The coronavirus disease (COVID‐19) situation is evolving rapidly, with an increase in the number of reported cases and countries affected worldwide. The World Health Organization declared the COVID‐19 outbreak a public health emergency of international concern (PHEIC) on 30 January 2020 and a pandemic on 11 March. Japan was the third country to register a first case of COVID‐19 on 16 January 2020, after China and Thailand. The number of reported COVID‐19 cases rapidly increased from the end of February 2020. Therefore, the Japanese government declared closing all schools from the 1st through 12th grades on 2 March and declared a PHEIC on 7 April. School and other education facilities' closures substantially disrupt the usual daily life and add stress for children and their families. At the time of writing this paper, the Japanese government continues to have all schools closed and insists that citizens stay at home as much as possible.
It is challenging for children with autism spectrum disorder (ASD) to understand the situation and to stay at home. 1 In addition, care for ASD children could be more difficult than that for children without ASD as the condition is characterized by difficulties in reciprocal social interaction skills; deficits in communication skills; stereotypic, obsessive, or repetitive behaviors; and restricted patterns of interests and activities. 2 Under the PHEIC, child psychiatrists must consider what can be done for ASD children in this stressful situation.
As for the situation above, we developed a supportive brochure about COVID‐19 for ASD children and their family members who could be reached by online communication. The main benefit we sought was to help ASD children understand COVID‐19 with visual supporting methods.
The brochure was made of three parts. The first part explains the purpose of the brochure and characteristics of ASD. The second explains coronavirus infection and how to avoid it. The third shows how to manage life while staying indoors. All content is accompanied by original hand‐drawn illustrations (cartoons) because visual support helps in the understanding of content, especially for ASD children. This brochure can be downloaded by everyone from the homepage 3 and the URL address was sent to parents of 262 ASD children by a letter.
First part: The purpose of the brochure
With COVID‐19 infection, all schools are closed and ASD children should stay at home, so the circumstances are different from usual, and they may have much friction with parents and other household members. Children with ASD have limited social cognitive ability and difficulty understanding only for words information. In this part, we made cartoons that explain the characteristics of ASD and problems that ASD children may have with the COVID‐19 situation (Fig. 1a).
Figure 1.
COVID‐19 supportive brochure for parents of children with autism spectrum disorder (ASD). (a) Characteristics of ASD. The behaviors and characteristics of ASD patients with relation to COVID‐19 are explained. For example, they may not understand the reasons for the instructions issued by the government to stay home. They might feel uncomfortable and limited with being forced to stay at home for the whole day. Information regarding COVID‐19 from media sources, such as the television or the Internet, may cause unnecessary anxiety in ASD patients due to deficits in social and communication skills. Children with ASD may be hypersensitive and unwilling to wear masks. (b) How to prevent corona virus disease (COVID‐19)? This slide explains the prevention measures. (c) Structure their lifestyle: Time and place management is very important for ASD children. Both verbal and visual information will help ASD children understand that their daily lifestyle has changed. For that purpose, it might be helpful for each family member to write their planned activities on a shared whiteboard after communicating them verbally. (d) Find a shared interest: Encourage activities and subjects that the child is naturally interested in. This image has been included in regards to ASD patients with restricted interests. They may be willing to engage with family members about a specific interest, such as trains, national flags, animals, insects, maps, or history, which can serve as a bonding opportunity.
Second part: COVID‐19 infection
It is difficult for children in elementary school to understand the COVID‐19 infection. In order for ASD children to understand correctly, we made cartoons that explain COVID‐19 infection and the methods for preventing it (Fig. 1b).
Third part: Eight small tips for helping ASD children stay at home
In this part, we indicate eight methods for ASD children and their family members. For example, how to structure daily life activities (time and place management) is indicated (Fig. 1c). Playing games also helps ASD children and family members to remain calm at home. 4 It may be valuable for them to play by themselves, too. Sharing feelings like anxiety and restricted interest of ASD children with family members will sometimes make their relationship better in the abnormal situation created by the forced staying at home (Fig. 1d). However, some patients and their family members are anxious about COVID‐19 and would like to have professional support. Others who stay at home together for the whole day may experience stress. In that situation, child psychiatrists and support staff may provide medical advice over the telephone, as part of telemedicine services.
It is also important for children with ASD and their parents to connect with friends, teachers, and health‐care practitioners. Parents of children with ASD showed significantly elevated parenting‐related stress levels compared to those with typically developing children. 5 Providing greater parental leeway has a good influence on children with ASD. The social utility of mental health professionals in the management of the COVID‐19 outbreak is confirmed. 6 Therefore, we should provide mental health support not only to children with ASD but also their families.
In conclusion, COVID‐19 is an emerging illness that is rapidly spreading through Japan and the rest of the world. This brochure could aid parents by providing interventions for children with ASD. We have not collected the parents' comments on the brochure yet. We will assess the effect of this trial in future studies.
Disclosure statement
The authors declare no conflicts of interest.
References
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