Due to the current health pandemic that has been created by Covid-19, the Center for Disease control recommends “that you wear masks in public settings around people who don’t live in your household and when you can’t stay 6 feet away from others. Masks help stop the spread of COVID-19 to others.” This guideline can be challenging for all children, especially those on the autism spectrum and those with sensory sensitivities. The skill of learning how to wear a mask is especially important for children as it’s a necessary precaution for them to return to school. In person learning helps generalization of skills. It promotes children learning in their natural environment and it supports social opportunities outside of the home.
Although challenging, these rules do not discriminate due sensitivities or diagnoses, so compliance is required in order to participate with others at stores, restaurants, parks, social gatherings and travel. This fact has been highlighted recently in the news by airlines prohibiting children with autism from traveling if they are not wearing a mask. Attempting to force children, especially those on the spectrum, to wear a mask is likely to cause a drastic increase in anxiety and challenging behavior. This method also has the potential to create an aversion to masks, making it less likely that they will be able to learn to wear a mask in the future.
Teaching your child to wear a mask when outside the home, may seem like an impossible task, but there are strategies that can be used to desensitize sensitivities and encourage mask wearing. Before implementing these approaches, understand that this is a process and may take some time, so be patient with your child and make sure that if your child begins to reject the mask, you may need to take a step back.
A few ideas to get you set up for success:
- Choose a mask that your child is likely to be drawn to. Whether the mask is the child’s favorite color, has a character that your child likes, or you decorate a mask together, allowing them to choose what mask is theirs will help them want to engage with it. Due to the necessity of masks in recent months, they can be found in many stores and online vendors, and can fit around the ears, back of the head or around the neck and be pulled up (gator masks). You may need to try a few different types before you find the perfect fit for your child. Cloth masks will need to be washed and disposable masks will need to be replaced frequently, so it may be necessary to buy multiple masks when being worn regularly.
- Set up a reward system to reinforce your child for participating. Depending on what is more appropriate for you child, you may need small rewards that can be delivered frequently after each step like treats or stickers, or tokens that can be earned to get a big reward at the end like when using a reward chart or token board.
- Create opportunities for the child to put a mask on you and/or a special toy. As you go through this process, allow your child to see you and/or their favorite stuffed animal wearing a mask as well and let them practice putting the mask on you and the toy. You can use phrases like “Teddy needs to wear a mask too, let’s put one on him.”
After you have selected your child’s mask(s), have appropriate reinforcers and have a toy to practice with, you are ready to start the process. Depending on your child’s level of aversion towards wearing a mask, you may be able to skip some of these steps or move to the next step quickly. Alternately, some may need to be worked on for longer, so feel free to try to move forward, but if the child struggles with the next step, then it may be necessary to go back to the previous step for a longer period of time.
- Begin by having the mask in the environment where the child is, so that they get accustomed to having it near them. Move the mask closer to them and begin to talk about it, show them how you put it on yourself and/or on their toy.
- Have your child touch the mask with their hands, then touch it to their face, and eventually put the mask on. This step could be done at one time, or over hours or days, as you may need to give your child time in between each trial. You may be able to skip some of these or need to add in more “feeling” the mask opportunities. Remember that if at any point during this step the child has an aversive reaction, that next opportunity you will go back to the previous step. After each part of this step, immediately remove the mask and provide a reward, as this is not to get them to actually wear it, but to experiment with how it feels.
- Once the child can tolerate putting on the mask and having it immediately removed, you will begin to extend the time that they wear it. This can be done by counting seconds together, setting a timer, wearing the mask into another room or area, doing a preferred activity during this time, or allowing the child to play with a preferred item while wearing their mask. You will do this step multiple times a day, until you child can tolerate wearing the mask for whatever specified amount of time that you choose. Be sure to reinforce after each trial.
- After your child is wearing the mask for the time of your choosing with no aversion, then it is time to begin to experiment with wearing it outside the home. Initially, choose a familiar place, that the child enjoys going to and that is easy to get in and out of in a short amount of time. Some suggestions for this would be going into a frozen yogurt store, convenient store, grocery store or walking into a restaurant to get a pickup order. After the child gets accustomed to these short trips and is able to wear the mask with no problems, then begin to extend the time of the trips out of the house.
Once your child is consistently wearing a mask in the community, they should remain comfortable with it. If your child infrequently goes out in public wearing a mask, you may need to practice at home to retain the skill. It is hard to know how long masks will remain a fixture in our lives, but helping your child learn to wear one, will help to protect them and others and allow them to participate in everyday life.