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

Masks and respirators for prevention of respiratory infections: a state of the science review

SUMMARYThis narrative review and meta-analysis summarizes a broad evidence base on the benefits-and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts-of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of key clinical trials, produced seven key findings. First, there is strong and consistent evidence for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens. Second, masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect. Third, respirators are significantly more effective than medical or cloth masks. Fourth, mask mandates are, overall, effective in reducing community transmission of respiratory pathogens. Fifth, masks are important sociocultural symbols; non-adherence to masking is sometimes linked to political and ideological beliefs and to widely circulated mis- or disinformation. Sixth, while there is much evidence that masks are not generally harmful to the general population, masking may be relatively contraindicated in individuals with certain medical conditions, who may require exemption. Furthermore, certain groups (notably D/deaf people) are disadvantaged when others are masked. Finally, there are risks to the environment from single-use masks and respirators. We propose an agenda for future research, including improved characterization of the situations in which masking should be recommended or mandated; attention to comfort and acceptability; generalized and disability-focused communication support in settings where masks are worn; and development and testing of novel materials and designs for improved filtration, breathability, and environmental impact.

Telehealth services for children with neuro-developmental disabilities in the Asia-Pacific region: A systematic review

BACKGROUND

In recent years telehealth became a popular and a rational health service delivery approach, especially amidst multiple challenges posed while providing health care interventions during the COVID-19 pandemic.

AIM

We synthesized available evidence on telehealth for managing children with NDDs in the Asia-Pacific region with the aim of identifying successful methods.

METHODOLOGY

We systematically reviewed six electronic databases: MEDLINE, AMED, EMBASE, PsychInfo, Web of Science, and (CINAHL plus) using the keywords and database-specific subject headings from their inception to 25th August 2021. Review findings were synthesized narratively, and harvest plots were used to demonstrate the effect of interventions. The protocol and reporting the findings of this review adhered to PRISMA 2020 guidelines. PROSPERO registration: CRD 340690.

RESULTS

We harvested 30,823 records; 17,563 duplicates were removed, and 196 full-text articles were assessed for eligibility. 16 studies with multiple research designs were included in the review. Eight were from the Pacific region and eight represented Asia. The interventions targeted families and children with a variety of NDDs (autism spectrum disorder, Down syndrome, cleft lip and palate, hearing impairment, cerebral palsy etc.) via telehealth. Telehealth packages consisted of direct and indirect methods of synchronous, asynchronous, and hybrid approaches. All studies used parent-led intervention strategies. Telehealth reported a positive effect in 7/16 studies while five showed a neutral effect.

CONCLUSIONS

According to published evidence telehealth for children with NDDs is an evolving, evidence-based service facilitation modality in the Asia-Pacific region, with only a few published randomized controlled trials. The systematic review shows promising telehealth practices emerging across the region despite the diversity in NDDs studied.

Increasing Face Mask Wearing in Autistic Individuals Using Behavior Analytic Interventions: A Systematic Review and Meta-analysis

The current review aimed to evaluate the effectiveness of behavior-analytic procedures in increasing face mask-wearing in autistic individuals. This comes following recommended guidance during the COVID-19 pandemic. A systematic review and meta-analysis were completed of peer-reviewed and grey literature. Six databases were searched and seven studies using single-case experimental designs met the eligibility criteria which were then quality appraised. Data were extracted on participant characteristics, study design, independent and dependent variables, fidelity, generalization, maintenance, and social validity outcomes. Both the non-overlap of all pairs and Baseline Corrected TAU were used to estimate effect size. Two studies were rated strong and borderline strong quality and five were rated as adequate or below. All studies showed positive outcomes for mask-wearing, with an average of 0.92 for non-overlap of all pairs and 0.47 for Baseline Corrected Tau effect sizes. The most common and effective procedures for increasing mask-wearing were graded exposure and differential and positive reinforcement. Factors such as mode of delivery, implementer, and setting did not appear to influence study outcomes. Procedures were found to be rated as acceptable by parents and professionals in five of the studies. The existing literature on increasing face mask-wearing in autistic individuals provides promising findings to add to existing literature around increasing tolerance to medical equipment and hygiene practices in autistic populations. However, these findings are based on a small sample size, with six of the studies taking place in the United States with varying study quality.

Expert Consensus on the Resource Needs of Autistic Children and Young People in Ireland During the Early Months of the COVID-19 Pandemic

The COVID-19 pandemic has brought significant changes across society. This Delphi study aimed to gain expert consensus on challenges faced and resource needs for autistic children during the COVID-19 pandemic. Round 1 of the Delphi method employed semi-structured interviews with experts (N = 24) which were thematically analysed in order to identify needs, resource targets and resource development. In a follow-up Round 2 survey participants rated emergent need and resource in order of priority. Round 2 provided consensus on challenges faced with anxiety, routine and wellbeing ranked most important. Direction on resource design was also obtained. Consensus on the challenges and resources was achieved and is being integrated into a needs-based transition resources toolkit. Future studies could make use of the Delphi method to quickly gain consensus on focus of needs in other contexts and communities.

A Descriptive Review of Telehealth for Individuals With Autism Spectrum Disorder

Since the early 2000s, telehealth has been used to provide behavior analytic intervention to individuals with autism spectrum disorder (ASD). Evaluating evidence supporting telehealth remains valuable, especially as there has been increased accessibility since the COVID-19 pandemic. Although there is empirical support for telehealth as an effective service-delivery option, important variables (e.g., costs, implementer training) remain unknown. Despite potential roles in telehealth service-delivery models, a careful review of participant prerequisite skills, implementer characteristics (e.g., experience, education), technology variables (e.g., HIPAA compliance), and skill(s) targeted (i.e., mastered or untrained skills) have not been considered. Therefore, we aimed to extend prior telehealth literature reviews by evaluating current research across variables important for telehealth service-delivery involving individuals with ASD. We found thorough descriptions of participants and implementers, implementer training, and social validity evaluations. Limitations of telehealth literature include exclusion of teen and adult participants, limited description of prerequisite skills and evaluations of direct telehealth interventions. Future research areas were identified.

Effectiveness of a Brief Functional Analysis and Functional Communication Training Conducted Through Telehealth

This study evaluates the effectiveness of a brief functional analysis and functional communication training conducted via telehealth. Three interventionist-child dyads took part in the study including one speech and language pathologist and two school teaching assistants, each working with one child with autism spectrum disorder. Interventionists were trained using didactic training to implement a brief functional analysis as well as synchronous coaching from a BCBA^® to implement functional communication training. A multiple baseline across participants design was utilised to evaluate if interventionists could implement functional communication training to decrease challenging behaviours that included aggression, elopement and disruption. Sessions concluded earlier than planned due to school closures mandated by the COVID-19 outbreak for two of the three participants; however, existing data provide evidence that telehealth is a valid model for enabling clinicians to work in collaboration with school personnel to effectively deliver assessment and intervention procedures remotely via telehealth.

Patient safety implications of wearing a face mask for prevention in the era of COVID-19 pandemic: a systematic review and consensus recommendations

In the past, the use of face masks in western countries was essentially limited to occupational health. Now, because of the COVID-19 pandemic, mask-wearing has been recommended as a public health intervention. As potential side effects and some contraindications are emerging, we reviewed the literature to assess the impact of them in daily life on patient safety and to provide appropriate guidelines and recommendations. We performed a systematic review of studies investigating physiological impact, safety, and risk of masks in predefined categories of patients, which have been published in peer-reviewed journals with no time and language restrictions. Given the heterogeneity of studies, results were analyzed thematically. We used PRISMA guidelines to report our findings. Wearing a N95 respirator is more associated with worse side effects than wearing a surgical mask with the following complications: breathing difficulties (reduced FiO₂, SpO₂^, PaO₂ increased ETCO₂, PaCO₂), psychiatric symptoms (panic attacks, anxiety) and skin reactions. These complications are related to the duration of use and/or disease severity. Difficulties in communication is another issue to be considered especially with young children, older person and people with hearing impairments. Even if benefits of wearing face masks exceed the discomfort, it is recommended to take an "air break" after 1-2 h consecutively of mask-wearing. However, well-designed prospective studies are needed. The COVID-19 pandemic could represent a unique opportunity for collecting large amount of real-world data.

Views and experiences of individuals with autism spectrum disorder and their mothers during the COVID-19 pandemic

Background: The COVID-19 pandemic is thought to have a variety of effects on people with an autism spectrum disorder (ASD). The purpose of this study was to look into the perspectives and experiences of people with ASD and their mothers regarding the effects of the COVID-19 pandemic. Method: The current study employs a qualitative research approach. Semi-structured interviews were used to collect data. The study included the participation of 16 individuals. Eight of them had ASD, while the remainder were their mothers. Results: The information was divided into two categories: people with ASD and their mothers. The data collected from individuals with ASD were organized into four major themes: (a) the meaning of COVID-19 for them; (b) pandemic activities; (c) measures taken during the pandemic; and (d) pandemic reflection on the school. The data drawn from the mothers of the individuals with ASD were categorized into two themes: (a) the impact of the pandemic and (b) changes in children with ASD during the pandemic. Conclusions: The study results show that individuals with ASD could not perform as many activities during the pandemic as they would usually do. Hence, the results suggested that the participants were adversely affected by the pandemic.

Students with autism in an alternative classroom during COVID-19 pandemic: experiences shared by special educators in India

Introduction: During the COVID-19 pandemic, the students with Autism faced difficulties in teaching-learning due to campus closures. The special schools opted for alternative classrooms i.e. online mode. Due to certain specific and unique characteristics, the learning experiences of students with autism would be different from neurotypical students. Objectives: To know about the challenges and facilitators of the alternative classroom through the teacher's narratives. Method: The virtual interviews recorded by 15 special educators from special schools in Kolkata city and its outskirts, selected using purposive sampling were analyzed through inductive thematic analysis. Results: The generated themes reveal the challenges of setting up and adapting to the online classes faced by special educators, students, and their parents. The study findings also inform about the advantages gained during the pandemic such as parental involvement for better learning in a safe space. Conclusion: A combined mode of teaching might be appropriate for the future to bring out the best in the learners.

Using synchronous reinforcement to increase mask wearing in adults with intellectual and developmental disabilities

In 2020 the Centers for Disease Control provided the public with recommendations to slow the spread of COVID-19 by wearing a mask in the community. In the current study, experimenters coached group home staff via telehealth to implement synchronous schedules of reinforcement to increase mask wearing for 5 adults with intellectual and developmental disabilities. Results showed the intervention effectively increased mask wearing for all participants for up to 30 min. Additionally, some participants for whom we assessed generalization of mask wearing demonstrated generalization to various community environments. Furthermore, procedural integrity data suggested staff could be coached via telehealth to implement the intervention, and staff surveys suggested the procedures and coaching were socially valid.

The Efficacy of Using Telehealth to Coach Parents of Children with Autism Spectrum Disorder on How to Use Naturalistic Teaching to Increase Mands, Tacts and Intraverbals

There is a growing body of evidence supporting the use of telehealth to provide parent training in behaviour analytic interventions and researchers have begun to focus on international demonstrations of this model. The current study assessed the efficacy of a training package focused on naturalistic teaching strategies designed to upskill parents of children with autism spectrum disorder and provide them with ready to use strategies to increase social communication behaviours across verbal operants. Two parent-child dyads were trained to increase mand, tact and intraverbals during play. Parents displayed increases in fidelity for each strategy and viewed the training favourably. Both children showed gains across verbal operants, as captured by a multiple baseline across behaviours design.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10882-022-09859-4.

Extended Reality (XR) and telehealth interventions for children or adolescents with autism spectrum disorder: Systematic review of qualitative and quantitative studies

World Health Organization reported that almost one in 100 children is diagnosed with autism spectrum disorder (ASD) worldwide. Extended Reality (XR) and Telehealth interventions are evident to be effective for ASD treatments. While there is no comprehensive systematic review to summarize and evaluate the evidence for promoting the accessibility of different technology-based treatment regiments. This paper aims to verify the efficacy and validity of XR and Telehealth interventions for children and adolescents with ASD. We reviewed 112 studies from databases of PubMed, Web of Science and Cochrane Library, published in English between January 2010 to April 1st, 2022. We found that after interventions, positive improvements for ASD participants were observed in social interaction, acceptance, and engagement, communication and speech, emotion recognition and control, daily living skill, problem behavior reduction, attention, cost reduction, anxiety symptom reduction, pretend play, contextual processing, match to sample skill, and insomnia control. Our findings provide a solid and positive evidence of XR and Telehealth interventions in improving the treatment outcomes for children and adolescents with ASD. In the future, more research with RCTs and standardized outcome measurements are required to establish the therapeutic efficiency of the two interventions independently or combined.

The impact of COVID-19 measures on parent-reported restricted and repetitive behaviours in pre-school children with autism

Background

COVID-19 restrictive measures have had a considerable impact on daily life routines, which may be especially challenging for families of children with autism. In pre-schoolers with autism, it is likely that the disruption of routines mainly impacts the presence of restrictive and repetitive behaviours (RRBs). Furthermore, influence of comorbid conditions, secondary behavioural difficulties and home environment characteristics on RRBs was explored.

Method

A cross-sectional online survey design was used to collect parent-report data on 254 children with autism (2.5–6 years) during lockdown in the early months of the pandemic. RRBs were assessed using the Repetitive Behaviour Scale-Revised (RBS-R).

Results

Parents reported a significant increase in stereotypic, self-injurious, compulsive and ritualistic behaviour, and restricted interests after implementation of COVID-19 restrictions. The presence of a co-occurring condition, such as language impairments or intellectual disability, was associated with more self-injurious and stereotypic behaviour. However, there was no effect of home environment on RRBs. Further, most children showed increases in internalising and/or externalising behaviour. Increased inattentive behaviour was associated with more ritualistic and stereotypic behaviour, and restricted interests. Decreases in hyperactivity were related to more restricted interests. Importantly, in a subset of children, parents reported less behavioural difficulties during the lockdown.

Conclusions

Findings highlight the importance of flexible implementation and continuity of care for pre-schoolers with autism and support for parents. Further follow-up of children with autism and RRBs, and co-occurring behavioural difficulties is needed and could enhance our understanding of the long-term effects associated with sudden restrictive measures to daily routines.

Preliminary Practice Recommendations for Telehealth Direct Applied Behavior Analysis Services with Children with Autism

This article provides preliminary practice recommendations for telehealth direct applied behavior analysis (ABA) services for children with autism. In the face of COVID-19, there is an immediate need for discussion on how to implement various ABA procedures via telehealth for ABA practitioners. Alongside emerging scientific evidence on the effectiveness of telehealth direct service as well as various service-related guidelines, we provide preliminary practice recommendations that are based on the existing literature on in-person and telehealth ABA procedures. We also discuss these recommendations with case studies of two boys with autism. Social validity measures indicated that families were satisfied with telehealth direct services. Even after the COVID-19 pandemic has resolved itself, telehealth direct ABA service will still be a valuable option for remote and international locations where direct ABA service is limited, and thus, practice recommendations continue to be relevant for all practitioners that use telehealth direct service.

Psychosocial and Behavioral Effects of the COVID-19 Pandemic on Children and Adolescents with Autism and Their Families: Overview of the Literature and Initial Data from a Multinational Online Survey

Since COVID-19 has become a pandemic, everyday life has seen dramatic changes affecting individuals, families, and children with and without autism. Among other things, these changes entail more time at home, digital forms of communication, school closures, and reduced support and intervention. Here, we assess the effects of the pandemic on quality of life for school-age autistic and neurotypical children and adolescents. First, we provide a comprehensive review of the current relevant literature. Next, we report original data from a survey conducted in several countries, assessing activities, well-being, and social life in families with autism, and their changes over time. We focus on differences between children with and without autism from within the same families, and on different outcomes for children with high- or low-functioning autism. While individuals with autism scored lower in emotional and social functioning than their neurotypical siblings, both groups of children showed comparable decreases in well-being and increases in anxiety, compared to before the pandemic. By contrast, decreases in adaptability were significantly more pronounced in autistic children and adolescents compared to neurotypical children and adolescents. Overall, although individual families reported some positive effects of pandemic restrictions, our data provide no evidence that these generalize across children and adolescents with autism, or even just to individuals with high-functioning autism. We discuss the increased challenges that need to be addressed to protect children and adolescents’ well-being under pandemic conditions, but also point out potentials in the present situation that could be used towards social participation and success in older children and young adults with autism.

Humble Behaviorism Redux

The need to bring behavior analysis to scale is no more obvious or urgent than now. Collaboration between behavior analysts and healthcare workers, educators, policymakers, mental health clinicians, social workers, and so many other professionals is critical to reaching under-resourced and traditionally marginalized populations. First, however, interprofessional collaboration must be adopted widely and reinforced within the behavior analytic community. Disciplinary centrism and hubris pose barriers to effective interprofessional collaboration, leading one to assume the position that practitioners of the same discipline are better trained and smarter than those of a different field. However, cultural humility (Wright, Behavior Analysis in Practice, 12(4), 805-809, 2019) is an alternative to disciplinary centrism that allows professionals to retain identities born of cultural histories and training (Pecukonis, Journal of Teaching in Social Work, 40(3), 211-220, 2020). Furthermore, cultural reciprocity is a process of self-observation and collaborative inquiry that involves questioning one's own assumptions and forces individuals (and professions) to confront the contradictions between their values and their practices (Kalyanpur & Harry, 1999). In this paper, we revisit the call for Humble Behaviorism first made by Alan Neuringer in 1991 and the recommendations of fellow behavior analysts since. Specifically, we introduce a framework of cultural reciprocity to guide humble behaviorists as they acquire behaviors necessary to establish and maintain productive interprofessional relationships. We encourage them to act on their ethical and moral duties to address social problems of global concern and bring behavior analysis to scale.

A Scoping Review of the Healthcare and Hygiene Literature for Individuals with Intellectual and Developmental Disabilities

OBJECTIVES

Previous reviews highlight the similarities in teaching healthcare and hygiene routines to individuals with and without intellectual and developmental disabilities. Additionally, similar interventions are used when interfering behaviors occur. Although these routines are topographically distinct, there are enough similarities to suggest effective procedures for one routine may be used to inform another. This scooping review aims to identify effective teaching and intervention procedures for healthcare and hygiene routines specifically for individuals with intellectual and developmental disabilities. We also evaluated the extent to which functional analyses were conducted; a dimension not included in previous reviews.

METHODS

Eligible articles targeted compliance or tolerance within the context of a defined healthcare or hygiene routine as a dependent variable and used an experimental design with a demonstration of experimental control. Articles were identified through PsycINFO, PubMed, and Academic Search Premier databases. Additionally, a hand search of five related journals was conducted. Data were collected on dependent variables, functional analyses, baseline contingencies, teaching procedures, and additional experimental components.

RESULTS

A total of 52 articles met inclusion criteria. Most experiments produced positive outcomes. The findings show all experiments involved a treatment package with multiple components. The most common teaching procedures were graduated exposure and DRA. A lack of functional analyses and social validity was noted.

CONCLUSIONS

Component analyses are needed to identify the most effective and efficient procedures. Pyramidal training to teach medical professionals how to provide preventative pyramidal training should be explored.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s41252-022-00249-7.

Hand hygiene and mask-wearing behaviors and the related factors during the COVID 19 pandemic: A cross-sectional study with secondary school students in Turkey

PURPOSE

The research was conducted to determine the hand hygiene and mask-wearing behaviors and related factors of secondary school students in the COVID-19 pandemic process.

DESIGN AND METHODS

This descriptive cross-sectional study was conducted between March 02-April 022021 with 1284 students who continued their secondary education in a province in the east of Turkey. The data were collected face-to-face through the Descriptive Characteristics Form, the Mask-Wearing Behavior Form, and the Hand Hygiene Behavior Form. Percentage, mean, t-test in independent groups, Mann Whitney U test and Multiple Regression analysis were used in the evaluation of the data. Ethical principles were observed at all stages of the study.

RESULTS

It was determined that 80.1% of the students used disposable medical masks, 62.1% of their parents chose a mask suitable for the age of the student, and 52.1% used the mask they wore all day long. It was found that 41.4% of the students washed their hands before wearing a mask, and 51.9% after wearing a mask. It was determined that there was a significant relationship between students' mask-wearing behavior and gender, and hand hygiene behavior and gender, grade level, previous training on hand-washing and mask-wearing. As a result of multiple regression analysis, it was found that gender and mother's occupation had a statistically significant effect on mask-wearing behavior, while gender and previous training on mask-wearing had a statistically significant effect on hand-washing behavior.

CONCLUSIONS/PRACTICE IMPLICATIONS

Students exhibited correct behaviors regarding hand hygiene and mask-wearing, but some misbehaviors suggest that training is necessary, especially in the COVID-19 pandemic period.

Children with severe disabilities: adaptation, virtual education, and prospects. Experiences of three Peruvian mothers, COVID-19 context

This study aimed to reveal and investigate mothers' experiences of students with severe disabilities regarding learning in distance education in Lima-Peru. This is a phenomenological study focused on understanding the world of mothers regarding the education of their children with severe disabilities. Their discourse focused on four categories: being the mother of a child with severe disability, pandemic category, virtual education, and family prospects. The participants were three mothers of children with Down Syndrome, Autism Spectrum Disorder, and Cerebral Palsy. An in-depth interview structured in 26 questions was used, applied face to face. With distance education, the mothers consider that their children's abilities and skills have assumed a leading role, developed creativity, and employed various strategies to comply with school activities. In addition, it also strengthened their family ties despite the pandemic.

Applications of Technological Solutions in Primary Ways of Preventing Transmission of Respiratory Infectious Diseases-A Systematic Literature Review

With the growing concern about the spread of new respiratory infectious diseases, several studies involving the application of technology in the prevention of these diseases have been carried out. Among these studies, it is worth highlighting the importance of those focused on the primary forms of prevention, such as social distancing, mask usage, quarantine, among others. This importance arises because, from the emergence of a new disease to the production of immunizers, preventive actions must be taken to reduce contamination and fatalities rates. Despite the considerable number of studies, no records of works aimed at the identification, registration, selection, and rigorous analysis and synthesis of the literature were found. For this purpose, this paper presents a systematic review of the literature on the application of technological solutions in the primary ways of respiratory infectious diseases transmission prevention. From the 1139 initially retrieved, 219 papers were selected for data extraction, analysis, and synthesis according to predefined inclusion and exclusion criteria. Results enabled the identification of a general categorization of application domains, as well as mapping of the adopted support mechanisms. Findings showed a greater trend in studies related to pandemic planning and, among the support mechanisms adopted, data and mathematical application-related solutions received greater attention. Topics for further research and improvement were also identified such as the need for a better description of data analysis and evidence.

Evaluation of a Graduated Exposure Procedure to Teach Extended Mask Wearing in Various Settings to Children With Autism

During the COVID-19 outbreak, the Center for Disease Control (CDC) recommended that everyone 2 years and older wear a face mask while in a community setting. However, children with autism may be reluctant to wear a mask, particularly for extended durations. In the current study, we implemented a graduated exposure procedure to teach mask wearing for a minimum of 1 hour in an early intensive behavioral (EIBI) intervention clinic to three children diagnosed with autism. We subsequently probed mask wearing, and if necessary implemented the graduated exposure procedure, in each participant's home and in a mock physician's office. Finally, we collected probe data on mask wearing in another community setting and 1 month post-treatment maintenance data in the EIBI clinic. During baseline, participants wore masks for 0 second to 5 minutes. After treatment, all participants wore the mask for at least 1 hour in each setting, with maintenance probes indicating 4 to 5 hour mask tolerance.

Facial masks affect emotion recognition in the general population and individuals with autistic traits

Facial expressions, and the ability to recognize these expressions, have evolved in humans to communicate information to one another. Face masks are equipment used in healthcare by health professionals to prevent the transmission of airborne infections. As part of the social distancing efforts related to COVID-19, wearing facial masks has been practiced globally. Such practice might influence affective information communication among humans. Previous research suggests that masks disrupt expression recognition of some emotions (e.g., fear, sadness or neutrality) and lower the confidence in their identification. To extend the previous research, in the current study we tested a larger and more diverse sample of individuals and also investigated the effect of masks on perceived intensity of expressions. Moreover, for the first time in the literature we examined these questions using individuals with autistic traits. Specifically, across three experiments using different populations (college students and general population), and the 10-item Autism Spectrum Quotient (AQ-10; lower and higher scorers), we tested the effect of facial masks on facial emotion recognition of anger, disgust, fear, happiness, sadness, and neutrality. Results showed that the ability to identify all facial expressions decreased when faces were masked, a finding observed across all three studies, contradicting previous research on fear, sad, and neutral expressions. Participants were also less confident in their judgements for all emotions, supporting previous research; and participants perceived emotions as less expressive in the mask condition compared to the unmasked condition, a finding novel to the literature. An additional novel finding was that participants with higher scores on the AQ-10 were less accurate and less confident overall in facial expression recognition, as well as perceiving expressions as less intense. Our findings reveal that wearing face masks decreases facial expression recognition, confidence in expression identification, as well as the perception of intensity for all expressions, affecting high-scoring AQ-10 individuals more than low-scoring individuals.

'I did not even receive even a phone call from any institution!': experiences and recommendations related to disability during COVID-19

Background: Individuals with disabilities and their families, among the disadvantaged groups in society, have encountered increased hardships accessing support and services in various social contexts, such as education, health, transportation, rehabilitation, and social services. Thus, it is essential to examine parents' experiences as a background catalyzer to improve the currently available services and provide psychological and social support. This study examined the experiences of families of children with disabilities who were in Turkey during the pandemic's early stages, and yielded suggestions based on these experiences. Method: A phenomenological design was used in this study, and semi-structured interviews were conducted with 10 parents of children with disabilities. Findings: Three themes emerged from data analysis: (a) quarantine, (b) education, and (c) children with disabilities. Conclusions: The findings revealed the importance of taking necessary precautions for individuals with disabilities and their families to access social services. Additionally, findings underline the essentiality of providing psychological support to families while providing and extending family education.

Telehealth and Autism Prior to and in the Age of COVID-19: A Systematic and Critical Review of the Last Decade

There has been growing interest in the use of telehealth; however, the COVID-19 pandemic and the subsequent isolation and restrictions placed on in-person services have fast-tracked implementation needs for these services. Individuals with autism spectrum disorder (ASD) have been particularly affected due to the often-intensive service needs required by this population. As a result, the aim of this review was to examine the evidence base, methodology, and outcomes of studies that have used telehealth for assessment and/or intervention with children and adolescents with ASD as well as their families over the last decade. Further, the goal is to highlight the advances in telehealth and its use with this special population. A systematic search of the literature was undertaken, with 55 studies meeting inclusion criteria and quality analysis. Specified details were extracted from each article, including participant characteristics, technology, measures, methodology/study design, and clinical and implementation outcomes. Services provided via telehealth included diagnostic assessments, preference assessments, early intervention, applied behavior analysis (ABA), functional assessment and functional communication training, and parent training. Findings, although still emerging, encouragingly suggested that services via telehealth were equivalent or better to services face-to-face. Results support the benefits to using telehealth with individuals with ASD. Future research should continue to explore the feasibility of both assessments and interventions via telehealth with those having ASD to make access to assessment services and interventions more feasible for families, while acknowledging the digital divide it could create.

Mental health of parents of children with autism spectrum disorder during COVID-19 pandemic: A systematic review

BACKGROUND

Children diagnosed with autism spectrum disorder (ASD) may have great difficulties when their routines change, and this may affect the psychological well-being of their parents. For this reason, it is important to examine studies that address the mental health of parents in order to adapt to the coronavirus disease 2019 (COVID-19) pandemic.

AIM

To determine the mental health status of parents with children diagnosed with ASD in the COVID-19 pandemic.

METHODS

The study, which is a systematic review, was conducted between December 15, 2020 and December 30, 2020 by scanning articles in English. The Scopus, Science Direct, PubMed, Cochrane, Web of Science, and Google Scholar databases were used for scanning. The keywords COVID-19 AND ("autism" OR "autistic" OR "autism spectrum disorder") AND parent AND ("mental health" OR "anxiety" OR "stress") were used in the search process. The inclusion criteria in the study were findings regarding the mental health of parents with children diagnosed with ASD in the COVID-19 pandemic, addressing their anxiety and stress situations, being a research article, and accessing the full text of the article.

RESULTS

In the study, a total of 6389 articles were reached, and the full texts of 173 articles were evaluated for eligibility. After the articles excluded by the full-text search were eliminated, 12 studies involving 7105 parents were included in the analysis. The findings obtained from the articles containing data on mental health in the COVID-19 pandemic of parents with children with autism spectrum disorder were discussed in three groups. These were findings on the experiences of parents with children with ASD in the COVID-19 pandemic regarding the areas where parents with children with ASD need support in the COVID-19 pandemic and methods of coping with the COVID-19 pandemic for parents with children with ASD. In the systematic review, it was determined that the anxiety and stress of the parents increased, they needed more support compared to the pre-pandemic period, and they had difficulty coping.

CONCLUSION

In this systematic review, it was concluded that the COVID-19 pandemic negatively affected the mental health of the parents of children with ASD.

Electromyography of diurnal bruxism during assessment and treatment

Diurnal bruxism among individuals with intellectual disabilities is often measured on the basis of its auditory products, thereby precluding the contingent presentation of stimuli during silent bruxism events. Electromyography (EMG) offers a technological solution to the identification of all bruxism events. EMG has not been previously evaluated in nonvocal clients with intellectual disabilities in the context of functional analysis and treatment. In the current series of analyses, we suggest a set of methods to implement EMG technology with this population. In Analysis 1, we propose a strategy for systematically identifying bruxism events. In Analysis 2 we evaluate an EMG staff-training package with naïve interventionists without past experience with EMG technology. Finally, Analysis 3 presents a practical example of this method during the functional analysis and treatment of a client with frequent diurnal bruxism.

"This may be a really good opportunity to make the world a more autism friendly place": Professionals' perspectives on the effects of COVID-19 on autistic individuals

BACKGROUND

The COVID-19 (C-19) pandemic affects everyone. Autistic individuals may be at increased risk of experiencing difficulties coping with the impact of C-19 (e.g. due to unexpected changes to usual activities and routines, and the general sense of uncertainty). This preliminary study gathered the perspectives of health and social care professionals, and researchers, about: (1) vulnerability factors for coping with the pandemic; (2) the impact of the pandemic; (3) service provision during the pandemic; and (4) interventions to support reintegration during and post the pandemic.

METHOD

We conducted an online survey, comprising Likert-scale and free text responses. Quantitative data were analysed descriptively, and qualitative data thematically.

RESULTS

Thirty-seven participants, working in clinical, education and academic settings with autistic individuals, completed the survey. C-19 had substantially impacted service provision, causing major disruption or loss of services. Thematic analysis indicated six overarching themes: (1) vulnerability factors for coping with C-19 and lockdown; (2) positive and negative impact of lockdown (for autistic individuals, families and professionals); (3) public health response to C-19; (4) service provision during the pandemic; (5) inequalities; and (6) looking to the future.

CONCLUSIONS

Professionals, across disciplines and settings, must now work together with autistic individuals and their families, to understand the impact of these extraordinary circumstances and develop ways everyone can be supported more effectively.

Tolerance of face coverings for children with autism spectrum disorder

Healthcare professionals and government officials have advised the use of personal protective equipment, such as face masks and face shields, to assist with limiting the spread of the SARS‐CoV‐2 (COVID‐19). Due to the prevalence of challenging behavior associated with other medical routines, the present study evaluated a treatment package composed of graduated exposure, prompts, reinforcement, and escape extinction on tolerance of wearing a face covering for up to 5 min for 12 children with ASD in a systematic replication of Cox et al. (2017) and Sivaraman et al. (2020). We also extended previous research by measuring generalization of face covering type (i.e., face shield) and the efficacy of a treatment extension for tolerating a face covering for up to 15 min during the participants' trial‐based instruction and play periods.

Increasing passive compliance to wearing a facemask in children with autism spectrum disorder

The current study taught 6 children with autism spectrum disorder (ASD) to increase passive compliance of wearing a facemask across sequentially increasing durations of time. A changing-criterion design embedded within a nonconcurrent multiple baseline design was used to evaluate the effectiveness of a resetting differential reinforcement of other behavior (DRO) without escape extinction procedure on passive compliance. Terminal probe sessions determined DRO fading intervals. Results showed that 2 participants acquired mastery level passive compliance (30 min) without fading during the initial baseline sessions. The remaining 4 participants acquired mastery level passive compliance following fading intervals within the DRO intervention. Participants' passive compliance generalized across 2 novel settings. This study replicates previous studies and extends empirical support for the use of DRO without escape extinction interventions for increasing passive compliance with medical devices in children with ASD.