Masks and New Routines: Helping Children with Special Needs During COVID-19

By: Parker Huston, PhD & Kara Miller, OTR/L
As seen on Nationwide Children's Hospital's 700 Childrens® Blog

Children with autism or other developmental delays may not benefit from traditional explanations about the need to wear masks during the COVID-19 pandemic. Additionally, they may not be able to express their fears and frustrations as easily or clearly as other children.

Adjusting to a new routine, like wearing masks or social distancing, can be stressful for everyone, but especially challenging for children who have rigid routines or have heightened sensitivity to change. Here are some common recommendations to help with communication, understanding and coping for these children.

How Can I Help My Child Understand and Adapt?

Your child may need extra support to understand what is going on around them. They likely also need to learn what is expected of them and that is best done by using learning methods that have worked in the past. Think of how you helped with existing habits or routines and use a similar strategy. The following tools can be helpful for supporting their understanding and adjustment:

Social stories – Social stories use pictures to explain social situations to children and help them learn appropriate behavior and responses. Use stories, pictures, and other visuals to help your child understand the steps for:

  • Washing hands – parents can demonstrate as well or watch a video online
  • Social distancing
  • New routines
  • Wearing masks for protection

Pairing and Shaping – Research shows that pairing and shaping may help with adapting to new routines. Each step may require several attempts and it’s important not to move ahead too fast.

Pairing is a method for introducing unfamiliar objects, like a face mask. Start with the goal of simply wanting your child to enjoy holding the mask:

  • Pair this item with positive reinforcement (tickles, hugs, praise, high fives)
  • Have them become more familiar with the mask by being silly, enthusiastic and fun! Try making goofy faces or playing peek-a-boo

Shaping uses rewards (praise, high fives, small tokens) for each small step towards a larger goal. This strategy can best be used once your child is comfortable in the presence of something new, like a mask. Provide the same rewards and positive reinforcement, like social attention, hugs, high fives, or small tokens for each behavior getting sequentially closer to the desired behavior:

  • Brings the mask towards their face
  • Touches the mask to their face
  • Allows us to pull back the elastic
  • Allows for fitting the elastic over the head
  • Wears for 1 second
  • Wears for 5 seconds, etc.
On Our Sleeves happy face with face mask

How Can I Help My Child Stay Calm?

Children with developmental delays who feel frustrated, worried, or scared may have more repetitive behaviors, tantrums and other challenging behaviors. Find ways for your child to express feelings and work through their emotions. Try implementing these activities as part of their regular routine before the behaviors occur.

  • Talk together and acknowledge your child’s feelings by understanding and sharing
  • Crafts, writing, art
  • Playing or acting out fears
  • Use augmented or alternative communication devices for kids who are non-verbal

Routines – Structured routines are comforting to all children, not only to those with autism or other developmental delays. Once established, routines are predictable and safe, which help your child (and their siblings) know what to expect. Have a set routine and clear expectations to help lower anxiety when things happen that are not in our control.

  • Stick to regularly scheduled meal and snack times, bedtime routines, wake up times, screen time, chores and other daily activities
  • Create new routines to include school-work, breaks and exercise
  • When appropriate, help your child have some control by giving them a couple of choices, such as what they want to eat for lunch
  • Visual schedules and to-do lists
  • Timers and 2-minute warnings to help with transitions

Try calming activities, such as deep pressure (heavy lifting, bear hugs, or exercise), slow linear movement (rocking or swinging), deep breathing, or music. These activities calm the nervous system and can help your child feel more organized and calm.

Featured Experts

Parker Huston, PhD
Psychology

Parker Huston, PhD, is a pediatric psychologist working in the Comprehensive Pediatric Feeding Program at Nationwide Children's Hospital. He primarily provides services through the evaluation clinics, outpatient treatment and intensive feeding track.

Kara Miller, OTR/L
Occupational Therapy

Kara Miller, OTR/L, MOT, has been an outpatient occupational therapist at Nationwide Children’s Hospital since 2009. Kara has a special interest in feeding. She works full time with the Comprehensive Pediatric Feeding Program.

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