Autism and Anxiety in Quarantine: How to Support Children, Teens and Young Adults on the Spectrum

The uncertainty of the coronavirus pandemic is hard for everyone. Core routines have been disrupted, household stress may be at a high, and information seems to change overnight.

For individuals on the autism spectrum – who usually do best with predictable routines and concrete information – this time may be especially stressful.

Pediatric psychologist Amy Signore, PhD, MPH, joins the blog with strategies to help kids, teens and young adults with autism manage anxiety.

> For more expert advice – including how to help a child with special needs manage distance learning, structure the day and talk about coronavirus – check out 18 Tips to Help Children With Special Needs Thrive While Learning at Home.

Routines are especially important for children with autism. Right now, that can be a challenge.

Routines make your child’s environment predictable – and this predictability is especially important to help kids with autism understand what behavior is expected of them.

Right now, in addition to missing out on typical school routines, your child may be missing daily or weekly support services they previously received in the classroom, at home or in the community.

And as your family quarantines together, the environmental cues that usually guide your child’s behavior have probably changed quite a bit too. (For example, they no longer get on or off a school bus to signal the start and end of the school day.) You may notice your child responding with more anxious, aggressive or challenging behaviors.

Try the suggestions below, and reach out to your child’s support providers for additional strategies.

Create a new routine for your child.

Not sure where to begin? Start with their morning routine – bathroom, brushing teeth, breakfast – and build from there. Use their school schedule as a guide. Add transitions and breaks between activities. To help with transitions, try using timers and two-minute warnings.
Include a transition or reminder to help your child prepare for “school” mode, like getting dressed in school clothes, having breakfast as usual, and even packing a backpack or pretending to get on the bus. Do this at the end of day too, to help transition out of school mode.
Try setting up a dedicated school space: Here’s how to create your child’s ideal “home office.”

Use social stories to help your child adapt to new routines.

Social stories are an easy and effective way to teach appropriate behaviors to children with autism. These resources use written or visual cues to help children navigate unfamiliar social situations.

Here’s a social story from Autism Speaks to help your child get used to a new routine.

Set clear expectations with visual schedules.

Visual cues and to-do lists help children mentally prepare for the day or task ahead of them, and can help reduce anxiety for individuals on the spectrum.

Try adapting your child’s classroom rules for your home. If your child uses a behavior chart or token economy system at school – for instance, stickers for good behavior or tokens they can trade in for rewards – create a similar chart for home. Ask your child’s teacher or specialists for help.
Create a visual calendar of the day to post on your refrigerator and in your child’s work space Include chunks of time for “learning slots,” breaks, play and calming activities. You might have a picture showing “eat lunch” then “play outside.”
Break down individual tasks – from getting dressed to unloading the dishwasher – into a series of steps with photos.
Planning a video chat with teachers, family or friends? Print out and post photos of whoever your child will be seeing.

Identify and practice coping strategies.

If your child has been acting out with challenging behavior, keep in mind that it may be an expression of anxiety or fear. Try guiding your child to a coping or calming strategy.

Pay attention to what helps your child calm down – exercise, listening to music with headphones, deep breathing, reading in a quiet corner, building with LEGO bricks, etc.
Once you’ve identified a coping activity for your child, schedule time for it throughout the day, and include reminders in your child’s visual routines.
Over time, help your child track their own level of anxiety, and empower them to use coping strategies as needed. To learn how, check out this article about teaching your child self-care.
Note: Children with autism may have additional health concerns, which can add to your family’s stress during the pandemic. We’ll cover this topic soon in another blog post.

Create visual routines for coping strategies.

Individuals with autism often benefit from concrete, visual cues, and having their choices laid out in front of them.

Include coping activities in a visual schedule of the day, posted clearly on your refrigerator or in your child’s work space.
Create a coping toolbox.
Create a “choice board” with of different strategies for your child to choose from – for example, climbing stairs, jumping rope, listening to music or taking deep breaths.
Print out a picture that represents your child’s favorite coping activities and put it somewhere visible.

Make sure your child is getting exercise.

Physical activity helps reduce stress at all ages, and that includes individuals with autism.

Try creating a new family tradition that involves physical activity like tracking steps, taking an online exercise class or going on an afternoon walk.
Test out fitness apps and resources offering free access during this time, such as the Down Dog yoga app, Nike Run Club and Facebook Live streams from Planet Fitness.
Need ideas when the weather doesn’t cooperate? Here are 23 Indoor Activities for Heart-Healthy Kids.
Check out these other ideas for athletes during COVID-19.

Need help maintaining sleep routines?

Good sleep is important for managing stress, but sleep disturbances tend to be more common for individuals with autism. Our pediatric sleep psychologist has solutions for bedtime challenges.

Create opportunities for your child to express their feelings.

It can be hard for kids (and adults) of all ages to put complex feelings into words. Individuals with autism may struggle with other aspects of communication too, so it’s important to find ways to let them explore feelings.

Encourage your child to create a daily journal – or video or photo or art – to track their mood, observations, worries and wins. Tracking exercises can be a soothing. They also help your child mark the passage of time (an abstract concept that can be tricky for some individuals on the spectrum).
Set aside time daily as a family to express your feelings. Embrace all the different ways that this can look: talking, writing, movie-making, music, dance, visual art and play.

As a parent, pay special attention to self-care.

On top of other challenges your family may be facing, if many of your child’s support services have been canceled (or now require your hands-on help to occur virtually), you’re probably missing out on the break from caregiving that those services once gave you. Make your own self-care a priority, in whatever ways you can.

Take breaks for yourself – even if it’s 5 minutes. Schedule a few minutes every hour to take five deep breaths, enlist a trusted friend to call or text to vent once a day, or wake up a little early so you can have coffee and breakfast in solitude.
Reach out to a therapist or mental health provider for yourself. Many are now offering telehealth sessions.

These are challenging times, but you’re not alone.

Try connecting with a local autism support group. In Connecticut, these include:

And don’t hesitate to reach out to your child’s pediatrician, support specialist or psychologist when you or your child needs support. (You can even schedule a Video Visit.) We’re here to help.

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