ASD and Mental Health During the COVID-19 Pandemic – Funto Orimalade
This article is written from the perspective of a psychiatrist with a special interest in Autism Spectrum Disorder.
These are unprecedented times for all, having to deal with a pandemic that has largely shut the whole world down. Schools, various community programs, and workplaces have been closed in order to conform to the requirements of various Public Health departments around the world.
These changes and the associated uncertainty are highly likely to affect individuals with ASD.
Since the pandemic, my experience has been that certain individuals with ASD have reported that being in a lock-down situation, and therefore not being under any pressure to go out of the house, has been one of the best things that have happened to them in a long time; whereas for other individuals that had routines that involved access to various communities activities, these have been very distressing times.
This article suggests certain strategies to reduce the likelihood and/or severity of a meltdown, distress, or mental health decline.
1. Communication Strategies
It is essential that individuals with ASD are given information about COVID -19 and the interventions in place to manage the current outbreak. Some topics needing discussion are related to:
- What is COVID -19?
- Social Distancing
- Keeping hands away from the face
- Changes in routines and plans
In order to communicate effectively, strategies should be targeted at the level of communication of the individual with ASD, and previously effective methods of communication should be considered first.
It is important that the information is:
- Easy to understand
- Consistently repeated by others
Apart from verbal communication, other means of communication may include:
- Visual aids with pictures or graphics
- Social stories
- Prompt cards for cuing
- Task charts that can be checked off, e.g. with a hand-washing routine.
2. Structure, Routine, and Predictability:
Many individuals with ASD thrive within a clear structure that affords schedules or timetables, predictable routines, and well-demarcated transitions throughout the day. Many already have routines that have run for a substantial length of time and have now been disrupted by the current circumstances. It is important to still keep all activities within a clear structure that also affords predictability.
Include the following in routines and schedules:
- Daily physical activity – e.g. walks, exercise, bike rides, yoga etc.
- A predictable positive bedtime routine.
- Opportunities for meeting sensory needs as per sensory diet or plan.
- Calming activities – for example, alone time and breaks. These may also serve to reduce the impact of unwanted sensory input. There are probably more people at home and more gadgets, some of which may be producing unwanted noise, e.g. by video calls from relatives or care providers working from home.
During these times, using virtual means to create new activities and, as much as possible, to allow certain prior activities to happen, will help minimize the impact of the disruption and keep routines going.
3. Social Connectedness
Although we are keeping social distancing rules, we can still stay connected. For some individuals with ASD, staying connected to the people they regularly see is important to them. These should be fostered as much as possible through virtual means. Encourage staying in touch with friends; relatives are other positive contacts. During these times, social media may be a healthy outlet and support. Again, for some individuals, this is best achieved within a structured framework.
4. Mental Health
The mental health of the individual with ASD and of the care provider is equally important.
- Watch out for changes in behavior, or increases in the frequency or intensity of old behavior.
- Regular services may be unavailable, so find out what services the individual can access. Many services are running virtually, and so it is important to be able to connect with support virtually, including via video.
- Reach out to regular treatment team professionals like mental health therapists, psychologists, psychiatrists, pediatricians, and family doctors.
- Refer to a crisis plan – it is ideal that a crisis plan is drawn up at the start. It may still be possible to get one drawn up as soon as possible for a future crisis. If one is already available, use it in a crisis.
- Proceed to the nearest Emergency Room (ER) as needed, making sure that the particular ER is accepting Non-COVID patients by making a call ahead to inquire.
5. Managing Challenging Behaviour
- The behavior usually serves a function.
- It is important to watch out for changes in behavior during this time.
- Use clear communication and empathy to find out what may be underlying the distress or behavior as early as possible.
- If there is a Support Plan already drawn up for the individual, follow this as much as possible.
- For new behaviors, as mentioned above, clear communication is essential to find out what is underlying the behavior.
- Keep notes, as you gather information on what the triggers of new behavior seem to be and what happens after the behavior has ended. This is useful information for the treatment team, as well as for care providers.
- Follow guidelines for using prescribed medication as the individual’s doctor has instructed.
- As a care provider, stay calm and positive as much as possible, as you continue to be empathic, confident, and clear in communication.
Dr. Funto Orimalade MD MRCPsych (UK) FRCPC (Canada) LLM
- Addiction and Mental Health, Alberta Health Services, Edmonton
- Edmonton Autism and Neurodevelopmental Clinics- Edmonton Specialists Clinic, Edmonton
- Adult Autism Diagnostic Service, Glenrose Rehabilitation Hospital, Edmonton
- Forensic Assessment and Community Services, Edmonton
- Assistant Clinical Professor, Department of Psychiatry, University of Alberta