The COVID-19 pandemic has created significant challenges and obstacles for many individuals and families, including those with autism spectrum disorder (ASD) and related developmental disabilities (Eshraghi et al., 2020; Eshraghi et al., 2022). Children with ASD often depend on a combination of services ranging from applied behavior analysis (ABA) therapy, speech therapy, and occupational therapy (OT) to school-based special education services. Given the established benefits of both early and intensive intervention for these individuals in order to ensure more positive outcomes and increase independence throughout adulthood (Fuller & Kaiser, 2020; Koegel et al., 2014), the availability of and access to these services for children with ASD is vital. With the elevated stress levels and disruptions to routine that the COVID-19 pandemic resulted in (White et al., 2021), it was perhaps even more important in this context to provide continuous access to evidence-based services and supports to bolster ongoing developmental gains. Disruptions in such access to care certainly would be expected to negatively impact social, academic, and overall life outcomes. Unfortunately, but somewhat expectedly, disruptions in schooling and therapy were widespread for many children with ASD.
Despite disruptions in physical attendance at school during the height of the pandemic, the education of students continued in various formats. Remote learning through virtual formats, for example, was widely deployed across school districts in the United States. These efforts, while admirable and necessary, have not been widely studied among learners with autism or other unique learning needs, thus the impact, both short- and long-term, remain largely unknown. A common concern within school districts across the country was the ability to safely provide all students with disabilities “the free appropriate public education (FAPE) to which they are legally entitled under the Individuals with Disabilities Education Act” (IDEA, 2004; Lund & Gabrielli, 2021). This, of course, involves access to the special education services these students have become accustomed to. While many students with autism and related disabilities in our state of Florida, in addition to many other states, are generally permitted to have their ABA therapists in school with them, many of these therapists were no longer permitted in the classroom due to school and district COVID-19 regulations, which further impacted the education of these students. Special educators are thus forced to face the issue of maintaining the health and well-being of their students and the general public, while simultaneously ensuring the availability of these specialized services for those who are unable to connect and engage in them remotely (Lund & Gabrielli, 2021). For those with access, remote learning is beneficial for both safety and continuity, as it provokes the least risk for immunocompromised students as well as being less likely to be interrupted compared to in-person education (Ullman, Shade & Ware, 2020). This is especially important as individuals with ASD frequently experience co-existing conditions that make them more medically vulnerable. Due to the low likelihood of cancellation or disruption, remote learning services can prove beneficial for children who do not react well to changes in routine (Ullman Shade & Ware, 2020).
On the other hand, however, school-based ABA therapy is frequently covered, at least partially, by families’ private insurance. Although some insurances covered remote assessments and treatments for some time, insurances do not always cover online services despite recent increases in this type of service delivery during COVID-19 (Bellomo et al., 2020; Digitale, 2022). This can make the switch to online therapy an added financial burden, on top of the challenge of requiring student adjustment to the change in service modality. This can become especially challenging for individuals who are required to switch between in-person and online services, either due to COVID-19 infection or changes in regulations. Even for those insurances that do cover online therapy, obtaining approval may cause a delay in services. Remote services for children with ASD also often require parent or caregiver assistance in order to ensure proper effectiveness. While this can be difficult for parents/caregivers to manage in their already busy schedules, it also resulted in the improvement of teacher-caregiver relationships which can benefit the child’s education. Studies have shown that communication between caregivers and schools tends to decrease as the students age, so this increased parent involvement and collaboration can help contribute to the child’s continued progression (Hurwitz et al., 2021).
Caregivers globally have discussed receiving benefit from increased tele-education services, written educational materials or tips, and “tool kits with visual schedules, activities, and videos” (Jeste et al., 2020). Due to the reported advantages many have had from tele-education services, it is possible that digital services may continue after the pandemic (Holtz, 2021; Tenforde et al., 2020; Genova et al., 2021). However, as noted, we do not have adequate validation of these instructional practices in terms of skill acquisition of students with a range of special learning needs. It is likely that, while some students may have thrived remotely, others may have regressed as a result of reduced opportunities for social interaction, as well as a decrease in the dosage and intensity of direct instruction which is required to maintain existing skills or acquire new skills. This generation of students will likely be studied carefully over the next decades to gain a better understanding of the actual long-term impact of the pandemic and resulting changes in educational practices on school and life outcomes for students with autism spectrum disorder and other special educational needs.
Dr Michael Alessandri is the Executive Director of the Center for Autism and Related Disabilities (CARD). He is also a Clinical Professor in the Departments of Psychology and Pediatrics at the University of Miami, Florida. Dr. Alessandri also serves as the Department of Psychology’s Assistant Chairman for Community Outreach and Engagement. Dr Adrien Eshraghi is a Professor in the Departments of Otolaryngology, Neurological Surgery, Biomedical Engineering and Pediatrics at the University of Miami, Miller School of Medicine, Florida. Please free to contact Dr Eshraghi at aeshraghi@med.miami.edu.
References
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