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Working through the Challenges of Wearing a Mask

As wearing a mask becomes our new normal, supporting an individual with autism to wear one for any amount of time might feel like a mountain to climb. In this blog, I will discuss potential reasons it can be particularly challenging for individuals with autism to wear masks, some alterations/adaptations to try, and suggestions for where to start in supporting your loved one.

Patience and practice are key to teaching and learning any challenging new life skill. It’s also important to keep in mind that some individuals with autism may not be able to tolerate wearing a mask, despite your resourcefulness and attempts to accommodate sensory and cognitive needs. Be kind to yourself and your loved one as you take on this challenge together.


What might impact an individual with autism’s ability to wear a mask

Anxiety: Wearing a mask can make it feel like your airflow is being restricted, and for some individuals with autism, this could cause feelings of increased anxiety. The body’s fight or flight system may be responding to a perceived threat (suffocation), even though there is no actual risk of a mask preventing breathing.

Sensory challenges: The new feelings of elastic over your ears, material across your face, or the heat caused by the mask can be uncomfortable and overstimulating. Individuals with autism might also be extra sensitive to smell inside the mask; clean the mask regularly or use a preferred scent.

Visibility: If you wear glasses, you understand how tricky it is when masks cause them to fog up. (Try tucking tissue between the mask and the bridge of your nose, it may help to position glasses on top of the outer edge of the mask, or clean glasses with shaving cream, soap, or toothpaste to prevent regular fogging.) Wearing a mask can also reduce peripheral vision and be distracting when looking down, particularly for people with autism, who often have difficulty blocking out extraneous sensory information.


Adaptations/alterations to try

  • Different shapes of masks: Cloth masks sit close to your face, and masks used for construction/yard work tend to be more rounded and sit away from your face a little more. Some have elastic that goes behind your ears and some tie behind your head.
  • An “ear saver” to clip mask loops behind the head instead of looping around the ears. Watch out for skin irritation or breakdown, particularly behind the ears, and adjust as necessary.
  • Position mask loops around the earpieces of headphones rather than over ears.
  • Tie the mask more tightly or more loosely.
  • A bandana that covers your nose and mouth but allows for more airflow from below
  • A buff/circular scarf or headband pulled up over your nose and mouth
  • A themed mask with favorite characters or Superheroes! Have your loved one choose their preferred mask design.
  • Brush teeth (or consider gum or mints) immediately before putting on mask to prevent odors inside the mask

**If your loved one has a chronic lung condition, consult with your health-care provider as to the most appropriate type of mask for them.


Before you start

Explain to your loved one why we must wear masks. Use concrete language that is clear and unthreatening. For example, “People are getting sick. Masks will stop us from getting sick,” or “To go to Target, you have to wear a mask.”

Use our social narratives to help explain, in concrete language with pictures, why we need to wear masks.

For some, it can be helpful to develop a visual support that can eventually be carried out in the community.  This visual might convey the basic expectations or sequence of events.  For example, the visual might show in written words and/or pictures “Mask on in store, then mask off in car.”


Start small

Prior to asking an individual with autism to wear a mask, practice with them:

  • Holding the mask
  • Bringing it toward their face
  • Touching the mask to their face
  • Fitting the elastic over one ear
  • Then over the other ear

When your loved one is ready to practice keeping the mask on, use a concrete statement to explain what is going to happen, such as “First mask, then iPad.” Start with small, attainable goals. For example, practice keeping the mask on for 5 seconds, then 10 seconds, and slowly increase up to a reasonable amount of time for your loved one.

Use a visual timer, such as a timer on your phone, to show the individual how long you would like for them to practice keeping the mask on, so they can see how much time is left and watch it go down. As soon as the timer goes off, celebrate and give them the promised reward, e.g. the iPad as noted above.

Practice frequently throughout the day for short periods of time. Practice with your loved one with your mask on too, and get siblings involved as well. It helps to do things together!

It might help to practice wearing a mask during a favorite activity, such as swinging or using an iPad. This could help your loved one to get used to it while they are distracted by their favorite activity.


When the time comes to leave the house

Plan your first outing to one of your loved one’s favorite places and try to keep it short – maybe just 5 minutes to start. Continue using concrete language and simple rewards (e.g. “First mask in Target, then Snickers!”). Consider whether a timer can be used to show how long they will need to keep their mask on. Make sure to have that Snickers ready to hand over as soon as the goal is met.

Success is important and feels good to all of us! Celebrate all the successes, no matter how small. If things don’t go as planned, praise your loved one for what they managed to do, and try again tomorrow!


Lesley Fraser-Ball, MSW, BCBA, is a member of ASNC’s Clinical Department in the Triangle region and can be reached at lfraser@autismsociety-nc.org.

 ASNC’s Clinical Department staff is composed of PhD and master’s-level licensed psychologists, Board Certified Behavior Analysts, and former special education teachers. We provide individualized intensive consultation using evidence-based practices to support children and adults across the spectrum in home, school, employment, residential and other community-based contexts. We also deliver workshops to professionals on a wide range of topics including but not limited to, strategies to prevent and respond to challenging behaviors, best practices in early intervention, functional communication training, and evidence-based practices in instruction for K-12 students with autism.

To find out more, contact us at 919-390-7242 or clinical@autismsociety-nc.org.


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