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BMOXXX10.1177/0145445517740871Behavior ModificationBoyle et al.

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Behavior Modification
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Treatment of Elopement © The Author(s) 2017
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DOI: 10.1177/0145445517740871
https://doi.org/10.1177/0145445517740871
Child With Autism journals.sagepub.com/home/bmo

Megan A. Boyle1, Ginny Keenan1,

Kara L. Forck1, and Kaitlin S. Curtis1

Abstract
Elopement is a dangerous behavior common in children with autism
spectrum disorder (ASD). Relative to other forms of problematic behavior,
elopement has received little attention in both assessment and treatment.
The current study entailed a functional analysis of elopement of one child
with ASD, results of which suggested a partially automatic function. We then
evaluated a differential reinforcement procedure, along with a rule, which
successfully decreased elopement without the use of blocking. A changing-
criterion design embedded within a withdrawal design was used to gradually
increase the criterion for maintaining a close proximity to a therapist prior
to being allowed to run.

Keywords
changing criterion, elopement, rules

Elopement is defined as leaving a specified area without permission and is

common among individuals with autism spectrum disorders (ASDs; Anderson
et al., 2012; Kiely, Migdal, Vettam, & Adesman, 2016). Elopement is particu-
larly dangerous given that the outcome of the behavior involves the individ-
ual becoming out of reach of a caregiver, which may then result in the

1Missouri State University, Springfield, USA

Corresponding Author:
Megan A. Boyle, Missouri State University, 901 S. National Ave., Springfield, MO 65897, USA.
Email: MeganBoyle@MissouriState.edu
2 Behavior Modification 00(0)

individual becoming missing, experiencing traffic injuries, or drowning

(Anderson et al., 2012).
As with other forms of problematic behavior, it is considered best practice
in the field of applied behavior analysis to conduct a functional behavior
assessment (FBA), including a functional analysis (FA), to identify the func-
tion of elopement prior to developing a function-based intervention (Hanley,
2012; Hanley, Iwata, & McCord, 2003; Mace, 1994). However, the FA of
elopement is complicated by the fact that many operational definitions and
measurement systems require that the opportunity to elope be reset following
each response. For example, a study may define elopement as “exceeding a
given distance from a therapist” and convert responses into a “rate” measure
and interpret higher rates of behavior in a test condition relative to control as
indicative of behavioral function. Once elopement occurs, the individual
could theoretically remain away from the therapist for the entire session (if
not retrieved by a therapist), and yet data would reflect only one instance of
elopement. Accordingly, many studies implement “retrieval procedures” to
return subjects to a given area or therapist following elopement (e.g., Kodak,
Grow, & Northup, 2004; Lang et al., 2010; Tarbox, Wallace, & Williams,
2003). For example, Call, Pabico, Findley, and Valentino (2011) conducted
an FA and treatment evaluation with a child with ASD and used frequency
recording to score elopement, defined as “passing the plane of the doorway
of the session room” (p. 903). During the FA, a retrieval procedure was
implemented in which the subject was physically guided back to the location
from which he eloped 20 s following the response.
Although necessary for allowing elopement to occur multiple times in a
session, returning an individual to a given area following each response intro-
duces attention as a potential confound to whichever test condition is currently
in place. In other words, if an individual elopes during an escape condition
(which results in a break from demands) but a retrieval procedure is in place,
attention in the form of the retrieval is delivered in addition to escape. A pro-
cedure that may mitigate the potential confounding effects of retrieval proce-
dures but still allow for the resetting of the opportunity to elope is the delivery
of fixed-time (FT; i.e., response independent) prompts to the individual to
remain in a certain area (e.g., Perrin, Perrin, Hill, & DiNovi, 2008; Piazza
et al., 1997). For example, Piazza et al. (1997) delivered FT prompts to sub-
jects during FA test conditions that involved the therapist guiding a subject to
a given chair or prompting the subject to remain next to the therapist. This
procedure not only shares the advantage of retrieval procedures in ensuring
multiple opportunities to elope but also ensures that the delivery of attention
across conditions remains constant (whether or not elopement occurs). This
may be an additional advantage over retrieval procedures, because attention in
Boyle et al. 3

nonattention conditions is delivered contingent on time, not elopement, which

may decrease the likelihood that increased rates of elopement in nonattention
conditions are partially a result of attention delivered during retrieval.
Treatment of elopement is also particularly challenging, given the safety
concerns that result if elopement does occur. A review of recently published
treatments for elopement (Boyle & Adamson, 2017) found that functional
communication training (FCT), teaching a functionally equivalent communi-
cative response, was the most commonly used intervention, regardless of
function. For example, Stevenson, Ghezzi, and Valenton (2016) first con-
ducted an FA with a child with autism and found that elopement was main-
tained by access to tangibles. Treatment consisted of teaching the child to
emit a functionally equivalent vocal communicative response that specified a
preferred item or activity. Furthermore, of the studies that implemented FCT,
Boyle and Adamson (2017) found that the majority combined FCT with
response blocking or physically preventing the response from occurring
(Lang et al., 2010; Lehardy, Lerman, Evans, O’Connor, & LeSage, 2013;
Piazza et al., 1997; Stevenson et al., 2016; Tarbox et al., 2003). For example,
in addition to FCT, Stevenson et al. (2016) interrupted the child’s elopement
(physically stopped him) and prompted the communication response.
Blocking elopement during treatment may ensure the safety of subjects, but
caregivers or teachers may be unable to implement blocking with fidelity. For
example, a caregiver may be physically unable to chase his or her child, or a
teacher may be unable to leave other students unattended to pursue the child
who eloped. Difficulties related to blocking are especially problematic for
interventions that are only effective when response blocking is part of the
intervention. In fact, Call et al. (2011) treated elopement of a child with ASD
and found that blocking was necessary to decrease elopement when using a
differential reinforcement of other behavior (DRO) procedure; DRO without
blocking did not decrease elopement. Therefore, further research is needed
on treatments for elopement that do not include blocking.
One class of interventions that has received relatively little attention from
researchers but may be useful in cases in which the delivery of consequences
during treatment is difficult includes the use of rules to evoke or abate behav-
ior (Skinner, 1984). Rules either specify or imply the relation between behav-
ior and a consequence and are important because they allow behavior to be
controlled without an individual actually contacting contingencies or conse-
quences associated with a given response. Behavior evoked by rules is termed
rule-governed behavior (Skinner, 1984). For example, a caregiver might say
to her child, “Brush your teeth so that you don’t get a cavity,” which evokes
teeth brushing without the child needing to experience the aversive stimula-
tion associated with cavities.
4 Behavior Modification 00(0)

Rules and rule-governed behavior have been studied in their own right
with children with ASD (e.g., Tarbox, Zuckerman, Bishop, Olive, & O’Hora,
2011) and have also been incorporated into treatments for problem behavior
(Brusa & Richman, 2008). For example, Brusa and Richman (2008) used
rules in combination with discriminative stimuli and response blocking to
develop stimulus control of stereotypy in the form of string playing with a
child with ASD. The authors provided statements to the child regarding when
stereotypy would versus would not be blocked—in the presence of a red card,
stereotypy was blocked, while in the presence of a green card, stereotypy was
not blocked. However, rules were combined with consequences for behavior
(response blocking), and thus, the role of rules in the differentiation of behav-
ior is unclear.
Given the paucity of research on the assessment and treatment of elope-
ment, we conducted an FA on the elopement of a child with ASD and evalu-
ated a treatment that did not include blocking. To decrease the likelihood of
attention as a confound during retrieval procedures, we used FT prompts dur-
ing the FA as a method of resetting the opportunity to elope. We evaluated the
effectiveness of an intervention that consisted of a rule that specified an
incompatible response. The intervention was therefore a variant of differen-
tial reinforcement of incompatible behavior (DRI), in that access to rein-
forcement (stimuli produced by engaging in elopement) was contingent on
remaining next to the therapist, which is behavior that is incompatible with
elopement. Finally, using a changing-criterion design, we thinned the sched-
ule of reinforcement by gradually increasing the amount of time during which
Abby needed to engage in the incompatible response before accessing rein-
forcement. Results of this study contribute to the literature on the FA of
elopement (specifically by using FT prompts), the use of rules in the treat-
ment of problem behavior, and treatments for elopement that do not include
blocking.

Method
Subject and Setting
Abby was a 6-year-old girl diagnosed with ASD. She engaged in multiple
forms of problem behavior (aggression, property destruction, negative vocal-
izations, and elopement), but only elopement was targeted in the current
study. We hypothesized that the other forms of behavior comprised a separate
response class and thus targeted them in a separate intervention. Abby had
sophisticated vocal mand, tact, and echoic repertoires, although she struggled
with intraverbals. She was also able to follow two-step instructions but often
Boyle et al. 5

failed to do so (i.e., noncompliance). She engaged in high rates of mands and

had difficulty waiting when mands were denied (e.g., she continued to emit
mands or engaged in problem behavior).
All sessions were conducted in a University office building in a large hall-
way, as Abby’s mother indicated that she frequently eloped in such narrow
settings (e.g., aisles in supermarkets and bookstores). Even though elopement
was not blocked during the study, safety measures were in place such that
Abby was never permitted to completely leave the experimental setting with-
out permission: Therapists stood in the entryways to the hallway, and doors
within the hallway were locked during assessment and treatment sessions.

Response Definitions and Measurement

Elopement was defined as Abby exceeding a distance of 1 m from the thera-
pist without the therapist giving her permission to do so. During the FA,
elopement was converted into a rate measure (responses per minute). During
treatment, elopement was reported as the latency following the initiation of a
trial. Requests were also recorded as a secondary dependent variable during
the FA. Requests were defined as Abby vocally asking the therapist to chase
her and included any variation that indicated behavior on the part of the thera-
pist to go near her (e.g., “Follow me!” “Chase me!” “Come here”).

Interobserver Agreement (IOA)

A second observer independently scored elopement during 33% of all ses-
sions/trials (12% of FA sessions, 40% of treatment trials). Data were com-
pared between the primary and secondary observers to assess reliability. For
FA sessions, total-frequency IOA was calculated by dividing the smaller fre-
quency by the larger and multiplying the quotient by 100 to yield a percent-
age. For treatment trials, IOA was calculated on latency measures by dividing
the smaller latency by the larger and multiplying the quotient by 100 to yield
a percentage. Mean IOA for treatment trials (40% of trials) was 95.9% (range:
61%-100%). For FA sessions, IOA was 100%.

Procedures
Indirect assessment.  The Functional Analysis Screening Tool (FAST; Iwata &
DeLeon, 1996) was conducted prior to the FA with Abby’s mother to identify
potential antecedents and consequences for Abby’s elopement. Results from
the FAST suggested multiple forms of reinforcement, including automatic
(sensory stimulation), social positive (attention), and escape from tasks.
6 Behavior Modification 00(0)

FA.  The FA was conducted with methods similar to those used by Piazza
et al. (1997). Sessions lasted 5 min and were conducted in a multi-element
arrangement. All sessions began with the therapist within 1 m of Abby and
the therapist stating, “Stay by me.” An FT–30 s prompt was delivered
throughout all sessions in the form of the therapist standing next to (within
1 m) Abby while again stating, “Stay by me.” Sessions were thus divided
into ten 30-s intervals. If Abby was not within 1 m of the therapist at the
time of the scheduled prompt, the therapist discreetly moved to within 1 m
of her before again delivering the prompt. Retrieval procedures were not
necessary to reset the opportunity to elope because FT prompts were deliv-
ered throughout sessions. Only materials specified in each condition were
available (i.e., Abby was not allowed to engage with other materials during
elopement intervals). Four conditions were evaluated: demand, attention,
ignore, and play.
The demand condition consisted of the therapist instructing Abby to place
pencils into a box using three-step (vocal, model, full physical) prompting;
this task was chosen because Abby’s mother reported Abby engaging in
elopement during tasks that involved “cleaning up.” If Abby complied, the
therapist delivered neutral praise and issued a new instruction. If Abby eloped
during any part of the session, she received a break (the therapist ceased issu-
ing the demands and remained in the area in which the demands had been
occurring) until the next scheduled FT–30 s prompt, after which the therapist
moved the materials to Abby and resumed instructions. Attention was not
provided during the break.
The attention condition consisted of Abby receiving access to moderately
preferred items from a multiple stimulus without replacement (MSWO;
DeLeon & Iwata, 1996) preference assessment conducted prior to the study.
The session began with the therapist stating “I need to do some work, stay by
me” while the therapist diverted her attention to a book. If Abby eloped dur-
ing any part of the session, the therapist delivered attention by chasing after
her (this form of attention was chosen because Abby’s mother reported fre-
quently having to chase her when she eloped) until the next scheduled FT–30
s prompt, after which the therapist again diverted her attention.
The play (i.e., control) condition consisted of Abby receiving access to
highly preferred items from the MSWO. Abby received continuous attention
and no consequences were provided contingent on elopement.
An ignore condition was conducted as results from the FAST indicated
a potential sensory function in the form of positive reinforcement. No
items were present in this condition, and no consequences were delivered
for elopement. An FT–30 s prompt continued to be delivered by the
therapist.
Boyle et al. 7

Following the multi-element arrangement and six extended ignore ses-

sions, six additional ignore sessions were conducted with an FT–45 s prompt
schedule. The schedule of prompts was thinned from 30 to 45 s as we observed
Abby looking and laughing at the therapist when the 30-s prompt was deliv-
ered. In other words, it was possible that Abby’s elopement was adventitiously
reinforced by the prompt delivered by the therapist (i.e., maintained by atten-
tion). Therefore, we attempted to decrease that likelihood by delivering
prompts less frequently. If elopement decreased dramatically during these ses-
sions, it would have suggested that elopement was maintained by attention in
the form of therapist prompts and not automatic reinforcement.

Treatment. Prior to treatment, a baseline was established in which each

instruction from the therapist to Abby to “Stay by me” initiated a trial. Trials
lasted a maximum of 75 s. If Abby did not elope within 75 s of the therapist’s
instruction (with or without permission), a new trial was initiated by the
delivery of another instruction. If Abby eloped within 75 s of the therapist’s
instruction (with or without permission), 45 s elapsed from the time she
eloped until the initiation of the next trial. During baseline and treatment tri-
als, no consequences were delivered for elopement. The therapist did not
chase Abby and no materials were available with which to engage. The
latency to elopement was measured as the time between the therapist’s state-
ment and Abby eloping.
Next, the treatment was evaluated, which consisted of the therapist stating
rule, “Stay by me and then you can run,” at the initiation of each trial. After a
time-based criterion was met, the therapist then stated, “Okay, you can run.”
The therapist did not make any additional statements or use visual aids (e.g.,
timers) during the waiting interval. The initial criterion was twice the mean
of latencies to elope during baseline trials. Subsequent criteria were calcu-
lated by multiplying the previously mastered criterion by 1.5. If Abby eloped
prior to the therapist stating that it was okay to run, she was not prevented
from doing so; she was able to elope at any point during the trial. Blocking
was not utilized because Abby’s mother indicated she wanted a treatment that
did not rely on being able to block Abby. Two generalization probes were
conducted at the end of treatment in different settings (an atrium and a land-
ing in a stairway).

Experimental design.  The effects of treatment were evaluated within a reversal

design (ABAB) with an embedded changing-criterion design (Kazdin, 1982).
Experimental control was demonstrated by a return to baseline latencies and
recovery of treatment effects in their respective replications in the ABAB
arrangement. Experimental control was further demonstrated in the
8 Behavior Modification 00(0)

Figure 1.  Results of the FA of elopement.

Note. Rate of elopement is on the top panel and rate of requests is on the bottom.
FT = fixed-time.

changing-criterion arrangement when latencies to elopement corresponded to

the time-based criteria.

Results
The results of the FA are shown in Figure 1. Elopement is shown in the top
panel and requests are shown on the bottom. Abby eloped during all condi-
tions of the FA except for play, and she continued to elope across 12 consecu-
tive ignore sessions, which suggested that her behavior was sensitive to
multiple contingencies, possibly including automatic reinforcement. In addi-
tion, requests occurred frequently during the attention condition but were
infrequent in the remaining conditions, including ignore.
The results of treatment are shown in Figure 2. Dotted horizontal lines
denote criteria for staying next to the therapist prior to the therapist’s state-
ment that it was okay for Abby to run. The dashed horizontal line denotes
when Abby did not run on a given trial despite being told by therapist that she
could do so, which occurred on one trial (Trial 46). During baseline, the mean
latency to elopement was approximately 4 s. During the first treatment phase,
Boyle et al. 9

Figure 2.  Treatment evaluation for elopement.

two criteria were evaluated, and Abby did not engage in elopement prior to
either criterion (8 and 12 s). Latencies to elopement during the second base-
line phase returned to those in the initial baseline condition. During the sec-
ond phase of treatment, six criteria were evaluated: 18, 27, 34, 40.5, 43, and
54 s. When the 40.5-s criterion was evaluated (Trial 38), Abby eloped prior to
the therapist stating it was okay for her to run on the seventh and eighth trials.
Therefore, the previously mastered criterion (27 s) was replicated, followed
by a smaller increase to 34 s. At the 34-s criterion (Trial 54), three trials
occurred during which Abby eloped prior to the therapist’s statement (58-60),
but she waited for the statement from the therapist in the last five trials. A
terminal criterion of 54 s was achieved before the semester ended and Abby
no longer attended sessions. Two generalization probes were conducted in
the atrium of the building and on a stairway landing, as we had observed
Abby elope from those areas earlier in the semester; she waited for the crite-
rion to elapse in both cases.

Discussion
This study entailed an FA of elopement and successfully decreased elope-
ment through the use of a rule and without the need for blocking. Elopement
during the FA occurred in all test conditions, including ignore, suggesting
that elopement was maintained by multiple contingencies (escape and atten-
tion), perhaps including automatic reinforcement. Requests during the FA
(although never reinforced) were differentiated, occurring most frequently in
the attention condition and decreasing to 0 in extended ignore sessions. As
the therapist’s attention was only delivered as a consequence for elopement
10 Behavior Modification 00(0)

in the attention condition, this suggests that requests may have comprised the
same response class as elopement. Because Abby continued to elope in the
ignore condition and did not emit requests, it is likely that elopement was
partially maintained by automatic reinforcement, although it could also be
the case that requests simply extinguished.
Notwithstanding, there remain three possibilities regarding the function of
Abby’s elopement, that it was maintained: (a) solely by automatic reinforce-
ment (continued elevated levels in extended ignore sessions), (b) solely by
social consequences (elevated levels in attention and escape; elevated levels in
ignore due to an establishing operation for attention), or (c) by a combination
of social and automatic contingencies. The extent to which individual contin-
gencies contributed to elopement is unclear, although elopement maintained
by multiple contingencies is not unusual. For example, Neidert, Iwata,
Dempsey, and Thomason-Sassi (2013) reported similar outcomes with latency
measures in FAs of elopement with two subjects. Both subjects engaged in
elopement in all test conditions (attention, escape, ignore) in a multi-element
arrangement and continued to engage in elopement in all test conditions when
the conditions were assessed in pairwise or extended-session arrangements.
Although not unusual for behavior to be maintained by multiple contin-
gencies (e.g., Neidert et al., 2013), results of Abby’s FA are somewhat unique
in the elopement literature in that they suggested (at least partially) an auto-
matic function. In a recent review of published literature on elopement, Boyle
and Adamson (2017) found that elopement was only maintained by auto-
matic reinforcement in one study (Neidert et al., 2013), and an intervention
was not evaluated. Another unique and potentially related case involving
automatic reinforcement was reported by Falcomata, Roane, Feeney, and
Stephenson (2010), who treated elopement maintained by access to stereo-
typy (which was automatically maintained) of a child with ASD. Falcomata
et al. implemented FCT without blocking, followed by delay fading that
entailed restricting access to the communication card for longer and longer
periods of time. However, the elopement in Falcomata et al. may be concep-
tualized as having been maintained by access to an activity and engaging in
the activity was maintained by automatic reinforcement. In any case, given
the difficulties in treating problem behavior maintained by automatic rein-
forcement (Rapp, 2008), it is clear that more research is necessary on treating
elopement maintained by automatic reinforcement.
Although we did not conduct extended sessions of test conditions other
than ignore, the treatment we implemented was successful at decreasing
elopement, at least with the criteria we were able to evaluate. Abby was
unable to attend further sessions following the end of the semester during
which this study took place, but it is possible that had we continued to
Boyle et al. 11

lengthen the criteria associated with her staying by the therapist we would
have needed to deliver social interactions (as a functional reinforcer) or pre-
ferred items (to compete with automatically maintained elopement) during
the “staying” interval to abate her elopement. If elopement was indeed sensi-
tive to multiple sources of reinforcement (e.g., attention), the other functional
reinforcers may have needed to be incorporated during schedule thinning. A
potential limitation of the current study may be that the treatment did not
address all maintaining sources of reinforcement; indeed, our intervention
consisted of teaching Abby to tolerate delays only to reinforcers produced by
eloping (i.e., addressed the automatic reinforcement function only).
Another potential limitation of the current study is that sessions were
always conducted in a place where Abby was eventually told she could run.
This situation is obviously not always the case in nonresearch settings (e.g.,
leaving a grocery store parking lot). Future researchers may lengthen the cri-
terion for compliance by several minutes or hours, perhaps through the use of
a token economy. For example, a child may earn tokens throughout the day
by staying near a caregiver, and contingent on a number of tokens and/or a
specific time of day, the child may exchange her tokens for a period of run-
ning around a safe area (e.g., an enclosed park). Relatedly, although we con-
ducted generalization probes, it is unknown whether the improvements in
elopement generalized to nontreatment settings or across time. Such clinical
questions warrant future investigation.
An area for future research may be to identify the prerequisite skills a
child should have mastered prior to attempting to utilize rules in the treatment
of problem behavior. Although we noted Abby’s skills regarding the basic
verbal operants (mands, tacts, intraverbals), we did not conduct a formal lan-
guage assessment. Future researchers may wish to first administer a behav-
iorally based language assessment (e.g., the Verbal Behavior Milestones
Assessment and Placement Program; Sundberg, 2008) with individuals prior
to evaluating the effects of rules, to determine whether certain prerequisite
skills are necessary for rules to be effective components of interventions.

Ethical Approval
All procedures performed were in accordance with the ethical standards of the institu-
tional research committee and with the 1964 Helsinki declaration and its later amend-
ments or comparable ethical standards. Informed consent was obtained from all
individual participants included in the study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
12 Behavior Modification 00(0)

Funding
The author(s) received no financial support for the research, authorship, and/or publi-
cation of this article.

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Author Biographies
Megan A. Boyle is an assistant professor in the Department of Counseling, Leadership
and Special Education at Missouri State University and is a doctoral-level board certi-
fied and licensed behavior analyst. Her research interests include refining functional
analysis methods and increasing the effectiveness of reinforcement-based procedures,
including token economies and functional communication training.
Ginny Keenan is a graduate student in the Master’s Program in Special Education at
Missouri State University. Her interests include incorporating behavior analytic pro-
cedures into classroom settings.
Kara L. Forck is a graduate student in the Master’s Program in Special Education at
Missouri State University. Her interests involve investigating contemporary
14 Behavior Modification 00(0)

functional analysis methodology, including trial-based and synthesized-contingency

formats.
Kaitlin S. Curtis is a graduate student in the Master’s Program in Special Education
at Missouri State University. Her interests involve investigating methods of schedule
thinning during functional-communicating training, including response chaining and
delay tolerance.