The Experiences of Autistic People When Facemask Wearing and Interacting with Masked Individuals

Abstract

Background:

The World Health Organization recommended that individuals use a facemask to prevent the ongoing spread of COVID-19. Many governments implemented this recommendation into law. However, the increased usage of facemasks may have had particular impacts on the autistic population, due to differences in emotion processing, sensory issues, and anxiety about regularly changing rules. This research aimed to investigate the lived experiences of autistic people when wearing facemasks and their experiences interacting with others wearing facemasks.

Methods:

First, the research team conducted a content analysis of social media posts (n = 124) created by autistic individuals. Based on this, we developed a novel questionnaire and distributed it so that autistic adults could share their facemask experiences (n = 49).

Results:

Seven main themes were identified from the social media analyses: general attitudes toward masks, sensory issues, “wear-a-mask” message, rules and expectations, sunflower lanyards, social problems and benefits, and mask exemption. Secondary questionnaire responses highlighted that the experience of facemasks was mixed. Many individuals experienced sensory issues. Yet, for some individuals, there were benefits: they did not have to monitor their facial expressions to camouflage their autistic responses. Participants reported differing opinions on the topic of mask exemption, and the sunflower lanyard as a symbol of mask exemption. Data did not suggest anxiety around rule changes but did suggest feelings of anger at others who were perceived not to be following the rules.

Conclusions:

These findings highlight the mixed experiences of autistic people with facemasks and suggest lessons for future events in which there are rapid changes to public health messaging.

Community brief

Why is this an important issue?

During the COVID-19 pandemic, people across the world were suddenly asked to wear facemasks to stop the spread of infection. Rules around mask wearing then changed frequently, as scientists and governments learning more about the virus and how it spread. For autistic people, who have sensory sensitivities and can find unpredictable changes difficult and distressing, this may have made wearing a facemask more difficult than it was for non-autistic people.

What was the purpose of this study, and what did the researchers do?

This study set out to try to understand autistic people's experiences of wearing facemasks and interacting with other people who were wearing facemasks. To do this, the researchers took a two-stage approach. First, they looked at what autistic people were saying about facemask wearing online (in social media posts), and used this to develop a specific questionnaire. That questionnaire was then filled out by 49 autistic adults (age 18–63 years) online.

What were the results of the study?

The stage 1 social media posts revealed seven themes: general attitudes toward masks, sensory issues, “wear-a-mask” message, rules and expectations, sunflower lanyards, social problems and benefits, and mask exemption. The stage 2 questionnaire showed that autistic people had varied experiences of facemask wearing, with sensory issues being a common challenge. Some autistic people said that there were benefits of facemask wearing, such as being able to think less about controlling their facial expressions in social interactions. The sunflower lanyard, and the masking exemption it indicated, was a particularly divisive topic among participants.

What do these findings add to what was already known?

Before this research, nothing was formally known about the experiences of autistic adults when wearing facemasks, or their attitudes toward this during the pandemic. The few studies that do exist on facemask wearing focus on teaching children to tolerate masks better, rather than asking autistic people for their opinions. We now know that experiences varied, as would be expected in such a varied group, but that some common themes were present—especially around the sensory aspects of facemask wearing.

What are the potential weaknesses of the study?

As the research was conducted entirely online, there is potentially a bias toward autistic adults who are capable and interested in sharing their thoughts and experiences in writing. This means that our findings may not apply for autistic adults with learning difficulties, for example. The sample was also mostly made up of cis-women, which means that the experiences of other genders of autistic people may not be fully represented. The study also does not have a non-autistic control group, so some of these experiences may be common to autistic and non-autistic people.

How will these findings help autistic adults now or in the future?

Understanding how autistic adults experienced facemask wearing during the initial waves of the COVID-19 pandemic can inform how future mask mandates are implemented and communicated if there is a need for this in response to further waves or novel illnesses.