In the first of our “Accessible Academia” series, as we approach the five year mark since the first discovery of a COVID-19 case, we look back at how the following years had an impact on the lives of neurodivergent people and why it is important to learn from this to make life easier for neurodivergent people.
What is Accessible Academia? (Click for the answer…)
We take the latest academic papers about neurodivergence and neurodivergent people, and with the permission of the authors, condense it into an accessible summary for non-academics.
Drop downs like this provide further information about research methods and writing styles and can help you learn more about how research is conducted and communicated.
Too much to take in in one go? Jump to specific sections of this post and come back later to read the rest:
– Face Masks and Communication
– Eating Disorders in Neurodivergent and Gender Diverse Youth
– References
Face Masks and Communication
While the general public was initially suspicious of wearing face masks or coverings in early stages of the COVID-19 pandemic, changes in the law over the summer of 2020 saw a peak of three-quarters of people donning a mask1. For some, especially neurodivergent people and those with disabilities, who couldn’t wear a mask, the threat of confrontation or the humiliation of having to publically explain their disability created a fear of entering public spaces2.
Face masks can also make social interactions more difficult for autistic people, particularly when talking to another mask wearer. Researchers at the University of York and Royal Holloway, University of London recently published a paper in the journal Research in Autism Spectrum Disorders, investigating how face masks can impact the face processing abilities in autistic and non-autistic adults3.
Baxter et al. highlight previous research that suggests that autistic people rely more on the mouth than the eyes when trying to identify an person or emotion from a face than non-autistic people. Face masks, then, might create more of a challenge for autistic people when identifying emotions, which in turn could have an impact on social communication.
What does “Baxter et al.” mean?
(Natasha) Baxter is the first author on this paper, and et al. is a latin phrase meaning “and others”. In this case, we are aknowledging the work of all the authors, without having to write all the names out. The full list of the authors is available as part of the references below: number 3 for this article.
The authors also take into consideration the role of alexithymia, a condition more commonly co-occuring in autistic people compared with the general condition, which affects the ability to recognise and interpret one’s own emotions. They cite other research which suggests that it might be alexithymia, rather than autism, which is responsible for the differences in emotional recognition skills.
The researchers used a set of images created by Cook et al.4 in 2013 which blend between images of Harold and Felix, and between emotions of anger and disgust as facial expressions in four dimensions. A version with a face mask was also created for each of these, meaning that there was 28 images in total.
Following some learning and practice trials, these images were shown to participants over 560 trials (20 blocks of 28 images) where the inclusion of the face mask was randomly chosen. For each image, the participant was randomly asked either to identify the person (Harold or Felix) or to identify the emotion (anger or discust).
After analysing the data, Baxter et al. found that performance on both the identity and emotion recognition task was negatively affected by the presence of masks, both for autistic and non-autistic people, and with a greater effect on emotion recognition than identity recognition. The authors also note that the presence of face masks didn’t cause much a shift to where people would switch to seeing Harold vs Felix or anger vs disgust.
What does data analysis consist of?
In this case, the authors used a series of mathematical and statistical tests and models to check whether a difference in the data is actually present, or was caused by random chance. There’s so many different options for statistical tests that it probably requires an article of its own! For a quick preview, search “ANOVA”: a series of very versatile and flexible models, and one the authors of this paper made use of.
Importantly, the authors identified that autistic people are more negatively affected by face masks than non-autistic people, and the greater effect on recognition of emotion, rather than identity, still holds. They also found that the extent of autistic traits and alexithymia wasn’t related to performance on the task.
Baxter et al. also highlight some of the limitations of their study: they acknowledge the limited number of emotions (just anger and disgust), as well as the need to include a more diverse sample of participants and stimuli to help identify the role of ethnicity and gender in these face processing abilities.
Why is it important to identify limitations?
Good researchers point out the limitations in their studies so that others reading it can fully understand the context in which the findings might apply, as well as to identify other future methods to build on these results.
This research shows the importance of considering how “important public health measures like face masks may have unequal effects on populations with pre-existing atypical face processing abilities”.
“The impact of face masks on autistic and non-autistic adults’ face processing abilities” was written by Natashsa Baxter, Lucy Harlow, Ebony Harrison, Caitlin Smith, and Hannah Hobson. This work was publised under the CC BY 4.0 license: the full citation is provided in the references.
Eating Disorders in Neurodivergent and Gender Diverse Youth
As well as introducing new challenges for neurodivergent people, the COVID-19 pandemic also brought attention to a lot of existing problems, which were exacerbated by the new social norms. One recent paper by Brown et al.5, published in the journal Frontiers in Psychiatry, gives one indication of changes in the lives of neurodivergent people throughout the pandemic.
With an authorship representing a large number of universities throughout the United States, Brown et al. set out to identify whether increasing rates of autism, ADHD, and gender dysphoria were related to increased experiences of eating disorders before and after the pandemic.
To test their hypothesis, the researchers took a large sample from the TriNetX databases, a large list of de-identified real-time eletronic health records from inpatient and outpatient settings, covering over 118 million people.
Are you allowed to use data like this?
The TriNetX databases contain deidentified data, which means, that while it represents real people, any information that could be used to identify someone is removed. Records are linked together, so that the dataset avoids counting individuals multiple times.
So they could identify a difference between pre-pandemic and post-pandemic data, they matched individuals from both datasets by sociodemographic status (e.g. age, sex, ethnicity) and clinical characteristics prior to diagnosis of an eating disorder. They then looked at these individuals, and identified how many of these people were diagnosed with autism, ADHD, and/or gender dysphoria.
Brown et al. discovered that in children, adolescents, and young adults with diagnosed eating disorders, more had a co-occuring neurodivergent condition or gender dysphoria after the pandemic then before the pandemic. These findings were also consistent after controlling for baseline levels of psychiatric diagnoses.
This shows one example of how children, adolecents, and young adults diagnosed with neurodivergent conditions and gender dysphoria may have been disproportionately impacted by the pandemic. It is not just important to learn about the impacts of the pandemic, but also the social and environmental changes as a result of the pandemic.
The authors discuss how this finding could be a result of challenges experienced by neurodivergent people with relation to online learning, motivation, the rise of social media platforms, and decreased access to physical activity and social outlets. An interuption to access to support and community groups may also have had a long lasting impact.
This sort of research can help us to put the challenges in context: identifying the hidden impacts of the pandemic which we might not have realised at the time.
“Co-occurring autism, ADHD, and gender dysphoria in children, adolescents, and young adults with eating disorders: an examination of pre- vs. post-COVID pandemic outbreak trends with real-time electronic health record data” was written by Tashalee R. Brown, Madeline O. Jansen, A. Ning Zhou, Dominic Moog, Hui Xie, Katherine V. Liebesny, Kevin Y. Xu, Binx Y. Lin and Wisteria Y. Deng. This work was publised under the CC BY 4.0 license: the full citation is provided in the references.
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References
1. YouGov. ‘Personal Measures Taken to Avoid COVID-19’. YouGov, 30 July 2022. https://yougov.co.uk/international/articles/29430-personal-measures-taken-avoid-covid-19.
2. Hanna, Esmée, Graham Martin, Anne Campbell, Paris Connolly, Kriss Fearon, and Steven Markham. ‘Experiences of Face Mask Use during the COVID-19 Pandemic: A Qualitative Study’. Sociology of Health & Illness 44, no. 9 (2022): 1481–99. https://doi.org/10.1111/1467-9566.13525.
3. Baxter, Natasha, Lucy Harlow, Ebony Harrison, Caitlin Smith, and Hannah Hobson. ‘The Impact of Face Masks on Autistic and Non-Autistic Adults’ Face Processing Abilities’. Research in Autism Spectrum Disorders 118 (1 October 2024): 102485. https://doi.org/10.1016/j.rasd.2024.102485.
4. Cook, Richard, Rebecca Brewer, Punit Shah, and Geoffrey Bird. ‘Alexithymia, Not Autism, Predicts Poor Recognition of Emotional Facial Expressions’. Psychological Science 24, no. 5 (1 May 2013): 723–32. https://doi.org/10.1177/0956797612463582.
5. Brown, Tashalee R., Madeline O. Jansen, A. Ning Zhou, Dominic Moog, Hui Xie, Katherine V. Liebesny, Kevin Y. Xu, Binx Y. Lin, and Wisteria Y. Deng. ‘Co-Occurring Autism, ADHD, and Gender Dysphoria in Children, Adolescents, and Young Adults with Eating Disorders: An Examination of Pre- vs. Post-COVID Pandemic Outbreak Trends with Real-Time Electronic Health Record Data’. Frontiers in Psychiatry 15 (20 August 2024). https://doi.org/10.3389/fpsyt.2024.1402312.