'We're all experiencing somewhat of a mental health crisis'

War trauma compounds challenges faced by autistic children and their families

Much-needed routine, predictability, and consistency are taken away by rocket fire, displacement, and absence of loved ones since October 7. How can special-needs families cope?

Renee Ghert-Zand is the health reporter and a feature writer for The Times of Israel.

Illustrative image of autism (KatarzynaBialasiewicz; iStock by Getty Images)
Illustrative image of autism (KatarzynaBialasiewicz; iStock by Getty Images)

The brutal attack by Hamas on October 7 and the ensuing war have been traumatic for all Israelis. However, professionals who work with autistic children and teenagers report that they are experiencing more stress than their typically developing counterparts.

This appears to be largely related to the loss of familiar routine for many families with children with autism spectrum disorder (ASD) who have been internally displaced, lost a family member, or have family members or key supporters such as teachers and therapists fighting in the war.

“We know that autistic children depend a lot on routine and predictability, and on the ability to know that whatever their world looks like today, it will look the same way tomorrow. For all of us, that foundational assumption has been shaken,” said clinical psychologist Dr. Judah Koller, director of the Autism Child and Family Lab at the Hebrew University’s Seymour Fox School of Education.

Koller and his team diagnose, study, and work with autistic children and their parents to find the best ways to support them as family units. For this reason, Koller is keeping a close eye on how both these kids and their parents are faring.

“We’re all experiencing somewhat of a mental health crisis right now, whether we realize it or not. But for autistic children who rely on that ability to know that things will remain constant, the challenges that they’re experiencing are just going to be much more pronounced. That obviously will then have a ripple effect on their parents and their families and the systems that they’re in,” Koller said.

Withdrawing into oneself because of war trauma

Dr. Naomi Ferziger, faculty member in the department of occupational therapy in the faculty of health professions at Ono Academic College. (Courtesy)

Dr. Naomi Ferziger, senior lecturer in the department of occupational therapy at Ono Academic College, has been commuting weekly to Eilat from Jerusalem since the beginning of November. She was asked by OTI – The Israeli Autism Association to work with children with ASD who have been evacuated from their homes in areas close to the Gaza border. They are living in hotels and attending unfamiliar schools and afternoon activities held in tents.

She told The Times of Israel that she has found that the events of October 7 and the war have caused autistic children to pull more into themselves and regress in their abilities to communicate.

“In general, a lot of work with these kids is to get them to communicate, to express themselves and interact with other people. Something like this pulls them back into their own world and makes them want to be more on their own. Of course, each child is unique, but in a broad way we are seeing more of this detachment,” Ferziger said.

“If it’s an extreme case, a child who has severe autism, there might be self-harm because they have no way of communicating their feelings so they might express them by banging or throwing things, even at themselves,” she said.

Ferziger and the other specialists who are either from Eilat or who have gone down there especially to work with these children are using various approaches to help them incrementally open up.

“I have done long intake sessions with parents and I contact the children’s teachers and therapists from their home communities. I learn about the child’s strengths and the best medium for communicating with them — music, sensory experiences, art, whatever — and use that,” Ferziger said.

Illustrative image of a care worker and an autistic child. (Business Wire via AP)

Ferziger shared two examples of how she used this approach to help draw children out and get them to communicate what they are thinking and feeling during this difficult time.

In one case, she learned from a boy’s mother that he loves to play with Lego, so she brought a large set of the building blocks to the therapeutic play session. The boy worked with the Lego the entire session and did not say a word.

“He was just working, working, working and made something really amazing. I said at the end, ‘Would you tell me about this?’ He showed me that this was the policeman and he’s inside there, and this is where he can shoot from. And these are the people who work for the cyber, they’re going to give him the information that he needs. The whole context was war-based,” Ferziger said.

In a second instance, Ferziger worked with a girl who liked writing. Unbeknownst to the occupational therapist, the girl’s father had been murdered. She did not pick up on it when the girl insisted on a red cover for her notebook and only used black markers. It was only when the girl said she wanted to title the book, “Daddy is in the Grave,” that Ferziger understood.

“In the end, she decided to call the book, ‘Daddy,’ and just put together remembrances of him. She was able to do this, and also do other things and play nicely during our sessions. She could move from one thing to the next, but that loss was always present,” she said.

Illustrative: Child survivors of the brutal October 7 Hamas attack on Kibbutz Kfar Aza enjoy activities at Kibbutz Shefayim in central Israel, where they were relocated. December 24, 2023. (Michael Giladi/Flash90)

Studying wartime trauma of ASD kids and their parents

When the war broke out, the Autism Child and Family Lab uploaded to its website videos and other information for parents on how to help their children during times of war. However, Koller and his team felt that as part of their research mandate, they should conduct studies that could shed light on how to further help families.

The first is a yearlong longitudinal study that is underway and will continue until October 7, 2024. Working with his graduate students and partners at ALUT, the Azrieli National Centre for Autism and Neurodevelopment Research of Ben Gurion University, Bar-Ilan University, Koller is studying a cohort that includes 57 families with autistic children and 35 control families with neurotypical children. The children and teens involved in the study range from age 3 to 17.

The parents are being asked to provide updates online every two months by answering questions about levels of child trauma and parent well-being in terms of negative emotional states such as anxiety, stress, and depression.

Dr. Judah Koller, director of the Autism Child & Family Lab at the Hebrew University. (Asaf Koller)

The second study will be cross-sectional and look at a single point in time. It will involve many more children (autistic and not) and their parents. All will have been uprooted from their homes and sent to live in temporary or new locations. The study will look at what services for children with autism and their families got off the ground, how quickly, and how beneficial they were.

According to Koller, he and others in Israel are in an exceptional situation in that they can conduct serious, high-level research during an ongoing war. The downside has been that there is no relevant literature for him to look to.

“We were able to look at studies that have been done in other areas where there has been ongoing conflict and war, such as Ukraine. But very little that’s been done on autism, and nothing that compares the experience of autistic and typically developing children in a context [exactly] like this one,” Koller said.

Changing routines and locations pose ongoing challenges

Ferziger believes that the fact that she and other therapists have temporarily moved to Eilat or other locations where evacuee families have been placed has been important for ASD kids and teens.

“I have been here over eight weeks, and this continuity is super-important for the kids. OTI asked me to come here and stay for a while because they saw how some therapists were showing up at the beginning to see how traumatized people were and then left soon after,” Ferziger said.

Some families are now moving out of Eilat hotels to communities where they can be more settled. Ferziger said some of the teenagers she worked with were moving to Ofakim, and that they expressed their worry about going to yet another place.

“Parents are telling me the same thing. The challenge of having a child with special needs is compounded while living in a hotel, but now they are also worried about uprooting their kids again. It’s hard for everyone, but especially for these children and families,” Ferziger said.

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