Study: Autistic Adults May Be at a Higher Risk for Severe COVID-19

New research finds that adults with autism, intellectual disabilities, or mental health disorders are at increased risk for COVID-19 and severe illness.

After sorting through data from more than a million people, researchers found that autistic people, or those with an intellectual disability, and any mental health condition were at higher risk of getting the virus and becoming severely sick (requiring hospitalization and ICU care) than neurotypical people.

This was likely due to a few risk factors including a higher likelihood of living in residential facilities, visiting the hospital more frequently, and receiving more at-home care.

"The area of disability and public health is in need of additional resources and research," study author Lindsay Shea, DrPH, director of the Policy and Analytics Center at the A.J. Drexel Autism Institute, tells Verywell via email. This lack, she says, made COVID-19's impact on these populations all the more detrimental.

"As we work to understand COVID-19 more fully, a wide-ranging focus on individuals with psychiatric diagnoses is needed to help them navigate public health information and participate in public health initiatives," Shea adds.

The study was published in late August in the journal Autism.

Multiple Risk Factors

The authors looked at adults who had Medicaid between 2008-2012 and how likely they were to have known risk factors for COVID-19.

They included more than 80,000 people with autism and over 600,000 people with intellectual disabilities aged 20-64 years. To add perspective, they then compared this data to over 1 million adults. About 35% had been diagnosed with some mental health conditions, excluding autism and intellectual disabilities.

The known risk factors evaluated included:

• Living in a residential facility
• Receiving services regularly in the home from outside caregivers
• Having had a long hospitalization
• Having had avoidable hospitalizations
• Having high-risk health conditions

These risk factors have been important to surveil during the pandemic, given the unique risks they pose to virus transmission.

Researchers found that autistic adults, adults with intellectual disabilities, and adults with any mental health diagnosis had more of these risk factors than adults without any of these conditions. The findings held even when accounting for individual characteristics like age, sex, race, and type of Medicaid insurance.

For example, adults with autism and/or intellectual disabilities were also more likely to live in a residential facility. It was more probable, too, that they had pre-existing conditions that put them at a higher risk of COVID-19.

Limitations of the Research

However, there are always data limitations to consider.

Everyone included in the sample had Medicaid, which provides healthcare coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. The authors write that this could mean that the data represents people who are more vulnerable to struggles associated with poverty than the general population.

Also, the data is from a decade ago, 2008-2012, although researchers said in a press release that the risk factors examined, such as living in a residential facility, are not likely to have lessened over time.

How to Reduce Risk of Severe COVID-19

"Adults on the spectrum and adults with either intellectual disability or mental health diagnoses cannot change their pre-existing conditions," Whitney Schott, MA, PhD, study author and researcher at the Drexel Autism Institute, tells Verywell, because they often need the crucial services provided in residential facilities or by outside care.

"[But] they may lessen their risk in other ways," Schott adds. The most important step for protection is vaccination.

"Vaccination of your loved one, as well as those around your loved one, including family members and other caregivers who interact with your loved one," Schott says.

If someone with autism, intellectual disabilities, or mental health conditions is living in a residential facility, she adds, it's also important to ensure it has adequate ventilation, which means at least six air exchanges per hour in indoor spaces.

"Ventilation can be improved with simple measures, such as allowing fresh air into the building, as well as with portable HEPA filtration devices," she says.

The small steps count, too. Following CDC-recommended steps of avoiding large crowds, wearing a mask when in shared spaces indoors and if in close contact with others outdoors, and sanitizing hands after touching high-touch surfaces such as door handles can make a difference.

Improvements for the Future

Knowing risk factors, Shea says, can help shape policy and public health outreach while saving lives. Still, these areas lack funds and research.

"We do not have robust information on how to tailor public health outreach materials or how to support clinicians in engaging these groups, especially when a crisis emerges quickly and national and local health and public health infrastructure is taxed," she says.

There is also a lack of facilities that can quickly pivot to meet the needs of these groups—such as vaccination clinics specifically for people with autism.

"Minor environmental modifications, like dimmable lighting or a quiet space for sensory processing, are not widely available and could substantively improve the vaccination experience of individuals with psychiatric diagnoses," she adds.

Schott emphasizes that we need to think about the future in another way: How do we prepare people for a post-pandemic future?

"Our hyper-focus on sanitation and carefully avoiding exposure can contribute to anxiety and build into routines that may not be necessary for the future," she says.

And there's also likely to be a social deficit. We've spent so much time avoiding and distancing ourselves from people that it may be challenging, for some more than others, to re-integrate into their communities.

"Care providers will need to be mindful of gradual reintegration and provide scaffolding and support to build successful community participation in these populations," she says.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.