COVID-19: Caring for children & adults with ASD.
Updated: Apr 12, 2020
Tips to keep your loved ones healthy during the COVID-19 quarantine.
Based on available evidence, children do not appear to be higher risk for COVID-19 than adults, although there are know pediatric cases. It’s not known yet whether some children may be at higher risk for severe illness, for example, children with underlying medical conditions and special healthcare needs.
The CDC has many tips and recommendations for children and adults to stay health on their website, some of the tips will be hard to apply for certain individuals with special needs, children and adults without modifications. Also, as many of you know, many of our kids do not do well with changes in routines, do not understand social distancing, may have a hard time keeping hands away from their faces, or using a mouth cover. So, I took the liberty to go over the CDC guidelines, do some modifications to them, and add tips that I have been using with my patients and own children. Hope this helps!
Be aware of COVID-19 symptoms
It is important that you are aware of COVID-19 symptoms, and get medical advice if your loved one presents fever, cough and shortness of breath. Emergency symptoms that require immediate medical attention are:
Persistent pain or pressure in the chest
New confusion or inability to arouse
Bluish lips or face
Protecting your loved ones and others from getting sick
Clean hands. There are 5 steps into washing hands: wet, lather, scrub, rinse and dry. The key is to scrub for 20 seconds. You can use a timer, count to 20, or sing a song during hand washing. Make sure your loved ones washes hands every time after using the bathroom, before eating, if there were in contact with another person, or returning home after being in public or playing outdoors. Many of you will have to completely assist with the hand-washing at first. Hopefully, time and practice will allow your loved ones to become more and more independent at this task, to the point that it can be performed completely independently. This is an essential functional skill for anyone to learn, and this is the perfect time to put it into practice and master it. Please use the visual below to learn how to scrub appropriately. Feel free to print the visual and tape it in your bathroom to use as a visual prompt.
Avoid people who are sick. I think this is pretty self explanatory, but I also want to mentioned the importance of treating everyone in contact with your loved one as if they were sick. I know many individuals continue to receive therapy and services as they are necessary. Make sure you ask everyone working with your child to wear a mask, and wash their hands before starting the session. If you are going into a practice setting, make sure your child is not receiving therapy in a shared room, and equipment is disinfected in between sessions. All sessions at this moment should be done one to one.
Limit time with older adults. Just like you treat everyone in contact with your loved one as if they were sick, you should protect your older family members as if your loved one was sick as well. Remember many people are asymptomatic, and although they show no symptoms, they can spread the virus. This also applies to your child.
Clean and disinfect high-touch surfaces daily. Many individuals tend to put objects on their mouth, use chewy sticks, hold objects in their hands, or use fidgety toys. Make sure you clean all these daily! Also... keep electronic and communication devices disinfected, including headphones and the cable of the headphones, if they are not wireless, as many times I see individuals chewing on the cable as they use their devices.
Social distancing. I keep reading online comments such as "individuals with ASD have been preparing for social distancing their entire lives" "my son practice social distancing all the time" blah blah blah. To practice social distancing, you need to be aware of personal space, something many individuals with ASD lack. My son can play alone for hours in his room, but he will randomly ask people for hugs, or he will come and hug you when you are not paying attention. This applies as well to respecting other people properties. I know many individuals that may not care much for social interaction, but will come and snatch your soda or water from your hand and drink it, even if they do not know you. They will eat leftovers in a table, even if it is not theirs. They will get very closed to you, because they like how your perfume or cologne smells, or they will touch your face cause they like to feel the skin. So, it is important for us as parents to reinforce those boundaries at this time and polish our loved ones social skills.
Covering mouth and nose. If your loved one can not keep their nose and mouth cover, you may need to do new arrangements to do errants, as they will not be allowed in any stores. They will have to stay home. The best is to start introducing the mask little by little at home. Allow them to wear it around the house. Use a reward system to introduce the mask, set shorter time goals and increase them as they reach them, until they feel comfortable leaving the mask for a certain period of time. Work also on one step instructions about putting their mask back over their mouth and nose if they take it off. For the ones that the face mask is a big NO NO, maybe you can try the face shields. The other option is character masks that they may have used already for Halloween, my son loves to wear his Spiderman outfit, and the mask covers his mouth. So if you can't make them wear a mask or face shield, then maybe you can let them dress up! Ideally, your loved one should not be leaving the house at this point, but I know there are a lot of single parents out there, therefore, sometimes there is not other option.
Keeping your loved one healthy
Watch for sign of illness. Be aware of COVID-19 symptoms as described at the beginning of this article. Often, sickness come with changes in behavior for individuals with ASD. One thing that many parents mentioned to me is that their kids are completely different when sick with a fever, more calm, more, engage, less stimmy. Also, self inflicting behavior can be trigger by pain, for example hitting the head could be do to headaches, or putting pressure on their stomach, like laying against a table or furniture, could be a sign of stomach discomfort.
Keep them active! It is important to keep your loved ones moving. Remember that they may be experiencing uncertainty which can lead to anxiety and depression symptoms rising. Exercising will help their bodies and brain produce hormones and neurotransmitters that have a positive impact on their mood, memory, energy levels, and sense of well-being. Some of these are known as endorphins, the body's feel-good chemicals. You can also create a daily exercise routine, from walking around the block, to riding bike, play outdoors, swimming (if you have a pool), etc. Vitamin D is also extremely necessary at this point, and the best source of vitamin D is the sun, so make sure they spend at least 1 hour outdoors every day!
Dietary Intake. Food is a key factor to support the immune system. Make sure diet is balanced. They should be eating fruits, vegetables and proteins. I know many of your loved ones are picky eaters. One tip that I can give you, is to use broth instead of water to boil their pasta or to make their rice. This way, the pasta and rice will absorb the nutrients of the broth. You can also mix vegetables and fruits to make popsicles, smoothies. Water intake is also important, keep them hydrated. Many individuals do not drink enough water thought the day (5 glasses for 5 to 8 year olds. 7 glasses for 9 to 12 year olds. 8 to 10 glasses for 13+ years). Introduce probiotic rich foods. One of the concerns that I have been hearing from families is individuals over eating because they are bored, or due to anxiety. They ask for snacks constantly. I recommend separating the "allowed" snacks for the day and set them in the kitchen counter. This way, you can teach them how to ration their food, and they learn to time themselves. May be challenging at the beginning, but eventually they will understand the idea that once all the "allowed" snacks are over, there are not more options. For this to work, consistency is the key. If you allow more snacks besides the ones assigned, it will not work at all. These are all opportunities to teach your loved one self control, and good eating habits. The ideal is to separate three snacks. One between breakfast and lunch, and the other two between lunch and dinner. At least one of the snacks should be a fruit.
Sleep. I would try to keep the same sleeping routine that they do during their normal schedule. Same bed-time and same wake-up time. For many individuals, if their sleeping routine is broken, it will be hard to go back to their regular sleep pattern schedule. Avoid sending them to bed with electronics, and stop usage of electronics at least 1 hour before bedtime.
Online schooling. This is new for everyone... schools, teachers, students, and parents. Patience is the key. Go to your child's pace. Keep in touch with school and teachers. If your child can not sit on the online class, go over the recording at a later time. There are many fights that you will loose, so you want to pick the ones that are worth fighting. If you have to struggle to sit them in front of the computer, is better for them to do the work on their own time. Do not try to reinvent the wheel, ask teachers the techniques they use to work with your child. Create a schedule, allow for body and mental brakes in between assignments.
It will be a while before things go back to normal. Until then, sit down, buckle up and enjoy the ride next to your pilot. Your role right now is to be the best co-pilot that you can be.
About Luciana Leo
Luciana holds a Master of Science degree in Traditional Chinese Medicine (TCM), and practices as a Licensed Acupuncture Physician (LAc) in Florida. She provides integrated and comprehensive care for individuals with cognitive, neurological, psychological and emotional conditions. Certified in Neuro-Endo-Immune (NEI) Connections, her major interests are in the assessment and treatment of imbalances in the nervous, endocrine, and immune system. Luciana’s career actively focuses on preventative care, offering her patients intervention, risk prevention of chronic diseases through lifestyle changes, testing, and advice on the nutritional and supplement components to benefit their wellness. Luciana has been part of the healthcare community for over 15 years, and she is a strong advocate of preventive care. She understands that a comprehensive preventive care program can lower the odds of an individual becoming another negative health-related statistic.
Luciana's practice is located in Miami, Florida. She also offers Telemedicine. To learn more about her practice, or to schedule a consultation, visit her website
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