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Autism and COVID-19: How Italy Delivered Care in Quarantine

By early March 2020, Italy was one of the hardest-hit countries by the COVID-19 pandemic. Families of children with autism spectrum disorders (ASD) were forced to move their applied behavioral analysis (ABA) treatment plans online when social distancing precautions became more heavily enforced. In an effort to provide insight into how effective these telemedicine plans might be for families of children with ASD in other countries as we endure this pandemic, a group of ABA practitioners detailed the custom plans assigned to 30 families and their results.

The need for at-home plans became clear when parents reported their child becoming increasingly uncooperative due to the traditional positive reinforcers being unavailable (swimming, playground, movie theater, etc.). Schedules are essential for many individuals with autism and the unpredictability of the pandemic has posed unprecedented challenges. Parents also expressed difficulty in balancing distant-working and around-the-clock care of their child, often with other siblings.

A risk assessment was conducted to evaluate verbal functioning and children were sorted into three categories: preschool-age, minimally verbal, and verbally interactive. Verbally interactive children received two 50-minute virtual sessions per day working directly with a tutor. Preschool-age and minimally verbal children had a parent coaching system implemented, where parents worked with ABA practitioners virtually to develop a detailed at-home plan.

In these plans, daily structure was provided via an hour-by-hour schedule for the child and a token reinforcement system was put in place based on the difficulty of the task/response required of the child. A certain amount of tokens could be exchanged for one item/activity at a time. Using the “Token Economy” psychological strategy is common in autism therapies to provide structure and clear communication. An activity-based reinforcement system was also instituted to allow the child and siblings under 10 to participate in adult-led instruction for a half-hour block, followed by a half-hour block of “fun” reinforcement time for everyone. Positive reinforcement ensures that rewarding a behavior will allow for more of that desired behavior (making eye contact, following instructions, responding, etc.) to occur.

These plans worked to provide structure to both parents and children, as well as combat the lack of motivation from the child, as many of the traditional reinforcers were readily available at home. Although this method of treatment is not ideal, the ABA practitioners reported increased parental engagement that was not present before. In the future, it would be interesting to learn of the results parents from other countries have with these types of plans, as well as how these plans can adequately address social development while in isolation. Additionally, how might these plans need revision when a parent returns to work in-person or the child’s school reopens?


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degli Espinosa, Francesca, et al. "A Model of Support for Families of Children with Autism Living in the COVID-19 Lockdown: Lessons from Italy."

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