As an emergency measure to prevent the spread of SARS-CoV2 (COVID-19) infection, Spain has declared a state of alarm according to RD463/2020.
Although this measure seems reasonable and is surely necessary, it is normal that there are some concerns regarding the negative effects that prolonged school closures and home confinement may have on the physical and mental health of children.
These measures can especially affect children with neurodevelopmental disorders such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) or various behavioral disorders, among others.
How does confinement affect a child with ASD?
Autism spectrum disorder is an umbrella term used to describe and encompass, under the same name, a complex group of neurodevelopmental disorders of variable cause and prognosis. They share a similar clinical expression at the expense of a qualitative impairment in language development and reciprocal social interaction, as well as the development of a restricted and repetitive repertoire of interests (cognitive, behavioral…etc).
Although all ASD show qualitative impairment in these areas, their intensity of involvement is variable and asymmetrical. Therefore, the clinical presentation will be particularly different for each child.
It is important to take this concept into account when assessing the impact of confinement in this group, since the repercussion will depend on the particular characteristics of each child, his or her environment (size and characteristics of the house), routines, habits, among others.
Thus, there will be children who enjoy being confined at home with their toys and routines, and others whose repetitive and disruptive behaviors worsen or who show symptoms of irritability, anxiety, aggressiveness…etc.
How and why can confinement affect ASD?
People with ASD require previously established routines. The development of a restricted and repetitive repertoire of interests and their low cognitive-behavioral flexibility makes it difficult for them to adapt to sudden changes in their daily life, such as a confinement situation.
If we add to this the difficulties they have in understanding social situations such as those we are currently experiencing and the limited ability to put themselves in the place of the other, it is easy to understand a decompensation in clinical symptomatology and the worsening of associated problems.
In this context, the confinement situation could:
- Increase their repetitive behaviors.
- Increase disruptive, oppositional and defiant behaviors.
- Hinder their capacity for self-regulation, increasing levels of anxiety and irritability that may manifest themselves with an increase in self-injurious or heteroaggressive behaviors and greater difficulty in controlling them.
How can we reduce the effects on children with ASD?
This situation can also affect the child’s main caregivers, increasing their level of stress, distress and anxiety, and all of this enters into a vicious circle from which it is difficult to escape if the situation is prolonged.
How can we alleviate these problems?
For people with ASD, anticipation is essential. It can be helpful to use stories or pictograms to help them understand the emergency situation and what lies ahead in the coming weeks. Various resources can be found online for free access.
It is helpful to establish a routine and find a schedule similar to what they had before the confinement. For example homework, lunch, TV-Consoles and in the evening special family activities (dancing, cooking, singing, board games… ). It is important to limit screen time (including TV) and avoid doing sedentary activities all the time.
It is necessary to be flexible and tolerate certain self-regulation behaviors such as the increase of certain stereotypies.
Regarding the concern that parents have about the loss of the corresponding therapies during the quarantine period, we recommend contacting the early care centers to provide them with certain guidelines or easy objectives that can be worked on at home, as well as using the many online resources available or contacting the specialists who, like me, have telemedicine.