But my son, who is 19, isn’t wearing a mask, and won’t. He’s not being difficult; he’s being autistic. His neurology makes him more sensitive than other people to touch and texture, and he cannot bear the feeling of having his nose and mouth covered by fabric.
This isn’t to say autistic people can’t ever wear masks. A friend and his autistic teen son are having fun with matching Spider-Man masks and gloves. Another autistic friend can cope with a face covering that meets coronavirus guidelines as long as it’s loose over her nose and mouth. She says that she “still hates it, but it’s that or starving, so” she makes it work while she goes out to get groceries and do other necessary errands.
Autistic people have varied individual experiences, preferences and needs, so although some kids can’t tolerate a mask, others are just fine with it. But before requiring them to put one on, consider the factors that may make masks intolerable or inadvisable for an autistic person:
- Anxiety: A mask doesn’t block breathing, but it does change the feeling of one’s airflow. For some autistic people, this can feel like suffocation.
- Sensory: My son can’t stand having anything covering his face. Some kids can’t bear the feeling of mask elastics pulling on their ears. One enterprising mom fixed the latter issue by sewing buttons on her son’s favorite hat and pulling the elastics around those instead.
- Visibility: If your child wears glasses, masks may fog them up. There are fixes, such as tucking a tissue between the mask and the bridge of your nose or changing your breathing pattern, but these solutions may not work for people with sensory issues or developmental disabilities.
- Smell: I nearly passed out from my own mask-confined coffee breath. Autistic people can be extra sensitive to smell, so be sure your child brushes their teeth before trying on a mask.
- Epilepsy: A significant percentage of autistic children have seizure disorders. Not being able to see an epileptic child’s face can be a safety risk if they have distinctive pre-seizure facial expressions. Masks with clear sections over the mouth, developed to aid deaf people, may be an option.
Whatever you do, though, it’s best not to force a mask on your autistic child. Although big changes, such as mandatory mask-wearing, are hard for many, they can be traumatic for autistic people. Instead of demanding they don a face covering, talk to your child calmly but frankly about why masks are important. Give them opportunities to try different masks. Be patient, be kind. Understand that your child may not be able to wear a mask, regardless of how resourceful and accommodating you try to be.
My son has tried a variety of mask styles, but he can’t find a workable option. If he could stay inside during the pandemic, this wouldn’t be a problem. Some of his autistic friends are pleased to stay home, for temperament or social anxiety reasons. Some who are medically fragile can’t risk going outdoors during a pandemic. But others, like my son, rely on intense daily physical activity, such as running or hiking, for their physical and mental well-being. He can’t do these activities indoors, and outdoor exercise is an acceptable activity under current guidelines, so forcing him to stay home wouldn’t be fair and could negatively affect his mental health.
What are our options? We are fortunate; my son’s doctor wrote him an exemption note, explaining that he cannot wear a mask because of his autistic sensory sensitivities. But that also leaves him more vulnerable to the coronavirus, or at risk of spreading the virus if he’s an asymptomatic carrier.
This means we are in overdrive with social distancing and disinfecting. When he goes on his walks, we stick to our neighborhood, avoid busy roads and go outside early in the morning or just before sunset, when fewer people are around. We use sanitizing wipes on any benches he sits on — and douse his hands with hand sanitizer immediately after he stands up. The moment we get home, we do 20 seconds of hand-washing together while singing favorite songs. These safety measures have become a routine — and he enjoys routines.
We haven’t had to bust out his mask exemption note, not yet. When I brought my son into urgent care for a non-respiratory infection recently, medical staff members believed me when I explained he was autistic, and that was why he wasn’t wearing the mask he held in his hand. (He’s a good sport; he keeps trying.) Again, we were lucky: Medical staff members typically have little to no autism training, and now that so many medical workers are overwhelmed and stressed out, the likelihood of autistic needs being accommodated may be reduced.
So we’re putting our efforts into keeping my son safe and healthy, and out of medical facilities as much as possible — because simply getting through each pandemic-era day is hard enough for us, and families like ours.