Children with autism spectrum disorder are uniquely impacted by the many changes that have come with the 2019 coronavirus disease (COVID-19) pandemic.
“COVID-19 brings many new changes to daily life for children with autism spectrum disorder,” says Rebecca Doggett, PhD, clinical assistant professor in the Department of Child and Adolescent Psychiatry at NYU Langone and clinical director of the Autism Spectrum Disorder Service at the Child Study Center. “Parents may need to design and implement new routines at home and help their child maintain social skills virtually.”
Dr. Dogett and Michelle Lee, PhD, clinical assistant professor in the Department of Child and Adolescent Psychiatry, in collaboration with the Department of Child and Adolescent Psychiatry’s WonderLab, offer practical tips for parents to support children with autism spectrum disorder during this time.
Use Social Stories to Describe COVID-19 and Current Restrictions
To help children with autism spectrum disorder learn about new situations, parents can use a technique called Social Stories™. This technique breaks down information into short, digestible content—including specifics on what to expect in a given situation and why—appropriate for children with autism spectrum disorder.
“Social Stories™ provide concrete language and visuals that can make abstract concepts more accessible,” Dr. Doggett says. “The repetition of these stories can be regulating as they provide a ‘script’ for navigating a situation.”
These stories can be used to help children with autism spectrum disorder understand the many changes associated with COVID-19. “Use Social Stories™ with visuals and read frequently with your child to ensure comprehension of the following abstract concepts,” Dr. Doggett says. This could mean providing stories on topics such as what COVID-19 is, social distancing, and appropriate hygiene.
Create New Routines
Children with autism spectrum disorder benefit from predictability and routine. “The changes caused by COVID-19 may lead to increased anxiety or emotional dysregulation,” Dr. Lee says. “While some changes in routine are unavoidable, many aspects of routines can be incorporated to support individuals with autism spectrum disorder during this time.”
Maintain consistency with your child’s previous schedule where possible, Dr. Lee says. “This means keeping up with their sleep–wake schedule, having meals sround the same time each day, preserving their evening andweekend routine, and even maintaing their electronics schedule, if you have one,” Dr. Lee adds.
To keep up with your child’s care team, most service providers are using video visits to provide ongoing support to families, including those at NYU Langone Health.
“Keep as many sessions as you can with your child’s mental health providers and therapists,” Dr. Lee says. “Video takes getting used to, but many kids respond positively.”
Dr. Lee adds that parents may need to provide more oversight to get their child set up and maintain attention during the visits.
Incorporate Visual Schedules and Supports
Using visual schedules for the day that include pictures can be helpful for children with autism spectrum disorder to maintain a daily routine. “Once an activity is completed, check it off or cover it up with a sticker,” says Dr. Doggett. “Include breaks in the schedule and prepare a break space with accessible, brief activities for your child.”
Parents can also follow less-preferred activities with highly preferred activities. “For free time, create visual activity menus, including non-electronic indoor activities, outdoor activities, and social activities,” Dr. Doggett says.
To facilitate transitions between activities, visual supports can be used. “Visual timers, such as TimeTimer or any timer that visually shows the passing of time, can be helpful,” Dr. Doggett says. “There are many free apps for visual timers, and the iPhone timer works in a pinch.”
Parents can also use “first/then” boards that have pictures of the current activity and what is coming next to help their child transition between activities, Dr. Doggett says.
Since space is at a premium with people at home during COVID-19, it can help to find a dedicated space that is conducive to sitting and attending during the school day. Use a visual support such as tape on part of a table to clarify where that space is. Visual supports and Social Stories™ can also be used to prompt rules and navigate the use of new technology.
Be Creative with Rewards
“Use rewards to support completion of daily routines,” Dr. Lee says. Create a menu of rewarding games, activities, snacks, new items, special time with parents, movies, or other things your child enjoys, she says. “You can even reuse small rewards during the day.”
A reward jar can be used for older children who can earn points for later. This is useful for children who are able to wait for a larger reward once COVID-19 restrictions are relaxed.
Practice Daily Living Skills
Parents can use this time at home to work on their child’s daily living skills. Example skills include cleaning and household chores, setting and clearing the table, laundry, and food preparation.
“Start small and break the task down into small steps, then slowly work up to the whole routine,” Dr. Lee says. Use rewards to reinforce new skills where necessary.
Support Virtual Social and Communication Skills
Children with autism spectrum disorder often have difficulties with social and communication skills, so supporting social interactions during this time is important to maintain those skills. “Online communication also requires unique social skills that may be new to children with autism spectrum disorder,” Dr. Doggett says. “Therefore, individuals with autism spectrum disorder will benefit from coaching to facilitate successful ‘virtual’ communication.”
To do this, Dr. Doggett suggest setting social goals. “Children with autism spectrum disorder will present with a range of interest in social activities,” she says, “Build social time into routines so it is predictable.”
For children who are less motivated, start small and reward efforts. “Start with a game with a sibling, texting a peer, or a brief conversation,” Dr. Doggett says. “Think about ways to incorporate special interests into social time. Then, follow up social time with a highly motivating activity.”
Dr. Doggett says parents can work with their child on the Ws of connecting—the who, what, where, and when—to practice social skills.
Start with the “who,” Dr. Doggett says. “These are parents, siblings, extended family, friends, or peers from school or extra curricular activities. Begin with people with whom you are most familiar to set your child up for success.”
“The ‘what’ can be any form of communication, such as the phone, text, or even free messaging applications like Zoom or Google Hangouts,” Dr. Doggett says. “Several organizations are offering game nights or translating other activities to virtual. Think about activities to structure the interaction and plan topics ahead of time.”
The “where” is the simplest part—try to find a quiet place that minimizes distractions so you child can focus. The “when” should be scheduled ahead of time to ensure everyone is available, Dr. Doggett says. “Keep it brief at first to ensure success, and think about communicating during your child’s social times as they would arise during a school day, such as lunch, recess, or after school.”
Children may need explicit coaching to know when are appropriate times to reach out and how many times in a row to reach out, she says.
In-the-Moment Coaching for Virtual Interactions
“Practicing and coaching are key,” Dr. Lee says. “If you are using a new form of electronic communication, your child can practice with a parent from a separate room before ‘going live.’”
Practice positioning so your child’s face is on the screen, their body is sitting up and at an appropriate distance from the camera, and can they be heard by others. If your child needs to get up and leave the screen, remind your child to let the other person know where they are going.
“Try to avoid critiques,” Dr. Lee says. “Praise what you see going well and offer suggestions for next time.” For example, “Next time, you can ask a question about your friend’s interest,” versus “You didn’t ask a question.”
Try to combine online video game play with time spent in conversation first, Dr. Lee adds. For example, “First let’s check to see how Johnny’s week has been and then you can start playing.”
When it comes to internet safety, Dr. Lee says parents should preview new websites, virtual opportunities, and social media tools before their child uses them. “Information in the virtual world can last a long time,” she says. “Review with your child not to share personal information, and what might be appropriate and less appropriate topics to talk about. And always discuss who is safe to engage with online,” Dr. Lee says.
Additional Resources for Parents
The Child Study Center hosts educational webinars throughout the year. Recent webinars on autism spectrum disorder include the following.
Providing Mental Health Services via Telehealth for Individuals with Autism Spectrum Disorder
This webinar offers strategies for engaging individuals with autism spectrum disorder over telemedicine platforms. Our experts discuss ways to set up sessions for success, tips for structuring sessions, and ideas for translating interventions to a virtual format. Watch here.
The Ultimate Change in Routine: Supporting Parents of Children with Autism Through COVID-19
Experts from the Child Study Center discuss strategies for designing and implementing new routines, ways to approach explaining changes in daily life caused by COVID-19, and how to maintain social skills virtually. They also share resources specific to individuals with autism spectrum disorder. Watch here.
Dr. Doggett and Dr. Lee also suggest these online resources for parents:
- Autism Speaks: COVID-19 Information and Resources
- Include NYC: Online Parent Support Group
- Young Adult Institute (YAI): COVID-19 Database for People with Intellectual or Developmental Disabilities, Caregivers, and Staff