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On the Spectrum: A Return to ‘Normal’ Is Not So Normal for Everyone

The pandemic had an outsized effect for those on the spectrum.

As the pandemic seems to be winding down and the self-isolation that characterized the last year and a half nears an end, at least in most parts of the United States, many of us have been talking excitedly about how eager we are to return to “normal” life.

That might mean going out to restaurants and movies, kids resuming camp this summer and in-person school in the fall, a return to offices and other workplaces. Most important, it means re-establishing relationships with friends, co-workers, and family, that were strained or suspended completely by a lack of physical proximity.

While Zoom cocktail parties and virtual meetings helped bridge the gap between socializing and isolation, the resumption of full, in-person interactions will feel like a significant shift, emotionally and mentally.

This will, of course, be welcomed by many, but there is a subset of adults and children for whom this transition is going to be extremely difficult, perhaps even more difficult than the original adjustment to pandemic restrictions in Spring 2020.

Many people with Autism Spectrum Disorders, for instance, have been uniquely impacted by the pandemic. The challenges that have come with social distancing and physical isolation seem almost precisely engineered to have an outsize effect on this population.

Autism Spectrum Disorder (ASD), while representing varying degrees of severity, generally presents as difficulty with social interactions, language, and nonverbal communication; a push towards repetitive and prescribed behaviors; the need for routine and fixation on objects, ideas, or sets of rituals.

For both adults and children with ASD, the switch from in-person to virtual learning and working required a recalibration in almost all these categories.

Zoom meetings turned interactions with colleagues from three-dimensional to two-dimensional. This may be just a mild annoyance for most people, but for those with ASD, it was a profound shift that posed challenges regarding transitions to a new style of interacting.

Switching to virtual face-to-face communications creates an entirely new vocabulary for both verbal and, especially, non-verbal cues. Those with ASD needed to develop new strategies to maintain attention and focus.

In my practice, I had many new patients, who had never before been diagnosed with ASD, come in and tell me that Zoom meetings and virtual interactions had alerted them to the possibility that they might be on the spectrum, or have ADHD because they noticed symptoms of each of these conditions in the context of Zoom or virtual meetings or classes. Many of them were right.

The absence of a daily commute, for adults and school children, altered routines and forced those with ASD to establish new structures to their days.

Virtually everyone had to make adjustments, but for those on the spectrum, the centrality of outward routine to their mental stability and emotional well-being is far greater.

For children, going to school entirely on a computer changed the nature of learning. For children with ASD, or those with hyperactivity and attention disorders, it cut off some of the vital resources they needed simply to process information, let alone maintain relationships with their peers.

Some children with ADHD needed the support of a one-to-one paraprofessional in the classroom to help them maintain attention. With in-person learning suddenly gone, replaced by Zoom classes at home, this much-needed support vanished, and these children found themselves trying to pay attention simply to a computer screen in a room filled with distractions such as toys, games, and windows.

Now that both adults and children with ASD face a return to something closer to pre-COVID “normal,” the readjustment may feel more like whiplash than a welcome home.

Social interactions can be draining for those on the spectrum. They need to develop specific strategies to navigate the world of close physical proximity, body language, and other non-verbal cues that most people take for granted.

Many workplaces and schools are adopting a hybrid model, which resembles neither the pre-pandemic world nor the extreme isolation of 2020. For those with ASD, having to once again organize their lives around a new routine will be emotionally disruptive and can cause developmental setbacks, particularly in children.

As we saw during the height of the pandemic, it will be vitally important to, first and foremost, diagnose whether someone has one of these conditions. Untreated, and without supports in place, the upheavals previously mentioned can be so overwhelming as to potentially be debilitating.

Treatment and intervention at the earliest possible stage can make a huge difference in how those with ASD and similar conditions are able to manage their lives amidst these transitions and changes.

If the last year and a half have taught us anything, it is that “normal” can be a fleeting and ephemeral state. For those with ASD, that uncertainty and instability have always been a reality. They will need more support now than ever.