Telehealth and ASD: Providing Autism Services to Youth During the COVID-19 Pandemic and Beyond
This is a student blog piece by Stephanie Miodus, a second-year doctoral student in the School Psychology Ph.D. program at Temple University.
The COVID-19 pandemic, along with tragedy, has brought uncertainty and a loss of structure across the world. For youth with autism spectrum disorder (ASD), many of whom already struggle with transitions and changes in their daily routines (American Psychiatric Association, 2013), it is likely that this change is especially difficult. This piece addresses relevant factors to providing services to children and adolescents with ASD during the current COVID-19 pandemic. These recommendations also serve as a framework for future considerations for providing telehealth services to this population of youth, which can particularly benefit youth in rural areas who lack access to services (Mello, 2016).
While services will be conducted over virtual platforms during the pandemic, it is important to recognize the limited research on providing clinical behavioral services for children with autism directly over telehealth (Ferguson, 2019). There is however more research on the effectiveness of behavioral telehealth consultations with parents of children with autism (e.g., Vismara et al., 2013; Wacker et al., 2013), which shows increased parental learning and improved child behaviors. Other research has shown positive effects for an Internet-based training program for parents of children with autism with increases in the children’s social communication (Pickard et al., 2016). With any of these methods, parents are a key component and it is essential that clinicians work collaboratively with them to ensure quality delivery of service. It is also critical that clinicians remain aware of the added stress that this adds to parents of children with ASD, who often already show elevated levels of stress (e.g., Giovagnoli, 2015).
In order to assist parents in helping their children adjust to their new routines, it can be beneficial to make use of a visual schedule, which visually showcases the order of planned activities and helps provide structure to the day, and has been shown to assist children with ASD in transitions (e.g., Mesibov, 2002). These serve the added benefit of providing additional consistency for children with ASD, as these are often already included in school-based and clinical services and will provide a source of familiarity. Another familiar strategy that clinicians and families alike can use with children with autism is Social Stories, which are stories that are written to help children better understand a situation in order to draw connections to their possible role within the scenario. Use of Social Stories have shown mixed results overall (e.g., Kokina & Kern, 2010), but in the limited research on their use for transitions to novel events, there have been positive results (Ivey et al, 2004), which suggests the potential for positive results if developed and used to explain COVID-19.
Developing social skills is also a key component of services provided to youth with autism. This is often conducted through social skills groups, which have been found to improve mastery of social skills concepts (e.g., DeRosier et al., 2011). While there is not current data yet on the impact of the delivery of these services during COVID-19, there are technical challenges that could arise if holding these groups over telehealth platforms, so parents should be supported by clinicians in developing strategies for children with ASD to continue engaging in social interactions virtually.
While behavior, communication, and social skills are often the focus of services for children with ASD, clinically, it is important to also address other challenges this population may be experiencing. Anxiety is one such issue that must be addressed as children and adolescents with ASD have been shown to have increased levels of anxiety, along with difficulty managing stress, (e.g., White et al., 2009), which is possibly exacerbated by the anxieties around COVID-19. One potential evidence-based path for treatment is cognitive behavioral therapy (CBT), which has been found effective in the treatment of anxiety in children with ASD, with even larger results when the CBT approach is adapted to address difficulties with social communication and self-regulation (Wood et al., 2019). Furthermore, there have been promising preliminary results from a study that delivered a cognitive-behavioral intervention over telehealth to children with co-occurring ASD and anxiety (Hepburn et al., 2016), which suggests that after correcting for technical glitches, this may be an efficacious intervention to treat anxiety in children with ASD.
As COVID-19 is likely to be a traumatic experience for many due to its impact, although research is needed to examine the full extent, it is also critical that clinicians prepare to address the traumatic after-effects of the pandemic for children with ASD, who have been shown to be vulnerable to traumatization (Hoover, 2015). Yet, there is a lack of research on specifically treating posttraumatic symptoms for this population of youth, so this serves as an area in need of development both in response to COVID-19 and in general. Overall, the areas outlined in this piece warrant further examination in order to provide best clinical practices to children with ASD during this pandemic and beyond as telehealth continues developing to increase access to care.
Stephanie Miodus, MA, MEd is a second-year PhD student in School Psychology at Temple University. Clinically, she is interested in working with children with autism and youth in juvenile detention. Her main research interest is the school to prison pipeline for children with autism and alternatives to harsh disciplinary practices in schools that push children out of classrooms and into the justice system.
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