Autistic children and adolescents with frequent restricted interest and repetitive behavior showed more difficulty in social cognition during mask-wearing during the COVID-19 pandemic: a multisite survey

Abstract

Background The public health measures enacted in order to control the coronavirus disease (COVID-19) pandemic have caused considerable changes to daily life. For autistic children and adolescents, adapting to the “new normal,” including mask-wearing, may be difficult because of their restricted interest and repetitive behavior (RRB) characteristics. We aimed to examine the relationships between RRB characteristics and the impact of mask-wearing on their social communications during the pandemic. Methods We recruited participants with a clinical diagnosis of autism spectrum disorder based on DSM-5 diagnostic criteria from two outpatient clinics in Tokyo, Japan, between November 2020 and April 2021 using a convenience sampling methodology. As a result, the participants consisted of 102 children and adolescents (mean (SD) age = 11.6 (5.3)). We collected data on RRB characteristics frequency before and during the pandemic using the CoRonavIruS Health Impact Survey (CRISIS) – Adapted for Autism and Related Neurodevelopmental conditions (AFAR). We then conducted factor analyses to compute the RRB severity composite scores, which are divided into lower- (e.g., sensory seeking), and higher-order (e.g., restricted interest). We also investigated mask-wearing culture using a bespoke questionnaire, and using Spearman’s rank correlation analyses, we examined the relationships between before pandemic RRB characteristics, and the impact of mask-wearing on social communications during the pandemic. Results We found that children and adolescents who exhibited lower-order RRB before the pandemic had difficulties in going-out with mask-wearing (rho = -0.25, q = .031), more challenges with mask-wearing (rho = − 0.34, q = .0018), and difficulty in referring to others’ emotions while wearing masks (rho = − 0.36, q = .0016). We also found an association between higher-order RRB before the pandemic and an uncomfortable sensation (rho = − 0.42, q = .0002) and difficulties in referring to other’s emotions while wearing masks (rho = − 0.25, q = .031). Conclusions We revealed that various behaviors, such as sensory seeking, repetitive motor mannerisms and movements, and rituals and routines, undertaken before the pandemic could be important predictors of difficulties with mask-wearing and social communication for autistic children and adolescents during the pandemic. Caregivers and teachers wearing masks may need to provide extra support for social communication to autistic children and adolescents showing RRB characteristics frequently.

Locked down-locked in: experiences of families of young children with autism spectrum disorders in Delhi, India

“…In terms of COVID-specific behavior such as wearing masks, regular hand washing etc., our study yielded mixed findings. While some children embraced the precautions, others found it difficult to adhere to them, and this may be due to underlying sensory sensitivities or a difficulty in adapting to novel routines ( 46 , 47 ).…”

Children's experiences of mask‐wearing: a systemic review and narrative synthesis

“…The specific educational setting of a child must be appreciated when evaluating mask-wearing, alongside any additional needs that children may have. 29,36,45,48,54,63 Literature has shown that accommodations can be made for specific populations of children who may experience additional barriers to mask-wearing, such as children with hearing loss. Lalonde et al 45 demonstrated that adults and children with normal hearing and children with bilateral hearing loss were similarly impacted by face masks, but that accommodations could be made if necessary.…”

“…The specific educational setting of a child must be appreciated when evaluating mask‐wearing, alongside any additional needs that children may have 29,36,45,48,54,63 . Literature has shown that accommodations can be made for specific populations of children who may experience additional barriers to mask‐wearing, such as children with hearing loss.…”

Investigating the impact of disposable surgical face‐masks on face identity and emotion recognition in adults with autism spectrum disorder

“…Typical face processing (i.e., holistic processing) can be “artificially” disrupted in TDs when a part of the face is concealed, thus leading to face perception difficulties, such as in faces wearing burqa (Kret & de Gelder, 2012), sunglasses (Graham & Ritchie, 2019; Kotsia et al, 2008), ski mask (Manley et al, 2019) and DSFMs (Ventura et al, 2023). This suggests that ASDs could be even more vulnerable than TDs to the massive use of DSFMs in everyday social situations; it has been already shown that DSFMs and lifestyle changes due to public health measures led to more difficulties in social cognition and communication in ASD subjects, particularly the ones presenting higher pre‐pandemic restricted interest and repetitive behavior characteristics (Tamon et al, 2022). Concerning identity and emotion recognition, the only study so far available on ASDs' “identity route” reported disruptive effects of DSFMs for faces initially learned unobstructed; on the contrary, when faces were memorized with DSFMs, ASDs showed an advantage in recognizing masked faces; thus, DSFMs' effect seems to be mediated by the encoding context (Tso et al, 2022).…”