4.1. Administration of Childhood Autism Spectrum Test and CBCL Questionnaire in Both Children with ASD and Typically Developing Children
The results of the initial administration of CAST for both groups were as follows: Children with ASD: mean/20.29/; SD/3.39/; median/20.00/. TD (typically developing) children: mean/5.43/; SD/1.94/; Median/5.00/, with statistically significant difference between the groups—Kruskal-Wallis test: p < 0.001.
The application of this questionnaire showed that all children in the ASD group have marked symptoms compared to the group of typical children.
The results of the initial administration of the CBCL questionnaire for both ASD and TD groups of children were as follows:
Internalizing Problems:
ASD children: mean/21.24/; SD/8.36/; TD children: mean/8.81/; SD/5.20/; Kruskal-Wallis test: p < 0.001.
Externalizing Problems:
ASD children: mean/20.24/; SD/9.39/; TD children: mean/10.00/; SD/4.44/; Kruskal-Wallis test: p < 0.001.
Total Problems:
ASD children: mean/61.62/; SD/25.14/; TD children: mean/26.48/; SD/13.16/; Kruskal-Wallis test: p < 0.001.
For all Empirically based scales in the subgroup of Internalizing problems—emotionally reactive, anxious/depressed, withdrawn, except somatic complaints, ASD children showed significantly higher scores compared to the TD children.
The differences for the scale sleep problems were not significant, although children with ASD displayed higher results than TD children.
For both attention problems and aggressive behavior in the subgroup of externalizing problems in the empirically based scales, ASD children displayed significantly higher results than TD children with a greater difference for the attention problems. The same was valid for the other problems scale.
In the subgroup of DSM-oriented scales: Depressive Problems, Anxiety Problems, Autism Spectrum Problems, Attention Deficit/Hyperactivity Problems, Oppositional Defiant Problems the ASD children showed significantly higher scores than TD children.
4.2. Comparison of the Results of Children with ASD of the CBCL Questionnaire before and after the First COVID-19 Lockdown
Results from scales belonging to the internalizing problems questionnaire subgroup—
Table 1.
For all scales in this questionnaire subgroup, the values of internalizing emotional and behavioral problems after the first lockdown period were lower than those before the lockdown, with no statistically significant difference observed. Similar results had with the sleep problems scale—3.95 means before the lockdown and 3.81 means after the lockdown with no statistically significant difference.
The results from the externalizing problems scales are included in
Table 2 and the results from the other problems scale are included in
Table 3. We observed significantly lower results in the attention problems scale in the second application of the questionnaire.
Results from DSM-oriented scales—depressive problems, anxiety problems, autism spectrum problems, attention deficit/hyperactivity problems, and oppositional defiant problems—
Table 4.
The results of all the scales in the second application of the test were lower than those before the lockdown, but only the results of the attention deficit/hyperactivity problems scale were statistically significantly lower.
Results from internalizing, externalizing and total problems—
Table 5, where we did not find statistically significant differences.
The internalizing problems questionnaire subgroup consists of inward-directed behaviors. They are often underestimated and hardly noticed by teachers, compared to the externalizing ones, which usually create more problems, especially when interacting in a group [
41,
42]. Internalized behaviors are more often observed by parents and nonetheless underestimated as well [
43]. A question of particular interest for the researchers regarding the ASD group was related to the internalizing problems, and in particular the relationship between them and the online education, as well as the forced stay at home, especially in the withdrawn scale, which comes closest to ASD symptomatic. According to the parents in the ASD group, internalizing behavioral problems, such as emotional reactivity, depression, somatic complaints and withdrawal, did not increase during the lockdown period. When drawing conclusions, we have to take into consideration parents’ own anxiety levels in these conditions, such as threat of illness for example [
10]. Another consideration relates to that parents were deprived of the much-needed therapies and activities, related to their state in that period [
44,
45].
In the externalizing problems questionnaire subgroup, which do the adults usually more easily note, children with ASD did not display increase, contrary to our expectations. We presumed that the monotony and lack of exciting activities and therapy will lead to lack of concentration and energy excess. In our study, we observed quite the opposite—the rate of the behaviors, related to attention and hyperactivity decreased, without it resulting in a significant decrease in the externalizing behaviors scale. This effect was also present in the group of the empirically based attention problems scales, as well as the DSM scale attention deficit/hyperactivity problems. Practically, it means that parents reported improved behavior, lowered physical activity and more opportunities for keeping the children engaged in activities [
46]. Perhaps, the strict and undisturbed routine, the interaction with parents, the time and patience that parents devoted to the children, as well as the lack of social pressure in a group, lack of stress meeting new people, despite the new and unknown conditions, played a positive role on both emotional and behavioral aspects of the children with ASD. Finally, yet importantly, the satisfaction and parents’ attention had their influence on the motivation, improved concentration, and engagement in home-based activities.
4.3. Results of a Parent Survey for the Consequences of the First COVID-19 Lockdown in June 2020
For the purpose of the present work, only some of the results are presented here. The included questions addressed emotional and behavioral problems. Questions related to educational issues, everyday life, and self-care were not included.
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Question 1: “Do you observe a decline in the social skills of the child as a result of the isolation during the COVID-19 lockdown, ability to communicate with adults and peers, or be part of a group and communicate successfully with other children?”
Parents of ASD children: Seven (7) parents answered “Definitely Yes” and seven (7) parents answered, “To a certain extent”. The other parents think that there was no decline or they are not sure.
Parents of TD children: According to one (1) parent, the child displays lower level of social skills during the pandemic, and other eight (8) parents answered “To a certain extent”. The rest of the parents did not report change—
Figure 1.
Social skills are a key characteristic of children with ASD. We expected a decline in these skills as a consequence of the isolation period, but parents only observed such a decline to a certain degree. Only a third of the parents confirmed a decline in social skills.
We expected the answers to the open questions to point towards social skills deterioration for both groups of children due to the lack of social communication in a lockdown period, especially the one with peers [
47,
48]. According to the participants in the study, the social skills of their children with typical development were not severely affected. Parents of children with ASD reported certain impact, but still not as significant as we expected. Perhaps, in children with ASD, this reporting referred to the loss of already acquired behaviors, a result of the intensive therapeutic interventions, work in groups and meetings with various people every day, beforehand.
In addition, there are several factors that might have affected the answers of the parents from the ASD group. Children with ASD already displayed significant difficulties in the acquisition and use of social skills, and therefore a change was more difficult to note. In addition, an acquired skill or behavior in therapeutic settings, if not generalized, would not be demonstrated by the child in a real-life situation. Last but not least, we have to bear in mind that parents’ opportunities for observation of their children’s interactions with peers after the lockdown were limited.
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Question 2: “Do you think that the language skills of the child declined as a result of the isolation during the COVID-19 lockdown—the ability to use words, apply grammatical rules, etc.?”
About half of the parents of children with ASD/n = 12/did not consider that their children’s language skills worsened as a result of the lockdown and one (1) of them is not sure. The rest of the parents are equally divided between the answers “Yes” and “To a certain extent”.
Most parents of typically developing children/n = 16/report that the language abilities of their children did not deteriorate during the pandemics. Three parents/3/noted some deterioration and two/2/parents stated they are not sure they did—
Figure 2.
Speech and language ability is also a key skill for the children with ASD. They are of utmost importance for the development of communication and social skills, increasing the opportunities for the children to express themselves and understand the others leads to less behavioral problems and easier adaptation. Communication with peers plays a major role in this context. We expected the children with ASD to display deteriorated language skills during the lockdown period, which, according to the answers of the parents, did not prove right. A possible reason for this could be that they were given the opportunity to stay at home together and interact in new ways for the first time. We believe that parents experienced a shift towards the new role of a co-therapist, because in this situation they had to—under the guidance and directions, given by the therapist—revert to and invent new ways of work with the child in home settings, e.g., embed therapeutic activities within home routines and thus practice existing and acquire new language skills. The answers to this and other questions in the frame of this study point to the more relaxed atmosphere, the opportunity to interact with the child at home, the lack of strict schedule of therapies as possible reasons for the perceived benefits for the children with ASD and shift the focus from the lack of fully structured yet useful activities.
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Question 3: “Do you observe, as a result of the isolation during the COVID-19 period, an increase in the anxiety levels of the child?”
Ten/10/of the parents of children with ASD gave a negative answer to this question, and one was not sure. The rest were equally divided between “Yes” and “To a certain extent”. Parents of typically developing children had answered “No”—fifteen (15), “I am not sure”—two (2), and “To a certain extent”—four (4)—
Figure 3.
Anxiety plays a major role in the functioning of the children with ASD [
49,
50]. We relate anxiety to the obsessive attachment to routine and stereotypical movements in children with ASD and consider its reduction to be an important aspect of the therapy. As expected, according to the results, anxiety in children with ASD showed lower values, probably due to the less intensive daily routine, seldom change of places, therapists, hurry and commute in heavy traffic. The restriction in activities and lack of new ones largely eliminated the anxiety trigger. Parents of children with special needs would enroll them in many and diverse intense therapies, that are, in most cases, exhausting for the children. Perhaps the forced stay at home had taken away part of this pressure, and at the same time, interaction with parents had played its positive role. As a result, children with ASD did not display an increase in anxiety levels during the pandemics.
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Question 4: “Did the child become more irritable during the isolation period during the COVID-19 pandemic?”
Nine (9) parents of children with ASD have confirmed that their children have become more irritable to a certain extent, and four (4) parents definitely noted increased irritability; seven (7) parents did not find any difference and one (1) was not sure. In the group of typically developing children, four (4) parents find their children more irritable during the pandemics, six (6) parents reported increased irritability to a certain extent, nine (9) have answered negatively and two (2) were unsure—
Figure 4.
Irritability, expressed in behavioral aspect, is easier to be observed by parents. One of the most common complaints on behalf of the parents in clinical practice are the emotional crises of their children. In both groups of parents, the answer to this question was predominantly “To a certain extent” and “No”, which might be partially due to the increased time at home with the children.
In addition, for the children in the ASD group, we may attribute the result to less exposure also to external triggers for irritability and predictable routine, due to the lockdown situation. Finally, less irritability and anxiety lead to a more efficient learning process in the aspect of social communication and speech and language ability, which in turn is very satisfactory for both children and parents.
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Question 5: “Did your own anxiety levels increase during the isolation period?”
This was a very important question for the parents and it tackled their own anxiety levels. In the group of children with ASD, seven (7) parents report increased anxiety levels, seven (7) thought that it has increased to a certain extent, six (6) answered negatively and one (1) was unsure. In the group of TD children, one (1) parent reported increased levels of anxiety, fourteen (14) thought that it had increased to a certain extent, and six parents (6) did not observe any increase in their own anxiety levels—
Figure 5.
The mental well-being of the parents is a major factor in the development of their children [
51,
52]. Increased parental anxiety has a negative effect on the overall state of the children and affects the outcomes of therapeutic interventions. The long stay at home during lockdown triggers worries about the future, fear of possible health issues and unclear consequences for the children, which may have negative effect on the care of children with developmental difficulties. This research points to a general lack of support for parents concerning the online work with their children. This support needs to be carefully designed, with all possible threats of uncertainties of the future in mind.
Parents’ Answers to Open Questions
Instruction: “Please share other consequences of isolation at home during COVID-19 pandemic”.
Typically developing children
In general, parents of children with typical development shared only negative consequences of the isolation period: lack of opportunities to go out, less physical activity, overuse of electronic devices, and lack of social interaction and contact. When responding to the open-answer questions, no parent pointed to any positive effect on the child during the lockdown period.
Children with ASD
Parents of children with ASD gave both positive and negative comments. Their answers are presented in
Table 6.