Many children in Australia have autism spectrum disorder (ASD) and their symptoms vary considerably. It is estimated that the Australian prevalence of ASD lies between 5 and 10 per 1000 (Randall et al. 2016). People with ASD commonly display atypical sensory processing, including auditory, visual and tactile hyper- or hypo-sensitivities. These symptoms can be mild to severe (Marco et al. 2011). These sensory processing difficulties present a particular challenge to parents and carers when they are attempting to protect children with ASD from being exposed to harmful levels of solar ultraviolet radiation. Parents and carers of children with severe ASD often struggle with the most basic functions of life, including eating, speaking, toileting, washing and socialising. Amongst these challenges, developing strategies for sun-safety behaviours might not seem to be a priority. Given the growing number of children being diagnosed with ASD, it is perhaps time for the medical profession, particularly dermatologists and skin cancer specialists, to think about this population with its special needs and vulnerabilities.
All children should be encouraged from infancy to wear hats and protective clothing, tolerate sunscreen creams on their skin and learn to instinctively seek shade when outdoors. Doing so will not only protect young children from sunburn but also establish lifelong habits of sun safety which will endure into adulthood. However, children with ASD may be extremely averse to wearing hats, the feel of sunscreen creams on their skin, which involves regular reapplication, and the wearing of clothing which covers and protects the skin. The famous and very successful Australian ‘Slip, Slop, Slap, Seek and Slide’ campaign (Geddes 2019) when analysed may, in each element, be difficult for a child with ASD. Nevertheless, parents and carers, supported by dermatologists, skin cancer specialists and public sun-safety campaigners, should be encouraged to persevere in developing strategies for sun-safe behaviours that are acceptable to the child with ASD. Some children with ASD may find spray or roll-on sunscreens preferable to the conventional pump or squeeze bottle, where a hand needs to spread the thick sunscreen onto the skin. If even this cannot be tolerated, sun-protective clothing could be used in place of sunscreen altogether. If children with ASD are presented with these types of choices, they may also feel they have some control over an activity they do not like. Persevering to find a favourite sun-safe hat that is perhaps loose fitting and comfortable may also prove worthwhile. Social stories about sun safety and visual aids may be helpful. Promoting the use of beach tents may be effective in allowing children with ASD to take a break from wearing their hat or rash shirt which is uncomfortable for them, or perhaps just take a short break before reapplying sunscreen. Considering the fact that 40–50% of actinic skin damage at age 60 occurs before the age of 20 (Green et al. 2011), this large and growing population of children with ASD must be thoughtfully considered and cared for when thinking about sun safety.
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References
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