Autistic children and adolescents with frequent restricted interest and repetitive behavior showed more difficulty in social cognition during mask-wearing during the COVID-19 pandemic: a multisite survey

Hiroki Tamon, Takashi Itahashi, Sosei Yamaguchi, Yoshiyuki Tachibana, Junya Fujino, Miki Igarashi, Makiko Kawashima, Riina Takahashi, Nozomi A. Shinohara, Yoshihiro Noda, Shinichiro Nakajima, Tomoya Hirota, Yuta Y. Aoki

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The public health measures enacted in order to control the coronavirus disease (COVID-19) pandemic have caused considerable changes to daily life. For autistic children and adolescents, adapting to the “new normal,” including mask-wearing, may be difficult because of their restricted interest and repetitive behavior (RRB) characteristics. We aimed to examine the relationships between RRB characteristics and the impact of mask-wearing on their social communications during the pandemic. Methods: We recruited participants with a clinical diagnosis of autism spectrum disorder based on DSM-5 diagnostic criteria from two outpatient clinics in Tokyo, Japan, between November 2020 and April 2021 using a convenience sampling methodology. As a result, the participants consisted of 102 children and adolescents (mean (SD) age = 11.6 (5.3)). We collected data on RRB characteristics frequency before and during the pandemic using the CoRonavIruS Health Impact Survey (CRISIS) – Adapted for Autism and Related Neurodevelopmental conditions (AFAR). We then conducted factor analyses to compute the RRB severity composite scores, which are divided into lower- (e.g., sensory seeking), and higher-order (e.g., restricted interest). We also investigated mask-wearing culture using a bespoke questionnaire, and using Spearman’s rank correlation analyses, we examined the relationships between before pandemic RRB characteristics, and the impact of mask-wearing on social communications during the pandemic. Results: We found that children and adolescents who exhibited lower-order RRB before the pandemic had difficulties in going-out with mask-wearing (rho = -0.25, q =.031), more challenges with mask-wearing (rho = − 0.34, q =.0018), and difficulty in referring to others’ emotions while wearing masks (rho = − 0.36, q =.0016). We also found an association between higher-order RRB before the pandemic and an uncomfortable sensation (rho = − 0.42, q =.0002) and difficulties in referring to other’s emotions while wearing masks (rho = − 0.25, q =.031). Conclusions: We revealed that various behaviors, such as sensory seeking, repetitive motor mannerisms and movements, and rituals and routines, undertaken before the pandemic could be important predictors of difficulties with mask-wearing and social communication for autistic children and adolescents during the pandemic. Caregivers and teachers wearing masks may need to provide extra support for social communication to autistic children and adolescents showing RRB characteristics frequently.

Original languageEnglish
Article number608
JournalBMC Psychiatry
Volume22
Issue number1
DOIs
Publication statusPublished - 2022 Dec

Keywords

  • Asperger’s
  • Autism spectrum disorder
  • CoRonavIruS Health Impact Survey (CRISIS)
  • COVID-19 pandemic
  • Mask-wearing
  • Restricted interest and repetitive behavior (RRB)

ASJC Scopus subject areas

  • Psychiatry and Mental health

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