During the coronavirus disease 2019 (COVID-19) lockdown, all face-to-face support and planned activities of children with ASD were interrupted. This brought a significant change of routine for them [1]. They reported higher levels of anxiety, reduced dispositional hope, and psychological well-being [2]. Information technologies have been an essential tool during these challenging times [3]. Studies have reported positive effects of parental empowerment with training and support using technological platforms [4]. We investigate the impact of lockdown on children with ASD and their families in India and the UK.

Parents of 45 children with a confirmed diagnosis of ASD - 15 from Conwall, United Kingdom [mean (range) age, 11.06 (7.02-17.05) years] and 30 from Lucknow, India [mean (range) age, 5.2 (2.11- 8.07) years] participated in the survey. Children with confirmed ASD were identified from clinical records of the child development center in Lucknow and Cornwall. Consent was obtained and General Data Protection Regulation guidelines were followed during data collection and analysis.

A semi-structured survey was constructed. It included four variables: change in behavior (CIB), change in the routine (CIR), regression in skills (RIS), and parental stress (PS) (Web Fig. 1). The final survey was reviewed by an expert panel, and their suggestions were included before conducting the telephonic survey. Speech and language therapists in the UK and trained child psychologists in India conducted telephonic surveys in mid of April over two weeks. Each interview took approximately 45 minutes. All questions on CIB, CIR and RIS were rated on an 8-point scale ranging from 0 to 7 and for PS on a 5-point scale ranging from 0 to 4.

Nonparametric t-test, Pearson correlation and multivariate regression analysis were calculated to measure the difference, bivariate associations, and the impact of lockdown on the study variables.

The mean rank for CIR, PS and CIS were higher in the UK as compared to India, whereas there was no significant difference in CIB. CIR and CIB were reported for all children. All parents reported increased PS (Table I). There was a significant correlation of change in behavior score with change in routine score (r=0.446, P<0.01), regression in skills score (r=0.750, P<0.01) and parental stress score (r=0.370, P<0.05). Parental stress score also significantly correlated with change in routine (r=0.535, P<0.01) and with regression in skills (r=0.375, P<0.05). Regression in skill and change in routine scores were also significantly correlated (r=0.410, P<0.01).