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

The psychological impact of the COVID-19 pandemic on children/adolescents with ASD and their family environment: a systematic review

The main objective of the review is to analyze the impact of the pandemic in children/teenagers with Autism spectrum disorder (ASD) and in their family environment. An electronic search was carried out in different databases (PsycInfo, Web of Science and Scopus) in order to find publications associated with the aim of this project. The search terms used were derived from the combination of the following search string: "((Pandemic OR Epidemic OR Outbreak OR COVID-19 OR Coronavirus) AND (Children OR Adolescents OR Youth OR Child OR Teenager) AND (Autism OR ASD OR Autism Spectrum Disorder))''. In total, 21 articles were included in this review. The findings of the different investigations included in this review show that the pandemic has produced a negative psychological impact in children/teenagers with ASD. Therefore, long-term follow-up studies should be carried out with the objective of creating effective interventions to treat this problematical.

A mixed-methods examination of clinicians' perceived barriers to telehealth delivered applied behavior analysis

Following the COVID-19 pandemic, clinicians relied on telehealth to ensure continuity of essential healthcare services, such as Applied Behavior Analysis (ABA). Identifying barriers and examining them in the context of other implementation outcomes is important to support appropriate adaptations and sustainability of telehealth-delivered ABA services. Convergent mixed methods design was utilized to identify barriers experienced by ABA clinicians (N = 388) when delivering ABA services over telehealth to autistic children and their families following the first six months of the COVID-19 pandemic. Additionally, barriers were examined in relation to telehealth implementation outcomes and intentions for continued adoption. Findings reveal that clinicians rated providing direct services (M = 3.52, SD = 1.14) as more difficult than conducting assessments (M = 3.29, SD = 1.06), and both as more difficult than providing parent-mediated interventions [(M = 2.47, SD = 1.11), F(2, 381) = 162.26, p < 0.001]. A principal components analysis indicated a 3-factor solution of barriers related to: (1) technology (α = 0.82), (2) administrative tasks (α = 0.88), and (3) client characteristics (α = 0.88). The most frequently endorsed barriers were related to client characteristics, including increased difficulty providing telehealth services to children who elope (M = 4.37, SD = 0.81), children who exhibit challenging behaviors (M = 4.31; SD = 0.83), and children who are in the preverbal stage or use nonverbal language to communicate (M = 4.07; SD = 1.00). Fewer barriers related to client characteristics uniquely predicted implementation variables including acceptability, appropriateness, and feasibility. Thematic analysis revealed challenges related to technology, caregiver involvement, child engagement, implementation of intervention strategies over telehealth, and administrative or logistical barriers. These findings highlight the need for targeted strategies that facilitate telehealth use to address specific client needs and support the implementation of telehealth services in usual care settings.

Autism spectrum disorder, parent coping, and parent concerns during the COVID-19 pandemic

The COVID-19 outbreak beginning in 2019 has created a challenging period for families who have children with autism spectrum disorder (ASD). The purpose of this study was to examine parents' perceptions about the consequences of the pandemic on their child who has ASD and parents' concerns and resources during the pandemic. Data was collected between July to November 2020 from U.S. parents who have at least one child with ASD between 3 and 21 years old. An online survey, consisting of 88 items, was developed and distributed online in newsletters and Twitter pages of several ASD organizations, and various caregiving support groups on Facebook. Descriptive analysis showed that during the data collection time (N = 57), 79% of the children had immediate access to electronic devices to utilize online services. Many of the children used remote learning services for less than 2 h (74%) per day. Many children had difficulties following social distance rules. They spent more time in passive activities than active activities. Twenty-five percent of parents reported that they drank alcohol more often during the pandemic. However, parents who participated in support groups consumed less alcohol. Also, child symptom severity was associated with parents taking less times for themselves. These results can assist practitioners in identifying specific difficulties that parents and children with ASD experienced during the pandemic. This work also underlines the parents' needs for community supports and mental health services.

Serving Individuals With Autism Spectrum Disorder in the Age of COVID-19: Special Considerations for Rural Families

This position paper explores the needs of rural families of children, adolescents, and adults with autism spectrum disorder (ASD) during the COVID-19 pandemic. Prior to COVID-19, literature portrays elevated stress in families of individuals with ASD and health and socioeconomic disparities for rural and underserved populations. These disparities were exacerbated due to COVID-19 and subsequent lockdowns and economic turmoil. Academic and adaptive skills training were particularly impacted due to school closures, with parents tasked with taking some responsibility for training these skills. Our goals for this article focus on special considerations for rural families regarding (a) neurobiological and developmental impacts of stressful experiences like COVID-19, (b) delineation of the impacts on individuals with ASD and other comorbid and related conditions, and (c) education and intervention needs during these times. Finally, we offer suggestions for future care during pandemic events, including recommendations for improving service delivery under such conditions.

Social contact patterns during the COVID-19 pandemic in 21 European countries - evidence from a two-year study

BACKGROUND

Most countries have enacted some restrictions to reduce social contacts to slow down disease transmission during the COVID-19 pandemic. For nearly two years, individuals likely also adopted new behaviours to avoid pathogen exposure based on personal circumstances. We aimed to understand the way in which different factors affect social contacts - a critical step to improving future pandemic responses.

METHODS

The analysis was based on repeated cross-sectional contact survey data collected in a standardized international study from 21 European countries between March 2020 and March 2022. We calculated the mean daily contacts reported using a clustered bootstrap by country and by settings (at home, at work, or in other settings). Where data were available, contact rates during the study period were compared with rates recorded prior to the pandemic. We fitted censored individual-level generalized additive mixed models to examine the effects of various factors on the number of social contacts.

RESULTS

The survey recorded 463,336 observations from 96,456 participants. In all countries where comparison data were available, contact rates over the previous two years were substantially lower than those seen prior to the pandemic (approximately from over 10 to < 5), predominantly due to fewer contacts outside the home. Government restrictions imposed immediate effect on contacts, and these effects lingered after the restrictions were lifted. Across countries, the relationships between national policy, individual perceptions, or personal circumstances determining contacts varied.

CONCLUSIONS

Our study, coordinated at the regional level, provides important insights into the understanding of the factors associated with social contacts to support future infectious disease outbreak responses.

Short-Term Outcomes of an ESDM Intervention in Italian Children with Autism Spectrum Disorder following the COVID-19 Lockdown

The COVID-19 pandemic caused a temporary lockdown period in Italy, during which the delivery of in-person treatment for children with autism spectrum disorder (ASD) in public health services was discontinued. This occurrence represented a crucial challenge for both families and professionals. We assessed the short-term outcomes of a sample of 18 children who received an early intervention with the Early Start Denver Model (ESDM), delivered at low intensity over one year in the pre-pandemic period, after six months of interruption of in-presence treatment due to lockdown restrictions. Children who received the ESDM treatment maintained their gains in sociocommunicative skills and did not exhibit any developmental regression. Additionally, there was evidence of a decrease in the restrictive and repetitive behavior (RRB) domain. The parents, who were already familiar with the principles of the ESDM, only received telehealth support from therapists that aimed to sustain the gains already achieved. We believe that it is always helpful to support parents in their daily lives by implementing interactional and play skills with their children to integrate and consolidate the results obtained in the individual interventions conducted by experienced therapists.

The impact of COVID-19 pandemic on emotional and behavioral problems of children with autism spectrum disorder and developmental delay aged 1-6 years in China

Introduction

The COVID-19 pandemic outbreak have caused increased levels of emotional and behavioral problems, particularly among people with pre-existing mental health conditions. Young individuals with autism spectrum disorders (ASD) and developmental delay (DD) are particularly at risk due to their vulnerability. The purpose of this study was to look into the different effects of the COVID-19 pandemic on 1-6-year-old children with ASD and DD.

Methods

Parents and guardians of children with ASD completed an online survey that included questions about their children's socio-demographics characteristics, the effects of the COVID-19 outbreak on their health, and what they needed in order to deal with the conditions of the pandemic.

Results

This study compared 4,138 children with ASD to 711 children with DD. Children with ASD had a higher risk of having more emotional and behavioral problems than children with DD (OR 1.38, 95% CI 1.12-1.70). Compared to parent-oriented rehabilitation at home, discontinuing rehabilitation had a higher likelihood of negative emotional and behavioral change (OR 1.67, 95% CI 1.41-1.98). Having teachers' online support had a higher likelihood of negative emotional and behavioral change for ASD children (OR 1.26, 95% CI 1.03-1.54).

Conclusions

This article provided evidence that children with developmental disabilities, particularly ASD, were at risk for a variety of challenges to their emotional functioning during the COVID-19 period, and that online support was not an ideal way for children with ASD to receive effective educational intervention in China.

Integration of art and technology in personalized radiation oncology care: Experiences, evidence, and perspectives

Cancer diagnoses expose patients to traumatic stress, sudden changes in daily life, changes in the body and autonomy, with even long-term consequences, and in some cases, to come to terms with the end-of-life. Furthermore, rising survival rates underline that the need for interventions for emotional wellbeing is in growing demand by patients and survivors. Cancer patients frequently have compliance problems, difficulties during treatment, stress, or challenges in implementing healthy behaviors. This scenario was highlighted during the COVID-19 emergency. These issues often do not reach the clinical attention of dedicated professionals and could also become a source of stress or burnout for professionals. So, these consequences are evident on individual, interpersonal, and health system levels. Oncology services have increasingly sought to provide value-based health care, considering resources invested, with implications for service delivery and related financing mechanisms. Value-based health care can improve patient outcomes, often revealed by patient outcome measures while seeking balance with economical budgets. The paper aims to show the Gemelli Advanced Radiation Therapy (ART) experience of personalizing the patients' care pathway through interventions based on technologies and art, the personalized approach to cancer patients and their role as "co-stars" in treatment care. The paper describes the vision, experiences, and evidence that have guided clinical choices involving patients and professionals in a co-constructed therapeutic pathway. We will explore this approach by describing: the various initiatives already implemented and prospects, with particular attention to the economic sustainability of the paths proposed to patients; the several pathways of personalized care, both from the patient's and healthcare professional perspective, that put the person's experience at the Gemelli ART Center. The patient's satisfaction with the treatment and economic outcomes have been considered. The experiences and future perspectives described in the manuscript will focus on the value of people's experiences and patient satisfaction indicators, patients, staff, and the healthcare organization.

"A breath of fresh air": mindfulness training for early-career mental health social workers in Israel during COVID-19

The present study examined the effectiveness of participation in a mindfulness group for Israeli early career social workers during the COVID-19 period. Eleven participants conducting fieldwork in a mental health rehabilitation center were interviewed. The participants described a variety of benefits from their mindfulness training, in three main areas: (1) Personal: applying mindfulness in their daily life; (2) Family: improved work-life balance and family relationships; and (3) Professional: applying mindfulness in their work with mental health clients. Mental support and self-care tools provided to early-career social workers were perceived by the participants as helping them overcome uncertainty, fatigue, and overwork.

Parental Stress of Children with Autism Spectrum Disorder During the Coronavirus Pandemic (COVID-19): Experience from Serbia

OBJECTIVE

Taking care of children with autism spectrum disorder (ASD), as of children with other developmental disorders, is associated with greater parental stress. The aim of this study was to determine the prevalence and impact of integrative and co-morbid ASD-related symptoms on parental stress levels during the COVID-19 pandemic at four time points. Testing was performed during significant changes related to the state of the COVID-19 pandemic in Serbia.

METHODS

The research sample included 67 parents of children with ASD 4 to 7 years and 6 months of age. The Autism Parenting Stress Index, Gilliam Autism Rating Scale - Third Edition, diagnostic criteria for ASD from DSM-5 and Wechsler Preschool and Primary Scale of Intelligence - Fourth Edition were used to assess the tested abilities.

RESULTS

Core behavior (problems of social development and communication skills) as well as co-morbid behaviors related to ASD (tantrums, aggressive behavior, self-injurious behavior and difficulties with transitions) caused the highest degree of parental stress. Post hoc tests that used Bonferroni correction found that parental stress caused by basic and co-morbid behaviors gradually decreased from first to fourth measurement, respectively. Sleep and toilet training problems, as well as co-morbid physical problems, caused the greatest degree of parental stress during the first measurement. Measuring total parental stress caused by integrative and co-morbid symptoms related to ASD showed that it was at the highest level during the first measurement, decreased during the second measurement and remained unchanged during the third and fourth measurements.

CONCLUSION

Time, as a repeating factor, during the COVID-19 pandemic has an effect on lowering the levels of parental stress caused by all examined ASD-related domains. These results may be useful in creating individual programs to support parents of children with ASD during the COVID-19 pandemic.

Mental health challenges during COVID-19: perspectives from parents with children with neurodevelopmental disabilities

BACKGROUND

The global pandemic and subsequent denials, delays, and disruptions in essential daily activities created significant challenges for children with neurodevelopmental disorders (NDDs) and their parents. Public health restrictions during the COVID-19 pandemic limited access to supports and services required by children with NDDs to maintain their health and well-being.

OBJECTIVE

This study sought to understand the impacts of these public health measures and restrictions on mental health from the perspective of parents with children with NDDs to inform pathways for public health policies responsive to the needs of this population.

METHOD

Interpretive descriptive design was used to guide data collection and data analysis. Forty caregivers were interviewed about their experience with pandemic restrictions.

FINDINGS

Generic policy measures contributed to many gaps in families' social support systems and contributed to mental health challenges for children and their parents. Four themes emerged: 1) lack of social networks and activities, 2) lack of access to health and social supports, 3) tension in the family unit, and 4) impact on mental health for children and their parents.

RECOMMENDATIONS

Emergency preparedness planning requires a disability inclusive approach allocating resources for family supports in the home and community. Families identified supports to minimize further pandemic disruptions and enhance recovery.

Brief Report: A Pilot Study Examining the Effects of PEERS® for Adolescents Telehealth for Autistic Adolescents

The COVID-19 pandemic sparked a worldwide transition to providing online services overnight, highlighting the urgent need for empirically supported telehealth interventions. The current study examined the effects of PEERS® for Adolescents Telehealth, an adaptation from the original social skills intervention developed for in-person provision, among 22 autistic adolescents and their caregivers. To evaluate the intervention, caregivers completed questionnaires assessing core autistic features and frequency of get-togethers. Adolescents completed questionnaires measuring social knowledge and frequency of get-togethers. Improvements in social skills knowledge, increased get-togethers, and decreased core autistic symptoms were evident. Preliminary results suggest PEERS® for Adolescents Telehealth improves social competence, as found for the in-person version. Further research exploring the equivalence of telehealth to in-person social skills intervention is recommended.

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.

Life under lockdown for children with autism spectrum disorder: Insights from families in South Africa

BACKGROUND

Children with Autism Spectrum Disorder (ASD) remain vulnerable during the Covid-19 outbreak due to significant changes to their daily routines, social interactions and diets. In addition, these challenges may be exacerbated for children living in low- and middle-income countries (LMIC) such as South Africa where there are already barriers such as poverty, access to resources and availability of support. Understanding the impact of the Covid-19 outbreak on children with ASD is imperative in order to create awareness as well as provide equitable services and support to both children with ASD and their families.

PURPOSE

The study aimed to explore family-reported changes for children with ASD and their reactions and responses to the Covid-19 restrictions in South Africa.

METHOD

A qualitative research design was employed. Twelve families consisting of different family compositions with a total of 21 family members (mothers, fathers and grandmothers) participated in the current study using semistructured interviews. Data were transcribed and analysed using a framework method for thematic analysis.

RESULTS

Findings indicated that children with ASD present with unique challenges related to Covid-19. Negative themes such as children's obstructive reactions due to the immediate changes to their routines, increases in emotional dysregulation as well as loss of previously acquired skills as a result of lack of access to services during lockdown were reported. However, families also reported on positive changes such as improved social interactions as children became more accustomed to their new lockdown routines.

IMPLICATIONS

The Covid-19 response has had a negative impact on children with disabilities, specifically around access to services and support for both children with ASD and their families. While the future of the virus and impending lockdown measures is unknown, clinicians, providers and educators need to ensure that provisions are made for children's current adjustments as well as further adjustments to their current routines both during and after the pandemic.

Spartan Caregiver Support: Program Description and Key Findings During Michigan's Stay-At-Home Order

Objectives

The purpose of this paper is to describe a university program, Spartan Caregiver Support, that provided free on-demand telehealth services to caregivers of people with autism during the State of Michigan's 2020 Stay-at-Home order.

Method

Participants (n = 17) were caregivers of people with autism residing within the State of Michigan. Participants engaged with program members over video-conference technology, where participants received specific advice to support social and behavioral needs.

Results

We found that caregivers reported a variety of social and behavioral concerns, including concerns related to problem behavior, social/play skills, school/academics, and daily living.

Conclusions

This program description provides a framework for how to deliver on-demand telehealth support to caregivers of people with autism, especially during moments of crisis or emergency.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41252-022-00281-7.

A Pediatrician's Guide to Working with Children on the Autism Spectrum in Coronavirus Disease 2019 and Beyond: Retrospect and Prospect

The COVID-19 pandemic is an unprecedented event with devastating effects on children and families, highlighting and broadening disparities in the care of children with developmental disabilities, while simultaneously catalyzing innovation. Children are vulnerable to the impacts of COVID-19, resulting in increased stress, anxiety, isolation, and health challenges, further amplified in autistic children and children with other neurodevelopmental disabilities. These children are uniquely vulnerable due to communication impairments, comorbid medical disorders, reduced adaptability, and reliance on therapeutic interventions. Abrupt reduction in services and access to care during the pandemic compromised physical and mental health and led to missed intervention opportunities at critical times. It is important to examine the effects that the pandemic triggered, address deficiencies, and recognize new opportunities to improve systems of care to prepare for unforeseen futures.

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.

Autism spectrum disorder during French COVID-19 lockdown: The importance of individualized support

AIM

This observational and repeated measures study assesses the impact of the first, most restrictive, COVID-19 lockdown in France on children with autism spectrum disorder (ASD) and their families.

METHOD

During the first COVID-19 lockdown, families of ASD children enrolled in the day-care centre of the child and adolescent psychiatry department of the Tours University Hospital were contacted weekly. A total of 95 parents took part in this study between the 18th of March and the 8th of May 2020. Advice and personalized support materials were provided by professionals involved in children's care. Questions regarding clinical outcomes were addressed to parents, and their assessments were reported on a 5-point Likert scale. Two time points were considered: the first 3 weeks and the three last weeks of the lockdown period.

RESULTS

No difference was highlighted between clinical scores collected at the beginning and at the end of the lockdown. No effect of intellectual disability, accommodation type (house or apartment) or parental status was observed. The reasons for the relatively minor impact of the COVID-19 lockdown observed in this study are discussed.

CONCLUSIONS

Individualized and regular support provided by caregivers, familiar with ASD children's clinical specificities, in the context of a trusted relationship with parents may have contributed to the stability of this population. This 'tailor-made' approach should be promoted, in order to help support families of ASD children in this challenging period.

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.

Sense of Parenting Efficacy, Perceived Family Interactions, and Parenting Stress Among Mothers of Children With Autistic Spectrum Disorders

This study examined the relationship between maternal sense of parenting efficacy and parental stress in children with autism and the moderating effect of family interaction. A total of 263 mothers of children with autism were investigated with the Parenting Ability Scale, Family Interaction Scale (FIS), and Parental Stress Scale. The results showed that (1) maternal sense of parenting efficacy significantly predicted parental stress in children with autism; and (2) family interaction significantly moderated the relationship between maternal sense of parenting efficacy and parental stress in children with autism, that is, when family interaction was lower than -1.54 standard deviation (SD), the sense of parenting efficacy did not significantly predict parental stress. When family interaction was higher than -1.54 SD, parenting efficacy had a significant negative predictive effect on parenting stress.

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.

Parents Are People Too: Implementing Empirically Based Strategies During Daily Interactions

The outcomes of the COVID-19 pandemic have resulted in decision-making related to in-person versus remote behavior-analytic service delivery. For those service providers who shifted from delivering in-person therapy to remote consultation, parents have presumably, at least at times, assumed a role similar to a registered behavior technician (RBT). We suggest that behavior analysts recommend two empirically based strategies to parents that they could incorporate into their daily lives during service disruptions: environmental enrichment and differential reinforcement of alternative behavior. We provide examples of naturally occurring contexts during which parents could integrate these procedures: (1) self-care or daily living activities, (2) physical activity, and (3) preferred learning activities. We support selecting these strategies and their application during exemplar contexts under the premise that they do not result in additional time expenditure, afford parents opportunities to complete essential (household, work-related, or personal) tasks, and still result in therapeutic gains.

Burden and Growth during COVID-19: Comparing Parents of Children with and without Disabilities

The COVID-19 pandemic and the measures taken to contain it have had a disproportionate impact on families with young children, especially with disabilities. This study examined factors associated with burden and growth among parents of young children in Israel, while comparing parents of children with and without disabilities. We hypothesized that the association between family functioning, informal social support, and perceived adequacy of educational services and burden and growth would be moderated by disabilities. An online questionnaire was completed by 675 parents of young children, 95 of them with disability. The moderating effect of disability on burden and growth was examined using PROCESS. Compared to parents of children without disabilities, greater burden was found among parents of children with disabilities, but levels of growth were similar. External support was lacking for both parent groups. Educational services were perceived as severely inadequate. Lower perceived adequate educational services were associated with greater burden. On the other hand, higher levels of family functioning (i.e., family cohesion and adaptability) and greater adequacy of educational services were associated with growth. The results show that while burden was greater for parents of children with disabilities, growth during the COVID-19 period was possible for parents of both groups. The findings also pointed to the importance of the family system for sustaining the wellbeing of its members in lockdown situations. Put together, the findings highlight the importance of planning for such national and global emergencies.

Impact of the COVID-19 pandemic on children and adolescents with autism spectrum disorder and their families: a mixed-methods study protocol

BACKGROUND

The COVID-19 pandemic is a challenge for everyone, particularly for children and adolescents with autism spectrum disorder (ASD). ASD is a developmental disorder characterised by limitations in social communication, repetitive behavioural patterns, and limited interests, and activities. It is expected that many families with children with ASD will experience more problems due to the COVID-19 pandemic and the related public health restrictions. At the same time, some may experience improved functioning, due to fewer expectations and social demands.

METHODS/DESIGN

In a mixed-method study to identify the impact of the COVID-19 pandemic, parents of children with ASD (ages 4-21) who were in care pre-COVID-19 at one of three large mental healthcare institutions in the region of Rotterdam participated (68 for T0, 57 for T1). The aims are (1) to investigate the impact of the COVID-19 pandemic on overall functioning and autistic symptoms of the child/adolescent with ASD, as well as parental and family functioning (QUANT-QUAL), in both the short term and longer term, and (2) to investigate risk and protective factors (in light of resilience) (QUANT-qual) and (3) to investigate care and informational needs (QUAL-quant). Pre-COVID-19 baseline data will be retrieved from clinical records. Participants will fill out two surveys (one during a COVID-19 peak-January-May 2021-and one thereafter). Survey participants were invited to participate in interviews (n=27). Surveys include measures thar were included pre-COVID-19 (ie, overall functioning and autism symptoms) as well as specific measures to identify family functioning and COVID-19 impact. The semistructured interviews focus on child, parent and family functioning and care-and informational needs.

ETHICS AND DISSEMINATION

The Medical Ethics Committee of the Erasmus MC has approved the study. Findings will be available to families of children with ASD, their care providers, the funders, autism societies, the government and other researchers.

Parent observations about the impact of COVID-19 on children with autism spectrum disorder in Turkey

Objectives: The Covid-19 pandemic has shown that people with disabilities are the most vulnerable, neglected and discriminated individuals at times of emergency. National and international studies are needed to understand the extent to which the general well-being, quality of life, and positive and negative behaviors of children with ASD are affected during the pandemic. Methods: This study explores the impact of Covid-19 on the typical behaviors of children with Autism Spectrum Disorder (ASD) by focusing on quantitative observation findings obtained from their parents and caregivers. In order to explore the effects of three months of pandemic restrictions during the initial period, 103 parents and caregivers were asked to describe significant behavior changes in their children with ASD comparing before and during the pandemic period. Results: The results showed that children were negatively affected in 21 of 32 typical ASD traits. However, a significant number of participants also reported positive changes in several of their children's social and communicative behaviors as shared family time increased during the pandemic. This finding alone was not statistically supported. However, when it was coupled with the variable of access to online education assistance, it was concluded that the two variables together reduced the negative impact on children. Additionally, we found a sex difference in the impact of Covid-19 on children with ASD. The test results and mean scores show that girls were affected either more negatively or more positively than boys. Conclusions: Our results indicate that the negative effects of a natural disaster such as Covid-19 may be decreased when family members cooperatively share their responsibilities, spend more time with their children with ASD, and use distance education support services.Keywords: Autism spectrum disorder, Covid-19, pandemic, parents, sex difference, social distancing.

ASDesign: A User-Centered Method for the Design of Assistive Technology That Helps Children with Autism Spectrum Disorders Be More Independent in Their Daily Routines

COVID-19 has posed new physical and mental challenges for the population worldwide, establishing social and structural changes in the labor market that could be maintained and implemented permanently. This new reality will require new strategies to improve family and work conciliation, which is especially challenging for families with children suffering from psychological pathologies such as autism spectrum disorder (ASD). These changes have led to more frequent and intense behavioral problems, causing stress, anxiety, and confusion for these children and their families. Thus, the need to have tools that help parents reconcile work with the care of these children, who have low autonomy, is reinforced. This work develops a method for the design of assistive technology and smart products to support children with ASD in following a routine and managing tasks autonomously. In this way, the article analyzes the design problem including the needs and preferences of children with ASD and their parents during confinement in terms of dependence and adaptability; develops a design method for interactive and smart products focused on children with ASD in confinement situations; and validates this method in a case study, in which a robot is developed that makes it easier for children with ASD to follow a routine.

Effects of the COVID-19 Pandemic on Parental Burnout and Parenting Practices: Analyses Using a Retrospective Pretest

Background

Many of the conditions of the COVID-19 pandemic were consistent with factors shown to be predictive of parental stress and burnout. The purpose of the current study was to use a retrospective pretest method to gain an understanding of the effects of the COVID-19 pandemic on levels of parental burnout and on parenting practices.

Method

A brief survey was conducted using a retrospective pretest method to examine parental burnout (The Parental Burnout Assessment, Roskam et al, 2018) and parenting practices (The Alabama Parenting Questionnaire, Frick, 1991). The survey asked parent participants to answer questions about their experiences before and during the pandemic.

Results

Findings indicated that the pandemic had a significant impact on parents, increasing overall levels of parental burnout and impacting parenting practices by reducing use of positive parenting strategies and increasing use of inconsistent discipline and corporal punishment. These changes in parenting practices were even more pronounced for parents whose levels of parental burnout moved from “normal” levels before the pandemic to clinical levels during the pandemic.

Conclusion

The findings of the current study suggest that the COVID-19 pandemic has had a negative impact on levels of parental burnout and parenting practices. Although additional research is needed, the results suggest that there is a need for clinicians to understand the effects that the pandemic may have had on parents and families with an understanding that families may be at ongoing risk despite a relaxation of COVID-19 restrictions.

Transitioning ABA Services From in Clinic to Telehealth: Case Study of an Indian Organization's Response to COVID-19 Lockdown

Due to the coronavirus (COVID-19) pandemic, around the middle of March 2020, in-clinic intervention services based in applied behavior analysis provided to children had to be stopped abruptly in India. This qualitative and quantitative case study details how Behavior Momentum India (BMI), an organisation providing ABA-based interventions, transitioned services from in clinic to telehealth while continuing to target each student's skill acquisition goals in language and communication domains. A cohort of 92 students diagnosed with autism or other learning disabilities participated in this study; 51 therapists, 9 behavior supervisors, and a doctoral-level Board Certified Behavior Analyst collaborated with parents; 78% of the students and 82% of the therapists used smartphones; and only a few used iPads and laptops. Therapists conducted direct sessions and parent-mediated sessions with 82 students. With 10 students, behavior supervisors trained parents to implement interventions with their children. The critical transition decisions, logistics, and ethical challenges were identified using qualitative methods. Despite significantly reduced session durations, all students continued to acquire targeted skills, and 52% of the students acquired more skills in telehealth compared to in clinic. A parent satisfaction survey returned high ratings onour organization's initiative, and 72% of the parents reported that their familiarity and confidence with the science of applied behavior analysis had increased.

Maintaining Effective Supervision Systems for Trainees Pursuing a Behavior Analyst Certification Board Certification During the COVID-19 Pandemic

Behavior analysts acting as supervisors of individuals pursuing Behavior Analyst Certification Board certification are tasked with designing effective and ethical supervision and training systems. Behavior analyst supervisors and their trainees may face challenges fulfilling their responsibilities in the midst of barriers that include competing contingencies, transitions, and interruptions. In this article, we review potential obstacles faced by supervisors in designing effective supervision through site closures and transitions to telepractice as a result of the COVID-19 pandemic. We explore related potential barriers faced by trainees serving clients through public school settings, as well as through insurance-funded agencies in the United States. We review some practical solutions and offer tools for supervisors and trainees to consider at this time. We present a template for trainees to help them develop a personalized applied behavior analysis fieldwork plan for their supervision, a client/family needs assessment, and a corresponding trainee needs assessment to assist with adaptations to supervision and service delivery in an individualized manner.

The (a)typical burden of COVID-19 pandemic scenario in Autism Spectrum Disorder

Psychological and mental health consequences of large-scale anti-contagion policies are assuming strong relevance in the COVID-19 pandemic. We proposed a specific focus on a large sample of children with Autism Spectrum Disorder (ASD), developing an ad hoc instrument to investigate changes occurred in specific (sub-)domains during a period of national lockdown (Italy). Our questionnaire, named AutiStress, is both context-specific (being set in the COVID-19 pandemic scenario) and condition-specific (being structured taking into account the autistic functioning peculiarities in the paediatric age). An age- and gender-matched group of neurotypical (TD) controls was also provided. As expected, the severe lockdown policies had a general negative impact both on ASD and TD children, reflecting the obvious burden of the pandemic situation. However, our findings also indicate that children with ASD experienced more positive changes than TD ones. Noteworthy, we report a thought-provoking double dissociation in the context-specific predictor (i.e., accessibility to private outdoor spaces), indicating that it impacts differently on the two groups. Focusing on the ASD group, results suggest a condition-specific impact of the COVID-19 pandemic on core autistic (sub-)domains. Taken together, our data call for a multi-layered, context- and condition-specific analysis of the pandemic burden beyond any oversimplification.

Thea: empowering the therapeutic alliance of children with ASD by multimedia interaction

The Therapeutic Alliance (TA) between patient and health provider (therapist or clinician) is one of the most relevant factors for the success of a therapy. In the case of people suffering from Autism Spectrum Disorder (ASD), the alliance is extended to all the people involved in their care (i.e., teachers, therapists, clinicians, relatives). In this paper, we propose a multimedia application named Thea for empowering the TA of children with ASD by improving the communication among the TA members, sharing guidelines, multimedia contents, and strategies to comply with challenging behaviors and progress with particular attention towards end-users who are occasional smart-users. A detailed process for empowering the TA members by enhancing the informed interaction among all of them is proposed and implemented. A vocal assistant also supports patients/caregivers and therapists in documenting their activity with the person with ASD by recording videos in a free-hand modality. After a contextual analysis based on Thematic Analysis Template, Thea has been implemented using a user-centered development approach. We performed three iterations involving the end-users. A user study is performed at the third iteration. Results of the user study revealed a positive attitude towards the application. In particular, the perception of empowerment of participants increased after the tool had been used. We also highlighted the guidelines and tools that may be adopted for empowering different kinds of patients. The first results seem to suggest that the use of Thea may increase the belief of the caregivers of a person with ASD to be able to better take care of her, in a more controlled and informed way.

Psycho-social consequences associated with COVID-19 in people with ASD and their families: A literature review

Background: COVID-19 has become a global pandemic and has inevitably affected the whole world. This effect is greater on people with ASD (ASD) and their families. Depression, attempts to cope with change, and having difficulty interacting with others are some of the challenges people with ASD often face. The aim of this study was to review the psycho-social consequences of COVID-19 in people with ASD and their families. Methods: This study is a Literature Review. Extensive electronic search results for the keywords ASD, COVID-19, Coronavirus, psychological, psychosocial, and consequence in Google Scholar, PubMed, Scopus, ProQuest, Science Direct, SID and Magiran in 2020, eventually provided a total of 130 articles. After reviewing the titles of the articles, we excluded 85 articles as they were duplicated and/or irrelevant. Finally, based on the inclusion and exclusion criteria, 17 articles remained. Results: In general, the change in routine and uncertainty caused by COVID-19 have caused distress for people with ASD and will worsen their symptoms and mental health. Excessive stress worsens the mental health of caregivers, and as this burden increases, they report higher rates of social harm, depression, and anxiety that affect their daily functioning. Conclusion: The COVID-19 epidemic affects all strata of society. People with ASD are particularly vulnerable to the psychosocial effects of this epidemic. COVID-19 increases anxiety, distress, depression, financial problems, loss of a job, and even marital conflict. Access to necessary services and transmission problems are also the result of rapid social and environmental changes.

Analysis of the SPARK study COVID-19 parent survey: Early impact of the pandemic on access to services, child/parent mental health, and benefits of online services

Children with ASD receive a multitude of educational, medical, and therapeutic services. At the onset of the COVID‐19 pandemic, all of these services came to a complete halt following strict lockdowns. Many services have resumed in a hybrid format using face to face and virtual modes of delivery. This study describes findings from the COVID‐19 impact survey administered at the onset of the pandemic in a subgroup of families from the SPARK cohort (N = 6393), one of the largest ASD cohorts in the US. The differential early impact of COVID‐19 on various subgroups of children with ASD and their families was examined. Caregivers of children and adolescents with ASD between 19 months and 18 years completed an online survey inquiring about the impact of COVID‐19 pandemic on access to services, parent concerns about the same, impact on child's ASD‐related behaviors, child, and parent mental health, and the benefits/potential benefits of online/future online services. Analysis revealed that certain demographic (age, income/SES) and child‐related factors (repetitive behaviors, language, functional, cognitive, and motor impairments, and child's understanding), as well as parent's past mental health were associated with/predicted greater service disruptions, greater ASD‐related behaviors, and greater negative impact on parent mental health. In conclusion, younger children, children from low‐income families, and children with greater impairment severity (more severe repetitive behaviors, language, cognitive, function, language, and motor impairments) were more negatively impacted by the pandemic through service disruptions, increased ASD‐related behaviors, parent health/family impact, and found online interactions to be less beneficial.

'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.

Efeitos do isolamento na pandemia por COVID-19 no comportamento de crianças e adolescentes com autismo

Com a pandemia da COVID-19 a Organização Mundial da Saúde declarou estado de emergência de saúde pública. O isolamento tem transformado as relações sociais de crianças e adolescentes com Transtorno do Espectro do Autismo. Este estudo objetivou analisar os efeitos do isolamento no comportamento desses sujeitos. Trata-se de um estudo descritivo, de caráter transversal, no qual pais ou responsáveis responderam um questionário online. Os resultados da pesquisa apontaram que o confinamento acentuou os sintomas do autismo. Conclui-se que são necessárias medidas de intervenções com os sujeitos e suas famílias.

Home education for children with autism spectrum disorder during the COVID-19 pandemic: Indonesian mothers experience

This study aimed to explore the experiences of mothers and efforts in implementing home education for children with autism, during the COVID-19 pandemic in Indonesia. Five mothers were recruited as participants and interviewed online, as the data obtained were examined through the use of thematic analysis. Also, three main themes were shown, (1) Mothers' experience in implementing home education, as regards adaptability and burden of caregiving, (2) The constraints in home education implementation, as regards maladaptive behaviours of ASD and emerging negative emotions, (3) The efforts to alleviate barriers, as regards problem-focused and religious copings. Also, the implementation of home education during the pandemic was less than optimal, due to the increase in maladaptive behaviours of the autistic children, low adaptability, the burden of caregiving, and emerging negative emotions. Appropriate coping strategies were also observed to help mothers in alleviating the constraints to implementing home education and parenting stress.

The Effects of COVID-19 on Early Childhood Education and Care: Research and Resources for Children, Families, Teachers, and Teacher Educators

The COVID-19 world health crisis has profound implications for the care and education of young children in homes and schools, the lives of preservice and inservice teachers, and the work of college/university faculty. This article begins by discussing the implications of a world health pandemic for education and the challenges of conducting a literature review on such a rapidly evolving topic. The next four sections categorize the COVID-19 literature into themes: (1) threats to quality of life (QoL) and wellness, (2) pressure on families and intensification of inequities, (3) changes in teaching methods and reliance on technology, and (4) restructuring of higher education and scholarship interrupted. Each of the four themes is introduced with a narrative that highlights the current context, followed by the literature review. Next is a compilation of high-quality, online resources developed by leading professional organizations to support children, families, and educators dealing with the COVID crisis. The article concludes with changes that hold the greatest potential to advance the field of early childhood education and care.

Online art therapy in elementary schools during COVID-19: results from a randomized cluster pilot and feasibility study and impact on mental health

BACKGROUND

Emerging literature on the current COVID-19 crisis suggests that children may experience increased anxiety and depression as a result of the pandemic. To prevent such school and mental health-related problems, there is a timely need to develop preventive strategies and interventions to address potential negative impacts of COVID-19 on children's mental health, especially in school settings. Results from previous child clinical research indicate that art-based therapies, including mindfulness-based art therapy, have shown promise to increase children's well-being and reduce psychological distress.

OBJECTIVE

The goal of the present pilot and feasibility study was to compare the impact of an emotion-based directed drawing intervention and a mandala drawing intervention, on mental health in elementary school children (N = 22), in the context of the COVID-19 pandemic. Both interventions were group-based and delivered online and remotely. A pilot study using a randomized cluster design was implemented to evaluate and compare both interventions in relation to child anxiety, depression, inattention and hyperactivity symptoms.

RESULTS

Analyses of covariance revealed a significant effect of the type of drawing intervention on levels of inattention, after controlling for baseline levels. Participants in the emotion-based directed drawing group showed lower inattention scores at post-test, when compared to participants in the mandala group. Post-hoc sensitivity analyses showed significant decreases in pre-to-post scores for levels of hyperactivity for the complete sample.

CONCLUSION

Overall, results from this pilot and feasibility study showed that both an emotion-based directed drawing intervention and a mandala drawing intervention may be beneficial to improve mental health in elementary school children, in the context of the current COVID-19 pandemic. From a feasibility standpoint, results indicate that the implementation of both interventions online and remotely, through a videoconference platform, is feasible and adequate in school-based settings. Further work incorporating larger sample sizes, longitudinal data and ensuring sufficient statistical power is warranted to evaluate the long-term impact of both interventions on children's mental health.

Impact of the COVID-19 Lockdown in Malaysia: An Examination of the Psychological Well-Being of Parent-Child Dyads and Child Behavior in Families With Children on the Autism Spectrum

Background: The COVID-19 pandemic lockdowns have adversely impacted children on the autism spectrum and their families, especially in Malaysia where this population is often marginalized. The current quantitative research aimed to investigate the impact of the Malaysian COVID-19 lockdown on the behavior and psychological distress of children formally diagnosed with an autism spectrum condition (ASC) as well as the psychological distress and well-being of their parents, in comparison with a typically developing (TD) control group. Methods: The children's ages ranged between 5 and 17 years. The sample included 72 ASC parent-child dyads and 62 TD parent-child dyads. The primary caregiver completed an online survey including the following: demographic and diagnostic information; ASC symptoms; children's inattention, hyperactivity/impulsivity, perceived stress, depression, and anxiety; parents' perceived stress, depression, anxiety, and well-being based on their experience pre- and mid-lockdown (March 18th to June 9th 2020) in Malaysia. Results: Among the ASC group, no significant pre- and mid-lockdown change was found in ASC symptoms (p > 0.05). There were no significant gender differences (boys/girls) in all the child scales. The 2 [diagnosis (ASC, TD)] × 2 [lockdown (pre-lockdown, mid-lockdown)] mixed-model ANOVAs revealed main effects of lockdown on children's attention, hyperactivity/impulsivity, anxiety, and parents' perceived stress, depression, and psychological well-being (p < 0.005). There was a main effect of diagnosis in all child and parent variables, except parents' perceived stress (p >0.005). However, there was no significant interaction effect between diagnosis and lockdown (p >0.005). All child behavior (inattention and hyperactivity/impulsivity) and child psychological distress (anxiety, depression, and perceived stress) were significantly correlated in both the ASC and TD groups (p < 0.005). On the other hand, only some of the parent variables were significantly correlated with child variables (p < 0.0045) in the ASC group while none of the parent variables were significantly correlated with the child variables (p > 0.005) in the TD group. Conclusion: The results provide preliminary evidence indicating negative effects of the Malaysian lockdown on both children on the autism spectrum and TD children, as well as their parents. These quantitative results will be triangulated with the qualitative interview data to provide a holistic understanding of the impact of the pandemic, informing translational policy and practice recommendations.

ABA Finding Its Heart During a Pandemic: An Exploration in Social Validity

The COVID-19 pandemic has presented practitioners of applied behavior analysis (ABA) with new and uncharted challenges. Upholding ethical responsibilities while navigating an international public health crisis has opened areas of uncertainty that have no precedent. Although there is general guidance on how to respond ethically from the Behavior Analyst Certification Board (BACB) in their publication specific to the COVID-19 crisis (BACB, 2020, March 29, Ethics Guidance for ABA Providers During COVID-19 Pandemic, retrieved from https://www.bacb.com/ethics-guidance-for-aba-providers-during-covid-19-pandemic-2/), there remains a huge responsibility on the individual practitioner to make potentially life-changing decisions. In that regard, practitioners are urged to ensure that they rely on socially significant and valid decision-making processes. The goal of this article is to provide an exercise in accounting for stakeholder feedback and connecting with patients and families regarding their input on the acceptability of treatment during the COVID-19 pandemic. The exercise is in the form of a structured parent interview to help practitioners account for the setting variables and social validity of treatment during a crisis. It is our ethical responsibility to remember this critical dimension of our science and practice.

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

SARS‐CoV‐2 is the virus causing COVID‐19 and is spread through close person‐to‐person contact. The use of face masks has been described as an important strategy to slow its transmission. We evaluated the effects of coaching caregivers via telehealth technologies to teach face mask wearing to children with autism spectrum disorder. Six participants with a history of challenging behavior associated with mask wearing were recruited from different parts of the world, and trained using graduated exposure, shaping, and contingent reinforcement. By the end of the intervention, all participants wore a face mask for a period of 10 min without exhibiting challenging behavior. The skills generalized to a novel mask or a community setting. Mask wearing did not affect the percentage of oxyhemoglobin saturation of participants, and caregivers found the intervention useful. The findings support previous tolerance training treatment evaluations in children with developmental disorders exhibiting resistance to healthcare routines.

Behavioral Implications of the Covid-19 Process for Autism Spectrum Disorder, and Individuals' Comprehension of and Reactions to the Pandemic Conditions

During disasters and pandemics, vulnerable populations such as patients with mental conditions are known to be overly influenced. Yet, not much is known about how the individuals with autism spectrum disorder (ASD), one of the most common neurodevelopmental conditions globally with a prevalence of 1%, are affected from health-related disasters, especially the current Covid-19 pandemic. Therefore, we conducted an investigation of how individuals with ASD responded to Covid-19 in terms of comprehension and adherence to implemented measures; changes in their behavioral problems; and how their caregivers' anxiety levels relate with these behavioral changes. Our sample consisted of 87 individuals with ASD (15 girls; ages ranged from 3-29, with an average of 13.96 ± 6.1). The majority of our sample had problems understanding what Covid-19 is and the measures it requires. They also had challenges in implementing social distance and hygiene-related regulations of the pandemic. The majority stopped receiving special education during this period. We observed a Covid-19-related clinical presentation that resembled PTSD in individuals with ASD in terms of increased stereotypies, aggression, hypersensitivity, behavioral problems, and sleep and appetite alterations. All subscales of Aberrant Behavior Checklist (ABC) differed significantly between before and after the pandemic conditions. The number of hours the children slept significantly decreased from before to during Covid-19. The anxiety levels of caregivers were high and correlated with the current behavioral problem levels of their children, but not with the level of their behavioral problems before the pandemic. The difference in ABC total score and specifically the lethargy/social withdrawal subscale score predicted parents' anxiety score. Our results suggest that the Covid-19 period inflicts specific challenges to individuals with ASD and their caregivers, underlining the need for targeted, distance special education interventions and other support services for this population.