COVID-19 Pandemic Impacts on Behavioral and Emotional Health of Young Children With Autism

Objective

To test initial hypotheses that the coronavirus disease 2019 (COVID-19) pandemic was associated with decreases in adaptive behavior and increases in behavioral and emotional problems of children with autism; greater impacts for children who lost specialty services; and greater behavioral and emotional problems for children with autism vs control participants.

Method

Eligible participants (N = 1,158) enrolled in phase 3 of the multisite, case-control Study to Explore Early Development (SEED) before March 31, 2020, were between 2 and 5 years old, and completed follow-up assessments between January and July 2021. Caregivers completed a COVID-19 Impact Assessment Questionnaire, Vineland Adaptive Behavior Scales (VABS), and Child Behavior Checklist (CBCL) for 274 children with autism and 385 control participants.

Results

Mean VABS communication scores of children with autism decreased significantly (mean difference [SD] = −4.2 [10.5]) between prepandemic and pandemic periods, while VABS composite (+2.0 [9.0]), daily living (+5.5 [11.4]), socialization (+2.3 [10.0]), and CBCL (−3.2 [8.4]) scores improved. In contrast, CBCL scores worsened in population control participants (+3.4 [8.8]). Children with autism who missed specialty appointments scored significantly lower on VABS during the pandemic vs children who did not miss appointments (VABS Composite 70.6; 95% CI 68.8-72.4 vs 74.5; 95% CI 71.8-77.2).

Conclusion

While stay-at-home policies of the COVID-19 pandemic may have beneficially impacted daily living skills, socialization, and behavioral and emotional well-being of children with autism, benefits may have occurred at the cost of communication skills. These findings indicate the need for strategies to maintain therapeutic services in future emergency settings.

Plain language summary

In this study of 274 children with autism, measures of daily living, socialization, and behavioral and emotional wellbeing improved following the COVID-19 pandemic, whereas a measure of communication skills worsened. Findings emphasize the nuanced impact of the COVID-19 pandemic and resultant policies on the behavioral and emotional health of children with autism. Children with autism who missed specialty appointments scored worse on follow-up measures of communication skills, highlighting the importance of maintaining therapeutic services during emergency situations.

Diversity & Inclusion Statement

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.