Approximately 10–15% of people with developmental disabilities engage in challenging behavior such as aggression, property destruction, self-injury, and elopement (Emerson, et al., 2001), with some studies suggesting that number increases to more than 50% in individuals with a diagnosis of autism (Mazurek, et al., 2013). Further, 74% of children with autism, or other developmental disabilities, were found to escape from their child safety restraint (Yonkerman et al., 2013). This behavior may continue as the child transitions from a child safety restraint to a seat belt. Escape from the child safety restraint or seat belt is especially dangerous for children who engage in challenging behavior as it may lead to distracted driving by the caregiver, which has been observed to increase the likelihood of becoming involved in a motor vehicle crash by as much as two times that of model driving (Dingus et al, 2016). Interventions are available that are shown to decrease the likelihood of escape from motor vehicles or vehicle restraint systems, as well as aggressive and disruptive behavior by children in the vehicle. These interventions include the antecedent procedure of adaptive car seats and restraints, which can be applied when a conventional car seat is determined to no longer be appropriate. However, it can be difficult to conduct an assessment to determine the appropriate car seat or restraint device for children who exhibit these behaviors.

Phone and video evaluations as well as in-person car seat checks were conducted with a number of families indicating escaping behavior while travelling in vehicles. CPSTs evaluated families' specific concerns and conducted informal interviews on sensory triggers and observed behaviors. Recommendations for interventions included distraction aids, use of items that trigger sensory deficits and/or reduced sensory overload, and DME and other physical interventions.

In many cases, families did not respond to follow-up messages after discussing new intervention ideas with CPSTs. Given indications of feeling overwhelmed during in-person evaluations, we suspect that suggested interventions were moderately helpful, at minimum, though we can't be certain. When available, successes and additional challenges were shared. In some cases, car seat misuse was discovered, such as improper harness tightening or improper leg buckle location. Upon correcting misuse, escaping behavior was reduced. It has been noted repeatedly that "best practice" scenarios aren't always met and occasionally families will need to make choices they feel appropriate for their families that may not align with CPST recommendations.

Taking an individualized approach to car seat evaluations with families reporting escaping behaviors can help CPSTs support families in making safer decisions while travelling. This includes taking time to get to know observed behaviors in broader scenarios and understanding how actions in the vehicles may be similar or different. Suggestions of sensory interventions and distractions that may address a child's particular hyper- or hypo-sensitives and reduce escaping behaviors. Other more restrictive interventions may be needed when distraction aids are ineffective.

1. Identify common behaviors that may create barriers to assessing a child’s safety needs while riding in a vehicle.
2. Provide recommendations and resources to help reduce the likelihood of these behaviors occurring during car seat assessment appointments.
3. Be able to identify resources, including DME products and other behavior interventions, that can help a family create a safer travel scenario.