key: cord-318809-v3505tq3
authors: Goh, Tze Jui; Lim, Tammy; Foo, Magdalene; Ong, Sze Kiat Alan; Aishworiya, Ramkumar; Tanuja, Nair; Kang, Ying Qi; Agarwal, Pratibha Keshav; Sung, Min
title: Supporting Individuals with Autism Spectrum Disorder in Medical Settings during COVID-19
date: 2020-10-09
journal: Asian J Psychiatr
DOI: 10.1016/j.ajp.2020.102441
sha: 
doc_id: 318809
cord_uid: v3505tq3

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Tze Jui, Goh a* , DPsych, Tammy The novel Coronavirus, COVID-19, became a pandemic situation globally in a short span of time.

While we are becoming attuned to the effects of the pandemic on mental health and wellbeing of the general population (Ghebreyesus, 2020) , the impact on vulnerable populations such as special needs individuals, as well as their caregivers is currently unknown. It is imperative that the needs of the vulnerable groups not be neglected (Tandon, 2020) . As mask-wearing and staying at home directives become the new norm, drastic changes in routines exacerbated by the fluidity of the situation make it challenging for individuals with special needs, particularly those with Autism Spectrum Disorder (ASD) and Intellectual Disability (ID), to cope (Den Houting, 2020). They not only have had to adjust to the loss of their regular routines, but also have had to adapt to changes in societal rules, and reduction of access to the outdoors. In addition, some individuals may be unable to maintain personal hygiene or adhere to safe-distancing measures and mask-wearing, especially for those with sensory stimulatory needs or aversions (Hazen et al., 2014) . They are also vulnerable to anxiety, which can be further exacerbated when they are processes in a step-by-step format. These include testing procedures such as nasopharyngeal swabs, blood tests and X-rays; and scenarios to expect, such as encountering healthcare workers in Personal Protective Equipment (PPE). Instructions to alleviate and manage anxiety, such as breathing and relaxation exercises, are also included. An animated video clip of the whole process was also produced to enhance engagement and improve clarity (Figure 1 ). Figure 1 In addition, explanatory information for the medical team regarding the use of the resources and simple strategies to support the care of the person with special needs are also provided.

Personalisable/ replicable templates in the form of information sheets about the individual with special needs further allow for customization to the unique profiles of each individual. An example of a visual schedule is shown in Figure 2 .

The physical copies of the resources and materials were disseminated and implemented at frontline settings, from the General Practitioner (GP) clinics, ambulances, and emergency services to treatment facilities. Soft copies are also made available via online platforms 2 .

The materials were made to be adaptable and applicable for situations beyond the current COVID-19 pandemic, and generalisable for use with different populations such as individuals with communication barriers (i.e. children with language delays or individuals who may not be fluent in or comprehend the English language).With the Special Care Kit, frontline healthcare services will be better prepared and have some basic resources to support individuals with special needs who require medical services, whether during infectious disease outbreaks in the future, or in other medical scenarios. The materials are easily accessible and free for use on the online platforms. We hope these materials can also benefit the international community, especially populations with limited resources, and also improve access and preparedness of frontline healthcare services to support special needs individuals. Continual dialogue about the experience of the pandemic situation from the perspectives of the special needs community, especially about areas requiring support, and understanding of existing resilience will be important, so that we can be better prepared and respond in the future. 

Dr. Sung and Dr. Goh conceptualized and drafted the initial manuscript. Dr. Lim, Ms Foo, Dr. Ong, Dr.Ramkumar, Ms Nair, Dr. Kang and Dr. Agarwal reviewed and edited different components of the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Funding Source: This work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

The authors have no financial relationships relevant to this article or conflicts of interest to disclose

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We would like to express our gratitude to all contributors of the Special Care Kit. Additional thanks goes to Ms. Sharrie Lu Yuyi, Mr. Nicholas Goh Kun Lie, Ms. Soh Chui Pin and Ms. Jane Teo Sze-Hui for assisting in the compilation, editing and distribution of the Special Care Kit. We would also like to thank our colleagues from the corporate communication departments of the IMH, NUH, KKH as well as our colleagues at MOH, for their immense support of the project. 
