Helping people with autism spectrum disorder manage masks and COVID-19 tests

by Fitcoachion | Last Updated: June 10, 2020



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?

The challenges of a COVID-19 nasopharyngeal or throat swab test

Testing for COVID-19 requires a nasopharyngeal (through the nose) and/or oropharyngeal (through the mouth) test using a cotton swab. These tests can cause distress for people with ASD due to the associated discomfort, unfamiliarity with the procedure, and change of routine. The use of visual aids to help prepare a person with ASD, and strategically selecting a comfortable testing environment, can help with a successful procedure and reduce anxiety.

What to do?

It is important for parents and healthcare providers to understand why adjusting to wearing face masks and enduring a COVID-19 test can be especially challenging for individuals with ASD. There are a number of strategies, including advanced preparation using visual aids, gradual practice, and modifying the sensory experience, as well as online resources, that can be used to help individuals with ASD and their caregivers rise to meet these challenges.

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