PFA Tips: Testing for COVID-19

By Alizah Patterson, MD, Pediatric Resident, PL-3 , The Herman & Walter Samuelson Children’s Hospital at Sinai

Download a printable version of “Testing for COVID-19”

COVID-19 is the topic currently on everyone’s mind. One of the biggest questions is “Should I get tested?” Any sign of a respiratory illness can raise concern. And for individuals with autism, the testing process can be a challenge.

Symptoms of COVID-19
Prior to getting tested, it is important to understand the symptoms of COVID-19. Children typically present with mild upper respiratory symptoms, such as fever, cough, runny nose, and headache. Less common symptoms include sore throat, belly pain, loss of sense of smell, and shortness of breath. If your child has any of these symptoms, you should contact your primary care advisor and ask if testing is recommended. If your child has direct contact with someone who has been diagnosed with COVID-19, they may also qualify for testing. It is important to keep in mind that most children with COVID-19 are asymptomatic. Screening tests in patients with no symptoms are not necessary but may still be available at certain testing locations.

Many health conditions put patients at risk for more severe disease with COVID-19. Autism is not known to be clearly associated with more severe disease in children with the disorder, but certain aspects of their immune system may contribute to their susceptibility or severity.

Where can I get tested?
Every state has different criteria and different locations where testing occurs. There may be drive through testing, where you remain in your car and a healthcare professional swabs your nose or mouth. You can also go to a walk-in clinic or hospital testing center for the same process. Depending on your state and testing site, you may or may not require a prescription from your primary doctor for the test.

Types of tests
Three types of tests for COVID-19 are available:
• Nasopharyngeal swab – a thin flexible swab is inserted into the patient’s nose for 10 seconds to swab the back of the nose. This test detects if you have an active infection and is preferred by the CDC.
• Oropharyngeal swab – a thin swab is used to collect secretions from the back of the patient’s throat. This test also detects an active infection and can be used if the nasal swab is not an option.
• Antibody test – a blood test to detect antibodies to COVID-19 which indicates you have previously been infected. Tests will result positive 1-3 weeks after an active infection.

Prepare the person for COVID-19 testing
Both the nasal/oral swab and the blood test can induce significant anxiety and stress. Preparing individuals in advance for what to expect can help the process go more smoothly. Explain what will happen during the test, go through the motions, and provide videos or social stories to help familiarize them. When possible, contact the testing center ahead of time and discuss your child’s needs, ways of communicating, and behavior with the person performing the test.

There are also certain techniques you can do to help reduce the discomfort of the test. Distraction is the easiest technique. Provide the person with headphones for music, a tablet or phone playing their favorite show, or a small toy or fidget item they can focus on for an alternative sensory stimulus. For some individuals with autism, especially those with high levels of anxiety, deep pressure stimulation may have a calming effect. This can be done through a weighted vest, a weighted blanket, or simply from a tight hug. A comfort hold is an excellent way to constrain the patient for safety as well as providing the deep stimulation that may relieve some anxiety.

What to do after the test
The result of the person’s COVID-19 test may not be available for several days. Until then, your child and everyone in the household should quarantine from others. If your child had symptoms of COVID-19, quarantine should last 10 days after symptoms started and he or she has been fever-free without medication for 24 hours. If your child was asymptomatic, he or she should continue to quarantine for 14 days after the test is done or until you receive a negative result.

My child cannot get tested. What should I do?
For some individuals with autism, the testing process is not possible. Significant anxiety and intense behavioral reactions can prevent a test being performed. The sensation of the swab in their nose may cause them to fight it away, and with an older child or adult, social stories, comfort holds, and distractions may not be enough. Should the person be symptomatic, the CDC advises to isolate for at least 10 days after symptoms present. To prevent spread to other family members, keep your child in a separate bedroom if possible, using a different bathroom than other members of the household, and wearing a mask (if tolerated) around other people. Frequent hand-washing should be encouraged for everyone in the household. If you are concerned about symptoms, if the symptoms worsen, or if you have any questions, contact your primary care provider.

Additional Resources

Do You Feel Sick? graphic from Autism Nova Scotia 2020

Comfort Positions graphic from University of Michigan POKE program

Local health department testing center sites

COVID-19 Testing: What to Expect – video from Vanderbilt University Medical Center

Drive thru COVID-19 testing social story

In-office COVID-19 testing social story