**5. Maintain the safety of children with autism spectrum disorder in a pandemic situation**

Currently, we all live in a time of uncertainty related to the covid-19 pandemic situation. These are particularly challenging times for all of us and for children with autism spectrum disorders, this is no exception. Children with characteristics of the autism spectrum have greater difficulty in dealing with uncertainty and changes, as previously mentioned. In this phase in which your routines have changed profoundly and in which therapies, support and consultations have been suspended or are taking place in a different way than usual, it will be important to pay special attention and respond to your needs.

Thus, the pandemic caused by the new coronavirus poses numerous challenges in guaranteeing the fundamental rights of children. In order to prevent the overload of health systems and to protect those who are most vulnerable, States must establish policies to combat Covid-19 in an agile way to minimize the contagion as much as possible, a fact that is unfeasible based on the general population, but also based on the peculiarities and rights of children with autism spectrum disorder.

Some of these measures can be adapted to reconcile the fight against coronavirus with the rights of children. The best way to fight the disease has been through preventive actions, following some control and protection measures such as hand washing and hygiene, wearing masks and social isolation as a way to prevent the spread of the disease. These measures are currently widespread [34].

The COVID-19 pandemic has generated a series of changes in the lives of families and society in general, which may impact not only on physical and biological health, but also on mental health. As an example, social isolation and other recommendations, necessary for the prevention and reduction of disease transmission, end up significantly modifying daily life, which may result in tension, fear, stress and anxiety, both for caregivers and children with TEA [35].

For this specific population, it may be difficult to understand the pandemic scenario and all the ramifications resulting from COVID-19, especially when it comes to young children and/or those who have intellectual and sensory disabilities concomitant to the condition [36].

It is important to note that autism is not a risk factor for COVID-19. Thus, children with ASD have symptoms similar to those of other young people without the disorder. However, the characteristics of autism can create difficulties in adopting preventive measures. An example is changes in sensory functions. An autistic child may have a great interest in the smell, taste and texture of objects, and it is common to observe him passing his hand over everything and bringing the utensils to his mouth. This practice increases the possibility of contamination and parents must be aware of hygiene issues, keeping the environments ventilated and avoiding sharing objects [34].

Thus, children and adolescents with ASD can be considered more vulnerable to COVID19, not because they are susceptible to the complications of the virus, but due to the characteristics of the clinical picture that weaken the understanding of the pandemic scenario as well as the control and protection measures, exposing them to greater risks of contamination. In this sense, considering the particularities present in this picture, all the existing complexity and the current pandemic scenario, it is essential to reflect on the impacts of this global health crisis on the daily lives of this population, since they naturally already experience very difficult and challenging situations.

The control and protection measures adopted by countries to contain the spread of the virus and contagion of the population need to be carefully managed to avoid

#### *Autistic Spectrum Disorder in the Context of Pandemic by Covid-19: Caring for Children… DOI: http://dx.doi.org/10.5772/intechopen.96583*

the intensification of psychological distress in families and behavioral difficulties in children with ASD. In this direction, the text presents ten tips that aim to help families deal with these children during the pandemic, such as explaining children about what the disease is, organizing daily activities, having time for play activities, using games for teaching, online therapy, among others [18]. Another author says that the process of social isolation and its implications in the lives of children with ASD, depend on personal, contextual, political aspects and mainly on the current health systems. Children with autism may show strong resistance to change. The closure of kindergartens, schools and other facilities that children with autism attend daily can create additional tension. In addition, the author points out that the current moment has mobilized the community to develop solidarity actions and to deal with the invisibilities of the most vulnerable populations [36].

Safety measures must be enforced by parents. These are the example for the child with ASD. This technique is called live modeling. If the child is interested in videos, this is a resource that can also be used. Hand washing as we have seen is extremely important and therefore parents should wash their hands as recommended by specialists and record each step of this activity. The process list is a guide to start learning the child with ASD. Recording the video of the child performing the process can be a way to improve their learning. The child's help should be gradual and little by little it should promote the child's autonomy. It is very important to provide these children with compensation for the goals achieved, this motivates the child to do more and better [37].

It is reinforced that adopting these measures is fundamental not only for the protection of these individuals, but also of the family and community. However, due to the difficulty of understanding and, in some cases, the presence of important sensory issues, some children and adolescents with autism will not be able to use the mask and/or remain in social isolation for a long time.

In Portugal, people with intellectual, developmental or autism spectrum, with a degree of disability equal to or greater than 60%, as evidenced by a multi-use certificate, are exempt from the use of a mask or visor in places that generally require it [37].

In addition to these sensory challenges, masks also create new social communication challenges. Autism spectrum disorder can include impaired visual perception skills, making the chances of accurately reading another person's facial expression under a mask, from a socially appropriate distance, more difficult than normal. In addition, when seeing another person's face while they are wearing a face mask, the eyes are the main area of the face that is visible. Individuals with ASD often have difficulty making eye contact, adding yet another obstacle for them in the realm of social communication. These factors can cause communication problems and frustration. As masks drown out voices, verbal communication also becomes more difficult. Fortunately, there are several strategies that can make using a face mask more bearable.

As we have seen, the impact of the pandemic can be even more worrisome in children suffering from autism spectrum disorders. Sudden changes in daily routine have consequences and can potentiate existing symptoms, increasing the risk of emotional, behavioral and relationship complications.

Children with special health needs may need additional support to adapt to new routines and to understand changes.

In the future, with the opening of schools and the return to routine, it is essential to create a balance between the public health measures necessary to minimize the impact of the pandemic and the gradual resumption of interpersonal relationships and school, professional and leisure activities, maintaining the child safety.
