Tips to Help Children with Autism Wear Face Masks

BCBA Shares How to Build Tolerance for Face Coverings for Kids on the Spectrum

COVID-19 has led to many changes in daily life and routine. From “sheltering in place” to social distancing to wearing a face mask, it is a lot for anyone to absorb. These changes in routine can be especially challenging for children with autism spectrum disorder (ASD).

Beyond keeping their children safe and in essential therapy, one of the top coronavirus-related concerns from parents is whether their children can successfully wear face-coverings. Sensory sensitivities, fear of change, discomfort seeing others wearing masks and communication challenges are all valid reasons for children to be nervous about wearing masks. While it is often easier – and safer – just to stay home in most cases, it is not always feasible.

The Progression of One Kiddo Learning to Wear a Face-Covering

At Hopebridge, we approach mask-wearing like we do other functional living skills. With proper time and support from applied behavior analysis (ABA therapy) strategies, kids can work through this like any other goal. Additional support from occupational therapy can help children with activities like the physical task of putting on and taking off masks and de-sensitizing children with heightened sensory sensitivities around mask-wearing.

Board Certified Behavior Analyst (BCBA) Stephanie Shrock from the Hopebridge Plainfield center has experience helping children wear masks, including one kiddo who needs one to transition to school.

“When I began working on mask-wearing with Lincoln, I tested him to get a baseline of his tolerance. He was comfortable holding it and touching it to his face, but could not tolerate wearing it properly for more than 15 seconds,” said Stephanie. “To be successful, I then programmed for him to wear it for small amounts at a time. We started at 10 seconds while pairing it with positive stimuli.”

During this time, Lincoln would participate in his two favorite activities: rocking in his rocking chair and watching videos on his tablet. After the 10 seconds ended, therapists removed the mask for him. This ensured he did not remove the mask whenever he did not want to wear it anymore. He could either ask to have the mask removed by using his new speech communication devices or an adult would remove it while he was in a safe environment. Once removed, Lincoln is reinforced with other preferred items and activities, such as playing on the swing.

Lincoln has already made a lot of progress! He is currently working on tolerating the mask for one full minute every 10 minutes. Stephanie and the rest of his therapy team will continue to increase the duration until he is able to wear it for three hours. Lincoln was recently able to wear a mask during an entire wellness checkup, which is especially exciting since he is transitioning to school soon and will need to wear it for an extended period of time.

12 Tips for Teaching a Child with Autism to Wear a Face Mask

Many establishments require mask-wearing and it is likely going to be part of everyday life for a while. If you are not sure where to start with your own child – or if your kid’s first attempt at wearing a mask did not end up as well as you hoped – we are here to help you through it with guidance from Stephanie. She shared 12 tips for parents as they embark on this new task with their children.

1. Approach mask-wearing as a series of goals.
   Remember, this is a new skill for your child and may not happen in one day. Give yourself and your child time to get used to it and do not force it on them all in one sitting. Your goal for the first introduction should be to make the experience pleasant, if not entirely successful. It can also help to engage your child’s therapy team to work together toward this larger goal.
   
2. Explain why masks are important.
   COVID-19 is not the easiest topic to discuss with children, but talking to them about why we must do certain things can ease their anxieties around the new tasks. How parents should approach this conversation is dependent upon the child’s developmental age and understanding. If your child may not be able to grasp the details, it is ok to skip this step. In simple terms, explain that many people are sick right now, but wearing a mask can protect them from germs and keep each other safe. There are some great resources available to help with this discussion, such as the downloadable “Task of the Mask” story and activity pamphlet from Conscious Discipline, and a range of mask-related social stories from Autism Little Learners.
   
3. Normalize wearing a mask by modeling it.
   The more children see someone wearing a mask, the more comfortable they will become with it. Parents and siblings should show off their masks in front of the child. It may also help to ask family and friends to send photos wearing face-coverings. Make it fun by creating masks for stuffed animals and dolls, integrating masks within a game of dress-up, or designing masks within a coloring book, which is also from Autism Little Learners.
   
4. Give your child choices.
   Increasing independence is one of the main goals behind ABA therapy. Teaching a child to wear a mask is no exception. In an effort to decrease their stress around wearing a mask, give them some control, and make it fun (of course!), let your child choose the print or fabric for the mask. By now, there are thousands of options with everything from do-it-yourself patterns on Pinterest to character options from the Disney Store. Multilayered fabric masks are considered the most effective, but neck gaiters, bandanas and disposable paper masks – which kids can decorate – are also good options.
   
5. Consider the challenges.
   There is not one type of face-covering that is best for every child, so consider your child’s preferences and challenges when asking them to wear a mask. For instance, a child who dislikes the feeling of headphones may also dislike having loops around their ears. Instead, consider a mask that ties at the back of the head or a neck gaiter or scarf that can be pulled up and down from their neck. Other accessories like glasses can add another layer to work around.
   
6. Make masks available.
   Don’t leave the masks locked away until they are ready to use. Keep them out in a visible place for your child to see and pick up, if desired. Give them the option to try one on at any time to make them more comfortable with the idea.
   
7. Build tolerance for face-coverings at home.
   This is a process that parents should personalize to their child’s comfort and needs. Some kids may be willing to try one on right away, whereas others will need more time to get used to it. Break it down into smaller goals. If you feel your child needs to ease into it, start by asking them to simply hold the mask. Once you bridged the first step, have them touch their face with the mask without putting it on to see how it feels against their skin. After practicing this step a few times, try hanging it around one ear. Eventually you can work with them to place it over both ears, including covering their mouth and nose. They can take it off right away if they wish, but work to slowly increase the amount of wear time with a visual timer. Parents should understand this process may take days or even weeks. The key is to take it step by step and continue to practice at home to increase tolerance.
   
8. Use reinforcers.
   Various forms of reinforcement are beneficial during practice and real-life use. Your child’s therapy provider can help you implement them in an effective manner. A BCBA can offer training on how to establish motivation and use contingency-based interventions, as well as provide a list of potential reinforcers that can create a change in behavior. Examples include allowing your child to watch TV or use a video or game device while wearing the mask, which can help provide some distraction to increase the duration of wear. You can also offer rewards like special treats or preferred activities if your child wears the face-covering for a certain amount of time. Wearing a mask the correct way is not necessarily easy, even for adults, so it is ok to use reinforcers like you would with other goals.
   
9. Make cue cards.
   Some children benefit from visual cues. Take a photo of your child wearing a mask that can serve as a cue card to let them know when it is time to wear it. If they use a communication device, you can add the photo as an option there.
   
10. Plan a short and easy trip out of the house.
    Going to a busy, over-stimulating restaurant or store is not the best way to test out a mask for children with autism. Try something quiet and less stressful for your first attempt, such as a walk around a calm farmer’s market or a socially distanced visit with grandparents.
    
11. Make expectations clear before you venture out.
    If appropriate for your child, tell them what to expect before you leave the house. Mention where you are going, how long you plan to be gone and which moments your child needs to wear the face-covering. This is a good time to re-inform them of the effective ways to wear a mask, such as washing hands first and refraining from touching their face once it is in place.
    
12. Practice wearing masks frequently.
    It is important to continue the practice, especially if you do not plan for your child to go out in public often. The more familiar your child becomes with wearing a mask, the easier it will be for them to wear it correctly while out and about. Aim to try it out every day.

For more information on how to deal with the challenges surrounding COVID-19 and more, please turn to our list of resources for autism families.

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