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COVID-19 and Autism Spectrum Disorder: What to do at home during confinement?

Dear Parents,


The situation of strict containment in which we find ourselves can be difficult to manage. You are maybe wondering how to occupy your child with Autism Spectrum Disorder (ASD).

We therefore offer you some ideas and recommendations for the upcoming weeks, until the reopening of schools and reception facilities occurs, hence allowing to resume the therapies.


This document aims to help you get through this period with your child as well as possible. It is not a question of working methods but simply of guidance. The goal is therefore to draw ideas from this guide and not to apply everything literally.


Do not hesitate to ask the professionals accompanying your children (child psychiatrists, speech therapists, psychologists, psychomotor therapists, educators, occupational therapists, etc.) if they can provide video consultations, parental guidance. They know your children and will be able to give you suitable advice to better live this period at home and suggest activities or exercises to do with your child, or even ensure the session directly with them by video.


The situation of radical change in everyday life can destabilize your child. There may be an increase in behavioral disorders and self-stimulation, this is completely normal. It is also possible to explain to your child the current situation.


Protect your child from the stress of this period. Talk to your child about the current situation in an open, calm and appropriate manner, without unnecessary details. Have reassuring words (for the child, for his health and that of those around him). Make sure to allow him to keep in touch with his loved ones, by organizing video calls where you can guide the discussions if possible. Try asking him about his concerns. A group discussion is always easier.


Explain that the application of barrier measures (such as hand washing, sneezing in his elbow, favoring single-use tissues, no close physical contact) will protect him from the risk of infection with the Covid-19 virus. Limit your child's exposure to television and social media information. Repeat this discussion regularly. Children are worried but don't express it like adults. Here is an illustration that can help you explain the situation.



During this period, you will undoubtedly have to adapt the requirements and be more tolerant of expectations concerning autonomy, academic learning or behavior (for example: self-stimulation, stereotypies, screen time...).


If your child has a sudden change in behavior, consider taking his temperature. It is possible that pain is involved. Do not hesitate to ask your doctor for advice by telephone.

If your child is taking medication, it should be continued during this time. For unsecured prescriptions (everything except methylphenidate: Ritaline®, Quasym®, Médikinet®, Concerta®), the pharmacist can renew prescriptions without going to your doctor. To renew methylphenidate, try to reach your prescribing doctor (general practitioner or child psychiatrist) preferably by email.

Table of contents


1. Structuring time

1.1. Time orientation

1.2. For school children

2. Structuring space

2.1. Space orientation

2.2. For school children

3. Supports to occupy my child

3.1. Some ideas for activities

3.2. For school children

4. School activities

5. Household tasks

5.1. How to involve my child

6. Screen management

6.1. Video games and social networks

7. Manage desirable and unwanted behaviors

7.1. To prevent behavioral difficulties for my child

8. Taking care of yourself

The essential ideas :)


1. I try to maintain a good quality of life and kindness

I trust my parenting abilities and my family to manage this unprecedented situation.

2. I create a suitable environment for all.

I structure time and space.

3. I try to alternate stimulating and educational activities with activities of absolute relaxation.

4. I try to continue learning and educational activities

I can ask for advice by phone or remote consultation with teams who know my child.

5. I try to involve my child in everyday life activities.

6. Access to screens (television, tablet, video games and social networks).

I authorize screen times without feeling guilty but by setting up contracts to increase screen time.

7. I manage desirable and unwanted behaviors.

I try to keep in mind that my child's health must be monitored and that I can call my doctor in case his behavior changes.

8. I take care of myself and keep simple moments of fun with the family.


1. STRUCTURING TIME


1.1. Time orientation


For my child with ASD, the notion of time can be difficult. All the more with confinement, the usual routines are lost. It is therefore important that I establish new routines, which remain close to those usual of my child. Here are some tips that can help:


- Video: https://deux-minutes-pour.org/video/mieux-se-reperer-dans-le-temps/

- I maintain a stable timetable: we get up and go to bed at the same hours as usual.

- I set up rituals throughout the day: washing, dressing, eating, sleeping, etc. A ritual that can also help my child find his bearings during the day can be a nursery rhyme at the start of the day and a story for the end of the day.

- I can use visual timetables with key moments or major activities of the day. If my child can do it, I make him cross the image, check it, touch it or remove the image when the activity is performed. I congratulate him and I can even reward him.

https://deux-minutes-pour.org/video/faire-un-planning-visuel/





When the children are in bed, I take some time to plan the next day.

- I can favor short activities (depending on my child's attention time).

- I plan a free time (without planned activity) for my child and for myself.

- I warn my child when we are going to move on to another activity. For this, I can use auditory or visual signals: bell or beep, a timer (Kids Timer® available on Google Play®), my phone timer, verbalize to my child, give an end of activity card to indicate the end.



1.2. For school children


- I involve him in creating the timetable, by retaining the highlights of the day: work but also the playful moments (e.g. Does he prefer a calm time alone or a moment of play with you before resuming lessons in the afternoon?).


- I take the educational support provided by my child's school and I indicate in the timetable what time of the day will be dedicated to which subject or exercise.


- I take into account the tiredness of my child: I alternate moments of relaxation and moments of effort. I am attentive to my child's attention span. Activities that seem “relaxing” to me can be costly for him.


- I can set up a logbook or a personal diary to be completed, depending on his abilities, more or less independently by my child each day. This fun activity will allow him to provide an overview of the day's events, such as what he enjoyed doing. He can also tell the story of a video, a film seen, a book or a comic read. I try to help him to identify his emotions (suggest words to him) during this time. If it is difficult for him, I can start by sharing with him an event of the day. An example will make it easier for him to relate his own. I can also help him choose the event of the day. This diary can be kept on the computer which allows you to add photos taken with the phone (e.g. a photo of him during an activity, an important object, a drawing, a photo of him that can represent his emotion of the day).




2. STRUCTURING SPACE


2.1. Space orientation


I try to structure different places in the house or the apartment. Even in a small space, this is possible.


Each space is intended for specific activities, hence it will be easier for my child to identify the activities that will take place in each place.


For example, I can divide the living room in different places:

- A corner for work,

- A corner for leisure,

- A corner for meals,

- A corner for sensory stimulation and relaxation.


For this, I can stick on the wall or on a piece of furniture, an image or a pictogram (which I can draw myself), to indicate to my child the function of each place. I can also mark out floor spaces with tape.



I try to keep the accommodation tidy and the toys not accessible, so that my child plays with only one game at a time and can ask me to move to another.

It is also important that I alternate places and people during the day's activities:

- Places: at the table, on the floor, on the sofa, outside if I have a small secured outdoor space (garden, balcony), in the kitchen, the bathroom, the bedroom etc.

- People: I remember to change the intervener if possible. For example: some activities with dad, others with mom, brother, sister, etc. This will allow you some time for yourself.


2.2. For school children


A “relaxation” space where my child has access to reassuring activities or objects: for example a “cabin” with appreciated or reassuring objects, a sensory space in the bedroom. When my child has access to this space, during a moment of relaxation, the whole family respects this calm time and the carried out activities. Online sound level meters can help the siblings to respect the sound level: https://www.classcraft.com/lp/volume-meter/ or https://bouncyballs.org/.

3. SUPPORTS TO OCCUPY MY CHILD


I can establish a list of activities to suggest to my child in order of preference, so as to organize them throughout the day. I alternate the type of activities according to the age and educational level of my child.

I alternate with my child the moments of excitement and the moments of calm. I go from an activity that interests him a lot, to an activity that he likes less. I can use the activities he enjoys to motivate him to do the ones he likes the least. I am not too demanding and I encourage the activities that my child already knows how to do them.

3.1. Here are some activity ideas


- Global motricity: create a small motor pathway, play ball if space allows, dance etc. Websites offer physical activities to get your children moving despite confinement, here are some internet links:

o https://activeforlife.com/resource/individual-lesson-plans/

o https://activeforlife.com/activities/

o https://www.force4.tv

o Rock your Wixx - Canadian Active Break Program: https://www.youtube.com/results?search_query=grouille+ton+wixx

o Wixx Body Percussion: https://www.youtube.com/playlist?list=PLeMp3RrGD1UrfUrveGHsAtngoZVdkvVJ5

o https://cubesenergie.com/en/primary-school-quebec/challenge/what/

o https://cubesenergie.com/en/primary-school-quebec/activities/index/

o https://www.youtube.com/results?search_query=bouge+en+classe+avec+jeune+en+sant%25C3%25A9

I don't hesitate to put my child in sports clothes so that he understands the activity that is going to take place. We strongly recommend that you join him, physical exercise helps maintain good physical as well as psychological health.

- Fine motor skills:


Transfer: tray with lentils, rice, pasta, flour etc.




Put small objects in a bottle: pasta, rice grains, coins, toothpicks etc.



Move small objects from one box to another with clothespins or tweezers




Thread small rubber bands around a bottle, a rolling pin.




Put small items in egg boxes or ice cube trays.




Hang clothespins respecting a color code on a strip of cardboard.




• Make pearl or pasta necklaces.

Draw or color: simple, complex, coded coloring pages, https://www.hugolescargot.com/coloriages/magique/coloriages/




Glue stickers following a pattern or simply on a white sheet.

• Make cutting sheets.

• Make graphics cards.

Make plasticine, salt dough, slime, Fimo® dough, magic sand, mosaics.

Sorting games: cubes, pawns, colors, animals, objects, letters, numbers, toys, etc.




Sensory and social activities: tickling, peekaboo, jumping, swinging, spinning on a wheelchair, imitate the “plane”, boat on the water, nursery rhymes, etc.

• Other games:

- Pretend play: dinner party, doll or characters, disguises, puppets, craft games, Playmobil®, etc.

- Construction games: Légos®, Duplos®, with boxes, train rails, cubes, etc.

- Creative games: graphics, stickers, plasticine or salt dough, painting, cutting, collage, making bubbles with soap etc.

- Calm time & relaxation: it is useful to plan times of relaxation during the day for my child as for me. The events we are experiencing are indeed anxiety-provoking. Depending on the capacities and needs of my child, I can offer him a calm time, lying down or sitting on the bed, the sofa, a floor mat, in a cabin made with sheets and cushions. For children or adolescents who are more sensitive to light, do not hesitate to close the curtains, close the shutters to reduce excessive stimulation. Here are some ideas for calm times:

- Stories to listen to,

- Calm music: https://www.youtube.com/watch?v=DlnYANIVslc,

- Massages,

- “Active relaxation”: https://www.youtube.com/watch?v=n3zt0Aj0hZo,

- Breathing in cardiac coherence: https://www.youtube.com/watch?v=aKdJsYIGONM.

3.2. For school children


- Games of the 7 errors and games of the intruder to print on the Internet: http://turbulus.com/jeux-a-imprimer

- Search and find games on the Internet.

- Younger: http://www.mondedestitounis.fr/cherche-jeu.php?id=5

- Older: http://www.objets-caches.com/trouver-animaux-caches.html

- Mystery box: You can create a box with a hole on one of the sides to slide your hand in, so that you can discover without looking at what has been hidden in the box.


4. SCHOOL ACTIVITIES

If my child is accompanied by a school assistant at school, he will need sustained shoring to work at home. I contact the school to find out if it is possible to adjust the workload to my child's specific difficulties. I can also consult the teacher or the AVS to find out he supports my child, so as not to disturb my child in his work habits and maintain a relationship of trust with him.


It is preferable to split the work and thus avoid long periods of work, which sometimes generate annoyance.

5. WHAT ABOUT DOMESTIC TASKS ?


I involve my child in simple household chores. I can find ways to make them fun if necessary. My child can appreciate the structured and routine side of these activities by themselves. It is important to adapt to his preferences. Daily activities help developing autonomy. In addition, it makes him participate in the house daily life and these are activities that make sense to him.

How to involve my child?

- Sorting activities: remove dishes from the dishwasher, some cutlery for example (sorting forks and spoons), sorting socks in pairs, sorting the laundry by family member, etc.

- Fold the laundry: tea towels, small towels, etc.

- Set the table: this allows you to count the persons present and take the corresponding number of glasses, plates, etc. If my child does not yet know how to count, I can put place mats to guide him.



- Participate in cooking activities: cut and peel the vegetables, cut a baguette and put in the basket, help make simple recipes (with a recipe in pictures, for example: http://onaya.eklablog.com/recettes-en-images-a118831686).

- Clear the table, close the shutters, help with cleaning, etc.

- Tidy up his room.

- Develop autonomy: brushing his teeth, washing his hands, participating in dressing and undressing, etc.

https://en.ben-le-koala.com/

https://www.bloghoptoys.fr/jimprime-mon-poster-je-prends-ma-douche-tout-seul?utm_campaign=shareaholic&utm_medium=facebook&utm_source=socialnetwork




6. SCREEN MANAGEMENT

I give a screen time on a given moment, I can also use it as a reward, and I avoid continuous news channels. Exposure to screens longer than usual is quite acceptable during this period.


3.1. Video games and social networks

Managing video games is problematic for a large number of parents in normal times. This may increase during this period.

Developing a timetable will allow me to limit conflicts. I agree with my child on the number of hours allowed per day and their distribution during the day.

On some game consoles (Switch® in particular), it is possible to program playing times. The console then stops automatically at the end of the elapsed time.

I warn my child when his playing time is almost over: “Be careful, you have 10 minutes left”.

I offer him an alternative activity: a board game, a story to read together, making a cake, a shower or a bath, music etc. I accompany him in the sequence with another activity to allow him to better manage his frustration.


Please note: The use of social networks should be monitored during this period in order to limit access to anxiety-provoking information or content. However, these tools make it possible to maintain the link with friends or family members (think of cousins). It is an opportunity to help him in social relations. Before a call (preferably video) I can remind him of the “rules” of social exchanges such as greeting, taking news, alternating speaking turns, etc. Encouraging remote contact with fragile family members can help in reducing anxiety. In the same perspective, I can look at photo albums with my child to take up the constitution of the family and also work on face recognition.

7. MANAGE DESIRABLE AND UNDESIRABLE BEHAVIORS

Routine changes and confinement can cause behavioral problems in my child, which is why it is important to re-establish routines as mentioned above (paragraphs 1 and 2, structuring time and space).

In the context of the right to mental and physical health, measured, structured and ritualized outings can sometimes help your children. This varies with state recommendations and it is essential to follow the updated government rules.

Reminder: I can offer routines alternating easy structured activities for my child and free sensory activities which do not necessarily require interaction and which are pleasant for him, even if they sometimes have a negative connotation for me (turning the wheels cars before his eyes, swinging, etc.).



Despite all the organization, confinement can generate behavioral difficulties that are difficult to manage by their intensity and duration. I do not hesitate to ask the professionals who accompany my child on a daily basis for advice and guidance by telephone or video consultation. I can also consult the links at the beginning of the document. To prevent my child's behavioral difficulties:

- I clearly explain to my child what I want and what I don't want (by images or pictograms, words or by writing) and I can suggest a contract with rewards if I already have it.

http://ekladata.com/Skm1ynw0SLWRY2FzLOOBcVjRZZI/Systeme-d-economie-jetons.pdf

- When I set up an activity, I prefer to start with those my child is capable of and which he appreciates, then I alternate with activities in which he is less at ease.

- I give my child quieter moments, alone, when he can self-stimulate.

- I am careful not to just create moments of exigency.

- I can offer cardiac coherence exercises

https://www.bing.com/videos/search?q=application+respirelax&qpvt=application+respirelax&view=detail&mid=DBA94090E500E4B747CEDBA94090E500E4B747CE&&FORM=VRDGAR&ru=%2Fvideos%2Fsearch%3Fq%3Dapplication%2Brespirelax%26qpvt%3Dapplication%2Brespirelax%26FORM%3DVQFRML

8. TAKE CARE OF YOURSELF

I take time for myself, it is important. During the day, during the nap, or in the evening, when the children are sleeping. I allow myself leisure time. I keep in touch with my loved ones or also with people who also have ASD children (especially on chats or forums). Whenever possible, I can ask for help from the professionals who follow my child (by video or tele-consultation). I can also use a timer to structure the time dedicated to my work and thus indicate to my child that I am available or not (I can use a pictogram “available” or “not available”).

48 Boulevard Serurier, 75019  Paris France

©2020 by Dr. Benjamin Landman. Child Psychiatry, Robert Debre Hospital - Paris