LAUSR

The emergence of the COVID-19 pandemic has been acutely detrimental to individuals’ mental well-being and has led to longterm psychological distress for adults and children from all walks of life. The implementation of stay-at-home orders and the transition to working from home, along with social distancing guidelines and other pandemic regulations, have presented a new set of circumstances and challenges. This transition has been particularly difficult for individuals with autism spectrum disorder (ASD) and their families, as those with ASD tend to fixate on routines and predictability, oftentimes displaying resistance to change. There is much anecdotal evidence that COVID-19 has altered many aspects in the life of a parent/caregiver of a child with ASD, yet documentation resulting from well-designed studies is minimal. When compared to those of typically developing children, caregivers of children with ASD have overall higher levels of stress and anxiety. Common stressors for these parents include the dependency of their child, lack of effective support systems, concerns about societal acceptance, understanding the needs of their child, bolstering their child’s development, and managing ASD-related problem behaviors [1, 2]. These parents are also more prone to isolation and reduced socialization as a result of their child’s disruptive behaviors. The disruption of therapy services and the transition from in-person to virtual services during the pandemic has posed additional hurdles for the ASD community. This interruption of in-person services not only can lead to increased ASD symptoms in children but can also negatively impact the mental well-being of their parents. For these families, in-person therapies mean more than just direct care to improve the condition of their loved ones; they are also a much-needed respite for parents/caregivers from full-time care, as the constant need to monitor aspects of their child’s daily care can become increasingly overwhelming and stressful. There is emerging evidence supporting the “spillover hypothesis” [3], which suggests that high levels of stress and anxiety in parents, especially during the pandemic, can “spill over” to their children with ASD, leading to worsened autism symptoms, increased behavioral challenges, and decreased mental well-being of these children. The increase in parental stress levels may alter parenting behaviors which, in turn, can have an effect on their child’s ASD symptoms and behavior problems [1, 2]. As parents of children with ASD have demonstrated higher stress levels, these children may have heightened levels of sensitivity toward negative parenting responses that come from parenting stress, thus exhibiting more exacerbated behavior problems [1]. These elevated stress levels in the parents of children with ASD have only intensified further with the onset of the pandemic, due to the resulting circumstances such as working from home, isolation from family and friends, disruption of natural social supports, loss/ change of employment, and concerns about familial health. In addition, parents/caregivers of school-aged children with ASD are experiencing higher levels of stress than those of other age groups [4]. It is suggested that these differences may be related to the co-morbidities these children tend to face, such as ADHD and anxiety, which can be exacerbated by increased stress [4]. Due to the adverse effects, these parental stress levels can have on children with ASD, it is imperative to provide mental health supports to these families at this time of the pandemic in order to preserve the overall well-being of the entire family. Parental stress also places strain on parent–child relationships, often leading to uncharacteristic reactions from parents and increased occurrences of parent–child conflicts. Although it is unequivocal that autism is a neurobiological disorder, there are environmental and other family system factors that can impact outcomes. For example, poor mental health in parents can interfere with responsive parenting and instead lead to displays of withdrawn and unavailable interactions with their child, affecting the child–parent relationship [3]. As children tend to adopt their parents’ coping strategies, negative symptomatology in a parent can adversely affect their children’s coping mechanisms. The evidence has indicated that neurotypical children with caregivers who are considered to be highly distressed have worse outcomes following the disaster, attributed to the fact that children use modeling coping responses as their primary source of coping techniques [3]. Since some individuals with ASD are prone to mimicking or imitating the behaviors of others and they are