Children with autism, ADHD capable of face covering during COVID-19 pandemic

School-aged children with autism spectrum disorder and/or ADHD were capable of face covering across activities during the COVID-19 pandemic, according to results of a cohort study published in JAMA Network Open.

“Cloth face coverings are considered a key strategy in reducing the spread of SARS-CoV-2,” Benjamin Aaronson, PhD, of the department of pediatrics at the University of Washington in Seattle, and colleagues wrote. “However, policy makers and parents are concerned about students’ ability to mask effectively. We report the outcome of using positive behavior supports to promote masking in verbal school-aged children [ASD and/or ADHD] attending a summer day treatment program.”

The researchers assessed face covering behavior among 104 children aged 5 to 13 years (mean age, 8.9 years; 81% male) who took part in a summer treatment program at the University of Washington Autism Center in July 2020. A total of 27% of participants had ASD, 36% had ADHD, 28% had both and 10% had neither. Graduate and undergraduate students supervised groups of 10 children who participated in activities including group discussions, sports, board games, snack and lunch and recess, all of which were held outdoors. Participants earned points via a token economy for behaviors such as helping, sharing, following activity rules and sportsmanship, and a research assistant recorded a masking bonus for each 10- to 15-minute activity interval during which a child properly wore a face covering over their nose and mouth for most of the interval.

Results showed a total of 30,539 intervals and a mean of 24.47 intervals per day per child during the 3-week period. A total of 86% of children wore a face covering during 75% or more of all observed intervals, which included intervals for snack and lunch, during which there was not an expectation for face coverings. The researchers noted a significant link between age and the prevalence of wearing a face covering; they observed face coverings during 61% of intervals among children aged 7 years and 92% of intervals among children aged 12 years (P = .01).

“Our findings are consistent with recent reports of face covering in school-aged children but included direct observation and extended to children with greater special education needs,” Aaronson and colleagues wrote. “Limitations include a small sample size, a high staff to child ratio, no data on prior masking behavior and no interrater reliability. As policy makers and school personnel consider plans for in-person activities, face covering can be used as part of a constellation of practices to reduce the transmission of SARS-CoV-2 in pediatric settings.”