**1. Introduction**

Autistic spectrum disorder (ASD) is a psychiatric problem that used to be identified in childhood, between 1 and a half years and 3 years, although the initial signs sometimes appear in the first months of life. The disorder affects the level of communication, interaction with others and learning capacity, the child's adaptation to new situations and the display of stereotyped and restricted behavior. This description is reinforced by Leo Kanner, in 1943 who defines autism for the first time as a disorder in children that was manifested by the inability in the relationship and in the acceptance and adaptation to changes. They are children with physical development equal to that of other children but have great limitations in social or affective relationships, causing social isolation. In 2013, the Diagnostic

and Statistical Manual of Mental Disorders (DSM-5), aggregates as four separate previous categories: autism disorder, Asperger's syndrome, childhood disintegration disorder and generalized undefined development disorder, in a single concept of Autism [1]. Although it appeared to be a rare disease, the prevalence of ASD has steadily increased. In this context and in the face of the pandemic, children and families needed to reorganize themselves. The World Health Organization said the new coronavirus (COVID-19) was a global pandemic on March 11th, 2020 [2]. In Portugal, children were forced to stay at home with the closure of schools on 13th March. Some of them received daily tasks from their teachers, while others attended classes by videoconference. In addition, the portuguese government started broadcasting classes on television [3]. Despite the attempt to maintain access to universal education, some children who needed special education were hampered by the absence. In addition, with the adaptation of the health system, children with neurodevelopmental diseases, such as ASD, their therapies were suspended.

The child with ASD does not have a physical disability, looking perfectly normal. Therefore, understanding autism becomes more complex. Even to try to understand a child with autism it is necessary to consider their individual needs. However, these children have some genetic diseases associated with autism. This situation is due to the existence of a multifactorial genetic factor and several organic causes related to its origin. Thus, reinforcing the previous idea of children with autism spectrum disorders, the prevalence of associated diseases is about 2.5 times higher than in the general population [4]. The repercussions of the pandemic may be of more concern to children suffering from mental illness and development. Sudden changes in daily routine have consequences and can potentiate existing symptoms, increasing the risk of emotional, behavioral and relationship complications. With such special and peculiar characteristics, these children need help, specialized and continuous support in their most affected areas. In this way and due to the times in which we live due to the public health situation by Covid-19 and for reasons of quick action to prevent and minimize a major outbreak of infection and contagion, these children are more susceptible to the development of serious forms of COVID- 19 [3].

COVID-19 is caused by a coronavirus that can induce SARS in humans: SARS-CoV-2 [5] first reported in Central China in December 2019 [6]. Due to person-to-person transmission, it quickly spread across Europe [4], with northern Italy becoming the epicenter of Europe [7] and the USA [8]. As of May 1st, 2020, more than 3 million cases have been reported worldwide, affecting more than 200 countries. Currently, in October 2020, the USA has approximately 9,500,000 cases, followed by China with around 8,500,000 cases, Brazil with 6,000,000 cases, Russia with 1,700,000 cases, and Portugal in Portugal with 142,000 [9].

Since the beginning of the pandemic, most clinical and research efforts have been devoted to understanding the properties of the virus and its pathogenicity to treat the infection and prevent its spread [10].

However, according to some research evidence, the COVID-19 pandemic has revealed a worsening of the mental health of citizens in general [11]. The repercussions of the pandemic can be even more worrying in children suffering from mental illnesses and development. Sudden changes in daily routine have consequences and can potentiate existing symptoms, increasing the risk of emotional, behavioral and relationship complications [12]. The COVID-19 pandemic has brought important challenges to society and families, with repercussions on child behavior and development, the dimension of which we do not yet fully understand. The effects on children's mental health derive from several factors: concerns about the disease itself and uncertainties about contagion [13] and lethality, as well as measures taken to minimize its impacts, such as isolation and social distance [14]. In addition to the threat to the physical health of the general population, the pandemic has boosted a

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

plurality of psychological responses by the progressive increase in confirmed and suspected cases such as compulsory confinement at home or in health facilities, the decrease in the availability of personal protective equipment and/or the exhaustive coverage of the media capable of causing our alert and fear system to be constantly activated [14]. It is important to note that the pandemic required unprecedented measures by governments, including imposing quarantine on citizens [15].

The search for innovative approaches and the need to ensure continuity of care for children and young people with chronic health problems, should not be underestimated during the pandemic. A specific response is needed to minimize the mental suffering of children and young people who are quarantined.

Specialist Nurses in Child and Pediatric Health Nursing in partnership with Specialist Nurses in Mental Health and Psychiatric Nursing must design and develop socio-culturally appropriate programs to define strategies that facilitate the way to intervene in mental suffering and provide psychosocial support nursing care. to mitigate the adverse effects of prolonged isolation in children and young people [16].

The COVID-19 pandemic led families to adapt their lives, including social isolation and work from their parents' homes. The consequences of this confinement on mental health are still unknown [17].

Among vulnerable populations, children and young people with autism spectrum disorders are a group of special concern for the impact that the outbreak of COVID-19 may have on their well-being, as well as the specific support they may need to preserve their mental health during the pandemic [18].

Children and young people with autism spectrum disorders have problems with social communication, difficulties in maintaining social interactions and unusual patterns of repetitive behavior. These characteristics are associated with a preference for highly predictable environments, while children and young people may feel stressed, anxious or confused if unpredictable or complex changes occur [19]. The outbreak of COVID-19 has undoubtedly led to a fast-paced and rapidly changing social situation, which can increase the difficulties of children with autism spectrum disorders.

In view of the above, we intend to respond to the following objective: Identify and analyze the scientific evidence of interventions performed on children with Autism Spectrum Disorder in the context of a Covid-19 pandemic.
