The COVID-19 pandemic has presented many new challenges for people with autism spectrum disorder (ASD). Features of ASD, including impaired social and communication skills, repetitive behaviors, insistence on sameness, and especially sensory intolerances, make adapting to wearing face masks and the experience of a COVID-19 test particularly challenging.
Challenges of wearing face masks with ASD
Many people with ASD are highly sensitive to touch, and the face can be especially so. Wearing a face mask involves many unpleasant sensations. On the surface, there’s the scratchy texture of fabric, tight contact where the top of the mask meets the skin, and the tug of elastic on the ears. Sensations under the mask are no more pleasant and include the warm, damp smell of recycled air. In addition, the sensation of breathing in and exhaling air through the nose can feel restrictive, leading to concern and worry for many individuals with ASD. While wearing a mask is uncomfortable at best, these unpleasant sensory experiences can be intensely magnified in people with ASD.
In addition to these sensory challenges, face masks also create new social communication challenges. Autism spectrum disorder can include poor visual perception skills, making the odds of accurately reading another person’s facial expression beneath a mask, from a socially appropriate distance, more difficult than usual. Moreover, when viewing another person’s face while they are wearing a face mask, the eyes are the primary area of the face that is visible. Individuals with ASD often have difficulty making eye contact, adding yet another hurdle for them in the social-communication realm. These factors can lead to miscommunication and frustration. Because masks muffle voices, verbal communication also becomes more difficult. Fortunately, there are several strategies that can make wearing a face mask more bearable.
What to do?
- Demonstrate using the face mask on a preferred object or person, such as a stuffed animal, a doll, or a family member.
- Allow the person with ASD to choose among different types of fabric face masks to find one that is most comfortable.
- Start by practicing wearing the face mask for short durations of time, allowing for breaks when needed.
- Plan initial outings in low-demand environments that are quiet and calm, so that the individual can experience success wearing the face mask.
- Use a printed photo or digital photo of the individual wearing a face mask as a visual cue to wear the mask before outings. The photo can be stored close to the door or on a tablet that is easily accessible.
- Chew gum or suck on a hard candy while wearing a mask, for distraction and to improve the smell of recycled air beneath the mask.
- Some medical settings may have transparent face masks. These masks make the mouth visible.
6 US states plus D.C. and Puerto Rico mandate face coverings in public (Source: AARP – Updated January 25, 2023):
Alabama’s mask mandate expired April 9, 2021. The state Department of Public Health recommends face-covering in public as part of its COVID-19 safety guidance. Municipal mask mandates in Birmingham and Montgomery expired in May 2021.
Learn more: Read the Alabama health department’s COVID-19 prevention guidelines.
Alaska’s Department of Health Social Services “strongly encourages the wearing of masks in public,” but the state has not required it. Juneau, the state capital, downgraded its indoor mask requirement to a recommendation Feb. 28, 2022.
Learn more: Read the Alaska health department’s mask guidance.
Then-Gov. Doug Ducey issued an executive order in March 2021 lifting all state COVID-19 restrictions on businesses and restricting local governments’ ability to impose and enforce face-covering orders. Ducey signed legislation April 25 that bars school districts and local governments from requiring anyone under age 18 to mask up without the consent of a parent or guardian. He also signed legislation May 20 that prohibits mask mandates in buildings run by state or local governments.
Learn more: Read the Arizona Department of Health Services’ mask guidance.
Then-Gov. Asa Hutchinson lifted his 8-month-old mask mandate March 31, 2021. Health officials continue to recommend that Arkansans wear masks in public when unable to maintain 6 feet of distance from people outside their households. A state law barring local governments from imposing mask orders, enacted in April 2021, was struck down by an Arkansas judge later that year.
Learn more: Read the Arkansas health department’s mask guidance.
Gov. Gavin Newsom lifted California’s indoor mask mandate March 1. The state continues to strongly recommend face-covering for all individuals, regardless of vaccination status, in indoor public settings. Masks remain mandatory statewide in health care and long-term care facilities, correctional facilities, and homeless and emergency shelters.
Oakland requires masks in city government buildings and other municipal facilities such as libraries, senior centers and recreation centers. The mandate is in effect until March 31.
Los Angeles County lifted a mask mandate for public transit and transportation hubs such as airports Sept. 23. A face-covering mandate for riders on the BART rail system serving the San Francisco Bay Area ended Oct. 1.
Learn more: Read California’s updated face-covering guidance.
Gov. Jared Polis ended Colorado’s statewide mandate May 14, 2021. Face-covering is required in residential care facilities and on public transportation, regardless of vaccination status. Local indoor mask orders in the city of Denver and Adams, Arapahoe, Boulder, Jefferson and Larimar counties have been lifted.
Learn more: Read the Colorado health department’s mask guidance.
Gov. Ned Lamont lifted Connecticut’s face-covering order Feb. 28, 2022. Previously, masks were required for unvaccinated people age 2 and over in indoor public places. Masking remains mandatory for all in health care settings such as hospitals, doctors’ offices and urgent care centers; long-term care facilities; and shelters. The cities of New Haven and Bridgeport also ended indoor mask mandates in early 2022.
Learn more: Read Connecticut’s current COVID-19 health guidance.
Gov. John Carrey’s indoor mask order was lifted Feb. 11, 2022. Previously, masks were required for people kindergarten age and older in indoor public settings, except while eating or drinking in restaurants and bars. Masks remain mandatory in hospitals, long-term care facilities and state government buildings.
Learn more: Read Delaware’s face-covering guidance.
District of Columbia
The District’s order requiring masks for people over age 2 in indoor public places largely expired March 1. Fade-covering is no longer required in retail businesses, entertainment venues and most other public settings but remains mandatory in schools, childcare facilities, libraries, health care facilities, long-term care facilities, shelters, prisons and District government buildings in which employees interact with the public.
Learn more: Read the District’s updated COVID-19 action plan.
Florida recommends but has not required face coverings for the general public. Several cities and large counties, including Miami-Dade, Palm Beach and Hillsborough (which includes Tampa), had mask requirements, but Gov. Ron DeSantis issued an executive order May 3, 2021. that barred local governments and school systems from imposing COVID-19 restrictions, including mask rules.
Learn more: Read Florida’s order barring local mask mandates.
Gov. Brian Kemp issued an executive order in August 2021 prohibiting local governments from imposing mask rules on private businesses. Mandates in Atlanta and Savannah that required most individuals to mask up in indoor public places were rescinded in late February.
An indoor mask mandate enforced in Athens and Clarke County during periods of high community spread was fully lifted Oct. 6 as the county’s COVID-19 emergency declaration expired.
Learn more: Read the Georgia Department of Public Health’s COVID-19 guidance.
The state’s indoor face-covering order, in place since April 2020, expired March 25, 2022. Previously, people age 5 and up are required to wear a mask in most indoor public settings.
Learn more: Read Hawaii’s mask guidance.
“Everyone should wear a mask in public places,” the state Department of Health & Welfare recommends. Boise, Idaho’s capital and largest city, dropped its mask mandate in May 2021, as did several other jurisdictions. Gov. Brad Little signed an executive order May 28 restoring local governments’ authority to make their own mask rules, reversing a move by Lt. Gov. Janice McGeachin to strip such local control in an order she issued while Little was at a conference out of state.
Learn more: Read the Idaho health department’s pandemic recommendations.
Gov. J.B. Pritzker eliminated the state’s order requiring people to mask up in indoor public spaces Feb. 28, 2022. Chicago Mayor Lori Lightfoot lifted a similar citywide mandate the same day.
Learn more: Read a news release from the governor’s office on lifting Illinois’ mask order.
The state’s mask mandate became a “mask advisory” April 6, 2021. Face-covering is required for all people in state-run congregate facilities such as prisons, state hospitals and veterans homes.
Learn more: Read the Indiana Department of Health’s COVID-19 control guidance.
Gov. Kim Reynolds lifted the state’s mask order in February 2021. The following May, she signed legislation barring local governments from compelling businesses to require masks.
owa City’s indoor mask mandate, which municipal officials said was legal because it was binding on individuals, not businesses, was rescinded March 1, 2022. Cedar Rapids lifted a face-covering requirement in city buildings on August 11.
A federal appeals court panel ruled on May 16 that Iowa school districts cannot issue mask mandates unless they’re needed to comply with other federal or state laws.
Learn more: Read Iowa’s COVID-19 prevention guidance.
Kansas lawmakers revoked the state’s mask requirement April 1, 2021, hours after Gov. Laura Kelly issued an executive order intended to extend it, under a state law passed the previous month that gave a panel of top legislators authority to overturn the governor’s emergency orders. Kansas City and Wyandotte County, which have a unified government, repealed their indoor mask mandate Dec. 16, 2021.
Learn more: Read the Kansas health department’s mask guidance.
Kentucky’s general mask mandate ended June 11, 2021, along with the state’s remaining COVID-19 health restrictions. Masking is encouraged for Kentuckians when they are with people from outside their household and required for adults in some health care, day care and early education settings.
Learn more: Read the Kentucky Department of Public Health’s COVID-19 prevention and treatment guidance.
Gov. John Bel Edwards lifted the state’s general indoor mask order Oct. 27, 2021, as a delta-fueled spike in COVID-19 cases eased. The mandate, Louisiana’s second of the pandemic, had been in effect since early August. New Orleans ended its citywide indoor mask mandate March 3, 2022.
Learn more: Read Louisiana’s mask guidance.
Maine has not had a mandate in place since late May 2021. The state is following the CDC recommendations for masking based on community COVID-19 impact. Portland lifted its citywide indoor mask order Feb. 17, 2022.
Learn more: Read Maine’s mask FAQs.
Gov. Larry Hogan ended Maryland’s statewide mask mandate along with all other COVID-19 emergency orders July 1, 2021. The state’s two largest counties, Montgomery and Prince George’s, lifted indoor mask orders in late February, and the city of Baltimore did so March 1.
Learn more: Read the Maryland Department of Commerce’s face-covering FAQs.
The state’s general face-covering order was lifted May 29, 2021. Masks are required in health care and long-term care facilities, emergency shelters and prisons. Boston and Springfield lifted citywide indoor mask mandates in early 2022.
Learn more: Read Massachusetts’ current guidance on face-covering.
Michigan lifted its general mask mandate June 22, 2021, and ended site-specific face-covering requirements in health care facilities, long-term care facilities, jails and shelters Feb. 16. The state continues to recommend all individuals, regardless of vaccination status, mask up in such “high-risk congregate settings.”
Learn more: Read Michigan’s updated mask guidance.
Gov. Tim Walz ended the state’s general mask mandate May 14, 2021. The Minnesota Department of Health recommends masking “in some settings and situations,” in accordance with CDC guidelines. Minneapolis, St. Paul, Rochester and Duluth lifted municipal mask orders in February 2022.
Learn more: Read the state health department’s mask recommendations.
The Mississippi State Department of Health recommends face-covering in all indoor public spaces, regardless of vaccination status. A statewide order mandating indoor masking in counties with high COVID-19 case rates expired in March 2021.
Learn more: Read Mississippi’s COVID-19 prevention guidelines.
The state Department of Health and Senior Services recommends that all people age 2 and older mask up in public to help prevent the spread of COVID-19. St. Louis County’s indoor mask mandate ended Feb. 28, 2022. Kansas City and surrounding Jackson County lifted general mask orders in November 2021.
Learn more: Read the Missouri health department’s COVID-19 prevention guidance.
Gov. Greg Gianforte rescinded the state’s mask mandate Feb. 12, 2021 and signed legislation the following May invalidating local mask mandates, effectively ending face-covering orders in Gallatin, Missoula and other counties.
Learn more: Read Montana’s mask guidance.
The state Department of Health and Human Services recommends people wear face coverings in public when unable to maintain social distancing. Local indoor mask orders in Omaha and Lincoln were lifted in February 2022.
Learn more: Read the Nebraska health department’s COVID-19 protection guidance.
Then-Gov. Steve Sisolak ended the state’s mask mandate Feb. 10, 2022. Before that, Nevadans over age 9 were required to mask up in indoor public places, regardless of their vaccination status, in counties that met the CDC criteria for high or substantial rates of COVID-19 transmission.
Learn more: Read a press release from the governor’s office on lifting Nevada’s mask order.
Gov. Chris Sununu allowed New Hampshire’s the state’s mask mandate to expire April 16, 2021, about six months after it was implemented. The cities of Keene and Nashua lifted mask mandates covering local indoor public facilities in February 2022.
Learn more: Read New Hampshire’s COVID-19 public health guidance.
Gov. Phil Murphy lifted New Jersey’s general face-covering order May 28, 2021. Masking is strongly recommended in crowded indoor settings and required for people over age 2 in “high-risk areas” such as health care facilities, homeless shelters and prisons. The city of Newark lifted its indoor mask mandate March 2, 2022.
Learn more: Read New Jersey’s mask guidelines.
Gov. Michelle Lujan Grisham lifted the state’s indoor mask order Feb. 17, 2022, two weeks before the scheduled expiration date. Masking is still mandatory in “congregate settings” such as hospitals, long-term care facilities and detention centers.
Learn more: Read New Mexico’s updated COVID-19 emergency order.
Gov. Kathy Hochul lifted the state’s general mask order Feb. 10, 2022, and mandates covering public transit, homeless shelters and correctional facilities ended Sept. 7. Face-covering remains mandatory in health care facilities, including nursing homes.
Learn more: Read New York’s updated COVID-19 health guidelines.
Gov. Roy Cooper ended the state’s general mask mandate May 14, 2021. Face-covering is still required statewide for people age 5 and over in hospitals and long-term care facilities. The city of Raleigh and Wake, Durham and Mecklenburg counties dropped local mask orders in early 2022.
Learn more: Read North Carolina’s face-covering guidance.
The North Dakota Department of Health recommends residents follow CDC masking guidance. There has been no statewide mandate since Jan. 18, 2021.
Learn more: Read the state health department’s mask guidance.
The state’s mask order expired June 2, 2021, as the Ohio Department of Health lifted most other pandemic health orders. Face-covering is required inside county government buildings in Cuyahoga County, which includes Cleveland and is currently rate high on the CDC’s transmission index. Municipal employees in Dayton are required to mask up when working indoors.
Learn more: Read Ohio’s mask and social distancing guidance.
Gov. Kevin Stitt called on Oklahomans to wear masks in public but rejected calls for a state mandate. Local mask mandates in the state’s largest cities, Oklahoma City and Tulsa, ended April 30 and May 1, 2021, respectively.
Learn more: Read the Oklahoma health department’s COVID-19 guidance.
Gov. Kate Brown lifted the state’s mask mandate March 12. The Oregon Health Authority recommends face-covering in indoor public settings for people who are unvaccinated or at higher risk for severe cases of COVID-19 due to their age or condition. Masks remain mandatory for people ages 5 and older in state-licensed or -certified health care facilities, including long-term care facilities.
Learn more: Read Oregon’s mask guidance.
Pennsylvania’s mask mandate was rescinded June 28, 2021. The state Department of Health recommends that Pennsylvanians follow CDC face-covering guidelines.
Philadelphia reinstated an indoor mask order April 18 as rising COVID-19 case counts triggered a change in the city’s response level, but the city’s Department of Public Health lifted the mandate April 22, citing a leveling of case numbers and a drop in COVID hospitalizations.
Learn more: Read the Pennsylvania health department’s COVID-19 prevention guidance.
Gov. Pedro Pierluisi lifted the territory’s face-covering mandate for indoor public places March 10, 2022. Masking is still required in health care and long-term care facilities and recommended in indoor settings when the vaccination status of others present cannot be verified.
Learn more: Read a statement from the governor’s office on lifting the mask order (Spanish).
Gov. Dan McKee’s mask-or-vaccine order expired Feb. 11, 2022, about two months after it went into effect. The rule mandated masking at large indoor businesses and venues but gave smaller establishments an option to require either face-covering or proof of vaccination. Face-covering remains mandatory for staff in health care settings where people are treated for suspected or confirmed COVID-19 infections.
Learn more: Read Rhode Island’s mask guidance.
Gov. Henry McMaster has encouraged unvaccinated South Carolinians to mask up but did not impose a statewide mandate and issued an executive order May 11, 2021, invalidating existing local face-covering rules in several jurisdictions. Columbia, the state’s capital and second-largest city, repealed its indoor mask mandate in November, and a face-covering order in surrounding Richland County expired May 1.
Learn more: Read the South Carolina health department’s mask guidance.
The South Dakota Department of Health recommends “wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain, especially in areas of significant community-based transmission.”
Learn more: Read the state health department’s COVID-19 information page.
Gov. Bill Lee did not impose a statewide mandate and signed legislation Nov. 12, 2021, that severely limits local governments’ authority to enact their own mask rules.
Learn more: Read the Tennessee health department’s mask guidance.
Gov. Greg Abbott lifted the state’s 8-month-old mask mandate March 10, 2021. The following July, he issued an executive order barring local government bodies, including school districts and public health agencies, from instituting their own face-covering mandates.
Learn more: Read a roundup of Texas’ mask laws.
Utah’s order requiring masks in most public settings ended April 10, 2021, five months after it was issued, under a state law that phased out various COVID-19 public health restrictions. Indoor mask mandates implemented in Salt Lake and Summit counties Jan. 7 were overturned two weeks later by the state legislature.
Learn more: Read Utah’s mask guidance.
Gov. Phil Scott lifted Vermont’s mask mandate and all other COVID-19 restrictions June 15, 2021.
Learn more: Read the Vermont Department of Health’s mask guide.
Then-Gov. Ralph Northam’s order ending statewide COVID-19 restrictions took effect May 28, 2021, two weeks after he effectively lifted Virginia’s universal mask mandate to align with CDC guidance at the time.
Learn more: Read the Virginia Department of Health’s mask guidance.
The state lifted its indoor mask order March 12, 2022, about three weeks after a mandate for masking at large outdoor events ended. Face-covering remains mandatory for people age 5 and older in health care, long-term care and correctional facilities.
Learn more: Read the state Department of Health’s mask guidance.
Gov. Jim Justice signed an executive order June 20, 2021, revoking the state’s 11-month-old mask mandate. In its final weeks the directive had covered unvaccinated people age 9 and up in indoor public spaces.
Learn more: Read West Virginia’s past face-covering orders.
The Wisconsin Supreme Court struck down Gov. Tony Evers’ mask mandate March 31, 2021. In a 4-3 vote on a case brought by Republican state legislators, the court ruled that Evers, a Democrat, overstepped his authority by repeatedly extending pandemic-related emergency orders without lawmakers’ approval.
Indoor mask mandates in the city of Milwaukee and Dane County, which includes Madison, expired March 1, 2022. In Milwaukee County, masks are required on public buses and in the county courthouse.
Learn more: Read the Wisconsin health department’s mask guidance.
Gov. Mark Gordon rescinded the state’s 3-month-old mask mandate March 16, 2021. The state health department recommends that residents “consider wearing a well-fitting face mask that covers your nose and mouth in indoor public settings.”
Learn more: Read the Wyoming Department of Health’s COVID-19 guidance.