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ISSN: 1935-1232 (P)

ISSN: 1941-2010 (E)

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Research Article - Clinical Schizophrenia & Related Psychoses ( 2022) Volume 0, Issue 0

Effect of COVID-19 on Individuals with Autism Spectrum Disorder (ASD): A Narrative Study
Mitra Joudi1, Sheida Rezaei Jiryaei2, Payam Khalafi3 and Mohsen Hosseinbor4*
 
1Department of Psychiatry, Golestan University of Medical Sciences, Gorgan, Iran
2Department of Occupational Therapy, Shahid Beheshti University, Tehran, Iran
3Department of Psychiatry, University of Medical Sciences, Tehran, Iran
4Department of Psychiatry, Iranshahr University of Medical Sciences, Iranshahr, Iran
 
*Corresponding Author:
Mohsen Hosseinbor, Department of Psychiatry, Iranshahr University of Medical Sciences, Iranshahr, Iran, Email: [email protected]

Received: 15-Dec-2021, Manuscript No. CSRP-21-49930; Editor assigned: 17-Dec-2021, Pre QC No. CSRP-21-49930(PQ); Reviewed: 31-Dec-2021, QC No. CSRP-21-49930; Revised: 05-Jan-2022, Manuscript No. CSRP-21-49930(R); Published: 12-Jan-2022, DOI: 10.3371/CSRP.JMSJ.011222

Abstract

Background and aim: COVID-19 pandemic causes various negative impacts on individuals with Autism Spectrum Disorder (ASD). The main purpose of this study was to investigate the impact of the COVID-19 pandemic on mental health, leisure time at home, education, job status, and vulnerability of autistic people by a narrative review study.

Materials and methods: To carry out this study, all studies related to the topic under discussion during 2020-2021 by systematic search in internationally available databases, including Web of Science, Science Direct, Scopus, PubMed, and Google Scholar, were checked out. Finally, 23 completely related studies were selected to extract the results.

Results: The results showed that due to the inherent characteristics of people with ASD, such as differences in communication, socialization, and executive function, autistic people are more vulnerable to the COVID-19 pandemic than non-autistic people. A review of similar studies in the past has shown that the negative effects of this pandemic on people with ASD, families, caregivers, and professionals associated with these patients are well felt. In most countries of the world, the COVID-19 pandemic has severely affected mental health, educational and professional activities, leisure, and access to health and medical services in the community of people with ASD.

Conclusion: Considering the different negative impacts of this pandemic on individuals with ASD, it can be concluded that different strategies should be used to reduce these negative impacts. These strategies can include setting up special centres to provide health care for autistic individuals, educating parents, educators, and caregivers (to provide different ways of educating individuals with autism), providing financial assistance to families with autistic individuals, etc.

Keywords

Autism spectrum disorder • COVID-19 • Psychological impact • Vocational challenges • Education • Leisure time

Introduction

In December 2019, there were reports in China of the emergence of a new influenza-like virus that has infected many people in Wuhan, China [1]. Despite efforts to control the virus within the city, the disease spread rapidly in China and other countries in Asia and the world [2]. The virus was very similar to the coronavirus that appeared in China from 2002 to 2003 and was known as a Severe Acute Respiratory Syndrome (SARS). For this reason, in February 2020, the World Health Organization (WHO) named the virus SARS COVID 2 and the resulting disease COVID-19 [3].

The COVID-19 pandemic has caused considerable fear and uncertainty worldwide, as it has negatively affected almost every aspect of society, leading to near-global problems and stress [4,5]. In general, infectious disease outbreaks often lead to adverse psychological and behavioral reactions such as increased anxiety and depression, insomnia, decreased immunity, increased alcohol and tobacco use, physical symptoms (such as lack of energy and general weakness), and increased use of different drugs [6]. In addition, the economic consequences of a pandemic can complicate the psychological and behavioral functioning of many people who may be struggling to meet the basic needs of their families due to unemployment, food insecurity, and housing instability [7].

The aforementioned negative consequences highlight some special challenges for individuals with Autism Spectrum Disorder (ASD) and their families [8]. According to some studies on the impact of the COVID-19 pandemic in some parts of the world, people with ASD and their families in terms of several aspects, including educational and professional dimension, home and leisure activities, access to behavioral health services, and changes in health service delivery has been affected. The impacts of this pandemic, especially for individuals with disabilities, are not yet completely understood. However, it is clear that people with physical and mental disabilities also faced significant challenges before the COVID-19 pandemic [9-14]. Now is the time to evaluate the degree to which the COVID-19 pandemic affects people with ASD and the aspects of their lives that are most important to them.

The consequences of a pandemic disease such as COVID-19 may affect anyone in the community, but individuals with neurodevelopmental disorders, including ASD, are at the highest risk. Individuals with disabilities are more exposed to harassment, and this risk increases during the pandemic [15,16]. Individuals with ASD, especially children, miss out on more opportunities to practice social skills due to the limitations of social distancing. It is difficult for children with ASD to adapt to a changing environment. It has been found that during the COVID-19 pandemic, children with ASD become restless and may have behavioral problems and increased self-harm [17,18].

Considering the negative impacts of the COVID-19 pandemic on different aspects of the life of all people in the community and paying particular attention to the living conditions of people with ASD, so in the present study, we try to show the different impacts of the COVID-19 pandemic on different aspects of life. Therefore, people with ASD should be checked for vulnerabilities, psychological effects, education, leisure time at home, employment status, and the pandemic's effects on the autistic community.

Materials and Methods

A systematic search in available international databases, including Web of Science, Science Direct, Scopus, PubMed, and Google Scholar, was done from 2020 to 2021 to review and extract required results from published articles and reports related to the considered subject. Systematic review was performed using the Mesh terms including "Mental Health", "COVID-19", "ASD", "Autistic", "Patients", "Children", "Adults" and "Autistic spectrum disorder", "Social isolation", "Anxiety", "Stress", "Pandemic", "Depression", "Distress", "Mental wellbeing", "Vulnerability", "Autism Community", "Education", "Job status", "Vocational Challenges", "Leisure time "Behavioral Health Services", "Home and Leisure Challenges" and "Service Delivery". For other databases, the same Mesh terms were used similarly. The references were thoroughly evaluated to verify that no articles were missed for inclusion in the study (Reference Checking). In addition, the citations from the research were also checked (Citation Tracing) to make sure that the search was thorough and successful. According to Figure 1, the literature review, especially articles, was done according to the PRISMA guideline [19]. In addition, unofficial reports, articles in a letter to editor format, and unpublished articles and content posted on Internet sites were removed from the list of downloaded files. Finally, the results of 23 published articles were reviewed for the present review (Figure 1).

identification

Figure 1. Flow diagram of study identification according to PRISMA.

Results and Discussion

The impact of COVID-19 pandemic on vulnerability level of autistic individuals

According to the World Health Organization (WHO), vulnerability is the degree to which a population, individual, or organization cannot anticipate, cope, resist, and recover from the effects of a particular disaster [20]. Due to the inherent characteristics of people with ASD, such as differences in communication, socialization, and executive function, they are more vulnerable to the COVID-19 pandemic than non-autistic individuals [21]. Many autistic people have poor communication skills and have delayed information processing [22]. In addition, the presence of stress and anxiety and the mental disability of autistic individuals affect the effective and efficient response to the COVID-19 pandemic. People with ASD may experience expressive communication challenges, leading to communication difficulties with pain, symptoms, or emotional distress [23,24]. As a result, people with autism during the COVID-19 pandemic are more in need of their parents, family, and other caregivers to convey important information about the pandemic or observe the symptoms of a possible disease [25].

Anxiety symptoms have increased in the general population since the onset of the pandemic COVID-19, whereas they did not have such anxiety levels before the pandemic [26]. However, individuals with ASD had innate anxiety before the pandemic (due to the characteristics of ASD), and after the pandemic, their anxiety levels increased [27]. Therefore, people with ASD are generally more vulnerable to the general population when exposed to the COVID-19 pandemic in terms of mental health, learning, medical concerns such as seizure disorders, and behavioral health concerns [28].

In addition to diagnostic and mental health vulnerabilities, people with ASD may be more susceptible to genetic and physiological risk factors for COVID-19. Several studies have reported increased levels of proinflammatory cytokines in people with ASD [29]. Evidence suggests that with at least one phenotype of COVID-19 infections, the body can become inflamed through a "cytokine storm", leading to heart and lung damage [30]. The predisposition to proinflammatory status may put people with ASD at a higher risk and more severe symptoms when exposed to the virus [31].

In addition, various studies show that people with ASD than the general population have a higher risk in terms of poor overall health [32], sensory disorders, and physical disabilities [33], and also type 2 diabetes [34] All represent a special risk factor influential in poor recovery in patients with COVID-19 infection [35]. Therefore, on the above results, it can be said that people with ASD are more vulnerable than the general population in the COVID-19 pandemic period; therefore, they need more mental, social, and therapeutic attention health.

The impact of the COVID-19 pandemic on the community of autistic individuals

Various strategies worldwide (such as staying at home and social distance) have been implemented to counteract the effects of the COVID-19 pandemic. Unfortunately, these strategies left people with disabilities (e.g., ASD patients) without access to vital services and support [8]. Based on the results of previous studies, the impacts of this pandemic on individuals with ASD, their families, caregivers, and specialists who related with these patients were clearly felt [8,36-42].

Families and caregivers of children with ASD use various services and providers for their children's educational, occupational, and functional needs [40]. Adults with ASD may rely on community-based service providers to help them achieve their set social participation goals [41]. This means that during the COVID-19 pandemic, daily life activities are taught with support at home, social skills in the community, and educational and professional tasks on site. Homestay orders, closure of non-essential social facilities and health services, and standards of social distancing have prompted parents and caregivers of people with ASD to try to meet most service needs under severely limited options [42]. In addition, during this pandemic period, specialists used telemedicine to provide their services [8]. In most countries, the COVID-19 pandemic has severely affected educational and professional activities, leisure, and access to health and medical services in the community of people with ASD [8,36-42].

The impact of the COVID-19 pandemic on the educational process of autistic individuals

At the beginning of the COVID-19 pandemic, most schools in different countries closed to reduce the spread and transmission of coronavirus. As a result, educators and teachers used distance learning methods to provide training courses to learners. Therefore, rapid adaptation to this educational method was an important challenge for most educators and students. Another important challenge related to this issue was the incompatibility of students with mental disabilities with this education method. Due to the complex needs of children with ASD, the problems of this educational method for educators increased [8,43-45]. In addition, during this pandemic, many children with ASD received minimal services such as speech therapy, occupational therapy, and physical therapy [42].

With children with ASD accustomed to a specific routine, planning, training program, and schedule, now, with the onset of the COVID-19 pandemic, they are forced to receive educational services at home using a tablet or laptop. Unfortunately, they are not compatible with this educational method, representing another challenge for children with autism during the COVID-19 pandemic. Parents of children with autism face two major challenges in educating their children at home during the COVID-19 pandemic. First, the amount of work they have to do at home (such as caring for other family members, cooking, cleaning the house, and the like) is enormous, and they may not have enough time to educate their children. The second problem is that some parents may not have the necessary experience and scientific ability to implement an effective educational program for their children [8].

During the COVID-19 pandemic, performing homework with parents at home was probably unfamiliar and challenging to many students because parents may prefer other priority activities at home. While working and interacting with a tablet or laptop is probably familiar to many children. In the COVID-19 pandemic period, the use of cyberspace for education results in interaction with the teacher, and complete attention to education is very little. In addition, children with ASD have a special mental disability; this may have higher sensitivity and challenge. Therefore, adapting to the above challenges requires more time and effort from parents and caregivers [8,43-45]. Daulay, et al., discuss the challenges and barriers to educating children with ASD at home from the perspective of mothers during the COVID-19 pandemic in Indonesia. The results of this study showed that the implementation of education at home during the pandemic due to the increase in maladaptive behaviors of autistic children, their low adaptation to education at home by parents, the burden of care, and the occurrence of negative emotions had lower than desirable quality level [43].

A study by Cahapay, et al. interviewing mothers of children with ASD in the Philippines found that involving multiple people in educating a child with ASD at home was far more effective than educating one person alone (such as a parent). In addition, the use of different educational methods increases the quality of education [45].

Obliging parents and caregivers to learn their child's educational planning and adaptations, teaching instructors themselves to provide virtual learning methods, giving effective reinforcement strategies, and creating a realistic and sustainable schedule for educating children with ASD by parents or instructors can reduce barriers for children with ASD.

The impact of the COVID-19 pandemic on the job status of autistic individuals

In addition to children with ASD, adults with ASD were also severely affected by the COVID-19 pandemic in several ways, one of which was their occupational status. During this pandemic, autistic adults experienced reduced social services and potential employment [8,42]. In addition, individuals with ASD are at greater risk for social isolation, lower social participation, and lower participation in social activities [46,47].

Although no official statistics have been released to date, it can be assumed that adults with ASD have significant economic problems due to the COVID-19 pandemic. With countries reopening following the initial wave of the pandemic, returning to social activities, such as school and work, may continue to pose challenges for people with ASD [48]. Although most individuals with ASD enjoy social environments, they can also be anxious. In the COVID-19 pandemic, people with ASD, like all community members, have to deal with new restrictive practices such as wearing a mask and occupational restrictions. This can be stressful for individuals with ASD because they face difficult situations previously comfortable with [8]. One of the challenges facing autistic adults after the COVID-19 pandemic is the reintroduction of the workplace and the retraining of skills that have not been practiced for several months, which takes a long time to regain previous skills [8].

The impact of the COVID-19 pandemic on the leisure time of autistic individuals

In the COVID-19 pandemic, everyone in the community experiences a large increase in time at home as a result of restrictions on access to work, school, and community. Access to unstructured time at home poses challenges for many people with ASD who can cope with the performance of autistic people, which includes planning, organizing, getting started, and monitoring themselves [49]. Individuals with ASD, before the COVID-19 pandemic, had almost constant planning and routine activities while at home; now, with the onset of this pandemic, there is plenty of free time for autistic people at home. But limitations in the level and type of skills, changing routines, limitations in creating new ideas by autistic individuals, their parents, and caregivers are challenges that autistic people face [8,50].

The impact of the COVID-19 pandemic on the mental health of autistic individuals and their parents

Another important effect of the COVID-19 pandemic on individuals with ASD is psychological impacts. Considering that autistic individuals have a previous background in terms of mental health deficits, the impact of the COVID-19 pandemic on the reaction Psychology of people with ASD is significant. The results of previous studies showed that this pandemic not only caused anxiety and stress in children with ASD, these psychological impacts were also reported in caregivers, nurses, and their parents [39]. According to the results of some studies, the COVID-19 pandemic caused depressive and anxiety symptoms in both groups of non-autistic and autistic people, but the incidence of these symptoms was higher for individuals with ASD [51]. In addition, during the COVID-19 pandemic, people with ASD showed greater concern about their pets, work, food and drug intake, and safety/security [51]. Each of the above results has been reported in previous studies. For example, according to Pellicano, et al. increasing social isolation associated with this epidemic has had a serious and devastating effect on the mental health and mental well-being of autistic people [52]. The study of Amorim, et al., reported that caregivers and nurses of children with autism experienced more anxiety during quarantine than children without autism [39]. The study results by Oomen, et al. showed that depression, stress, and anxiety in response to this pandemic increased for both non-autistic and autistic groups, but the incidence of these symptoms was higher for adults with ASD [51].

Conclusion

Based on the present study results, it can be concluded that due to the intrinsic characteristics of individuals with ASD, such as differences in communication, socialization, and executive function compared to non-autistic individuals, in the face of the COVID-19 pandemic, are more vulnerable. Furthermore, based on the results of previous studies, the impacts of this pandemic on people with ASD, their families, caregivers, and professionals who work with these patients are clearly felt. Furthermore, in most countries of the world, the COVID-19 pandemic has severely affected educational and professional activities, leisure, and access to health and medical services in the community of individuals with ASD. Finally, one of the other impacts of this pandemic on individuals with ASD is the psychological effects, including increased stress, anxiety, and depression. Based on the various negative impacts that this pandemic has on individuals with ASD, it can be concluded that different strategies should be used to reduce these negative impacts. These strategies can include the creation of special centres to provide health services for autistic individuals, training parents of autistic children, educators, and caregivers to provide different methods of education for individuals with autism, financial assistance to families with autistic children, and so on.

References

Citation: Joudi, Mitra, Sheida Rezaei Jiryaei, Payam Khalafi and Mohsen Hosseinbor. "Effect of COVID-19 on Individuals with Autism Spectrum Disorder (ASD): A Narrative Study." Clin Schizophr Relat Psychoses 16S (2022). Doi: 10.3371/CSRP.JMSJ.011222.

Copyright: © 2022 Joudi M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.