The COVID-19 pandemic has presented many new challenges for people with autism spectrum disorder (ASD). Features of ASD, including impaired social and communication skills, repetitive behaviors, insistence on sameness, and especially sensory intolerances, make adapting to wearing face masks and the experience of a COVID-19 test particularly challenging.
Challenges of wearing face masks with ASD
Many people with ASD are highly sensitive to touch, and the face can be especially so. Wearing a face mask involves many unpleasant sensations. On the surface, there’s the scratchy texture of fabric, tight contact where the top of the mask meets the skin, and the tug of elastic on the ears. Sensations under the mask are no more pleasant and include the warm, damp smell of recycled air. In addition, the sensation of breathing in and exhaling air through the nose can feel restrictive, leading to concern and worry for many individuals with ASD. While wearing a mask is uncomfortable at best, these unpleasant sensory experiences can be intensely magnified in people with ASD.
In addition to these sensory challenges, face masks also create new social communication challenges. Autism spectrum disorder can include poor visual perception skills, making the odds of accurately reading another person’s facial expression beneath a mask, from a socially appropriate distance, more difficult than usual. Moreover, when viewing another person’s face while they are wearing a face mask, the eyes are the primary area of the face that is visible. Individuals with ASD often have difficulty making eye contact, adding yet another hurdle for them in the social-communication realm. These factors can lead to miscommunication and frustration. Because masks muffle voices, verbal communication also becomes more difficult. Fortunately, there are several strategies that can make wearing a face mask more bearable.
What to do?
- Demonstrate using the face mask on a preferred object or person, such as a stuffed animal, a doll, or a family member.
- Allow the person with ASD to choose among different types of fabric face masks to find one that is most comfortable.
- Start by practicing wearing the face mask for short durations of time, allowing for breaks when needed.
- Plan initial outings in low-demand environments that are quiet and calm, so that the individual can experience success wearing the face mask.
- Use a printed photo or digital photo of the individual wearing a face mask as a visual cue to wear the mask before outings. The photo can be stored close to the door or on a tablet that is easily accessible.
- Chew gum or suck on a hard candy while wearing a mask, for distraction and to improve the smell of recycled air beneath the mask.
- Some medical settings may have transparent face masks. These masks make the mouth visible. Susan Muller-Hershon, American Sign Language/English interpreter at Massachusetts General Hospital, notes that transparent masks can be helpful for better communication.
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