When routines shatter: Autism, trauma, and the October 7 war
“Individuals with ASD are particularly vulnerable during crises due to heightened past stress and trauma,” Inbal Millo David explained.
Toni Eliashar Shekel Therapeutic Center in Jerusalem.(photo credit: SHEKEL)ByGIL LEWINSKY
Individuals with autism spectrum disorder (ASD), with a prevalence rate of up to 3% of the population, are a world unto themselves. While they share characteristics in common – such as a focus on routine, lack of social acuity, and heightened sensory perceptions – each individual is unique and perceives changes differently than the next. Due to their highly charged sensory perception, ASD individuals feel their surroundings in a heightened way, but many struggle to properly express their feelings. One mother of an adult individual with severe ASD said that some sounds may become extremely painful, comparing it to a “needle going through your ears.” It can lead to major reactions, which adds complications and stress to families during events such as air raid sirens. “He shuts his ears and bangs his head against the wall in response to sounds,” the woman said in relation to how her son responds to stimuli. “He really shouts and cries. You really could tell that he is in pain.”
A displaced family from the North – a mother and three daughters, the oldest with high-functioning ASD – shared their story. In the days after October 7, with no relatives to turn to and minimal government assistance, they moved between friends’ homes before seeking help due to the autistic daughter’s heightened needs, which included routine and special education. Eventually, after a disastrous stay in Tiberias, where noise caused a deterioration in the daughter’s condition, they found shelter in an 18-square-meter room in a kibbutz, where they lived for 10 months under difficult conditions. The daughter showed a marked deterioration: She became frightened of everything and didn’t want to go outside. Additionally, she became depressed, began to scream for long periods, and escalated into physical violence due to all the sensory stimuli and lack of stability.
“She had a lot of reactions. She needs order and routine, familiar places. Suddenly everything was changing. The father wasn’t with us, as he had to stay in the security squad of our original kibbutz. All the familiar things we knew were gone, especially for her – teachers, school, routine. She had a very hard time,” the mother said.
Eventually, she found an apartment, which stabilized the situation; but she commented on the near zero support she received from the authorities. “We were alone. No one assisted us at first. No one thought that these kids needed these special treatments. Nothing.”
Needing support during Israel-Hamas War
Inbal Millo David is a clinical psychologist and head of Shekel’s Trauma Center. For people with disabilities, Shekel has clinics in Jerusalem, Beersheba, and Petah Tikva that provide psychological and emotional therapy. Following the events of October 7, Millo David’s clinic redirected its focus to support families affected by conflict. “Recognizing the urgent need for psychological assistance, we swiftly launched an emergency hotline and deployed teams to hotels and evacuation centers to ensure that vulnerable individuals received immediate mental health support,” she said.
Autism is a complex neurodevelopmental disorder and is not a mental illness. It is also not seen as something that should be ''cured.'' (Illustrative) (credit: PIXABAY)
“Individuals with ASD are particularly vulnerable during crises due to heightened past stress and trauma”, she explained. “This vulnerability stems from challenges in navigating a world that often fails to meet their needs, such as difficulties interpreting social interactions and a continuous experience of sensory overload. These factors also hinder emotional regulation.”
Families of individuals with ASD face immense challenges during crises. Millo David highlighted daily scenarios such as a mother unable to bring her child to a shelter during a siren alert, forcing her to choose between staying with her child or joining her other children in shelter.
Coping mechanisms for individuals with ASD differ significantly from those of neurotypical individuals, primarily due to variations in adaptability and social communication. “Many rely on routines, sensory avoidance, repetitive behaviors, and hyperfocus, which can become rigid and isolating,” Millo David noted. However, respecting these coping mechanisms is essential, and her team addresses them with tailored strategies. For example, social stories prepare individuals for unavoidable changes in routine, reducing anxiety. Sensory-based techniques, such as calming objects or earplugs, help manage sensory overload.
To support individuals with ASD after traumatic events, Millo David recommended creating safe, structured environments with predictable routines. She believes that trauma-informed care, training for staff, and integrating emotional regulation exercises into daily activities are essential. Caregivers should be offered regular guidance and support, and access to mental health professionals can ensure consistent assistance. “Regular check-ins with the necessary support personnel, focusing on feelings of safety and control, alongside emotional validation, are critical for helping individuals cope and recover effectively,” Millo David asserted.
Policy changes should focus on stabilizing the workforce of qualified professionals and creating robust systems for guidance and support. “The war has highlighted significant vulnerabilities in the system, particularly the high turnover of staff, driven by the overwhelming emotional and mental demands of the job,” she said. “I believe policy changes must tackle this issue by investing in highly qualified professionals and building comprehensive systems of support and guidance for teams”.
Dr. Judah Koller, head of the Autism Child and Family Lab at Hebrew University, has been investigating the effects of October 7 and the ensuing war on autistic children and their families, in conjunction with a team of doctoral students and collaborators. This study looked at child and parent trauma, and parental emotional well-being (depression, stress, anxiety). Data collected within 30 days of October 7 indicated that while both autistic and non-autistic children experienced clinically significant trauma symptoms, the effect was exacerbated in the ASD group. The results also revealed found that parents of autistic children showed higher levels of stress, depression, and anxiety. Comparing these findings to similar data collected prior to October 7, Koller found that parents of autistic children were reporting levels of stress, anxiety, and depression that were two to four times higher than those reported by an independent sample prior to the war.
Koller and his team continued to track these families for a year, collecting similar data every two months. These findings were recently presented by PhD student Tanya Nitzan at an international conference in Jerusalem. Koller summarizes these follow-up findings, focusing on a message of resilience.
“At the first time point, we saw significantly elevated responses and dire need for immediate support,” he said. “Data collected over the following year, which is not yet published, points to an encouraging trend, where both autistic and non-autistic children and their parents showed significant improvement in terms of trauma and emotional well-being.”
However, other traumatic events can compound one another, briefly igniting the symptoms, albeit to lesser extremes. Koller noted, “We saw a marked peak in child trauma that coincided with the Iranian missile attack.”
Koller believes that this research opens a window into a novel area of support for autistic individuals, with a focus on an institutional and policy level. “I think the main takeaway for us, on a policy level, is that this is a population that in times of trauma, stress, and disaster are in need of additional and targeted support. This needs to be considered in the amount and quality of support provided to this population.”
A poll taken in November 2024 by the Israeli Society for Autistic Children (ALUT) and the Israel Autism Association (OTI) indicated that the war has taken its toll on ASD individuals and their families. Among the results revealed, 81.8% of parents reported adverse effects of the war on their children. Significant disruptions of routine from noise (from rockets, sirens, and interceptions) were noted in 54.2% of respondents. Other significant reactions included general anxiety in 44.4% of cases; disruption of routines in 43.6%; and lack of access to educational frameworks in 31.6% of cases.
Adv. Tzipi Nagel Edelstein, CEO of OTI, responded to the poll results with the following statement:
“The war takes a heavy toll on individuals with ASD, especially those displaced from their homes, children who cannot attend tailored educational and therapeutic frameworks, and those whose daily routines are disrupted. ALUT and OTI have been working for years to raise public awareness about ASD. With a continuous rise in ASD diagnoses globally and in Israel, we must persist in raising awareness and advocating for equality and acceptance of people with ASD. We urge the public to contribute to this important cause.”■
