Apr 29, 2020 Coping with COVID-19 with a Child on the Spectrum

A. Malia Beckwith, M.D., Section Chief, Developmental and Behavioral Pediatrics, Children’s Specialized Hospital, an RWJBarnabas Health facility

The global pandemic of COVID-19 has made school closures, social distancing and home isolation part of our daily lives. While this is a challenging time for all, for parents of children on the Autism spectrum, time off from school and social distancing can bring the potential for major developmental setbacks. But there are coping mechanisms and tips on how to adapt our lives to this “new normal” particularly for children on the spectrum.

First and foremost, it is very important to acknowledge that everyone is different. There is no right or wrong answer to how to manage right now and you shouldn’t feel guilty about what you are able or unable to do. Each child with autism spectrum disorder (ASD) has different challenges – some may be challenged due to the routine change, some may be challenged by the environment, others may be challenged by “missing out” on what they used to get at school. It’s not one size fits all. You have to be flexible.

Talking to a Child About COVID-19
Communication is essential right now. When the environment becomes stressful, or they feel as if their parents are avoiding communication or that there just isn’t a safe place to ask questions, children can assume the worst. This applies to all children, not just children with ASD and can cause them unnecessary stress. While it’s challenging since adults don’t have all the answers right now either, we need to share what we do know with children in a factual, age and developmentally appropriate manner.

Ask them what they know or what they’ve heard and correct any misconceptions that they have. Let them know the things that you’re doing to keep them safe and what they can do to control their own safety. For example, more vigilant handwashing and social distancing. Try to limit their exposure to news coverage, as it can be overwhelming and excessive. Above all, make sure your child understands that this is not forever. This is just a rough patch or a difficult time we’re going through, and we’ve gone through difficult times before, but you always get through them together as a family.

Managing Disrupted Routines
A disruption to our regular routine can send any child in a spin, but for children with ASD, it can be especially hard to manage. Routine creates stability and order and any disruption in the routine can cause great stress and anxiety for a child with ASD. With the absence of your regular routine, create a new one for being at home quarantined. Creating a new routine creates comfort, reduces anxiety and promotes the maintenance of key skills. It may be challenging at first, but once a child with ASD learns a new routine, they often function incredibly well within the boundaries of that routine. Some tips that can help are:

  • If possible, try to stick to regular schedule for sleep/waking up.
  • Creating a visual schedule and calendars can be useful for indicating play, meals, schoolwork, exercise and other times.
  • Creating a special workspace if possible
  • Building in a few periods for physical exercise or outside time to promote health and help focus and organize the child.
  • Incorporating “lessons” into everyday activities such as cooking, laundry, cleaning, etc.

And give yourself permission to also “schedule” down time when your child and you can be away from each other if possible. Not everything has to be a learning opportunity, especially since parents may also be working from home and have many, many competing things to do.

Combating Setbacks from Social Isolation
This can be especially challenging for children with ASD who often have difficulty with social skills. You can create therapeutic social opportunities from home or while practicing safe social distancing, though via alternative modalities. You can FaceTime, video chat or make phone calls with family and friends. Look at your social support networks and explain to them that even a brief phone call or video chat gives your child an opportunity to engage in therapeutic interaction that’s necessary for them to practice. You can even have a conversation with a willing neighbor from a safe distance.

While it may be tempting, don’t let your child get too comfortable in the bubble they have at home. Build this new form of socializing into the new routine and schedule.

Monitoring Mood and Anxiety
Monitor your child’s mood and your own mood. Kids tend to pick up on the mood and anxiety of adults around them. Try to model calm. Watch for indications of that your child is upset, recognizing that people with ASD may express upset in distinctive ways, for example, laughing when anxious, increased irritability, etc.

Create an environment that is not hyper focused on stress or doom and gloom. Don’t have the news on all day in the background. This is a good idea for the whole family. Take media breaks. Schedule times where mom and dad watch the news but try to keep anything stressful out of the earshot of your child. Watch things that nurture us instead – fun reruns of shows that the whole family enjoys or educational programs.

Practice self-care for yourself as well. It’s important that parents take care of themselves, both for their own health as well as the well-being of the family. Call a friend, try to get some time to yourself, color, draw, listen to music, sing, etc. And be gentle with yourself. You’re not your child’s teacher or therapist. Some days, you won’t be able to get everything done and that’s okay.

How Children’s Specialized Hospital is Addressing the Challenges Associated with COVID-19
Children’s Specialized Hospital (CSH), an RWJBarnabas Health facility, is thinking outside the box and getting creative to continue to provide care. All of CSH’s medical services – such as Developmental Pediatrics, Psychiatry, etc. – are still seeing all patients as scheduled via virtual or telephone visits and are providing all of our therapeutic services (psychology, speech, occupational therapy and physical therapy) via telemedicine as well. We also encourage parents to stay in close contact with your child’s therapists and support staff for additional strategies on helping your child with ASD cope during this time.