Patients and staff perspectives on hospital ward strain and its impacts on patient care and the workforce: a mixed-methods systematic review.

Wandering – or leaving a supervised space and/or care of a responsible person – is common among toddlers who are learning to explore their environment (). It is much less common in older children and can be associated with serious injury, especially among those who cannot independently share their names, addresses, or phone numbers if they get lost. Wandering disproportionately affects children with intellectual and developmental disabilities, with some studies suggesting that a majority of those who wander are diagnosed with autism (; ; ; ; ). Child factors associated with wandering in early childhood are anxiety, hyperactivity, significant early learning delays, and the severity of autism traits (; ; ; ; ; ). Wandering among children with autism has been associated with risk for serious injury and premature mortality. In one study, 65% of caregivers reported that their child with autism who wandered was in danger of traffic injury and 24% reported that their child was in danger of drowning (). In another study, 17% of people with autism who were reported missing were found dead (). Accidental drowning accounted for most of these fatalities (71%) followed by traffic injury (18%). Wandering has also been described as the most commonly reported activity leading to fatal drowning incidents among children with autism 3–14 years of age (). Adverse caregiver and family impacts of wandering have also been reported. For instance, 62% of caregivers of children with autism reported they did not attend or enjoy activities outside the home because of child wandering, and 56% said that wandering was one of the most stressful parenting challenges (). In addition, wandering concerns may affect up to 73% of caregivers’ decisions to let their child spend time with friends or family in their absence (). Despite these concerns, many parents of children with autism do not receive anticipatory guidance on how to prevent wandering or create emergency response plans ().