For ASD kids, ‘pandemic wall’ brings unique challenges

It starts with the general understanding that no two autism spectrum disorder kids present the same way.

But, when it comes to “hitting the pandemic wall” — an issue all young people are struggling with right now — Dr. Jeffrey Selman said there are some universal warning signs parents of ASD kids should look out for.

Start with changes in hygiene.

Selman, vice president, clinical services for First Children Services, a leading provider of behavioral health and special education services for children and families in New Jersey and southeastern Pennsylvania, said the change could go either way.

“Children may begin isolating themselves more than before, paying less attention to self-care than before or not wanting to engage with others more than before,” he said. “Additionally, a regression in skills, increased rigidity, not wanting to leave the house or even a preoccupation with sanitation due to fears of the virus could all point to underlying mental health challenges.”

Selman said parents may notice changes in their child’s behavior patterns, poor sleep, increased anxiety, resistance to doing things they typically would be willing to do, oversensitivity or poor grades, too.

Selman said the concern is that ASD kids may fall further out of touch with day-to-day interactions.

“I have seen many kids disappearing into an ‘online orbit,’ since they are experiencing extreme levels of loss and trauma due to being isolated from friends,” he said. “Kids with autism have social deficits to begin with, and increased screen time and social isolation can make it increasingly hard for them to get off of the computer. Conversely, we see a marked decrease in this behavior when kids are in school.”

As part of Autism Awareness Month, we spoke with Selman about a number of issues involving ASD kids and the pandemic — and how First Children Services is working with the community. Here is the conversation, edited for space and clarity.

ROI-NJ: Let’s start at the top. What is the ‘pandemic wall,’ and how has it impacted kids with autism spectrum disorder?

Jeffrey Selman: The pandemic wall is essentially referring to the fact that, now, we are over a year into the COVID-19 pandemic and the associated isolation and trauma, (and) people have reached their breaking point — they are burnt out, overwhelmed and have been grappling with continually shifting expectations and ongoing disappointments leading to emotional dysregulation.

Experts initially anticipated the pandemic to end by this time last year, but the goalposts have constantly been pushed back. Kids are resilient and have a certain threshold for disappointment, but many have reached their limit, and the accumulated disappointment and loss at this point has become too much for kids to handle.

ROI: Are ASD kids impacted more by Zoom fatigue?

JS:  Pandemic overload coupled with screen burnout, or ‘Zoom fatigue,’ has taken a toll on everyone’s mental health, but kids with autism spectrum disorder are facing increased challenges. Many are struggling with adjusting to continually shifting schedules and disorganized routines, which has led to increases in anxiety. Virtual learning has also increased problems with sensory regulation and has made communication and developing and practicing everyday social skills that much more challenging.

ROI: What are some mental health challenges prevalent among kids with ASD, and how have they been exacerbated by the pandemic?

JS: Some of the most prevalent mental health comorbidities that present with autism spectrum disorder are ADHD coupled with executive function deficits, anxiety and mood disorders, and depression, as well as symptoms like increased rigidity, mood dysregulation, restlessness, externalized behavior problems, difficulty concentrating or being easily distracted, which are often related to comorbid symptoms of mental health conditions. All of these have been exacerbated by the accumulated disappointments and trauma kids are coping with amid the pandemic.

ROI: Why is it important to treat both ASD and any underlying health conditions?

JS: Treating both conditions lead to better outcomes for these kids. Kids with autism spectrum disorder historically have been treated with applied behavior analysis, which is the gold standard of autism treatment. However, ABA therapy historically, and even currently, largely has to do with observable behavior. Therefore, internalized mental health conditions like anxiety or depression, which kids often keep private, require additional supports.

Through our STRIVE Autism Care Continuum, we provide ABA therapy, but we also address the mental health piece by teaching kids coping skills so they can regulate their emotions and problem-solve on their own. It is critical to integrate both ABA therapy and mental health services because, otherwise, you may not be addressing the underlying internalized problem.

ROI: What should someone do if they think their child is demonstrating any signs of mental health challenges?

JS: I always tell parents to try to communicate with their child and ask them how they are feeling, so you can work through those emotions together. Secondly, it is important to reach out to your support system — your child’s schools and their pediatrician as well as a professional who has experience working with kids with autism spectrum disorder and comorbid mental health conditions. I would also recommend increasing supervision and spending more time with your child in addition to making sure you are taking care of your own needs. Parents should also be mindful of their own experiences and emotions and reach out if they need help.

ROI: Here’s the bigger concern: Is there a potential for prolonged mental health effects due to the pandemic for kids with ASD?

JS: The long-term mental health effects are still largely unknown right now. In general, for kids who have more limitations, we are concerned about skill loss as well as reinforced behavior patterns that would otherwise be corrected if they had a more regular routine. The prolonged isolation also raises concerns about the social disconnect these kids are experiencing — the longer kids stay isolated at home, the harder it will be for them to get back outside and engaged.

ROI: Finally, what resources and/or services does First Children Services provide to support kids and families with comorbid ASD and mental health conditions?

JS: Through our STRIVE Autism Care Continuum, we offer a comprehensive suite of on-site diagnostic, assessment and treatment services, as well as community-based services to promote increased access to care and earlier detection and intervention.

We do not just provide services through our centers — our primary goal is to serve as a resource for these families by collaborating with their pediatrician, their school and everyone in the child’s life to coordinate the best care possible. We provide integrated care programs in our centers, in collaboration with school districts and also in the community. We provide individual counseling, family counseling, cognitive behavioral therapy, social skills groups, as well as diagnostic testing to rule out any cooccurring conditions.

We also offer a range of innovative community-based programs like our STRIVE Sport & Social Club, which is specialized program for kids with autism that is led by certified experts who teach and promote social skills through interactive fitness.

At First Children Services, we also believe it is crucial to treat not just the child with autism, but to help support the entire family. We focus on treating the whole family, providing family and sibling trainings and support groups to address the individual needs of our clients as well as their family members.