case, the behavior of leaving the area, upon the presentation of an aversive task, produces escape in a different fashion: it directly terminates the EO (without any social mediation needed). Hence, the act of elopement immediately and directly terminates the aversive EO. Therefore, if escape from tasks is a correct diagnosing of the function, the antecedent condition of the task creates an aversive EO. The elopement behavior is immediately effective in the termination of the task for the period of time the elopement occurs. Hence, one must conclude that assignments of some sort constitute aversive EOs.

Particularly when working with students who are not severely intellectually disabled, it is often necessary to determine why instruction is aversive to the particular student. When examining the reason why an instructional demand, assignment, or task(s) acquires aversive properties, one needs to determine which of two factors is at play. In the Cipani Behavioral Classification System (Cipani BCS), I have two classification categories that represent two different escape functions: Difficult tasks and/or lengthy tasks. Let us examine if either of these creates the aversive element for the instructional program.

I do not feel that task difficulty constitutes an aversive EO for this child. If this were the case, the evidence would be very clear that tasks not involving writing (e.g., math work, reading) would result in no elopement. In contrast, elopement would be far more common for tasks involving writing. I am not inclined to view this escape function as plausible in this case. It would seem that writing tasks would occur daily. Therefore, the behavior that terminates such would be more frequent. Your information on the rate of elopement is not congruent with this supposition.

The instructional stimulus condition can still be creating an EO for problem behavior, but not because of difficult material. The factor at play in the escape function is the length of the instructional period. This is often the case when a student’s performance does not differentially affect the termination of the task. Finishing one’s work before the end of the designated instructional period just results in getting more work. Do you see how such an outcome of completing (accurately) work will result in a punishment contingency (for completing one’s work)? It also creates an aversive EO for relatively lengthy tasks/assignments. I term this the “wacky contingency” (Cipani, 2017, pgs. 118-119), i.e., finish your work, you get more work!

However, I do not believe that instructional session length constitutes an EO for elopement with this student. Given that she goes many days without eloping, it does not appear that lengthy instruction creates an aversive EO (unless the length of the instruction varies across days).

Collecting evidence for task difficulty variable 

Difficult task. It seems that instructional difficulty is not the motivating variable. Nevertheless, for teaching purposes, let me delineate the following test that would reveal pertinent evidence for determining if difficulty of the task/assignment is operative. I term this functional analysis method the single EO hypothesis test (Cipani, 2017, pgs. 72-74). This test can be conducted in-vivo if the teacher is provided with the relevant instructional materials for the experimental condition. Given that there is an experimental manipulation, always obtain informed written consent before conducting this analysis. There are two conditions. The control condition consists of the current materials and tasks presented for a few designated sessions. The contrast condition, which tests whether difficulty is the variable, involves the presentation of tasks that are slightly below the student’s capability for an equal number of sessions. In academic school environments, selecting materials that are about one grade level below their norm-referenced tests should do the trick. The target problem behavior produces escape from the task in both conditions. These two conditions are alternated in a multi-element design. As you can imagine, the rates of the problem behavior would be significantly different if task difficulty creates an aversive EO.

Collecting evidence for task length variable 

Lengthy task. The same methodology described above can be used here as well. If the reason for the behavior is not difficulty, but it is the wacky contingency, then the control condition consists of the typical length of the instructional period. If the student finishes his/her work, they are given more to complete. The student must keep working until the instructional period ends. The contrast condition is a short session, possibly 50-80% of the usual duration. The student can be initially apprised of the short session (e.g., “When you finish this work sheet, you are done with this work”). Ditto on informed written consent here as well.

Hypothesis #2: Aversive EO is conflict with peers 

A second antecedent you mention is conflict with a peer. I will assume that you are suggesting that elopement functions to escape (terminate) such a circumstance. First, it would be necessary to state what the “conflict” consists of. For purposes of an example, let me arbitrarily designate the aversive EO as criticism from peers. If it is criticism, then there should be the following differential observed outcomes. When she interacts with persons who have historically criticized her (their presence can serve as an aversive EO), elopement is very probable (direct escape function). The behavior becomes particularly probable if the interaction eventually involves a direct criticism at some point in the interaction. When she interacts with peers or adults who do not criticize, the rate of such behavior is low or non-existent. That differential result would only hold up if the aversive component of social interaction were receiving criticism, or some other form of negative comments. If this were the case, then it would confirm this hypothesis.

This does not seem to be the case, given your information. If evading peer criticism were the function under an EO of receiving criticism, then she would simply leave that area (direct escape function). It would not be necessary to run out of the building, crawl over walls, etc. Further, after she is retrieved, if she contacts the same group again, elopement would occur immediately (as the aversive EO is present again). In time avoidance of that particular group would become prevalent, but not so with others who do not criticize her (i.e., aversive EO absent). Usually, for younger children, social situations that are aversive/unpleasant would also evoke crying at the point of the unpleasantry. Has she ever cried, engage in tantrums, shortly after contact with peers? Again, I would discount such a hypothesis as pertinent.

Hypothesis #3: Access to tangible items, activities? 

If elopement were maintained by access to tangible items, events, activities, one would see one of two reliable effects. In the first scenario, the elopement constitutes a socially maintained access function to tangible reinforcers (SMA 2.3 in my category system). An act of elopement would subsequently result in someone giving her something. In other words, the following would be in effect: “When I am told I cannot have something, I run away, they retrieve me, and then someone gives me “cake.” You mentioned that being told she cannot have something is an antecedent to elopement. Is it common that subsequent to elopement, she is given the item or activity she requested? If so, elopement would be functional under that particular EO.

How would you experimentally test for such a putative function? If the client elopes in order to get an item after being denied such, the test would involve a straightforward in-vivo manipulation. On select “test” days, instead of denying their request, give the item to her (i.e., honor the request). On other days, the current environmental arrangements would be in place. When requesting produces speedy and efficient access to the desired item, elopement should be minimal to non-existent. When requesting is highly ineffective, then elopement becomes the most efficient manner of obtaining the item. Ditto on informed written consent here as well.

For argument’s sake, let us say that no one gives her any item or activity subsequent to an act of elopement, e.g., “Okay, you can now play on the swings.” What is left? What does happen every act of elopement is the following. First, elopement immediately results in going outside the classroom and running around. Such a stimulus change in and of itself can be the maintaining reinforcer. In addition, elopement creates a threat to her safety, whereby staff will have to “chase” her. Consequently, such staff action possibly provides an activity that is of significant value at that particular point in time (e.g., Playing Catch me). While elopement may have inherent reinforcing properties in the act itself (getting to be outside), it is possible that staff chasing after her have added value to such an act.

How does one explain the rate of elopement to be multiple times in a given day and then zero occurrences on many other days? It may be that going for several days without access to such an activity is not sufficient to induce an EO4 . But once she has a “taste” of it, she wants more of it, on that same day. For example, you may not want to play video games for several days. However, once you start playing, you play for multiple hours in a day. This could then be followed by several days showing a lack of interest.

If it is socially mediated access (SMA 2.3) to the Catch me activity, what can be done? I will address my specific recommendations in the next newsletter! Stay tuned.

Ennio Cipani, Ph.D.

1 Given that you work for a school district, I would first consult with school legal counsel. However, if you feel strongly, no one can prevent you from stating your clinical opinion, but it might be wise to seek outside consultation also
2 based in psychodynamic theory
3 this is not my area of expertise, so I am only citing reports I have read of such studies
4 It is also unknown how often access to this type of activity, eloping, occurs in the home environment. Varying amount of access in the home certainly would affect the state of deprivation present at any given school day.

Stay tuned  for Dr. Cipani's recommendations and for the next case! Here is a sneak peak of the upcoming case:

From BCBA S.D.
I am involved with a very challenging low cognitive student, who likes to spend inordinate amounts of time in the bathroom. I used a simple procedure with a behavioral momentum and a timer to get him out, so that seems to be working, but he is many other self-stim type behaviors, like picking skin, including his genitals, spitting continually, etc. One that is particularly disruptive lately is peeing through his pants, where he is. The data shows no pattern yet, at least to me, in regards to time of day, particular demands, and other antecedent conditions. He will change himself in neutral manner, in terms of his mood. But we cannot keep changing him 3-5 times a day. We recommended a full medical check up, as he has already done a UTI which came up fine. Any other ideas? A shower has been proposed as an aversive and natural consequence, but this will be too complicated at school. I am looking into edible rewards, as nothing else appears reinforcing.

About: Ask Cipani! is a periodic column that addresses a submitted case presentation from a BCBA who wants some suggestions/advice on identifying the function of a particular challenging behavior(s). Dr. Ennio Cipani's response addresses the presenting case in terms of possible motivative conditions (EO) and subsequent environmental functions to consider, and possible tests/validation strategies to conduct to verify the putative function. The advice provided in the Ask Cipani! column is provided with the caveat that its use is considered carefully by a certified or licensed behavior analyst. Since Dr. Cipani is only aware of the information presented to him, each reader must make a determination of whether such advice fits any particular case. It also is incumbent on any reader to determine if additional consultation should be sought for either program design and/or logistical implementation.

Ennio Cipani, Ph.D., is the author of the popular text, Functional Behavioral Assessment, Diagnosis and Treatment (2018, 3rd edition), which features a unique function-based classification system, the Cipani Behavioral Classification System or Cipani BCS. He co-authored a diagnostic manual for school settings on the Cipani BCS with his daughter, Alessandra Cipani, titled, Behavioral Classification System for Problem Behaviors in Schools. He also authored an e-book called "A Clinical Treatment Guide to 10 Common Behavioral Pediatric Problems" which can be downloaded for free here. Dr. Cipani partnered with BDS to bring you a companion CE course for his free e-book called, "10 Common Pediatric Problems & Solutions," available here.

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