Safety
- If they are missing, check water first. Pools, ponds, ditches, the neighbour's hot tub. Drowning is what kills. Wandering and water.
- When someone starts hurting themselves, look for pain first. Teeth, ears, gut, head. Behaviour is often the only way pain gets reported. Pain first.
- Hitting or hurting you or others? When they hit, bite or break things.
- Never hold anyone face down, and never hold to punish. Prone restraint kills people. The restraint line.
- Say the word "autistic" in your first sentence to any officer or dispatcher. Police and 911.
Decide the plan while everyone is calm. Nobody decides well in the ten minutes after a door clicks shut.
Wandering and water have their own page: check water first, alarms, ID, trackers, and telling people before anything happens.
Self-injury: when they hurt themselves
Head-banging, biting or hitting themselves, scratching, hair-pulling. Frightening, and common. What follows keeps everybody in one piece without force.
Pain first, always
Before anything else, assume something hurts. A person who cannot describe a symptom reports it in the only currency they have. The American Academy of Pediatrics autism toolkit handout for families puts it plainly about gut problems. Constipation, diarrhoea, reflux, vomiting, belly pain and feeding problems "can add stress to the child and family and may cause behaviors such as aggression or self-injury".
Ask a doctor to check, by name, the things that are silent:
- Constipation. The most common and the most missed, especially with a narrow diet.
- Teeth. Abscesses and eruption pain. Head-banging on one side is worth a dental look.
- Ears. Infection and fluid.
- Reflux. Especially when the behaviour is worse lying down or after meals.
- Headache and migraine, and light or sound sensitivity that got suddenly worse.
- Sleep and seizures. New or changed behaviour that arrives out of nowhere deserves a clinical look, not a behaviour plan.
The words that get this taken seriously: This behaviour is new, or it has changed. Before we treat it as behaviour, I want the medical causes ruled out. Please check for constipation, teeth, ears and reflux.
The pattern log
Keep it for two weeks, one line each time: the time, the twenty minutes before, what happened after, how long it lasted. Note hunger, noise, heat, a changed plan, a new person. Patterns show up fast (before lunch, the supermarket, a sibling home, no sleep), and a clinician can act on them.
Protecting the head, and setting up the room
- Move the furniture, not the person. Slide the coffee table away, put a cushion between a head and a wall, and clear anything glass or hard. You are shaping the room, not pinning a body.
- Have one safe room ready before you need it. Soft floor, nothing heavy on shelves, nothing sharp, no lock. You stay in it or in the doorway. It is not a seclusion room, and the door does not shut on anyone.
- Reduce input. Lights down, the TV off, everybody else out, and your own voice down to almost nothing. Talking more usually makes it longer.
- Protect your own body. Long sleeves, hair up, glasses off, and stand to the side rather than in front. Getting bitten helps nobody.
- Ask the doctor about head protection if head-banging is causing real injury. That is a clinical decision made with them, not a purchase you make alone.
When to call the doctor, and when to call 911
Call the doctor within days if the behaviour is new, has suddenly got worse, or is causing injuries that need dressing. Call too if it is happening most days, or if you can no longer take the person out or leave them with anyone else.
Call 911 for a head injury with confusion, drowsiness or vomiting, or a wound that will not stop bleeding. Call for a suspected broken bone, a swallowed object or chemical, or when someone in the house is in danger you cannot get them out of. For a swallowed substance in the US, the Poison Help line is 1-800-222-1222, free, confidential and answered around the clock.
If you call 911 and it is about behaviour rather than injury, read the police section below first. What you say in the first sentence changes what arrives.
Some families reach a point where love and effort are not the missing ingredient. A parent is being injured. A sibling is not safe in the house. Nobody has slept properly for a year.
Say it out loud to the paediatrician, in these words: I need you to hear this as a crisis, not a complaint. We can no longer keep everyone in this house safe. I am asking what exists between here and nothing. Ask specifically about a developmental-behavioural paediatrician, a psychiatric referral, in-home behavioural support, respite hours, and whether your state's Medicaid waiver covers any of it.
Ask whether your area has a mobile crisis team before you need it. (Medicaid covers one only in states that chose to.) Or call or text 988, free, any hour, and for people supporting someone else too. More: crisis help, START and the ER.
And this. Residential placement, a group home, or a specialist school is a faithful path. Families who choose it have usually fought longer and harder than anyone watching them knows. Families who keep their person at home through everything are on a faithful path too. Neither is the loving one and the other the failure. The question is not who is willing to sacrifice most. It is where this person is safest and most themselves, and whether the people around them can still stand up. "Carry one another's burdens, and in this way you will fulfill the law of Christ" (Galatians 6:2, BSB). A burden carried alone until it breaks the carrier was never the arrangement.
The restraint line
Restraint and seclusion injure and kill children, and they do not work. The U.S. Department of Education's Restraint and Seclusion: Resource Document says so in the Secretary's own letter. These practices "can have very serious consequences, including, most tragically, death". And there is "no evidence that using restraint or seclusion is effective in reducing the occurrence of the problem behaviors that frequently precipitate the use of such techniques."
Its core principle: "restraint or seclusion should never be used except in situations where a child's behavior poses imminent danger of serious physical harm to self or others." Even then, it "should be avoided to the greatest extent possible without endangering the safety of students and staff." Four more of its fifteen principles:
- "Restraint or seclusion should never be used as punishment or discipline (e.g., placing in seclusion for out-of-seat behavior), as a means of coercion or retaliation, or as a convenience."
- "Restraint or seclusion should never be used in a manner that restricts a child's breathing or harms the child." The document is specific: "Prone (i.e., lying face down) restraints or other restraints that restrict breathing should never be used because they can cause serious injury or death."
- "Schools should never use mechanical restraints to restrict a child's freedom of movement," and never a drug to control behaviour except as authorised by a licensed clinician.
- "Parents should be notified as soon as possible following each instance in which restraint or seclusion is used with their child."
Ask your school these, with the answers in writing:
- What is the district's written policy on restraint and seclusion, and may I have a copy today?
- Who is trained, when were they last trained, and in what method?
- Does this school have a seclusion room or a quiet room, and may I see it?
- Will you notify me the same day, every time, in writing?
- Has my child been restrained or secluded this year, and how many times?
Ask the last one even when you are sure the answer is no. State law varies widely, and the federal document is guidance, not a ban.
At home, the same. Block, do not hold. Move objects, not bodies, give more space, and let it run its course. Never sit on anyone, hold anyone face down, or hold wrists or arms to make a point. If holding feels like the only option left, that is the signal to get help for the whole family, not to get better at holding.
Police, 911 and first responders
Police there right now? Open the police card.
An arriving officer knows nothing. They see a large person not following instructions, not making eye contact, not answering, moving suddenly, maybe hitting themselves. With no other information, each reads as a threat. Your first sentence is the other information.
Say this, in this order: He is autistic. He does not speak. He is not being defiant, he cannot follow those instructions. Please turn the sirens off and give me space to help him.
Calling 911 yourself, lead with it: I need help with my autistic son. This is a disability crisis, not a crime. He is not armed. He may run. He does not respond to shouted commands. Please send someone trained in crisis intervention if you have one. Ask the dispatcher to add the word autistic to the call notes so it reaches the responding car.
Before any of that is needed:
- Register, if your area has a registry (see telling the police first).
- A window decal by the front door and on the car saying someone autistic lives or travels here. (The Big Red Safety Box includes one.)
- A card you can hand over instead of explaining: in the glove box, the wallet, by the door.
- Meet them first, if you can. (A calm ten minutes in a station car park is worth more than any document.)
The traffic stop
For an autistic driver, a traffic stop is the highest-risk ordinary event of the week. (Lights, a raised voice, instant orders, and a reaction that looks like non-compliance.)
Practise it, more than once, in a car park with a friend playing the officer. (Rehearsed sequences hold up when new thinking does not.) Pull over promptly, park, engine off, interior light on if it is dark, window down, hands flat on top of the wheel, and stay there. Documents come out only when the officer asks, slowly, saying out loud where you are reaching.
Carry a disclosure card and speak first. Officer, I am autistic. My card is in the visor. I may not make eye contact. Please tell me one instruction at a time.
Ask your department and state DMV what they have. Pathfinders for Autism's traffic-stop toolkit, for one, holds a printed tip sheet and a sun-visor card with the top five instructions. Its envelope "lists the steps to follow on one side, and tips about autism for the officer on the other side".
The home
- Chemicals up and locked. Cleaners, detergent pods, laundry liquid, bleach, vape liquid, alcohol, essential oils, batteries. (High is not enough once someone climbs.)
- Medicines in a locked box, including your own. (Not the bathroom cabinet, not a handbag on a chair.) Keep Poison Help where you can see it: 1-800-222-1222, free and confidential, around the clock.
- Pica, eating things that are not food, is more common in autism. The CDC's Study to Explore Early Development found the prevalence of pica was "around 28% in children who had both ASD and co-occurring ID, around 14% in children who had ASD without ID". In the general population: "less than 4% of children". If this is your person, treat small objects, coins, batteries and paint chips as poison. Tell the dentist and the doctor, and ask about testing for lead and for low iron or zinc.
- The stove and the oven. Knob covers, a stove guard, and cooking on the back burners. Ask your utility company whether they supply a gas shut-off you can use.
- Windows above the ground floor. Nationwide Children's: "window screens are not designed to stop a child from falling. A normal window screen is NOT enough to keep children safe." Use window stops "to prevent windows from opening more than 4 inches", and guards with a quick-release for emergency escape on upper floors. And "move all furniture away from windows": a bed under a window is a ladder.
- The car. Child locks stay on for teenagers and adults too, if they might ever leave a moving car. Lock the car on the driveway and keep keys out of reach. NoHeatstroke.org, whose counts NHTSA cites, finds that in 23.8% of US child hot-car deaths from 1998 to 2025, the child "gained access on their own". And "on an 80 degree day, temperatures inside a vehicle can reach deadly levels in just 10 minutes". For seatbelt escapes, ask an occupational therapist or your state's child-passenger-safety technician about approved solutions, never an improvised restraint.
Online safety, for teenagers and adults
The risk online is rarely the one families brace for: it is being liked. An autistic teenager or adult who has been lonely for years may be literal about promises and slow to accept that someone kind is lying. So the protection is a rule, not a judgement call.
The US Federal Trade Commission's warning signs need no social reading. Scammers pretend to be an organisation you know, say there is a problem or a prize, "pressure you to act immediately," and tell you to pay in a specific way. Tape their line to the laptop: "Honest businesses will give you time to make a decision. Anyone who pressures you to pay or give them your personal information is a scammer." Gift cards, wire transfers, payment apps and cryptocurrency, demanded urgently, mean stop.
Teach one rule, in the same words every time, and practise it when nothing is happening. Money and photos: I do not send either one until I have talked to you. Nobody real needs it in the next five minutes. Tell them out loud they will never be in trouble for telling you (shame is what keeps people trapped and paying). If someone has images and threatens to share them, that is a crime against your person, not something they did wrong. In the US, report it to the National Center for Missing & Exploited Children's CyberTipline, which takes reports of online enticement and child sexual abuse material: report.cybertip.org or 1-800-843-5678. For images of someone under 18, use Take It Down. Report scams and fraud at reportfraud.ftc.gov.
Verified September 2026 against the National Autism Association's safety and water-safety pages, the CDC on wandering and on pica, the U.S. Department of Education's Restraint and Seclusion: Resource Document, Poison Help, the 988 Suicide & Crisis Lifeline, the FTC and NCMEC. Sources on the sources page. Background for a caregiver, not medical, legal or financial advice.