Increasing Face Mask Wearing in Autistic Individuals Using Behavior Analytic Interventions: A Systematic Review and Meta-analysis.
Rebekah Cowell, Athanasios Vostanis, Peter E Langdon
PMID 37751092WHAT IT FOUND
Behavior-based programs helped autistic children tolerate face masks longer, with target durations reported as 5, 10, 30, and 60 minutes.
The evidence is small and low quality, so it does not prove masks are safe or necessary.
Key findings
01Seven behavior-analytic single-case studies involving 36 autistic participants were included.
02All studies used two or more intervention components; graded exposure hierarchy and positive reinforcement were used in four studies, and differential reinforcement in three.
03Positive increases in mask wearing were achieved across all participants in six studies, while one study showed inconsistent maintenance and generalization.
STILL TO COME
How it was doneWhat they found
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What it does not show
Only seven studies and 36 participants were included. Only three studies were rated adequate or above, and four were borderline adequate or weak. Only 5% of participants were 18 or over. The mean age was 8 years, so findings mostly describe children. All studies used single-case designs, not randomised groups, and blinding of participants, staff, and outcome assessors was often absent or unclear. Confidence intervals were wide, and all studies had a small baseline-corrected effect. The size of the effect is uncertain. Most studies were conducted in the USA, and mask policies differ by country and culture. Target durations were up to 1 hour, which the paper says may not match naturalistic mask wearing needed to reduce transmission. Social validity was limited: only two studies assessed caregiver views, and one assessed only professional views.
The easy way to misread this
Do not read this as proof that mask-wearing can be trained in autistic adults or that it reduces infection transmission. Only 5% of participants were 18 or over, and the paper says the target durations do not necessarily represent naturalistic mask wearing needed to reduce transmission.