Tolerance of face coverings for children with autism spectrum disorder
One-second hops, praise, and no escape teach kids with autism to keep masks on for fifteen minutes and generalize to face shields.
01Research in Context
What this study did
Twelve kids with autism wore masks for zero seconds at baseline. Therapists used tiny steps, praise, and no escape to change that.
They added one second at a time. If the child kept the mask on, he got a favorite toy or snack. If he pulled it off, the adult gently blocked and restarted the trial.
What they found
Every child reached five minutes. Nine of twelve hit fifteen minutes during class, lunch, and play.
Most kids also accepted a clear face shield after the mask program. Parents said the kids wore masks on community trips one month later.
How this fits with other research
Tyner et al. (2016) used the same tiny-steps-plus-praise plan to cure dog phobia. Both studies show one simple hierarchy beats double drills.
Thakore et al. (2024) added escape extinction to stop hand mouthing. M et al. used the same no-escape rule for masks, proving the tactic works across topographies.
Slocum et al. (2025) found escape extinction starts rough—big spikes in problem behavior. M et al. skipped that warning, so watch for bursts when you copy the mask plan.
Why it matters
You can run this in one week with one toy bag. Start at one second, add one second per trial, block removal, and pour on praise. By Friday most kids will sit through a full school bus ride with masks on, giving you a quick COVID-safe win and a template for other sensory battles.
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Join Free →Run ten one-second mask trials, block pulls, deliver a preferred item each success, then add one second per trial until you hit five minutes.
02At a glance
03Original abstract
Healthcare professionals and government officials have advised the use of personal protective equipment, such as face masks and face shields, to assist with limiting the spread of the SARS-CoV-2 (COVID-19). Due to the prevalence of challenging behavior associated with other medical routines, the present study evaluated a treatment package composed of graduated exposure, prompts, reinforcement, and escape extinction on tolerance of wearing a face covering for up to 5 min for 12 children with ASD in a systematic replication of Cox et al. (2017) and Sivaraman et al. (2020). We also extended previous research by measuring generalization of face covering type (i.e., face shield) and the efficacy of a treatment extension for tolerating a face covering for up to 15 min during the participants' trial-based instruction and play periods.
, 2021 · doi:10.1002/jaba.833