Autism & Fear Wearing Masks

It's all about Autism, wearing masks and issues related to medical treatment and returning to school-UGH!  What’s Next?

I received some info recently about a child with autism who was refused necessary medical treatment because she wouldn’t wear a mask. Of course, there was a lot of outrage because a child with a disability wasn’t cared for as needed.

And the recent news is full of conversations about opening schools as soon as possible and questioning what is going to need to happen to keep children safe. This discussion includes all kinds of issues about if they need to wear masks in school, how do you keep children 6’ away from each other and how do you keep the favorite Time Out Chair in the classroom clean.

Parents can meet the challenge
Parents of children with autism have had to deal with so many changes in these last few months that I’m sure that dealing with kids with autism wearing masks can feel like overload. But parents of autism are resilient and strong and the answers will unfold.

Some children may put on a mask and there is no problem. That’s fortunate, but not typical.

So many issues
So many children on the autism spectrum are sensitive to touch or how something feels. A mask touching the face, pulling on the ears or just the air from breathing inside the mask can be bothersome. I don’t like how those masks feel either.

Children who don’t like tight clothing or wearing shoes are probably going to have a problem.

Just the fact that a child with autism wearing a mask is different from the child’s normal routine can be enough to cause protest.

Dealing with fear
Remember that children with autism can make associations that we don’t even recognize. They may associate a Covid 19 mask with past negative experiences.

Some children are afraid of Halloween costumes or clowns or other situations where faces are covered. Superheros can be another problem. Either children love them or hate them. 

Seeing their parents or other familiar people wearing masks can cause strong emotion and confusion.

If there is anything at all about those situations that a child doesn’t like, he may resist masks. 

Some interesting research
According to Kang Lee (who conducts facial recognition research) adults and typically developing teens are able to look at a person with a mask on and still recognize who that person is.

In contrast, typically developing younger children may have difficulty understanding even familiar faces if they are covered with a mask.

The youngest children, under 6, may have the most difficulty. 

Now take this information and translate it to children with ASD. There’s a high possibility that even their parents and their most familiar people with masks may seem like strangers. This adds to the fear.

Things you can do
Dealing with strange and new and fear is common for helping children with autism adjust. Here are some suggestions.

Look at the mask first
Just touch it. Hold it. Explore it so it isn’t a strange thing. Label it. See someone else wearing one. Put it on and take it off another person. Use a mask as a piece of “clothing” to put on a doll or a stuffed animal.

Superhero with mask

Make it fun
Make it a game. Pair putting on a mask with some giggles or tickles or whatever will make it fun or funny. Play peek-a-boo.

Give them choices
All masks don’t look alike or feel alike. There are the “classic” white institutional looking ones. But lots of people are doing home-made varieties. You need to have a mask that meets the medical/institutional requirements for safety. But given those requirements, use some creativity.
Create something the child will like
Can you decorate their mask? Use some fabric with a special character? Make it a favorite color? Write something on it?

Think about what makes a mask undesirable and change it. If elastic hurts, can you tie it instead? Can you change the size to make it more comfortable? Parents know what their children will be attracted to and comforted by.

Work up to it and build in rewards
All kids are different. But most of them will do a lot for a reward. You may need to create a step-by-step approach to get to your final goal.

Here’s an example for a very hesitant child:
•Touch it
•Hand it to Mom
•Hold it up to your face
•Put it on & take it off
•Put it on for 20 seconds

Some children need more steps and some need less. But be sure to use your most helpful reward system to let them know they are doing something good.

Take some pictures
Photos work really well to give information, give directions, or brag about an accomplishment.

Take a picture to show someone else how the child accomplished a step with the mask. Post a picture on the refrigerator of the teddy bear wearing the mask. Then ask the child if he wants a picture of him wearing the mask.

Write a story or make a book
We know that Written Conversations, Social StoriesTM and picture books all help children understand. Depending on the age and skill level of your child, you can create something for him or have him create his own book.

Take some time
Just remember this. Children with autism are known for establishing a routine and then once they have learned that routine, it can be difficult to change it. That means that once one of these students learns a negative reaction to the whole mask thing you may have long term difficulty dealing with masks. Take the time you need to develop a positive routine with masks.

The problem is that right now, we don’t know how long we are going to have to deal with the Coronavirus and masks. If it was just a couple of weeks, we could ignore it and hope it goes away. Unfortunately, that doesn’t appear to be one of our options.

Think long term
So, keep our children’s long-term best interests in mind. We want them to be able to handle life events like getting medical treatment without a problem. And we want to be able to have them attend school without experiencing trauma.

Think of this as an opportunity to learn a new skill and learning how to overcome fear. Teaching our students with autism to wear masks may be a step to become more flexible and that is a good goal.

P.S. Keep in mind that one issue is the child wearing a mask. The other issue is related to seeing others wear them. These are really two different issues, but they get very mixed and combined from a child's perspective. And fear can jumble everything together.

P.P.S. One more thing to consider. Get t-shirts made with your pictures on them so kids will know who is behind the mask. That could help them identify the people behind the mask.

P.P.P.S Here's a picture of a face shield that I saw recently.  I wonder how well they work.  Seeing faces is important for children, but I wonder how difficult these shields would be to wear around children? We'll be learning many new things.

P.P.P.P.S. These steps introducing a mask can be used for other "new" experiences, too.

Nurse with face shsield

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  1. So, so very important as we look to the fall. Hoping parents are working on this throughout the summer.
    Like the picture t-shirt idea and even using some sticker name tags as we think of the upcoming school year.

  2. I wonder if it would be helpful to a child with autism and the parent to have the lip reading masks with clear vinyl that is being used for the deaf and hard of hearing. Child could still see the parents eyes and mouth.

    1. Interesting idea. I have seen some people on television wearing clear plastic face shields. I don’t know how safe they are, but the ability to see the face of people seems very important for the children with autism or related special learning needs (actually for LOTS of children). I’m thinking that some creative solutions will unfold as time goes on.

    2. Yes, I’m a music therapist and ordered a mask with the clear vinyl in the middle, because I want my students on the AS to get cues from my mouth- along with seeing me smile at them!
      I know the one drawback is they can get fogged up, but I’m hoping my swim goggle anti-fog spray will take care of that.

    1. Very good question. Here’s the problem. How long is “temporary?” Our students can respond quite well when events have a very clear beginning and a clear ending. That is predictable, clear, concrete. I think calling it temporary could create more anxiety than reassurance. I wonder how others feel about this suggestion.

  3. I bought material with pictures on them that the autistic students like to make masks for them. That way they can pick out their favorite material themes such as cars, hearts, superheroes or whatever they like. Even wearing a bandanna mask like Woody in Toy Story. I can use commercially made filters or cut my own out of hepa vacuum bags. Prepping them on feeling more comfortable wearing them before going to school or out in public is a great idea. Watching videos on wearing masks may help also.

  4. Our students can respond quite well when events have a very clear beginning and a clear ending. Prepping them on feeling more comfortable wearing them before going to school or out in public is a great idea.

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