Caring Child and Adult Autism Spectrum Disorder in COVID-19 Pandemic

Autism spectrum, also known as Autism Spectrum Disorder (ASD), is a range of mental disorders of the neurodevelopmental type in the areas of the social communication, restricted interests, and repetitive behaviours [1]. Individuals with autism have atypical cognitive profiles, such as impaired social cognition and social perception, executive dysfunction, and atypical perceptual and information processing [2]. The worldwide population prevalence of autism is about 1% [2].

The current scenario that we are experiencing with the COVID-19 pandemic makes it difficult for many people to understand and assimilate everything that is happening. In persons with autism, this difficulty can become extreme, both in children and adults. Approximately 10% of autistic people have co-occurring physical disabilities [3]. Increased rates of various chronic illnesses and medical conditions have been observed in persons with autism [4]. Furthermore, atypical immune responses are shown [5]. All these factors may increase the vulnerability to COVID19. Recent evidence suggests that experiencing a pandemic carries symptoms of anxiety, depression, and posttraumatic stress disorder [6]. Since autistic people are overwhelmingly likely to experience mental illness [7,8] and nine times more likely than the general population to die by suicide [9], the mental health consequences of COVID-19 may be devastating [10].

The practice of isolation and quarantine, an essential preventive measure, carries implications in civil liberty and clinical practice [11]. Given the evident difficulties arising from the pandemic that present for people with ASD, they and their caregivers may be severely affected [11]. All aspects of confinement may influence living complications in different ways. However, there are some recommendations to help to process and assimilate this situation, and avoid or reduce complications in this population.

Routine and firmness are essential for people with autism. Even the smallest and most common changes can be annoying. COVID-19 has brought the end of the routine, school activity, special programs at school, day programs and, in some cases, support at work.

Most autistic people participate in multiple therapy ways (speech, occupational, physical, social, behavioural, and psychological) [12] in most cases, continuing with these therapies is impossible.

Difficulties in sensory perception are one of the most important aspects to consider in eating problems in people with autism [13]. Many of them may have taste and tactile hypersensitivity or hypersensitivity. The touch system is responsible for making us feel the temperature and notice the different textures of the food. In childhood, observing the different responses of the child may indicate possible problems related to taste and touch sensory processing and will help us to respond to these situations. Therefore, many autistic people are unusually picky about the foods they eat. Their diet may consist of specific foods or only certain brand names. During the current crisis, it is difficult to go to a grocery store, let alone find a specific brand of a specific food. Lack of familiar foods, known to their daily routine, can be incredibly stressful in the ASD.

Persons with autism trust their relationships with specific teachers, therapists, family members and caregivers [14]. During this health crisis, access to such persons may be limited or nonexistent, which can contribute to an increase in stress and behaviour problems.

Some people on the autism spectrum live in settings outside the home and, just like in nursing homes, these settings are now considered “Prohibited” for family members. This lack of interaction with acquaintances can be stressful for everyone.

The COVID-19 pandemic poses challenges for families with members with autism. When these family members struggle with stress and anxiety, people around them are likely to do so as well [2]. They struggle to maintain the routine since all people with autism need routine and consistency. This is difficult (or impossible) to provide if you are trapped at home, working from home, supporting other children education, or dealing with an illness [15].

There are problems in communicating the current situation. It can be challenging to explain the COVID-19 pandemic to some persons with autism who may have difficulties with receptive speech or may have intellectual disabilities.

On the other hand, while all children and parents are struggling with education at this time, it is particularly difficult for families with special needs to access the programs, educational supports and other resources to which they are entitled.

How to Support Your Loved One with Autism?

It may take a long time for a loved one with autism to return to their daily activities and routines. To live and be able to carry this, parents and other family members must establish and maintain a lifestyle at home that works well enough for everyone.

Help Understand what is Happening

Not all children or adults with autism can understand the details of a global viral pandemic, but the vast majority can understand the basics.

Teach Safety Tips

Make sure that the person with autism learns how to maintain proper hygiene. This is through frequent handwashing, lasting at least 20 seconds, covering your nose and mouth when coughing or sneezing, maintaining social distance and wearing a mask when in public. If these measures were difficult for them to apply, consider staying away from stores and other group settings during this time.

Maintain Social Connections

Many people with autism are used to regularly interacting with family, friends, or support staff, so communication via the internet or by phone can be used to maintain these crucial relationships [16].

Establish a Routine

Most people with autism or not, work best with a set routine and schedule, but it can be challenging to stick to if it is not necessary for work or school. For individuals with autism, a routine can make the difference between calm and pleasant family life and days full of emotional crisis and outbursts. Routines should not be complex, and they must be consistent. Establish regular mealtimes and help the family member with autism notice when it is time to prepare to eat. The use of timers and alarms can be useful so that the autistic family member knows what to expect and when to expect it. It is also important to try to offer familiar and preferred foods in this stressful moment.

It is recommended to assign a working time. If the family member with autism is of school age, it is a good idea to set aside relatively short periods (30-60 minutes) to focus on schoolwork. In the case of adults, consider assigning specific tasks or projects that interest him, such as cleaning, cooking, folding and doing laundry, putting away dishes, etc. during these periods.

Another critical point is to maintain rigidity at bedtime and wake up since lack of sleep (or excess sleep). It can be a big problem for a person with autism. If there exist sleep problems, consider using a melatonin supplement.

Reserve time for fun, choosing certain times of the day for activities as television, games and social networks and setting alarms to mark the beginning and end of those moments so that they become part of the daily routine.

Provide Relaxing Resources

Many persons with autism have extremely sensitive sensory systems and may need a wide repertoire of resources to stay calm [17]. They may also need help to maintain their emotions. Some options include to procure quiet space, create or take advantage of opportunities for stimulation, and physical exercise. Consider taking a walk with family, playing or walking in the backyard, climbing stairs, dancing, etc. [18,19].

Sensory resources for people with autism often include receiving sensory regimens, guidelines or activities from an occupational therapist. The therapist should be asked how to maintain sensory activities using balls, toys, swings, blankets or other means that may be at home.

If they are taking any drugs, make sure they are taking their medicine regularly. Anyone with a school-age child with autism has the right to take advantage of specialised education resources throughout their city. If this support is not being received or is not appropriate, feel free to contact your childs teacher, principal, or therapist.

Caregivers of a person with autism during COVID-19 face an unusually challenging situation. It would be advisable to take measures to ensure your own well-being (a walk to disconnect and recharge, meditation in the early morning, ask for help if necessary or there is an overload), it is mean to do everything possible to take it easy. Furthermore, this will be transmitted to the person with autism.

It should be noted that in adults, a greater social integration is common since they have learned compensatory social skills, especially in mild or moderate cases. Economic independence and the completion of professional or university studies, it is something that children do not consider. Adolescence is particularly problematic, as it is an awkward stage in itself.

The scientific and public health community is still learning more about COVID-19 transmission dynamics, it has become almost certain that a vaccine, even if partially efficacious, could be the most reliable intervention in the long-term. However, the development and testing of such a vaccine will take at least several months. Manufacturing the vaccine at large scale, distributing it globally, and achieving high coverage is also a gigantic task that is unlikely to be achieved rapidly, as experience tells with other vaccines [20].

In these times of isolation and uncertainty, both caregivers and educational staff and the individuals with ASD face difficult challenges. Autism is already an exceedingly difficult to handle disorder, and given the peculiarities of this population, they are extremely vulnerable during a pandemic. Only by knowing its characteristics and applying a few recommendations or guidelines, caregivers and the affected persons will be able to lead a more enjoyable life.

Author Contributions

Marcos Altable, Juan Moises de la Serna and Sara Mena have submitted equally to this manuscript.

Disclosure/Conflict of Interest

Marcos Altable, Juan Moises de la Serna and Sara Mena have no conflicts of interest to disclose regarding the manuscript. The authors declare that the manuscript was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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