Mask Wearing May Cause Mental Distress in People With Autism

Tanyatorn Ghanjanasak, DO

May 09, 2022

The study covered in this summary was published on as a preprint and has not yet been peer reviewed.

Key Takeaways

  • Mask wearing was significantly challenging for children with autism spectrum disorder (ASD) and resulted in difficulty in referring to the emotions of others while wearing masks

  • This study provides insight to the impact of public health policies on social communication skills of children with ASD and their ability to adapt to a new environment

Why This Matters

  • This study presents novel evidence of the impact of COVID-19 on psychological states specific to children with ASD

  • Public health policies, such as mask wearing, have the potential to negatively affect the social communication skills of children with ASD, particularly those with restricted and repetitive behaviors (RRB)

Study Design

  • This study used the CoRonavIruS Health Impact Survey (CRISIS) — Adapted for Autism and Related Neurodevelopmental conditions (AFAR) to evaluate sleep, exercise, and RRB problems in 102 participants with a clinical diagnosis of ASD

    • 75 (73.5%) participants were male

    • Mean age of participants was 11.6 years

  • One set of questions gathered information regarding behavior 3 months prior to the pandemic, and the second focused on behavior during the past 2 weeks of the study period, during the pandemic

  • The Spearmans’ rank correlation was used to analyze between the lower- and higher-order RRB symptoms and the impact of mask wearing on the CRISIS-AFAR-Japan

Key Results

  • No changes were observed in participants’ sleep behavior

  • Participants spent significantly less time outdoors during the pandemic compared to before (P = .005)

  • Mask wearing was associated with an uncomfortable sensation and difficulty in referring to others’ emotions while wearing masks for participants with lower-order RRB before the pandemic (P = .0004 and P = .0002, respectively)


  • The CRISIS-AFAR does not measure ASD severity or establish the diagnosis

  • It also doesn’t cover social communication deficits; therefore, it can’t be determined whether or not the findings are specific to RRB or ASD severity itself


  • This study was partially supported by the JSPS KAKENHI and supported by the Japan Agency for Medical Research and Development (AMED)

  • The authors declared no competing interests

  • Caregivers were asked to select the answers from options, so the sensitivity of the questionnaires to detect the change was limited

This is a summary of a preprint research study, "The impact of mask-wearing influenced by restricted interest and repetitive behavior on the mental distress of individuals with autism spectrum disorder during the COVID-19 pandemic: a multisite survey," written by Hiroki Tamon from the National Center for Child Health and Development in Tokyo, Japan, and colleagues on provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on

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