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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 53  |  Issue : 2  |  Page : 64-76

A study on impact of Corona Virus Disease 2019 Pandemic on activities of daily living, play, and sensory behaviors of children with autism spectrum disorder: A cross-sectional survey study


1 Department of Child Psychiatry, Institute of Child Health and Government Hospital for Children, Chennai, Tamil Nadu, India
2 Institute of Community Medicine, Madras Medical College, Chennai, Tamil Nadu, India

Date of Submission31-Jan-2021
Date of Acceptance22-Jun-2021
Date of Web Publication23-Jul-2021

Correspondence Address:
G Daris Nithya
Department of Child Psychiatry, Institute of Child Health and Government Hospital for Children, Egmore, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoth.ijoth_34_21

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  Abstract 


Background: New Corona Virus Disease 2019 (COVID-19) pandemic has a greater influence on all of us and has changed many of our everyday routines. Adjusting to a new routine is stressful for everyone, but especially for children with Autism who have difficulty with change, it is more stressful. As, insistence on sameness, inflexible adherence to routines, and ritualistic patterns are the core features of autism, environmental changes, home confinement, disrupted daily routines, restricted access to schools, therapy centers during this pandemic will have a unique impact on children with Autism and their families. Objectives: The objective of this study was to systematically assess the impact of the COVID-19 pandemic on activities of daily living (ADL), play, and sensory behaviors of children with autism spectrum disorder (ASD). Study Design: Cross-sectional survey study was conducted. Methods: Convenient sampling method was used. The study sample consisted of 100 parents/primary caregivers of children with Autism. A structured ADL, play, sensory behavior questionnaire (45 items) was designed, validated, and administered through face to face and telephonic interviews. The duration of the study was 1 month. Results: Substantial proportion of the parents (69%) reported inconsistent daily routines and inconsistent sleep routines (67%) since the COVID-19 pandemic. Eighty-three percent of ASD children spend more time on mobile phones and televisions than interactive play. Home confinement during this pandemic resulted in lower physical activity was mentioned by 69% of ASD parents and 70% mentioned the increased social withdrawal of ASD. Many parents reported increased intensity of vestibular-proprioceptive seeking (75%), other sensory behaviors during this COVID-19 pandemic. Conclusion: The study analysis suggests that COVID-19 pandemic has a major impact on children with ASD on their ADL, play, and sensory behaviors. Ninety nine percent of our study respondents were not able to access therapy centers, and other intervention facilities during this pandemic. Lack of access to these structured environments during this pandemic could have contributed to the worsening of ASD children's behaviors. So, this study stress, access to the health care services that serve ASD children, especially occupational therapy, needs to be considered essential and remain available during these kinds of pandemics with universal precautions and/or via alternative modes of delivery, i.e. tele-consultation.

Keywords: Activities of Daily Living, Autism, Coronavirus Disease 2019 Impact, Occupational Therapy, Play, Sensory Behaviors


How to cite this article:
Nithya G D, Damodaran V, Mythili V. A study on impact of Corona Virus Disease 2019 Pandemic on activities of daily living, play, and sensory behaviors of children with autism spectrum disorder: A cross-sectional survey study. Indian J Occup Ther 2021;53:64-76

How to cite this URL:
Nithya G D, Damodaran V, Mythili V. A study on impact of Corona Virus Disease 2019 Pandemic on activities of daily living, play, and sensory behaviors of children with autism spectrum disorder: A cross-sectional survey study. Indian J Occup Ther [serial online] 2021 [cited 2021 Sep 22];53:64-76. Available from: http://www.ijotonweb.org/text.asp?2021/53/2/64/322171




  Introduction Top


Coronavirus disease 2019 (COVID-19) pandemic is changing how society's operate.[1] Countries are continuing to observe lockdowns, social distancing, and various other measures to prevent the spread of the coronavirus. As a result, schools, special schools, therapy centers, and many entertainment places such as parks, beaches, play areas remain closed.[2] It has changed many of our everyday routines. Adjusting to a new routine is stressful for everyone, but especially for children with autism spectrum disorder (ASD) who have difficulty with change, who insist on sameness, and inflexible adherence to routines, it is more stressful.[3] Environmental changes, home confinement, disrupted daily routines, restricted access to services such as schools, special schools, therapy centers will have a unique impact on children with Autism and their families.[4],[5] It is critical to determine and systematically explore how specifically the COVID-19 pandemic has changed the behavior of children with ASD to have targeted intervention strategies, better healthcare system, and management during these kinds of future pandemics. Moreover, collecting a parent's perspective of impact is the first step to improve the quality of the healthcare system and interventions.

Information given directly by the parents of children with autism will provide valuable insights into the influence of the COVID-19 pandemic on their ASD kids. These insights will help to form actions to mitigate the negative impact of the COVID-19 pandemic.[6] Furthermore, insights may be relevant for future pandemics or public health crises. This need for research on the impact of the COVID-19 pandemic on autism is also evident from the emerging articles that emphasize the concern of individuals with autism during the COVID-19 pandemic.[7],[8],[9],[10],[11],[12] Furthermore, surveys performed during previous Public Health Emergencies of International Concerns have provided timely data to inform best practices in responding to emergencies.[13] Similarly, the survey study presented here will also provide a powerful data collection tool for future pandemics.

Hence, this study aims:

  1. To assess the impact of the COVID-19 pandemic in children with ASD.
  2. To determine the impact of COVID-19 pandemic on activities of daily living (ADL), play, and sensory behaviors of children with ASD.
  3. To find out the association between COVID19 pandemic and sociodemographic factors of children with ASD.



  Methods Top


A cross-sectional survey study was conducted on the parents/primary caregivers of children who were diagnosed by psychiatrists with ASD as per diagnostic and Statistical Manual of Mental Disorders-V criteria. We used mixed-method approach in which both quantitative and qualitative data were collected from the parents through face to face and phone interviews through one-on-one consultation base. Ethical approval was obtained from the Institutional Ethics Committee, Madras Medical College, Chennai, Tamil Nadu on January 19, 2021, Ethical approval number No. 30012021. This study was carried out at the Occupational Therapy Unit, Institute of Child Health and Government Hospital for Children, Chennai for one month.

Sample

A convenient sampling method was used. The study sample size was 100. Assuming 50% change in the behaviors among ASD children with alpha at 5% and precision of 10%. The minimum sample size was 96. Hence 100 participants selected for this study.[14],[15]



Parents and primary caregivers of children with Autism who were registered on regular treatment (Multidisciplinary Treatment) and on regular follow-up in the Child Psychiatry outpatient department (OPD) of a tertiary care hospital in Chennai were included in the study. Parents and primary caregivers of children with Autism with acute medical illness were excluded from the study. All participants were provided with a participant's information sheet that contained information about the purpose of the study, procedures, benefits of participating, voluntary participation, and contact information of the researcher, and a written informed consent form to consent to participate in the study. Caregivers were interviewed according to a structured ADL, play, sensory behavior questionnaire. The interview was conducted in person who reports regular OPD in the Institute of Child Health and Hospital for Children and the rest through the phone.

Instrument

Parent Survey [Appendix 1] was developed after reviewing literature[8],[9],[10],[11],[12] and based on survey writing guidelines. The survey questionnaire's content validity was checked by 2 renowned Psychiatrists, an expert Occupational Therapist of the Child Psychiatry Department, ICH and HC, Chennai, and some parents of children with ASD. The experts evaluated the questionnaire regarding its relevance, clarity, meaningfulness, and completeness and they gave some suggestions. Necessary modifications in the questionnaire were made as suggested. The literature review and expert-based panel supported the content validity of the questionnaire. The parents and primary caregivers of autistic children confirmed the understandability, completeness, and plausibility of the questionnaire. The Questionnaire consisted of 45 structured questions (Yes/No) in 6 categories and few open response questions about online classes/therapy sessions and sensory behaviors.

  1. Sociodemographic characteristics of parents of ASD kids
  2. Clinical characteristics
  3. Impact of COVID 19 pandemic on ADL of children
  4. Impact of COVID19 pandemic on play behaviors
  5. Impact of COVID 19 pandemic on sensory behaviors
  6. Positive effects of COVID 19 pandemic.


The respondents in the study considered that the questionnaire was helpful for reflecting the changes in the behaviors of their ASD children that occurred during the COVID-19 period. Despite the substantial length, the time required for administering the questionnaire was 15–20 min.

Statistical Analysis

Statistical analyses were performed using the Software IBM SPSS statistics version 26.0. Descriptive data were reported as numbers and percentages. Chi-square and Fisher's test were used to checking the correlation between sociodemographic characters and the impact of the COVID-19 pandemic in Autism kids. The significance level i.e., P value was set at P < 0.05 at the outset of the study. The open response questions did not have a scoring system. Responses for open-ended questions were categorized and analyzed by the author.


  Results Top


A total of 100 respondents participated in the study. Across 45 questions survey, participants provided 4500 answers.

Sociodemographic and Clinical Characteristics

Most of the participants were belong to the 30–40 years age group. Eighty-one percent of our participants are from urban areas. Most of our Clinical ASD samples were undergoing pharmacological treatment and other multidisciplinary treatment such as occupational therapy and speech therapy. Sociodemographic information about the participants is depicted in [Table 1]. Clinical characters of ASD kids are mentioned in [Table 2].
Table 1: Sociodemographics Characteristics of the Participants

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Table 2: Clinical Characteristics of the Autism Spectrum Disorder Children

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Impact of Corona Virus Disease 2019 Pandemic on Activities of Daily Living

During the COVID-19 pandemic 99% of parents had difficulty in accessing structured and regulated environments such as therapy centers, special schools, and schools. Ninety four percent of our participants mentioned about lack of one-to-one professional support during this pandemic. A proportion of parents reported difficulty in managing daily routine (69%), inconsistent sleep routine (63%) and difficulty in implementing daily activities (61%) during this pandemic. A substantial proportion of parents (51%) mentioned about their children become more dependent during this pandemic. One sample proportion test was conducted to find the P value. P value for the impact of COVID 19 pandemic on ADL was P < 0.001 and for a few questions P < 0.01 indicates significant changes occurred in ADL of children with ASD during this pandemic [Figure 1].
Figure 1: Impact of Corona Virus Disease 2019 Pandemic on Activities of Daily Living of Children with Autism Spectrum Disorder

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Impact of Corona Virus Disease 2019 Pandemic on Play Behaviors of Children with Autism Spectrum Disorder

Our findings show during the COVID-19 pandemic 83% of our respondent's with ASD children spent more time on screen-related activities and parents finding difficult to regulate their children's screen time. A larger proportion of our study participants mentioned about home confinement during this pandemic resulted in less social interaction (70%), lower physical activity (69%) and 51% of our study participants mentioned there is been more stereotypical behavior during this pandemic. On one sample proportion test P value for the impact of the COVID 19 pandemic on play P < 0.001 indicate play behavior of children with ASD affected significantly during this COVID 19 pandemic [Figure 2].
Figure 2: Impact of Corona Virus Disease 2019 Pandemic on Play Behaviours of Children with Autism Spectrum Disorder

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Impact of Corona Virus Disease 2019 Pandemic on Sensory Behaviors of Children with Autism

Seventy-four percent of the study participants mentioned increased vestibular sensory behaviors and 75% reported increased proprioceptive sensory behaviors since this pandemic. Tactile sensory issues have increased significantly during this COVID-19 pandemic. A small proportion of parents also have mentioned about the increased intensity of self-injurious behavior [Figure 3]. Forty participants responded to open-ended questions regarding sensory behaviors. Their responses are categorized into tactile sensory issues, vestibular/proprioceptive sensory issues, auditory sensory, and other sensory issues.
Figure 3: Impact of Corona Virus Disease 2019 Pandemic on Sensory Behaviors of Children with Autism Spectrum Disorder

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Some of their responses to our open-ended question about sensory issues are,

  1. ”My child cannot stay in the same confined place for a longer time”
  2. ”My son never wears a mask”
  3. ”Ever since this COVID 19, I cannot stop my kid using the sanitizer”
  4. ”He is constantly in overstimulation since this pandemic”
  5. ”My child always tries to run away from the house”
  6. ”He is always in the swing.”


Eighty percent (n = 32) of our respondents mentioned difficulties in making their ASD children wear masks. (Tactile). Seventy five percent (n = 30) mentioned their children overusing the sanitizers, frequent hand washing and smelling. (Tactile/Olfactory), increased hand flapping, jumping, and spinning were mentioned by 68% (n = 27) of our respondents. This indicates sensory issues of children with Autism have increased significantly since this COVID 19 pandemic.

The Positive Impact of Corona Virus Disease 2019 Pandemic

Our survey results suggest during this COVID-19 pandemic even though 82% of our participants could spend more time with their family and their children and have more family time only 39% of participants mentioned spending their time productively and 4% of respondents only could teach their children new skills and activities.

Online Classes and Therapy Sessions during Corona Virus Disease 2019 Pandemic

Even though 80% of our study participants have digital access such as smartphones, computers, and laptops for online classes, only 18% of our study participants were attending online classes/therapy sessions. Eighteen of our participants responded to open-ended question about online classes/therapy sessions. Their responses are categorized into positive and negative responses.

Few positive responses,

  1. ”Now I can home school my children”
  2. ”Because of the online therapy session, I can able to see and understand what is happening in the therapy session of my children”
  3. ”Online classes are saving us from traveling during this pandemic time”
  4. ”It is easier for me as I am doing work from home.”


Few negative responses,

  1. ”It is been very difficult to make my child sit in front of the computer during online classes”
  2. ”Recently he started interacting with other kids in the school, now in online classes, it is lost”
  3. ”My child is not paying attention to the online classes; I am the one paying attention”
  4. ”My kid behaves better with the therapist in the therapy center, not with me in the home.”


Fifty percent (n = 9) of the participants mentioned online classes or online therapy services resulting in positive effects such as self-paced schedule freedom from the highly challenging school environment. Eighty-eight percent (n = 16) mentioned online classes/therapy services resulting in more academic challenges and it has increased the parental burden.

Association between Socio Demographical Variable and Impact of Corona Virus Disease 2019 Pandemic on Behaviors Children with Autism

Descriptive analysis was performed to assess the distribution of variables. Chi-square test was employed to compare the prevalence of different categories of variables with 5% level of significance. The parameters of the model were estimated through generalized estimating equations approaching by considering exchangeable correlation structure among demographical data. The full model was run with those variables showing P < 0.25 in the unadjusted analysis. We analyzed the association between social demographic factors and the impact of the COVID19 pandemic both unadjusted and adjusted odds ratio (OR) were reported with a 95% confidence interval (95% CI). Only statistically significant associations between sociodemographic variables and Impact variables are depicted in the table [Table 3].
Table 3: Depicting Significant Association between Socio Demographical Variable and Impact of Corona Virus Disease 19 Pandemic on Study Variables (n=100)

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In the analysis, we found respondents who are more than 40 years of age reported significant loss (P = 0.042) in their children's social skills during this COVID 19 pandemic than other age group OR = 2.33 (95% CI: 1.02–5.32). Univariate analysis revealed, under occupation variable homemakers were 2.51 times more (95% CI: 1.00–6.59) reported to have difficult to manage their children's sleep schedule (P = 0.045). Homemakers also mention more OR: 2.52 (95% CI: 1.00–6.33) vestibular seeking behaviors in their children during this COVID 19 pandemic than other occupation variables (P = 0.041) [Table 3].

Respondents who are living in urban areas 70 (86.4%) 5.73 times (95% CI: 1.90–17.25) more likely to have a high prevalence of digital access than rural respondents (P = 0.001). Urban respondents 4.48 times more likely to (95% CI: 1.21–16.59) develop new hobbies or teach new skills to their ASD kids than the rural respondents. (P = 0.014) [Table 3]. Association between education status of the parents and impact of COVID 19 pandemic P = 0.9999 which implies no significant association.


  Discussion Top


This is the study that systematically explored the impact of the COVID-19 pandemic on ADL, Play, and Sensory behaviors of children with autism in India.

Impact Corona Virus disease 2019 Pandemic on Activities of Daily Living of Autism Spectrum Disorder Children

Study by Ameis et al. found that the ASD the kids experiencing disrupted daily routines, reduced food intake patterns, and lower physical activity during this pandemic.[4],[16] Liu et al. reported that the number of hours children slept significantly decreased from before to COVID 19 pandemic[17] and Mutluer et al. have reported changes in sleep time and quality in children and adolescents during this pandemic.[18] In line with the previous studies, our study also found inconsistent sleep routine and daily routines of ASD children increased since the COVID-19 pandemic. We found parents of autistic kids finding it very difficult to implement activities on of daily living on time ever since the COVID-19 pandemic and their autistic kids become more dependent on their parents for ADL than pre-pandemic.

Impact of Corona Virus Disease 2019 Pandemic on the Play of Autism Spectrum Disorder Children

Moore et al. found that there is the significant decline in physical activity and increased screen time during the COVID-19 outbreak in Canadian children.[19] Similar to the previous studies[4],[19] our study also found since the COVID-19 pandemic the parents are finding it very difficult to regulate their ASD children's time spending on screen-related activities such as TV, mobile phones, and video games. We also found during the COVID-19 pandemic home confinement resulted in more screen time, lower physical activity, and less social interaction. These results may be explained by previous research showing that children with autism were already more likely than neurotypical to face loneliness and social isolation before the pandemic.[20],[21] Losing access to schools, therapy centers, and other entertainment places such as parks, beaches could have further increased their burden.

Impact of Corona Virus Disease 2019 Pandemic on Sensory Behaviors of Autism Spectrum Disorder Children

Our study also found increase in tactile sensory behaviors, vestibular-proprioceptive and other sensory behaviors in ASD kids during COVID 19 pandemic than pre-pandemic. As revealed by responses to open-ended questions also particularly highlight the increased sensory behaviors during this COVID-19 pandemic. Similarly, Mutluer et al. found that there is increased sensory issues in children compared to before the pandemics.[18] Stankoric et al. found that 40% of Children with autism had difficulty in wearing masks.[22] An article in Washington Post shared the challenges children with autism experience when asked to wear masks due to sensory issues[23] Our findings are also parallel to these findings.

Our Healthcare System

We also found during the pre-pandemic period most of our participants were able to attend at least some kind of structured therapeutic services, special schools, and schools. But during this COVID-19 pandemic, 99% of our study participants were not able to access the structured interventions such as occupational therapy, speech therapy and special schools. Ninety-four percent of study participants mentioned about lack of one-to-one professional support during this pandemic. Our results suggest lack of access to these structured environments during this pandemic can contribute to the worsening of physical, mental status of the children with autism and exacerbate the sensory behaviors, worsen their ADL skills, and play behaviors. This is also supported by the study of Ameis et al., in which he mentions about changes to everyday routines and restrictions to regular service disrupt a number of domains (e.g., physical health, mental health, and familial factors).[4] These results highlight the current healthcare system and model or not sufficient to meet the need of autistic children during the COVID-19 pandemic.

Positive and Negative Effects of Online Classes/Therapy Services

Responses to our open-ended questions revealed that online classes/therapy services have both positive and negative effects. Our study found that online classes provide ASD kids freedom to be in their own home environment with a self-paced schedule. It also reduces the risk of traveling during pandemics. As per our findings, online classes make the parents understand their ASD kids better. Evidence from other studies also indicates parent involvement during online classes/early intervention can have positive long-term effects.[4],[24] We further found that online class and therapy services increased parental burden as making use of the online platforms was highly challenging for children with autism who have poor sitting tolerance and other sensory issues. These online classes/therapy services further reduced ASD children's social interaction with others as during prepandemic, schools and therapy centers were the only options for social interaction. As per our finding urban population have more access and benefit from online classes therapy services. This indicates there is a need to develop alternative models such as in-home therapy services to support autistic individuals and caregivers who are not able to access online classes/therapies.[25],[26],[27] And also, there is a need to advocate for equalizing access and adopting the Digital Health Equity framework.[28]

Association between Sociodemographic Variables and Impact of COVID-19

Our study further found that social determinants such as the area of living, age of the primary caregivers, and occupations variables were associated with changes in the behaviors of children with ASD during the COVID 19 pandemic. As per our study findings rural population, homemakers, primary caregivers above 40-year-old are more likely to affect by COVID 19 pandemic than other sociodemographic variables [Table 3]. At the same time another important sociodemographic variable, education status did not have any association between changes in the behavior of ASD kids during the pandemic.

Results from our studies indicate ongoing COVID-19 pandemic is a very challenging period for children with autism.

Limitations

  1. Our study sample size is relatively small. Sample size calculation was not done for each associated factor hence larger sample study might require.
  2. Most of our participants are urban population therefore, generalization of the study findings should be considered with caution
  3. Due to the nature of this study impact of the COVID 19 pandemic on parents' perspective only assessed. Future studies with standardized methods and investigations are recommended
  4. Further research on psychometric qualities, implementation aspects, the effectiveness of the questionnaire can be done.


Future Research and Clinical Implications

Our study portrays how individuals with autism affected by the COVID-19 pandemic such understanding is very much essential and crucial for the future development and implementation of targeted clinical intervention strategies, education services, policies geared toward this vulnerable population.

And, this study will help to drive enduring and Autism friendly changes in healthcare and social systems like, In-Home Therapy services, Tele-rehab, and other online rehab services to tackle the challenging behaviors of ASD kids during these kinds of the pandemic.[24],[25],[27]

This is high time to develop targeted intervention strategies to tackle the negative impact of the COVID 19 pandemic and other future pandemics on ASD kids. And much importance must be given to the health care facilities that serve the autism's kids, especially Occupational therapy to be considered essential and remain available, accessible, and affordable to tackle the challenging behaviors of children with autism during these kinds of pandemics.

The findings of this study will help to increase the awareness of the impact of the COVID 19 pandemic on children with Autism and that our recommendations will be inferred by the relevant healthcare institutions into targeted intervention strategies.


  Conclusion Top


ASD children's ADL including daily routines, sleep patterns, food intake patterns/routines are highly affected during this pandemic. ASD kids spend more time on screen-related activities than interactive play and physical play. Their sensory behaviors also significantly affected during this pandemic than prepandemic. During this COVID-19 pandemic, 99% of our study participants were not able to access the structured interventions such as occupational therapy and other therapy services. The impact of this COVID 19 pandemic is severe on the rural population and homemakers. The urban population has more access and benefit from online classes and therapy services than the rural population.

Acknowledgments

The author extends her sincere thanks to Dr. Shanthi, Associate Professor/HOD, Department of Child Psychiatry and Dr. Ezhilarasi, Director/Professor, Institute of Child Health and Government Hospital for Children, Egmore, Chennai for their continuous support throughout the study.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.


  Appendix 1 Top


Appendix: Questionnaire

Questions about Sociodemographic Characteristics of Parents and Primary Caregivers of Children with Autism Spectrum Disorder

  1. Gender


  2. Male/female

  3. Relationship to the child


  4. Mother/Father/Guardian

  5. Age


  6. 20–30

    30–40

    40–50

    Above 50

  7. Education


  8. Less than High School

    Graduate

    Postgraduate

  9. Occupation


  10. Employed Full Time

    Employed Part Time

    Homemaker

  11. Area of living


  12. Rural

    Urban

    Questions about clinical characteristics of children with autism spectrum disorder

  13. Age group in years


  14. 2–4

    4-6

    6–10

    Above 10

  15. Diagnostic age
  16. Communication


  17. Verbal – Single word

    Simple sentence

    Echolalia

    Nonverbal: Crying/guiding others hand/pointing

  18. Repetitive behaviors


  19. Hand flapping

    Jumping

    On the Go

    Fidgeting

    Spinning himself

    Self-injurious behaviors - Mention

    Other Behaviors - Mention

  20. Pharmacological treatment


  21. Yes

    No

  22. Child receiving any other therapies/attending school


  23. Occupational therapy

    Speech therapy

    Remedial education

    Special School/Normal School

    Questions about Impact of COVID 19 pandemic on Activities of Daily Living of children with Autism Spectrum Disorder

  24. Inconsistent sleep routine has increased since COVID 19 pandemic


  25. Yes

    No

  26. Longer time to fall asleep than the pre pandemic time


  27. Yes

    No

  28. It has become more difficult to manage your child sleep schedule since COVID 19


  29. Yes

    No

  30. Inconsistent daily routines have become prominent since COVID 19


  31. Yes

    No

  32. It has become more difficult to manage eating activity since COVID-19 pandemic


  33. Yes

    No

  34. Restricted food access during COVID19 pandemic resulted in reduced food intake/poor nutrition


  35. Yes

    No

  36. Since COVID19 pandemic it has become difficult to implement daily activities such brushing, bathing, dressing on time.


  37. Yes

    No

  38. Already acquired ADL skills lost or reduced during COVID 19 pandemic


  39. Yes

    No

  40. Your child has become more dependent on you for the activities of daily living since COVID 19 pandemic than prepandemic
  41. Yes


  42. No

  43. Since COVID19 pandemic It has become more difficult to teach new activities of daily living skills to your child


  44. Yes

    No

  45. COVID-19 pandemic resulted in lack of one to one professional support and other therapeutic services such as occupational therapy, speech therapy, remedial education, special school support the child was previously receiving


  46. Yes

    No

  47. Since COVID 19 pandemic it has become difficult to access structured and regulated environment such as Therapy centers, play schools, special schools, schools to facilitate learning


  48. Yes

    No

  49. Have digital access for online therapy services or classes


  50. Yes

    No

  51. Child receiving online classes or online Therapies and services


  52. Yes

    No

  53. Online classes or online therapy services resulting in positive effects such as self-paced schedule freedom from highly challenging school environment


  54. Yes

    No

    Others mention-

  55. Online classes or online therapy services resulting in more academic challenges and it has increased the parental burden


  56. Yes

    No

    Questions about impact of COVID19 pandemic on play behaviors of children with autism spectrum disorder

  57. Since COVID 19 pandemic it has become difficult to regulate time spent on screen such as TV, mobile phones, video games


  58. Yes

    No

  59. Since COVID 19 pandemic your child spend more time on screen related activities


  60. Yes

    No

  61. Since COVID 19 pandemic, home confinement resulted in lower physical activity


  62. Yes

    No

  63. Since COVID 19 pandemic, your child pursues more time on special interests such as puzzle fixing, coloring, lining up things, etc.


  64. Yes

    No

  65. Since COVID 19 pandemic Closure of schools, therapy centers, and other entertainment places such as park, beach, etc., resulted in less social interaction


  66. Yes

    No

  67. Since COVID 19 pandemic already learned, developed social skills such as greeting others, making eye contact, sharing, turn taking waiting tolerance, etc., or lost or reduced.


  68. Yes

    No

  69. Since COVID 19 pandemic your child engage more on stereotypical behavior than interactive play


  70. Yes

    No

  71. Since COVID 19 pandemic Social withdrawal has increased


  72. Yes

    No

    Questions about Impact of COVID 19 pandemic on sensory behaviors of children with autism spectrum disorder.

  73. Since COVID 19 pandemic there is increased intensity of Vestibular seeking behaviors such as spinning, on the go, rocking, etc.


  74. Yes

    No

    Mention the behavior

  75. Since COVID 19 pandemic, there is Increased intensity of proprioceptive behaviors such as jumping, hand flapping, climbing up and down, etc.


  76. Yes

    No

    Mention the Behavior

  77. Since COVID 19 pandemic, there is increased Tactile sensory behaviors such as problematic hair cutting and nail cutting, wearing masks, restricted food preferences and dress preferences


  78. Yes

    No

    Mention the Behavior

  79. Since COVID 19 pandemic, there is more self-injurious behaviors such as hitting and biting themselves, head banging, etc.


  80. Yes

    No

    Mention the behavior

  81. Since COVID 19 pandemic, other olfactory, gustatory, visual sensory behaviors such as smelling, taste preferences, mouthing of objects, lateral viewing, etc.


  82. Yes

    No

    Mention the Behavior

    Questions about positive effects of COVID 19 pandemic

  83. Since COVID 19 pandemic, could spend more time with the child


  84. Yes

    No

  85. Since COVID 19 pandemic, could have more family time


  86. Yes

    No

  87. Since COVID 19 pandemic, could pay more attention to the child


  88. Yes

    No

  89. Since COVID 19 pandemic, could develop new hobby/teach new skill to the child


Yes

No



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

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Abstract
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