How Psychiatrists Can Guide Distance Learning

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When thinking about education as it pertains to autism, it is imperative to consider what obstacles children and adolescents with autism spectrum disorder will face. Distance learning during the coronavirus disease 2019 (COVID-19) may present additional challenges. Psychiatrists are in the unique position to recognize the social, emotional, and developmental needs of these children. Psychiatrists can play a significant role in the coordination and implementation of multi-dimensional mental health care delivery systems across disciplines, including the pediatricians, parents, teachers and therapists.

Evidently autism is a lifelong condition, and the path to clinical improvement requires therapeutic and educational support. Among the assortment of educational barriers, the most prominent are alterations in sensory perception, behavioral inflexibility, and learning limitations.¹ Children with autism require a multimodal approach: specialized education planning, a great degree of structure (through predictable routines), visual schedules, and a dedicated learning environment to minimize distractions.² Professionals with different expertise must work together to offer a nurturing environment for these children’s intellectual growth. Children with autism thrive and meet their academic goals with the assistance of special education teachers, speech therapists, and mental health counselors.² Their educational requirements will also demand a lot of parental involvement and access to systems of care. For instance, extensive behavioral therapy for at least 25 hours a week is recommended for school-aged children with autism.² The aim is to facilitate improvement in social and cognitive functioning, verbal and nonverbal communication, and to address maladaptive behavior.

Children and adolescents with autism face many challenges to obtaining quality education, and COVID-19 has raised these hurdles to new heights.³ Since the start of the COVID-19 pandemic, many schools have transitioned to online learning modalities (eg, Zoom, Skype, Google Teach from Anywhere) to deliver education in children’s homes. The abrupt shift from in-person to distance learning may pose a difficult transition. Regulation of sensory needs, particularly visual and auditory processing, is quite difficult when learning is happening over a computer screen for long hours.⁴ Children with autism are also accustomed to relying on a school’s structured schedule and the help of paraprofessionals to learn necessary social and academic skills. Behavioral inflexibility in children with autism entails resistance to change and insistence on a structured routine, so deviance from their schedule can cause extreme distress.

These children also have a strong attachment to certain individuals or places, and they may be preoccupied with unusual activities that are impossible because of COVID-19 regulations. Relationship development interventions are essential to mitigate social deficits and improve adaptation skills for functioning in a dynamic society. Unfortunately, given COVID-19 restrictions, maintaining the same level of structure and routine is, to say the least, a challenge, not only for these kids but also for their caregivers.

The unique circumstance of COVID-19 has required children with autism, their caretakers, and health care professionals to adapt in creative ways. Parents of children with autism find themselves in a position where they need to take on multiple roles, such as teachers, and physical, occupational, and speech therapists. This causes stress in the lives of both parents and their children.

Unlike classroom learning, distance learning requires a significant amount of effort from parents. Parents must supervise their children’s classes and are primarily responsible for setting a schedule for their schoolwork. Parents may struggle to manage the learning needs of their children, as the behavioral issues may be compounded by pandemic-associated lifestyle changes. For example, the frequency of aggressive behavior and tantrums may increase.³ Given these setbacks, parents may understandably worry that their children could fall behind in their developmental course.

What Can Caregivers Do?

It is important for the mental health care community, paraprofessionals, and caregivers/parents to collaborate and develop strategies to handle the complications inherent to remote learning. Although distance learning has made it difficult to access the specialized care and services they require, parents and caregivers can still create an enriching learning environment. Here are a few strategies that psychiatrists and other caregivers can suggest:

• Provide a structured environment at home, such as designating a particular table or room for online learning and a separate area for social activities. This may help with sensory adaptation and foster a supportive learning atmosphere.⁵

• Set up visual daily and monthly schedules. This is an excellent way to incorporate routine into students’ lives.

• Incorporate frequent breaks into the schedule and use reminders to signify the end of 1 activity and the start of another.

• Equip play areas with familiar toys or objects to increase the overall familiarity of the students’ surroundings.

• Collaborate with skilled workers, professionals, and psychiatrists. It is crucial for parents to learn the best methods for satisfying the needs of students with autism.

• Maintain social connectivity with peers and professionals via an online platform. This can prevent the regression in these children’s social development.

Many autism societies and health care organizations have posted COVID-19 resources to guide care providers. Online resources also exist to support parents as they navigate the distance learning process. As individuals continue to be cautious and stay at home because of social distancing efforts, teachers, caregivers, and parents should work collectively to develop new methods to succeed even in these trying circumstances and provide the nurturing care that these children deserve.

Dr Satodiya is a fellow in the Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine. Dr Bodla is a medical intern at MS Ramaiah Medical College, Bangalore, India. The authors report no conflicts of interest concerning the subject matter of this article.

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References

1. Robertson CE, Baron-Cohen S. Sensory perception in autism. Nat Rev Neurosci. 2017;18(11):671-684.

2. Myers SM, Johnson CP; American Academy of Pediatrics Council on Children With Disabilities. Management of children with autism spectrum disorders. Pediatrics. 2007;120(5):1162-82.

3. Yahya AS, Khawaja S. Supporting patients with autism during COVID-19. Prim Care Companion CNS Disord. 2020;22(4):20com02668.

4. Mattard-Labrecque C, Ben Amor L, Couture MM. Children with autism and attention difficulties: a pilot study of the association between sensory, motor, and adaptive behaviors. J Can Acad Child Adolesc Psychiatry. 2013;22(2):139-146.

5. Narzisi A. Handle the autism spectrum condition during coronavirus (COVID-19) stay at home period: ten tips for helping parents and caregivers of young children. Brain Sci. 2020;10(4):207.