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.

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Individuals with autism spectrum disorder (ASD) have difficulties in social interactions. The cognitive domains that support these interactions include perceptual decision‐making, timing, and error‐monitoring, which enable one to appropriately understand and react to the other individual in communicative settings. This study constitutes a comprehensive exploration of decision‐making and interval timing in ASD as well as the first investigation of error‐monitoring abilities of individuals with ASD regarding their performance in the corresponding domains. We found that children with ASD fared similar to typically developing (TD) children in their first‐order task performance in two‐alternative forced choice perceptual decision‐making and temporal reproduction tasks as well as the secondary tasks (signal detection and free finger tapping tasks). Yet, they had a deficit in error‐monitoring in both tasks where their accuracy did not predict their confidence ratings, which was the case for the TD group. The difference between ASD and TD groups was limited to error‐monitoring performance. This study attests to a circumscribed impairment in error‐monitoring in individuals with ASD, which may partially underlie their social interaction problems. This difficulty in cognitively evaluating one's own performance may also relate to theory of mind deficits reported for individuals with ASD, where they struggle in understanding the mental states and intentions of others. This novel finding holds the potential to inform effective interventions for individuals with ASD that can target this error‐monitoring ability to have broad‐ranging effects in multiple domains involved in communication and social interaction. Autism Res 2019, 12: 239–248 © 2018 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary Decision‐making, timing, and error‐monitoring are three of many abilities that underlie smooth social interactions. To date, these domains have been only investigated separately, but given their interactive role in social interactions that are impaired in ASD, we conducted the first study to investigate them together. Children with ASD were as successful as typically developing children in their task performances, but unlike them, were unaware of their errors in both decision‐making and timing tasks. This deficit that is limited to error‐monitoring can contribute to unraveling the unique cognitive signature of ASD and to formulating interventions with positive implications in multiple domains.

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