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

Abstract

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.

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

“…First, although preference for facemask type was evaluated for one participant in this experiment, future research may want to expand upon preference for facemask color or pattern as well as material type and its potential effects on the rate of mastery for passive compliance (Dunlap et al, 1994). Additionally, in the current study, participants were not taught how to don a facemask on their own (see Sivaraman et al, 2020). This may have resulted in a missed opportunity to promote independence when wearing a mask (Code 4.0; BACB, 2014) and thus, limits the ecological validity of our findings.…”

“…Recently, Sivaraman et al (2020) evaluated the use of Telehealth technologies to teach caregivers of children with ASD methods to increase compliance to wearing a facemask. The researchers were successful in coaching caregivers to implement standard procedures to increase compliance (e.g., graduated exposure, shaping, and contingent reinforcement) such that participants wore a facemask for 10 consecutive minutes.…”

Tolerance of face coverings for children with autism spectrum disorder

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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.

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“…Individuals with intellectual and developmental disabilities have a higher prevalence of specific phobia than the general population (Dekker & Koot, 2003), and 33%-50% or more of children with ASD have higher rates of medical fears compared to other children (Evans et al, 2005;Gillis et al, 2009). Additionally, some children with ASD may engage in behavior to avoid medical protective equipment such as face coverings so that they are unable to be safely or appropriately placed on their face (Sivaraman et al, 2020). Children may also remove the face covering frequently or engage in accompanying problem behavior or incompatible behavior (e.g., object mouthing) related to wearing a face covering.…”

“…The treatment package was successful for all participants. Sivaraman et al (2020) extended the research on tolerance of medical devices to reduce the risk of viral transmission of COVID-19. They taught six children with ASD to wear face masks via a telehealth treatment package.…”