Behavioral affect in Children with Autism Spectrum Disorder During School Closures due to COVID-19 Pandemic in Japan: A Case-Controlled Study

<b>Aim</b>: Social distancing during the COVID-19 pandemic has affected the mental health of children. Children with autism spectrum disorder (ASD) display restricted behavior and could suffer more stress from change due to school closures than typically developing children. This study investigated the differences in behavioral affect between children with ASD and typically developing children during the COVID-19 pandemic. <b>Methods: </b>We conducted an online survey to collect data from mothers of 819 children with ASD and typically developing children in Japan aged between 6 to 18 years. We compared the prevalence of stress, stress factors, reactions, and behavioral affect during school closures between the ASD and the control group. <b>Results</b>: The data of 84 children with ASD and 361 age and sex-matched controls were analyzed. Over 75% of the children felt stress during this period in both groups, and there was no difference in the prevalence of stress between the groups (<i>p</i> = 0.74). However, children with ASD were more frustrated by changes in their schedule (<i>p</i> = 0.013). <b>Conclusion</b>: Behavioral affect in children with ASD might reflect stress reactions under school closures related the COVID-19. Therefore, strategies for mitigating the stress response of children with ASD should be implemented.