Category: Research

Our UAB team has published another paper related to injuries in autistic children (see previous post: https://sites.uab.edu/cedd/2025/02/10/study-on-unintentional-injuries-in-asd). The paper, “Lessons Learned From Mothers: Parenting Perspectives for Preventing Pediatric Unintentional Injuries Related to Autism,” was led by recent UAB and LEND graduates Dr. Alecia Mercier, Dr. Brianna Paquette, and Dr. Casie Morgan, with mentorship from Dr. David Schwebel, Dr. Kristi Guest, and Dr. Sarah O’Kelley. To read the published article, click the link above.

Unintentional injuries are a leading cause of nonfatal injury and death in children in the United States, and research suggests that autistic children face an even greater risk for experiencing these injuries. Caregivers of autistic children face many unique challenges, but  preventing unintentional injuries is a significant concern. Our recent study explored the lived experiences of mothers of autistic children, shedding light on the immense responsibility they carry to ensure their children’s safety on a daily basis.

The Study at a Glance: The study involved interviews with 15 mothers of autistic children, who shared their concerns, strategies, and personal experiences related to injury prevention. The research aimed to understand how these mothers navigate the heightened injury risks associated with autism and how their safety strategies impact their own well-being.

Key Findings

Constant Supervision Appears to be the Norm. Mothers overwhelmingly reported that close supervision was their primary strategy for preventing injuries. Due to their children’s differences—such as lack of danger awareness, sensory-seeking behaviors, and difficulties with communication—many mothers felt they had no choice but to remain hypervigilant at all times.

Emotional and Physical Toll on Mothers. The study revealed that this constant need for supervision led to stress, exhaustion, and cognitive overload for mothers. Many felt overwhelmed by the responsibility of being their child’s protector, often at the expense of their own well-being. Some even described feelings of isolation, as they found it difficult to trust others to care for their child safely.

Barriers to Teaching Safety Skills. Unlike parents of typically developing children, mothers of autistic children reported limited success in teaching safety behaviors. Many found that traditional safety lessons—such as teaching a child to stop at a crosswalk—did not work effectively for their child, forcing them to rely on direct supervision and environmental control instead.

The Sustainability Challenge. While intensive supervision is effective, many mothers worried about the long-term sustainability of their safety strategies. As their children grow older, the need for independence increases, yet parents struggle to balance this with their child’s ongoing safety needs.

What Needs to Change?

The study highlights a critical need for better support systems for families with autistic children. Pediatric psychologists, pediatricians, and clinicians can work with caregivers to develop practical, multi-system interventions that balance safety with reducing family stress. Some possible solutions include:

• Adaptive safety training: Using tailored approaches, such as visual aids and social stories, to teach autistic children basic safety behaviors.
• Supervision strategies: Helping caregivers identify when and where intense supervision is necessary versus when they can allow more independence.
• Community awareness and support: Encouraging public spaces, schools, and caregivers to implement better safety measures for autistic children.
• Use of technology: GPS tracking devices and other monitoring tools can provide an extra layer of safety, supporting caregivers in protective measures for their children.

Final Thoughts

This study paints a vivid picture of the experience of families in keeping their autistic children safe. While their efforts are often effective, they may come at an emotional cost to the caregivers. Moving forward, there must be greater recognition of these challenges—and more actionable solutions—to ensure children are safe and their caregivers are supported.

We are pleased to announce the publication of our latest paper, “A Qualitative Analysis of Unintentional Injuries in Autism Spectrum Disorder.” The study was led by Dr. Casie Morgan, with contributions from trainees Alecia Mercier and Bri Stein, who are affiliated with the CEDD at UAB. The team received mentorship from Dr. David Schwebel, Dr. Kristi Guest, and Dr. Sarah O’Kelley.

Why Are Autistic Children More Prone to Injury?

Prior research has shown that children with autism are at least three times more likely to experience fatal unintentional injuries than their non-autistic peers. However, less is known about the specific reasons behind this elevated risk. This study aimed to uncover these details by examining the perspectives of 15 mothers raising autistic children, and systematically identify common themes presented throughout the interviews.

KEY FINDINGS

Autistic Children are likely to experience an unintentional injury

• 80% of mothers reported that their child experienced an injury needing care in the past six months.
• Throughout their child’s lifetime, 73% of their children had an injury requiring a doctor, dentist, or emergency room visit.

Autism Traits Contribute to Injury Risk

Mothers identified several autism-related characteristics that may increase injury vulnerability:

• Communication Difficulties: Many autistic children struggle to understand safety rules or communicate when they are hurt. This can make it harder for parents to teach injury prevention or recognize when their child is in pain.
• Lack of Danger Awareness: Some children do not recognize hazardous situations, such as traffic or sharp objects, making them more prone to accidents.
• Restricted or Repetitive Behaviors and Interests: Many children are drawn to sensory-seeking behaviors—like spinning, climbing, or running—which can result in falls or collisions. Others have fixations on things like water, which increases the risk of drowning.

Co-Occurring Conditions and Behaviors Amplify Risk

Many autistic children are also diagnosed with conditions like ADHD, intellectual disabilities, or sensory processing issues, which increases concerns for behaviors that may increase the likelihood of injury. For example:

• Elopement (Wandering): Some children tend to run away from caregivers, putting them at risk for traffic crashes or getting lost.
• Motor Coordination Challenges: Many parents described their children as clumsy or uncoordinated, leading them to worry about potential fall-related injuries.
• Hyperactivity and Impulsivity: High energy levels and difficulty with impulse control can lead to reckless behaviors, such as jumping off furniture or running without looking.

The Heavy Stress on Parents

Mothers expressed high levels of stress and anxiety related to preventing child injuries. They reported feeling constantly on high alert and struggling to balance their child’s need for independence with safety concerns. Some even described the need to modify their homes—such as installing tall fences—to keep their children safe.

What Can Be Done?

This study highlights the urgent need for tailored safety interventions for autistic children. Potential solutions include:

• Visual safety cues: Using visual aids and social stories to teach safety rules in a way that autistic children can understand.
• Specialized water safety and swim lessons: Considering many autistic children are drawn to water, formal water safety programs tailored for autistic children could help reduce drowning risk.
• Technology-based solutions: GPS trackers and electronic monitoring tools can assist parents in preventing elopement incidents.
• Motor and spatial training: Occupational or physical therapy can help children develop better body awareness and coordination, potentially reducing accidental falls.

Final Thoughts

This study underscores that injury risk in autistic children may relate to specific traits and co-occurring conditions. While most parents work very hard to keep their children safe, they need better resources and support systems to manage these challenges effectively. By developing evidence-based safety strategies, healthcare professionals, educators, and caregivers can work together to create a safer environment for autistic children and minimize the pressure parents feel to keep their children safe from injury.

To read the published article, see https://rdcu.be/d89cW