Mary: Today we are talking to Dr. Amy Foxman, who is an educational psychologist and a BCBA, about safety with kids with autism and toddlers showing signs. Dr. Foxman has done a lot of groundbreaking research and work in the areas of safety skills for children with autism. She has an assessment, and we talk about elopement, wandering, pica, and all kinds of things, along with what you can do as a parent or professional to teach our kids the skills they need to prevent danger and dangerous situations, and also to teach them the good skills so their safety can improve. So, let’s get to this important interview with Dr. Amy Foxman.
Thanks so much for joining us, Amy. I’m excited to get to chat.
Dr. Amy Foxman: Thank you so much for having me. I just have to tell you that years ago—I mean, I’m a big fan—and years ago, when I was an earlier BCBA and new in my career, there was a kid I was working with who had severe sinus infections, like repetitive sinus infections. I didn’t know how to teach him to blow his nose, which was such a critical skill. So I went to Google, like any good BCBA would do, and I said, “How do you teach a kid with autism how to blow their nose?” Your site came up and your resource. I mean, it truly was life-changing for this kid to have a procedure to do that. It was so simple for a professional or a parent to use. So I just thank you for putting out these resources into the world. It’s really helpful.
Mary: Oh, that’s great. That’s great. Yeah, I developed that to teach my clients how to blow their nose, just by breaking down the skill. Unfortunately, my son, who’s almost 30, is still not a great blower of his nose. So it is a tough skill for sure.
Dr. Amy Foxman: Yeah.
Mary: But yeah. And when you Google things, I always think, even putting my name in there—Mary Barbera, how to—I probably have a video.
Dr. Amy Foxman: Well, your resources are so easy to use. I mean, if you don’t know what you’re doing, for parents and staff, it shows you.
Mary: Yeah. Yeah. So Amy, you and I met two years ago at the National Autism Conference, where you and Amanda Kelly, also known as Behavior Babe, were presenting on safety. I attended the lecture. It was awesome. And so I wanted to have you on. We recently caught up with Amanda Kelly too, just offline, but you’ve really done a lot in the world of safety. So we’re going to dive right into all kinds of safety issues for kids with autism, toddlers showing signs, or really any child who needs to be taught these skills.
Before we dive real deep, you are a behavior analyst and a special ed teacher. Kind of catch us up. How did you get there, and why safety? Why did you get focused on that?
Dr. Amy Foxman: Yeah. Well, it really started when I was in Philadelphia doing my undergrad at the University of Pennsylvania, and I was volunteering in a class with kids with severe autism. The way that this teacher navigated teaching them how to communicate and really engaged all of her students, who each learned differently, was a sight to see and was really inspiring. So I always knew I wanted to get into the field. I ended up doing my master’s in special education and behavior analysis at the University of Washington. Their model was very much this naturalistic model of teaching skills in a way that kids should be interacting with their world that’s developmentally appropriate—so a lot of play-based learning and social skills and communication.
Then I ended up coming to Dallas and got my doctorate in educational psychology here in Dallas. That’s really where I went into the world of safety. For my dissertation, I wanted to do something that didn’t have a lot of research, and especially research that would be useful to a clinician and someone in the autism world practicing. For me, it was behavior analysis. So I ended up specializing in fire safety for kids with autism and how to teach them to respond to a fire alarm and evacuate.
When I was doing that work in September of 2020, this incredible advocate in the autism world, Feda Almaliti, and her son tragically passed away in a fire. Her son, who had severe, profound autism, had trouble exiting the home and going down the stairs during the fire. She was found at the top of the stairs holding him, and it was horrible. Simultaneously, it really reiterated to me how important it was to be working on these safety skills and teaching them. As a behavior analyst who works with kids with autism every day, I never thought about fire safety in particular and how we were teaching it, versus when a fire drill goes off in our building or at school, and we’re just kind of pushing kids out and getting them out as quickly as possible. We’re not saying, “What are the skills that we need to teach?”
So I connected with Feda’s dear friend, Dr. Amanda Kelly—Behavior Babe—who you mentioned. She was speaking at a conference after this tragedy about Feda and her son Muhammad. I was going into it thinking, “Oh good, I’m going to get these practical resources that I can take back to clinicians I work with and to families.” Her presentation was beautiful at this conference. It really honored them, and it talked about a couple of different ways you could think about fire safety. But I didn’t walk away with these practical tools. So I connected with Amanda, Dr. Kelly, personally, and we said, “Listen, let’s create something that is a tangible tool”—and in this case, a safety assessment—that families and professionals can really look at and use to think about all these different areas of safety that we may not be thinking about. It wasn’t anything super smart. These days you can probably ChatGPT some of this stuff, but it really was just a way of saying, “Let’s get this in front of people and get it to the top of everyone’s mind.”
Mary: Yeah, that sounds like a really important moment for you, and to meet Amanda. At the same time, I was writing my book Turn Autism Around when Feda died. I had actually never heard of Feda or met her, but a couple of weeks before Feda died in the fire with her son, a famous behavior analyst, Jose Martinez-Diaz, died a couple weeks before that. Feda knew him, Amanda knew him well, and they were paying tribute online. Feda caught my eye as an autism mom who was really gung-ho, and I actually wrote her name down. I was going to reach out and get her interviewed on the show.
Then when she died, I was literally working on my book and writing chapter three on safety. One of the recommendations I had made—and later changed—was to make sure all windows are locked and secured, because I had literally had clients who went out on roofs and left the house that way. So I did go back to the draft and make changes for fire safety because I hadn’t included that in the safety chapter. So I know that even though I never met Feda, her death and her son’s death did actually change my safety instructions and that sort of thing.
And it’s not just fire safety. In my chapter, I’m sure I mention the fact that I had a client I worked with when he was ages two and three, and when he was six, on a summer day in June, he wandered away and drowned in his neighbor’s pool. Actually, I did an interview with mom in my video studio because they were local. It’s a very touching interview, so I think we’ll include that in the show notes. It’s kind of like a hidden interview. I mean, I think we broadcast it, but it didn’t get a lot of traction. It is really a touching interview about how she lost her son.
And I don’t want this to be all doom and gloom. I mean, we all have tragedies in our life, but there are definitely things we can do to make things a whole lot safer. So when families think about autism, they often focus on language and learning. From your perspective, why should safety be a top priority? Because it is a top priority for me.
Dr. Amy Foxman: Yeah. Well, and as a parent yourself, when your child was especially really young, what are the biggest things on your mind for your child?
Mary: Yeah.
Dr. Amy Foxman: It’s how do they communicate their simple wants and needs? Toileting—which you have great resources on toileting—is one of those things too. Those are the things that are really at the top of everyone’s mind because they’re happening every day. It’s certain that your child is going to have a challenge with them, and they’re so present. So things like safety, where it’s uncertain that something may happen, and it’s also pretty negative to think about—if you talk about it, it’s really hard to listen to a mother who’s lost their child in a drowning accident after wandering off. I mean, it’s super tragic.
A lot of times we kind of turn away and think, “Okay, let me focus on teaching my kid to communicate ‘milk,’ because it’s going to have such a positive outcome and it’s a lot better to think about.” So we’re just not thinking about safety, and we’re not prioritizing it, and it’s no one’s fault. But there are so many other big things that we’re thinking about. The problem becomes that there is a chance these accidents can happen. We see in the news every day, especially with wandering and water safety—the same thing with fire safety—that there is a chance. I’ve had friends whose homes have caught on fire and they’ve barely made it out alive. These are real threats, and we have to start thinking about them. It doesn’t mean you have to tackle every single threat at the same time, which can be really overwhelming, but especially prioritizing, for your child, a few different areas or skills or actions you can take as a parent to help your environment and make it safer is good to start thinking about.
Mary: Yeah. Yeah. So why don’t we talk about—you did your dissertation specifically on fire safety, and then you developed the safety assessment with Amanda Kelly, right?
Dr. Amy Foxman: Right.
Mary: So let’s talk about the safety assessment. I know you and I and Amanda talked about my Becca assessment—the Barbera Early Childhood Assessment—which has some safety questions, and we have lots of data, which we might work together and try to analyze. We ask about wandering, elopement, strangers, traffic, water safety. I know in your presentation at the National Autism Conference, the statistics for drowning were terrible. I don’t know if you know that well off the top of your head.
Dr. Amy Foxman: I mean, it’s awful. Just anecdotally, I can tell you that at least once a week, when I’m looking at the news, I see another child with autism who has wandered off and ended up, unfortunately, in a body of water. So it’s happening all the time, and it is a big safety concern for kids with autism.
Mary: Yeah. So your safety assessment—is that done by parents, professionals? It’s free of charge. We’re going to link it in the show notes.
Dr. Amy Foxman: It’s free. You can access it on our website. It can be used by anybody—parents, teachers, behavior analysts, speech therapists. We have physicians who are starting to use it, developmental pediatricians when they meet with patients, and to give it as a resource. It’s so easy. It really is just meant to start the conversation and get people thinking about the different areas that may be really concerning for your child.
So yes, I know that you talk about pica and eating food items that aren’t actually food, and it can be really dangerous. For myself, I have a four-year-old, and it’s something I think about in my environment. There are questions on there to start thinking about things like: Do we have small craft objects like beads in our house? Do we have little batteries or magnets that, if swallowed, can be deadly, unfortunately? So it’s things like that that may not be at the top of my mind as a parent because I have so much else going on, but I may say, “These are really easy changes I can make where I can put the beads on a big shelf on top that she can’t even get to with a chair if she pulls it up,” or take away things that have those little batteries that can be really dangerous.
Mary: Or some kids with autism even just eat handfuls of mulch and eat—right? Just really big concerns. So, I mean, there’s just so much safety stuff that, like you said, as a parent, you feel like you’re on edge. At least when Lucas was between the ages of two and ten, we had many times when he eloped from the house, got lost, ran off at the mall. I remember when he was two, before he was even diagnosed, he was in a double stroller with his younger brother, and my husband had him at a store. He just hopped out and ran. It wasn’t even a mall that he was familiar with, so he went one way, and my husband’s trying to get the double stroller out. So, you know, I think a lot of us parents—especially if we have kids who aren’t, language-wise or cognitively, at the level where they know danger—these kids don’t know danger, so we have to keep them safe, which is hard, especially as they grow taller. They can open doors, they can climb on chairs, they can unlock things.
And you know, it’s hard. Whether your child is typical or has autism or has ADHD or something like that, there’s a lot of guilt on parents. “Well, what were the parents doing?” Try to watch a child 24/7 and see how that goes—especially a child that is curious or darty or unaware.
Dr. Amy Foxman: Yeah. It’s really interesting. When we did our fire safety study, the four young children with autism in the study—when we did a test fire alarm just to see what their responses were going to be—none responded to a fire alarm like their same-age peers. The fire alarm would go off, and they would just continue doing what they were doing, or they would start running around the room, but there was no awareness of, “Oh goodness, there’s a fire alarm. This is different. This is unsafe. I need to move. I need to get out. I need to get a grown-up.” So that awareness really has to be taught for a lot of kids with autism—not just about fire alarms and fire safety, but things like crossing the road or wandering off, and that there is danger, and that these are how we react in these situations to stay safe.
Mary: Mhm. So if we have parents listening right now and they do have a child that is at risk of elopement or chewing on things, and there’s also risk of injury with self-injurious behavior, aggression—you know—I mean, I would say start with my Becca assessment. It’s free. We can link it in the show notes. Your assessment for safety dives in a little bit farther. But are there some steps that you think should be across the board for parents who are concerned?
Dr. Amy Foxman: Yeah. I mean, the first thing I would say is take—just like you said—take your assessment, take our safety assessment, but from there, we have to look at what the priorities are for that child. I wish I could say, “Here are the top three things any parent should be doing right now,” but it is so individualized. If your child has wandering dangers, then locking your doors or having alarms on your doors in your home may be the number-one priority for your young child. For another family, there may not be concern about that, but there may be concern about eating non-food objects and having that as a huge danger.
I think both of our assessments can really help you think about these are the priorities we should be considering, addressing, and teaching as far as skills go. Because we don’t just want—there’s a lot we can do today with our environment, whether it’s locks or whether it’s creating a safety plan. I live in an area with tornadoes, so we have a tornado bag that has my kids’ favorite toys and favorite foods, and every six months I go back and replenish it. So if we’re stuck in a small room together, she has it, right? That’s a simple, actionable thing that any parent can do. They can also have one for their car too. But really, the goal would be to look at, for your child, what are those top three priorities based on, I think, both of our assessments.
Mary: Mhm. Yeah. And to teach language skills and to teach awareness—especially language skills.
Dr. Amy Foxman: Yeah. Simultaneously, we can’t let all that other stuff go, right? As behavior analysts, we have really comprehensive plans on communication and social skills, and we can’t not be doing that. We have to be bolstering that at the same time that we’re thinking about safety. But it’s a heavy load to think about both.
Mary: Yeah. Yeah. One of my mentors, Mike Miklos, used to say it’s two sides of the same coin—like all your language and learning and good skills that you want, and then all the problems and dangers and safety awareness issues on the other side. So we need to spend 80% or more teaching good skills. Those good skills really matter.
Kelsey, for instance, was one of my very early success stories. She’s been working with me for a decade as our community manager. Her son Brenley, and I did a podcast with her—I think she was podcast number three, and we can link it in the show notes. She was a single mom with two boys, both on the spectrum. Brenley was so dangerous. He was eloping from the ABA clinic, running out the door and down the street for three blocks. He was banging his head on hard surfaces a hundred times a day, and she had a baby who would end up with an autism diagnosis as well.
What she found with the online course was that the ABA clinic was actually trying to teach him things that were way too hard—teaching him colors and that sort of thing. They wanted to put a helmet on him because he was banging his head. Meanwhile, she withdrew him and started teaching him requesting and labeling and Potato Head, and within months she was able to take him out in the community without a leash and a harness, and he stopped banging his head. So I think for my priorities, yes, assess, and then we have to teach those good skills on the top side of the coin for everything and for every kid. Try your best to keep things gated, keep doors locked, and keep things they’re going to put in their mouth away. But it is exhausting.
In my case, things got a lot better starting around age ten. I am 99.9% sure Lucas would never leave the house without an adult. He’s very much aware of what’s happening now. But it’s been years of progress, you know, and the ability to understand and follow one-step directions. When we’re teaching so many of these safety skills, we have to have that already in our skill repertoire. So you’re right. As kids get older and they gain a lot more of those communication and social skills, it helps with the safety skills too.
Dr. Amy Foxman: Yeah. And just awareness. I know when I saw you present in Harrisburg a couple years ago, you also talked about school shooting drills.
Mary: Yeah.
Dr. Amy Foxman: And so then there’s the opposite problem. I know the teachers and behavior analysts and professionals out there who work in schools—I mean, that’s a huge challenge that wasn’t around when I was a kid.
Mary: I know. I’m very old now. But yeah, that’s the opposite problem. You’re supposed to be quiet. You’re supposed to be in the coat room. I mean, it’s like that’s impossible too when you’re trying to keep kids quiet and calm, especially for the kids who have no awareness of what’s happening.
Dr. Amy Foxman: Yeah. I mean, when I was a teacher in a special education classroom, we had an active shooter on our campus. They were in lockdown. This was before we had a lot more resources around active shooter drills. But yeah, we had to keep six kids with severe autism and challenging behavior quiet and in a corner of the classroom. It was really scary as a teacher because that was super hard, and we hadn’t practiced it.
Thankfully, there are a lot of measures in place now where schools are practicing and rehearsing. They’re not calling them active shooter drills for kids—we don’t want to traumatize kids. There’s a lot of research coming out saying we don’t want to call them that—but they are practicing those skills. It’s the same thing with fire drills. When I was a teacher, we would just shuffle our kids out. We would have extra staff in our classroom, and the principal would say, “Hey, Amy, at 9:00 a.m. there’s going to be a fire drill. I’m going to send staff.” We would be doing the favorite things of each kid, so a lot of kids with autism who had a hard time transitioning away from preferred activities or difficulties with routine—we made it so easy when that fire drill went off to just take all the kids out. But in no way were we helping kids get the skills they need to be successful in a real fire, because we never would have those resources or that scenario where everyone is doing the perfect activities to leave in the fire drill and have extra staff on hand to usher them out.
Mary: Right. So what did you do? With your dissertation, you taught four kids fire safety skills?
Dr. Amy Foxman: We did. We did it in the home, and we had a fire alarm that I had recorded on my phone because a lot of these houses have high ceilings and we couldn’t hit the fire alarm in practice every time. So first, it was teaching using something called behavior skills training. We do instruction on, “This is a fire alarm. When it happens, this is the procedure that you do. You stop what you’re doing. You go as quickly as you can to an exit, to a door in the home.”
So we would tell them, and we used visuals sometimes—just pictures of the door they were supposed to go to. Then I would show them. We would model it. Then they would practice it. We would give them feedback. We’d be really specific, like, “I really liked how you stopped what you’re doing and got to the closest door that you’re supposed to get to.” We would practice it over and over and over again.
Then the last part was that we needed to practice from different places in the house, not just with me being there, and with different fire alarm sounds too. Three out of four kids who were participating were able to learn the fire safety skills. Interestingly, when we had a really high-pitched fire alarm, it was a lot harder for the kids to learn how to respond to that. But it was doable, and it was easy, and I didn’t need all these resources. I didn’t need fancy tools or curriculums. The wonderful thing about it is that anybody could be doing this, and it takes five to ten minutes a day to do that procedure.
Mary: Yeah. Yeah. Well, that’s great. I did take a look at your safety assessment. It’s excellent. We’ll link that in the show notes right below. How can people get in touch with you if they have research ideas or if they have interest in learning more?
Dr. Amy Foxman: Yeah. So Dr. Kelly and I have a website. We’re happy to share more information, and my fire safety study is available online. I think that’s going to be linked as well. You’re welcome to get that. Again, it’s just a really easy procedure that people can learn and do on their own, and they don’t have to be a behavior analyst to do it.
Mary: Nice. Nice. Well, I think it’s always good to talk about safety. I always say now, my kids are almost 30 and 28. Lucas still has moderate to severe autism, and Spencer is a physician now. But all I want for them—my two boys—is what I want for all the kids out there: for them to be as safe as possible, as independent as possible, and as happy as possible.
So safety looks different for my sons and for all of your kids. And like you said, Amy, it doesn’t have to be—well, it is stressful—but you can’t work on everything at the same time. So prioritize what safety measures are most important for your family. Prioritize teaching the good skills, and prioritize independence and happiness. No matter what program or what type of therapy you’re doing, safety, independence, and happiness are going to be key for the short term and for the long term.
Dr. Amy Foxman: So true. Thank you so much, Mary, for having me on, and again for all the resources that you put into this world for families and professionals.
Mary: Yeah. And we do have a safety bonus video within my online course and community. I’m going to link that as well. I don’t think that’s on YouTube yet, but let’s get that out there too. I want people to be as safe as possible. So any little bit—or maybe some tips that I have in that bonus video, or I have in chapter three of my book—might be something easy for you to do that would give you more peace of mind as a parent or as a teacher to help all your kids in your classes.
Dr. Amy Foxman: And just a simple thing you can do today is check your fire alarms, because a lot of times we hear awful stories about people whose fire alarms don’t go off in the middle of the night in a fire. So just press the button, make sure they work, and record the sound while you’re doing it so you can practice with your kid too.
Mary: Yeah, that’s great advice.
I heard too that when it’s time to switch the clocks in the United States, that’s a good time to check your batteries or test your alarms. At the time of this recording, it’s around that time. So yeah, that’s a great tip to leave us with.
Thank you so much for joining us, and let’s just make the world a safer place. I look forward to ongoing collaboration with you, Amy. Thank you.
