A Model of Support for Families of Children with Autism Living in the COVID-19 Lockdown: Lessons from Italy

Abstract

Italy has been the European country most affected by the COVID-19 pandemic to date and has been in social lockdown for the longest period of time compared to other countries outside China. Almost overnight, Italian behavior analysts were faced with the challenge of setting up remotely whole-family systems aimed at maintaining adaptive skills and low levels of challenging behavior carried out solely by caregivers. Given these extraordinary circumstances, the protocols available from the applied behavior analytic, parent training, and autism literature did not appear fully to meet the need of parents having to be with their child under extreme levels of stress in a confined space with limited reinforcers for 24 hours a day, 7 days a week. To meet this unprecedented challenge, we developed a dynamic and holistic protocol that extended to the full day and that recognized the need for sustainable intervention delivered solely by parents who were often looking after more than one child. These practices are presented in this paper, together with a discussion of lessons we have learned thus far, which may be useful for behavior analysts working in other regions in which the effects of the pandemic are not yet fully realized. Although somewhat unorthodox, we include some parent comments at the end with the goal of sharing the parent perspective in real time as this pandemic unfolds across the world.

The impact of the COVID-19 pandemic on children with autism spectrum disorders

“…This approach has been successfully implemented in Italy, which has developed the infrastructure to administer ABA therapy via telemedicine. In this program, children are provided ABA therapy of different intensity based on their needs [17]. Verbally interactive children receive direct daily sessions with an ABA "tutor" via telehealth using PowerPoints and shared screens.…”

“…Normally while at home, children are given free access to items and ac-tivities without being required to complete a task beforehand. In addition, parents are given a basic program of maintenance to prevent significant skill loss [17]. However, these regular reinforcement options are now limited (e.g.…”

Telehealth mask wearing training for children with autism during the COVID‐19 pandemic

“…The current context of the COVID‐19 pandemic poses severe restrictions to face‐to‐face interventions in many world regions. Therefore, telehealth delivery would add social validity to a mask wearing intervention (Degli Espinosa et al, 2020). An emerging literature has demonstrated the feasibility and effectiveness of training caregivers via telehealth to implement interventions for children with autism, including interventions to reduce challenging behavior (Wacker et al, 2013), increase communication (Barkaia et al, 2017), and improve joint attention (Neely et al, 2016) and imitation (Wainer & Ingersoll, 2015).…”

Higher education, behaviour analysis, and autism: time for coalescence

“…Behaviour analysts have addressed issues related to stress, isolation, and mental health as well as learning of new skills (O'Donnell, 2019). During the pandemic, behaviour analysts have made their materials and books available free of charge (Bondy & Frost, 2020;Espinosa et al, 2020;Fein, 2020;Hume et al, 2020) or at much reduced prices (Newman, 2020).…”