The coronavirus (COVID-19) has taken over the world, with most countries under lockdown including Qatar to try and stop the virus from spreading though self-quarantine and social distancing. As a result, most people are home, either working, studying or taking care of the home. There have been sudden changes within routines, no more connections with teachers or friends because of schools being suspended until further notice, no more outings, and a fear of being attacked by the virus. And, one of the main problems is that there is no real end date in sight. This has been daunting for everyone, adults and children alike, but especially for children with Autism who may face heightened levels of anxiety in this situation.
Since it's important for children with Autism to follow a routine, these children may feel unsettled when it abruptly changes, and even though they may not understand what is going on, when they see the people around them looking worried or upset, they may have more outbursts than normal, feel aggressive, not comply amongst other such behaviours.
We had the chance to talk to Hasna Nada, the Founder and CEO of the Child Development Center (CDC) in Qatar, which was established in 2013, and is made up of a network of internationally qualified and licensed professionals who offer child-centered and evidence-based early detection and intervention for children with developmental delays, including the Autism Spectrum Disorder (or just Autism), and Kamila Janik, MSc, BCBA who is CDC's Clinical Program Lead about how to keep children with Autism busy and reduce their anxiety at a time like this.
Hasna talked about the affects the current situation was having on children with Autism:
"Coronavirus (COVID-19) has caused a lot of disruptions for all families, with the added responsibilities of online learning and having to keep all their children busy and engaged. This has especially hit hard children with Autism spectrum disorder as they need routine and consistency to thrive and self-regulate. This sudden change and disruption to their schedule and services is not to be taken lightly."
Subsequently, Kamila believes:
"Home isolation has a detrimental impact on the lives of children with autism and their families mainly due to the lack of access to therapy services. It is a necessity for children with autism to receive therapy sessions and discontinuation of intervention will most likely result in a regression of previously learned skills. The e-learning is not a substitute for in-person therapy sessions as, unlike typically developing children, children with autism may not have the skills to access or benefit from the educational content delivered through the e-learning environment. Another problem is that many therapy centers, which are privately funded, may not survive this crisis. The heart-breaking reality is that if these therapy centers close down, children with autism in Qatar will not have access to therapy services, which will cause even more hardship for the families. In addition, home isolation may result in increased levels of challenging behaviors, which are often difficult for parents to manage, even more so when the child is confined to the house 24/7."
It is very important to explain to the child what is happening and why he or she is not allowed to go outside. The best way to help children with autism make sense of the current situation is to use social stories, which are simple narratives combined with visuals made to illustrate certain situations and how to deal with them. There are various COVID-19 social stories available online but parents can also create individualized social stories based on their child’s interests.
Both Hasna and Kamila support the use of social stories to explain to children with Autism what is happening in the world around them under the current scenario. Kamila describes social stories as simple narratives combined with visuals made to illustrate certain situations and how to deal with them. There are various coronavirus (COVID-19) social stories available online but parents can also create individualized social stories based on their child’s interests.
For children with Autism to understand what is happening in the world, Hasna advises parents and caregivers to use social stories to break down the scenario into small parts and use visuals. Social stories are invaluable when supporting children with Autism in making sense of specific life scenarios and helping develop their critical thinking.
In the case of coronavirus (COVID-19), parents, with the help of a visual can explain what is a virus and how it makes people sick, and then move on to people sneezing and coughing again with the use of a visual to explain how the virus spreads. From this point then parents can explain again, through a story with visuals, that if people stay home the virus will not spread and this is why all children and people are staying home. You can also, in the same way explain that when the virus is no longer a threat life can return to normal. The trick is to break down the social story into small parts, so the child is able to process what is happening.
Check out the following coronavirus social story.
Consistency is a very important component of life for children with Autism, and without it, often, these children struggle and become anxious. That's why, Hasna says:
"Home isolation during quarantine is difficult for both children with Autism and parents alike. Routine and consistency are key, and caregivers should continue to provide a set schedule and make sure the child is aware of the expectations of what is coming next. Children with autism struggle greatly with transitions, so providing and preparing them for what to expect next can relieve some of this anxiety and prevent meltdowns."
Kamila describes some of the things that parents can do to ensure a consistent daily routine, which resembles a child’s typical day as much as possible:
"Using a picture-based daily visual schedule can be very useful in providing children with a sense of predictability in their day. Waking up the child at the same time every day, having a scheduled snack time and lunch time, and maintaining the same bedtime routine are essential. Since kids cannot attend their therapy center or school, arranging similar types of activities at home is really important. For instance, parents can do a morning circle time, which resembles the one that the teacher normally runs at school and they can also use the same programs and educational materials that child’s therapists and teachers have been using at school/center."
Children with Autism need constant support and therapy whether it is Applied Behavior Analysis (ABA), speech therapy, occupational therapy or a mix of all. For services to suddenly stop means that children’s programs are disrupted along with their routines and a regression in behavior and skills can be observed after a short period of time.
Engaging in family-based activities is a great way to occupy children with Autism and the whole family, and this is fully endorsed by Hasna:
"Parents and caregivers can spend more time playing, using and encouraging language, providing movement activities and plenty of socialising opportunities with siblings. It is important that children with Autism be kept busy and engaged during this time to avoid meltdowns and regression."
Kamila gives some tips on what children with Autism can do to stay busy and engaged:
"Given that many children with autism are quite active, providing access to a Pilates ball, small trampoline, or creating obstacle courses (or treasure hunts) in the house would be very helpful. In addition to movement breaks, incorporating a lot of sensory play into child’s day is also a good idea. There are several Facebook pages, which provide a lot of interesting ideas for parents, for instance, the Family Isolation/Lockdown Activities and Support Group (Worldwide).
"Parents can also create a visual choice board to help children understand that although certain activities are not available at present, they still have a lot of fun activities to choose from. Parents can put pictures of available activities on the 'green side' of the board (e.g., trampoline, waterplay, slime, painting), and the ones that are not available (e.g., playground, swimming pool) can be placed on the 'red side' of the board."
Some other activities to keep children with Autism engaged include playing 'I Spy' with them, playing with lego, play dough, sand, dried beans and water.
This is a great time for the entire family to bond over activities that create positivity and are fun for everyone, especially those with Autism. Try baking together or preparing meals together. Help with laying the table and clearing it is also a positive activity, if the child is old enough to handle these things. Board games can be a lot of fun, too.
Sometimes, it's not such a bad idea to keep a child with Autism entertained with an iPad, computer or TV, and it just might give the parent or caregiver a much needed break. However, it's important to stick to time limits. By creating a visual schedule that's easy for the child to understand with the amount of time they can spend on screen time throughout the day and stick to it.
The current situation has resulted in lot of stress and anxiety for all parents, but particularly for those who have children with autism. It is an exceptionally difficult situation and parents should not be setting unrealistic expectations for themselves because it can lead to further stress. There is only so much a parent can do in this type of crisis situation and it is really important for parents to try to find some time for themselves because rest and self-care are essential for their mental health at this time. If this means allowing the child to watch a movie or spend an hour or two on an iPad so that parents can take a breather, then so be it. You can’t pour from an empty cup.
After centers like the CDC have closed temporarily until further notice since 9 March 2020, they are striving to find ways continue to support its clients with Autism. Ideally, children with Autism, depending on the level of severity, continue to need one on one services but with the current lockdown this had become increasingly challenging. CDC has, so far, developed online services through Zoom to work directly with the parents and meet on a daily or weekly basis, depending on the families’ needs, to supervise programs and offer activities and advice to parents but also support them with any advice on how to manage behaviors they may be experiencing during such times.
CDC's clinical Director and Clinical Lead (Kamila), both Board Certified Behavior Analysts (BCBA), offer parents consultations, follow ups, trainings and modeling of activities online for parents and caregivers who are working with their children to mitigate regression during this period. It provides remote initial consultations for parents who are concerned about any aspect of their child’s development or behavior. Specialists are available seven days per week so that parents can have access to professional help at all times.
CDC is also rolling out webinars online for the larger community on important topics and strategies for the home including how to respond to problem behaviors, how to motivate children and set up routines at home, and how to address bedtime, feeding, and toileting issues, where parents and professionals can participate and ask questions. It is working on developing occupational and speech therapy programs in the same way, while one-on-one in person therapy remains a necessity, such support can be truly useful in this transitional period.
CDC is researching and learning on what further programs to develop to support our community in this unprecedented time, so we are also looking at this as a learning opportunity for all in these ever-changing times.
Al information of CDC's online programs can be found on their website: www.cdcenterqatar.com and Facebook page: https://www.facebook.com/childdevelopmentcenterqatar/
To find out more about Autism and what Qatar is doing to create more awareness on ASD click HERE.
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