The world is a changing place and many new recommendations are coming into place everyday. This can be overwhelming to many of us . Across Quebec it is now recommended or mandatory to wear a mask while receiving therapy and medical services. Whether you are a parent or a healthcare worker, read on to learn how you can help.

Wearing a mask can present difficulties for people with low cognitive skills, anxiety, sensory and motor issues. Many people with disabilities also need to return to their therapy and respite services. Is wearing a mask really safer for this population? How can parents, caregivers, and health workers help?

Sensory Issues

Many, if not most people with disabilities often experience sensory difficulties.  This means, in the case of wearing a mask, they may feel like the mask is “too much”.  You don’t need to have a disability to have trouble wearing a mask. There are many sensory reasons for this: 

• Touch: The person with sensory issues may feel that the mask is too tight and even scratching them.  They can be bothered much more than others. For someone with sensory issues, this may feel like pins and needles and become overwhelming so they may take off the mask in a panic. 
• Temperature: Wearing a mask traps heat and the face can begin to feel sweaty and hot.  This is uncomfortable for many people but if the person has sensory issues this could be the reason they won’t wear the mask.  
• Visual: Wearing a mask and glasses can be a challenge.  The glasses may fog up.  For someone who feels “too much” this may cause visual changes that they cannot tolerate. 
• Smell: A mask may limit the person’s smell and to someone who is used to smelling and relies on it, this might be too much to bear.  They again may refuse to wear the mask.   Some masks may even have a new smell of their own that may distress a person who is bothered by certain smells. 

All of these feelings can create severe anxiety and even a feeling of claustrophobia that triggers your fight or flight brain and the person may rip off the mask or refuse to wear it. 

Motor Issues

• People who have had a stroke, who have motor disabilities such as Cerebral Palsy, and poor control of their mouth muscles may drool.  This makes wearing a mask hard and possibly less effective.  It is not recommended that they wear a mask.
• People working with clients who drool are recommended to wear a gown as well as a mask. 
• Children under 2 years old and those who can’t remove a mask on their own, are NOT to wear one.   It could lead to suffocation. 

Comprehension & Anxiety

It can be hard to understand other people when they are wearing a mask. Many of the facial expressions are blocked. It can even make it difficult to hear someone well while they are wearing a mask, especially if the person doesn’t speak loudly. Needing to wear a mask and be around people wearing masks is a big change for all of us.  It is even harder for people who cannot easily handle change.  People with Autism Spectrum Disorder (ASD) rely on predictability to be able to function.  When things are out of the ordinary it can cause a lot of stress and feelings of anxiety or fear.   Many people with disabilities will not understand the reasons why masks are necessary.  And when you don’t have the communication skills to say things like: “I don’t want to wear this”, “this mask doesn’t feel good” or “how long do I have to wear this mask?”, it can be even scarier.     Imagine not being able to tell someone that you are so scared or uncomfortable or confused.   

For people with a disability that impairs their memory, they may not remember that they have to keep a mask on or how best to take it on and off.  The mask loses its value when the hygiene rules are not followed.  

Here Are Some Ideas to Try:

1. Getting a client used to wearing a mask 

Put the masks near the play area.  If they are older, practice putting the masks on different stuffed animals! Make it fun and laugh so they see that you are ok with it. 

Speak positively about the masks and show them that you are ok with wearing a mask. 

Have times in the day where you practice wearing a mask.  Use a time timer to visually let the client know how long you are wearing them for. One good option is the Time Timer app which is available for both iPhone/iPad and Android & Chromebook.

Another option is the Visual Countdown Timer (iPhone/iPad) only.

Remember that because they might not understand the importance of the mask it will give them a visual timeline of what to expect.  This can significantly decrease anxiety with people with disabilities. 

Start with 1 minute on the visual timer and slowly build with lot’s of reinforcement i.e. “good for you, you kept your mask on the whole time”. 

Take a look at this video showing you how to use a visual timer:

Some other strategies that might help get a client used to wearing a mask are:

• Use the medical masks during play activities to pretend you are a superhero, a doctor, a bunny rabbit. Pick something that the client is interested in.  Act out a discussion between the stuffed animals. 
• Decorate your mask (draw a smile, pick your own fabric and add sparkles! 

2. If the client shows anxiety and panic when wearing the mask or is constantly taking it off: 

• Teach deep breathing and practice without the mask on.   Watch this video to learn the “hot cocoa” breathing technique!   

• See if they will tolerate a gentle massage on shoulders and back…never force.  A massage can calm the body down and prepare it for the uncomfortable feeling of wearing a mask. 
• Use time timer app for 30 seconds and give positive reinforcement.  (praise, sticker, high five etc…) 
• Include a visual schedule.    To learn more about visual schedules, read this blog post written by our team.

3. If a client shows fear/anxiety about being around people who are wearing masks 

• Masks are often associated with negative things; sickness, death, danger.  Also movies and TV show robbers with bad intentions wearing masks. 
• We know people with ASD have learned to look at someone’s mouth or face to figure out the other person’s emotions or feelings.  With a mask on, now they can’t ‘read’ the emotion of others. 
• During this pandemic, let’s explain to the client why we are wearing a mask.  
• We wear a mask when we can’t keep a 2-meter distance from someone else.   Don’t skip this step… it can REALLY decrease anxiety and help the client to cooperate.   
  • Wearing a mask is a sign of politeness, gentleness and helps to keep others safe.   
  • Even if we can’t see the mouth, the person may be smiling and happy.   
• Clients may still not understand when you explain only with words.  Help them see what’s under the mask by drawing a “smiley” face on the mask!    

A warning about mask use in specific cases:

For clients with difficulties with drooling or significant cognitive impairment the suggestions might not work, wearing a mask might not be an option and may prove a greater health risk. 

The following persons should not wear a mask as it may prove a greater health risk, lead to suffocation or make the mask ineffective (client and workers would not be protected):

• Children under 2 years old and those who can’t remove a mask on their own
• Clients with chronic respiratory conditions
• Clients with drooling issues
• Clients with significant cognitive impairment
• Clients for which the suggestions from this post don’t work