Impact of COVID-19 on Adaptive Skills and Psychiatric Symptoms in South Korean Children With Autism Spectrum Disorder

Abstract

Objective: We examine the effect of COVID-19 on South Korean children with autism spectrum disorder (ASD), using a comprehensive online caregiver survey. Method: Caregivers of 132 children were recruited among 292 children identified with ASD in a large general population epidemiologic cohort from a suburban South Korean city. Using the Korean translation of the CoRonavIruS Health Impact Survey, adapted for autism and related neurodevelopmental conditions (CRISIS-AFAR), data were collected at 3 time points (3 months before the pandemic, from January to June of 2021, and 3-4 months after). Changes in adaptive living skills, lower-and higher-order restrictive and repetitive behaviors (RRBs), co-occurring problem behaviors (activity/attention, oppositional, and anxiety/affect) were assessed over time. Characteristics of more vulnerable subgroups were identified. Results: Among 132 children with ASD (81.1% boys, mean 12.6 +/- 1.88 years of age), a significantly larger proportion maintained their initial level of adaptive living skills (43.9%), RRBs (39.4%-51.5%), and co-occurring problem behaviors (>75%) when compared with the proportion of children who worsened or fluctuated (p < .001). Less than 25% of the participants showed worsening in any domain from the first to second time point and from the second to third time point. Participants who demonstrated stability in activity/attention problem behaviors and lower-order RRBs had significantly better baseline physical health (p = .032) and higher intelligence, greater ability to attend general education, and milder language deficits (all p = .027). Conclusion: The majority of South Korean children with ASD demonstrated stability despite the lack of consistency or structure during the pandemic. A 2-year longitudinal follow-up study is underway. Plain language summary: Caregivers of 132 South Korean children with autism rated their children&apos;s behaviors at 3 months before the pandemic began and at two timepoints during the height of the COVID-19 pandemic in 2021. A larger group of children maintained their initial levels of adaptive functioning, autism symptoms, and co-occurring behavioral problems. Fewer than 25% showed progressive worsening over time, highlighting the resilience of a majority of children with autism during this difficult period. The study also found that better physical health was protective against behavioral challenges, while children with more severe autism symptoms, or cognitive difficulties, needed additional support-especially in environments lacking consistency and structure.