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תהליך גמילה מחיתולים - שיקולים לפני התחלת התהליך - למאמר בעברית A toilet training process is a part of children’s typical development. A transition between infancy and early childhood, into the adult world. Similar to different developmental stages, when everything goes smoothly, it is a transitional stage, quite quick, a little burdensome but also exciting and joyful. Among autistic children, there are often difficulties in the process and it does not go smoothly. Despite the parents’ prior knowledge, correct intuition, and advice from the surroundings, something does not flow, something gets stuck and the process becomes very prolonged. Sometimes there does not seem to be any readiness at all. The child will not alert before or after having a bowel movement or urinating. Sometimes different habits from what is customary will become fixed, such as having a bowel movement or urinating while standing instead of squatting. Refusal to sit on the toilet, lack of sensation, when am I dirty and wet and what needs to be done about it, inappropriate preoccupation with bowel movements and urine, refusal to stay in a diaper. As time passes and the child grows, the gap between him and his peers in this area deepens, and dealing with the subject becomes much harder, much more burdensome for the entire household routine. Frustration, guilt, anger, and disgust are added. these feelings feed one another, and influence the family’s ability to enter another toilet training process. With a child who is not toilet trained and uses diapers, the problem is present but relatively easy to manage, and the home is already used to it. With a child in a toilet training process, every time leaving the house becomes very complicated. Staying in public places, when there is a chance that the child will have an accident in his pants, becomes very embarrassing, and difficult to cope with, and also at home, getting dirty, endless laundry, smells. The parents are already tired, this part negatively affects the quality of life of the child, but also of the parents and of the siblings. There is an expectation that the child will already learn, but also despair, that this will never happen and that this problem has no solution. When approaching building a toilet training plan for a child, it is recommended to adapt the method to the child, and not the child to the method. תהליך גמילה מחיתולים - שיקולים לפני התחלת התהליך - למאמר בעברית Building a toilet training plan for an autistic child requires deep familiarity with him. His habits, his food selectivity, his liking for certain places in the home, his areas of interest, which seem completely unrelated to the topic but are very significant: What does he like? To hear, to touch, to do, to see. Familiarity with his daily routine and that of his family. What changes is the family capable of and which are they not? Familiarity with the bowel movements and urination themselves, constipation, sensitivity, pain, diarrhea. Familiarity with his fears and his sensory regulation ability, how is he with the cold of the toilet seat? With the sound of the water, with the splashes that are felt? With the small room, with the lighting. Familiarity with his personal pace, in what steps will we be able to move forward, what will make him trust us so much that he will be willing to reduce control and give himself over to a change that touches his private body. To the almost only place, over which he has full control (alongside what he puts into his body, what he eats and what he drinks). It is not always worthwhile to enter a toilet training process. Sometimes we will reach a joint conclusion that the time has not yet come and the timing is not suitable, we will always want to start from an assumption of the child’s capability, the key is to find the right way for this child, and to walk at a pace that suits him/her. Even if stages take longer than expected. The parents know their child best. The information the parents provide, their dedication to the tracking processes that need to be carried out, and to changes in the family’s daily routine, help very much in building a toilet training plan, whose chances of success are higher. 🟢 For all updates on autism and events at our center, join our quiet WhatsApp group 🟢

מה עוזר לילדים אוטיסטים לדבר? - למאמר בעברית A large new study (2025) examined 707 autistic children of preschool age (15 to 68 months) who received evidence based early interventions, in order to understand how many of them make progress in speech and which children remain with significant difficulty despite treatment. The researchers did not settle for asking whether there is treatment, but asked a much more important question for parents: How can we refine the intervention to increase the likelihood of the children developing spoken language? They compared several well known types of interventions, including intensive behavioral intervention, NDBI approaches (including approaches such as ESDM, PRT, JASPER), as well as the TEACCH approach. They also examined factors such as age at the start of treatment, duration of treatment, level of cognitive ability, ability to imitate movements, and social and adaptive functioning. The findings: About two thirds of the children who did not speak at the beginning did begin to use single words or more by the end of the intervention. About half of the children who had limited verbal ability (single words) at the beginning of the study were later able to combine words into short sentences or reach a more advanced level of speech. But still, about one third of the children with little or no speech at the beginning did not progress to a meaningful level of speech during the treatment period examined. מה עוזר לילדים אוטיסטים לדבר? - למאמר בעברית What characterized the children who did not succeed in acquiring speech? weaker motor imitation lower cognitive ability lower adaptive functioning more pronounced autistic symptoms later start of treatment The researchers also found that the duration of treatment (in weeks) was more important than its intensity, at least in the context of progressing to a more advanced stage of speech. In other words, continuity, consistency, and more time with the intervention may be very meaningful. Among all evidence based approaches, no clear advantage was found for one intervention over another in terms of progress in speech. The practical meaning of the study The primary insight from the study is that most children who receive evidence based interventions do make progress. Even when there is no immediate progress in speech, it is possible to identify earlier who is at risk and adjust the intervention accordingly. The researchers especially emphasize the importance of working on early skills such as motor imitation, social communication, and cognitive abilities, as these may support language development. They also note that it is important to consider, when needed, support through augmentative alternative communication, and not rely only on speech. The use of a tablet or communication cards as augmentative communication does not prevent language development and may even encourage it. מה עוזר לילדים אוטיסטים לדבר? - למאמר בעברית The full article: Vivanti, G., Lombardo, M. V., Zitter, A., Boyd, B., Dissanayake, C., Dufek, S., & Watson, L. (2025). Proportion and Profile of Autistic Children Not Acquiring Spoken Language Despite Receiving Evidence-Based Early Interventions.  Journal of Clinical Child & Adolescent Psychology , 1-18.‏  https://doi.org/10.1080/15374416.2025.2579286 🟢  For all updates on autism and events at our center, join our   quiet WhatsApp group   🟢

תת אבחון של של אוטיזם בבנות, האם כלי האבחון שלנו מפספסים? - למאמר בעברית Diagnosing autistic girls is a complex issue. Since most commonly used diagnostic tools have been validated primarily on boys, and given that autism in girls may present differently than in boys, diagnosing girls is often more challenging. A new Israeli study, conducted at the Hebrew University and in Ramat Gan and published in an international medical journal, examined the characteristics that autistic boys and girls display at the time of their initial referral for diagnosis. The findings of this study should be of interest to any parent raising questions about autism, and especially to parents of girls. What did the researchers find? The study included 135 children (69 boys and 66 girls), all referred for assessment due to suspected autism. All the children were similar in age and cognitive ability. Parents completed questionnaires about social and behavioral functioning. The children underwent a semi-structured diagnostic assessment (ADOS) and an in-depth parent interview (ADI), and their empathy and daily functioning (such as communication, independence, and social behavior) were also evaluated. The surprising finding was this: According to the parent-report questionnaires, girls showed more autistic symptoms than boys across all measures. However, according to the classic diagnostic tools, ADOS and ADI, there were almost no differences between boys and girls. In other words, girls are referred for diagnosis when their difficulties are already very noticeable at home, but the tools used to measure and diagnose autism do not always reflect that they have higher levels of symptoms than boys. תת אבחון של של אוטיזם בבנות, האם כלי האבחון שלנו מפספסים? - למאמר בעברית And what about empathy and daily functioning? Here, the picture becomes even more complex: Autistic girls received higher scores in empathy, especially in cognitive empathy, the ability to understand what others feel and think. Among girls, higher empathy was associated with better daily functioning. In other words, more empathetic girls tended to function better in everyday life. Among boys, this relationship was almost absent, empathy did not predict their level of functioning. In addition, it was found that among girls, the link between symptom severity and daily functioning was much stronger than among boys. In other words, the same severity score in a boy and a girl does not necessarily reflect the same level of difficulty in real-life functioning. So why are so many girls missed? The researchers explain that girls are often more socially adaptive: they learn to imitate, understand social codes, and show empathy, sometimes at the cost of a significant internal emotional load. The environment (including teachers, kindergarten staff, and even professionals) tends to interpret girls’ difficulties as shyness, anxiety, or sensitivity, rather than immediately considering autism. In addition, most diagnostic tools were originally developed based on samples of boys, and are therefore better suited to identifying the more typical presentation of autism in boys, and less sensitive to the ways autism may present in girls. We have written in other posts about diagnosing autism in girls and about the characteristics of high-functioning autistic girls. תת אבחון של של אוטיזם בבנות, האם כלי האבחון שלנו מפספסים? - למאמר בעברית What does this mean for parents? If you are parents of a girl with social, emotional, communication, or behavioral difficulties, don’t assume that if she appears empathetic, social, or high-functioning, she is not autistic. According to the research, autistic girls can appear highly empathetic, and still struggle with significant underlying difficulties. If your intuition tells you that something doesn’t quite add up, it’s worth insisting on a thorough, gender-sensitive assessment. It’s also important to share with clinicians the full picture of everyday life at home: how she is after school, how much energy it takes for her to hold herself together, whether there are meltdowns, extreme fatigue, or anxiety. These are things that a brief clinic-based assessment does not always capture. What does the research suggest for the system? The main takeaway from the findings is the need to develop diagnostic frameworks that are tailored to girls, rather than trying to fit girls into criteria that were originally built based on boys. It is also important to emphasize that even when boys and girls receive the same scores on diagnostic tools, we must ask how this translates into daily life, because in girls, the same numerical severity may sometimes be associated with more significant functional impairment.   The article: Shulman, C., Nir, Z., & Bitton, D. (2026). Gender Differences in Autism Presentation at Initial Clinical Referral: Diagnostic Measures, Empathy, and Adaptive Functioning.  Medical Research Archives ,  14 (1).‏  DOI: https://doi.org/10.18103/mra.v14i1.7164 🟢  For all updates on autism and events at our center, join our   quiet WhatsApp group   🟢

להיות אחים של ילדים אוטיסטים - למאמר בעברית A diagnosis of autism in one of the family members affects not only the child and the parents but also additional circles, the brothers, the sisters, the grandfathers, the grandmothers and others. The effects have been examined in quite a few studies, including in Israel and include many insights, in addition to recommendations for successful coping, one that makes the complex situation accessible to siblings and safeguards their emotional state. In general, it is important to provide brothers and sisters of autistic children with a clear and honest explanation, to involve them in a planned way in the treatment when possible, and to intentionally attend to their emotional needs as well. What should be explained to siblings about autism? One of the first questions that arises for parents is what to explain to the other children regarding the diagnosis of a family member. Psychoeducation is the provision of a simple and clear explanation about an emotional or developmental condition, in order to help understand what is happening and how to cope. It has been found that for most brothers and sisters, psychoeducation reduces anxiety and guilt and improves their attitude toward their sibling on the spectrum. Key principles: Use clear, concrete, and age appropriate language: for example, “Autism is a different way the brain works, and it can make speaking, playing with others, and coping with noise and changes more difficult.” Emphasize: “It is not your fault” and “It is not bad behavior”: connect behaviors to communication difficulties, sensory sensitivity, or a need for routine, rather than to meanness or poor upbringing. Provide a personal picture: explain how autism looks specifically in the sibling in the family (needs routine, gets startled by noise, needs help with shared play, and so on). Normalize mixed emotions: love and pride alongside jealousy, frustration, embarrassment, or guilt, and say explicitly that it is okay to feel several things at the same time. Invite questions over time, not just one big conversation: understand that the child will return to the topic at different stages, according to age and development. A simple example for young children: “Your brother has something called autism. It means that his brain feels noises and changes more strongly, and sometimes it is hard for him to speak or play like others. The adults are helping him learn, and it is not because of you.” להיות אחים של ילדים אוטיסטים - למאמר בעברית How can we protect the mental health of siblings? Siblings of autistic children are at a slightly higher risk for anxiety, stress, and emotional difficulties, especially when there is a heavy load at home. Therefore, it is important to pay attention to several principles: Personal time with a parent: set times when the parent is available only for the neurotypical sibling, without the sibling on the spectrum, so that they feel important in their own right. Make space for all emotions: encourage them to say “It is hard for me,” “I am embarrassed,” “I am angry,” and respond with empathy, not only with messages about being strong. Teach coping skills: how to breathe and calm down, whom to turn to when things are difficult, how to ask for help, and how to take a break when there is overload. Create space for group support: sibling groups, guided meetings, or even planned conversations with other children in a similar situation can normalize the experience and reduce loneliness. Be attentive to signs of distress: a sharp change in sleep, decline in school performance, withdrawal, recurring physical complaints, and consider referral to a professional when needed. How can siblings be involved in intervention? Research shows that siblings can learn simple skills and use them to improve play and communication with their sibling on the spectrum, and this can benefit both sides. Practical and safe guidelines: Teach 2 to 3 clear helping skills, how to gain attention, how to offer a choice, how to wait, how to use a picture, gesture, or sign. Set a short special play time of 10 to 15 minutes in which the siblings play together while using these skills, with the presence and support of an adult. Include siblings in the planning, ask what they enjoy doing together, Lego, ball games, pretend play, and incorporate this into the goals. Be careful not to turn the sibling into a little therapist, keep the role defined, time limited, and avoid placing ongoing caregiving responsibility on them. להיות אחים של ילדים אוטיסטים - למאמר בעברית Differences in coping between an older sibling, a younger sibling, and a middle child of a child on the spectrum Within the family structure, each sibling experiences autism through a different lens. Older siblings tend to take on excessive responsibility and often become a third parent, looking after their sibling’s safety and helping the parents. In contrast, younger siblings may develop a pattern of excessive self sacrifice, as they learn at a very early age that their needs are secondary to those of the diagnosed sibling, which may lead to self neglect. Middle siblings, those who are chronologically in between, often find themselves in a double and probably the most complex difficulty. They are expected to show maturity and responsibility toward the younger ones, and at the same time to give in and adapt to the sibling on the spectrum. The key to healthy coping does not lie in a desperate attempt to divide resources equally, since equality is not necessarily justice. Instead, one should strive for allocation according to individual need. Each child needs to feel that they are receiving what they need at that moment, whether it is a deep conversation, separate quality time, or simply recognition of their effort. This allocation must be dynamic. It changes with age, with periods of crisis or calm, and with the changing capacity of each family member to contain the situation. This understanding frees parents from the guilt of inequality and allows them to build resilience based on seeing each child as a whole world in their own right. The challenges and advantages of being a brother or sister of a child on the spectrum The challenges that it is important to keep a finger on the pulse regarding are: A sense of loneliness - The increased parental attention devoted to treatment and meeting the needs of the diagnosed child may at times lead to feelings of loneliness in the sibling who is not diagnosed. Early responsibility and excellence - By force of circumstances, one of the processes observed among siblings of diagnosed children is called parenting the sibling. The non diagnosed siblings may become a kind of additional parent at home. They feel a responsibility placed upon them to be fine, to excel in school and in other areas, not to ask for things, not to disturb, not to burden the parents, or even not to argue with the diagnosed sibling, which is very typical between siblings. Concerns about the future - Another phenomenon that we identify at later ages is siblings’ concerns about the future of their diagnosed brother or sister. Who will take care of them when the parents no longer can, how will they find work, will they be able to marry and start a family?                                                                                                                                                         Advantages: Development of high empathy and social sensitivity - Siblings of children with special needs often develop a strong capacity for empathy toward others. They learn to read nonverbal cues, body language, tone of voice, quiet distress, at a very early stage in life and to develop a high capacity for emotional containment. They understand that every behavior has a reason, even if it appears strange on the outside. This may turn them into friends and partners who are able to deeply understand other people, even without words. Tolerance and acceptance of difference as a way of life - For these siblings, difference is part of everyday life at home, and therefore it is not threatening. They develop resilience to social stigma. They see the person behind the diagnosis. In many cases, siblings become ambassadors of tolerance in their environment, at school or in youth movements, when they teach their peer group how to approach and accept someone who is perceived as different. Emotional maturity and a sense of competence - Due to the family circumstances, these siblings are often required to show greater responsibility. They learn to regulate their emotions, for example, to remain calm when their sibling experiences an outburst, and to function under pressure. Their maturity is reflected in the ability to distinguish between what is essential and what is secondary. They understand at an early age what the real problems in life are, which gives them a sense of proportion that their peers may not yet have. Capacity for emotional containment and cognitive flexibility - Life alongside autism requires constant improvisation and flexibility, changes in plans, adaptations of the environment. Siblings become very creative in finding ways to communicate or play with their brother or sister. This flexibility is a tremendous asset in adult life and in the world of work, the ability to adapt to changing situations and to solve problems without breaking down. Where is the line between healthy involvement of siblings and excessive emotional burden? The key word is balance . On the one hand, to share, to teach skills, to give space to be part of the family story. On the other hand, to protect from overload, not to expect the sibling to solve every crisis, not to impose ongoing supervision, and not to turn them into caregivers instead of parents and professional therapists. להיות אחים של ילדים אוטיסטים - למאמר בעברית Summary of research based guidelines for working with siblings of autistic children Aspect Evidence‑based guidance Key references Psychoeducation Provide repeated, age‑appropriate explanations, normalize mixed feelings, and invite questions. Understanding the disability reduces anxiety and increases empathy. Role in treatment Use structured, time‑limited sibling‑mediated strategies (e.g. play skills), with training and supervision. The goal is to improve the relationship, not to turn the sibling into a caregiver. Limits on responsibility Avoid chronic caregiving expectations; high responsibility is a risk factor for poorer mental health. Excessive responsibility is a risk factor for poorer sibling mental health. Family climate Promote open communication, warm support, and fair attention; these predict better quality of life and resilience. These predict high quality of life and psychological resilience among siblings. External support Offer sibling groups or therapy when there are signs of distress, especially with loaded family psychiatric history. The peer group (other siblings) constitutes a significant protective factor.   In conclusion, you as parents are the pillars of the family. When you are well, the children will be well. First and foremost, take care of yourselves and seek the support that is right for you, so that you can also be there for your children.        References: Quatrosi, G., Genovese, D., Amodio, E., & Tripi, G. (2023). The quality of life among siblings of autistic individuals: A scoping review. Journal of Clinical Medicine , 12 (3), 735. doi: 10.3390/jcm12030735 Rosen, N. E., McCauley, J. B., & Lord, C. (2022). Influence of siblings on adaptive behavior trajectories in autism spectrum disorder. Autism , 26 (1), 135-145. Shivers, C. M., & Plavnick, J. B. (2015). Sibling involvement in interventions for individuals with autism spectrum disorders: A systematic review. Journal of Autism and Developmental Disorders , 45 (3), 685-696. DOI: 10.1007/s10803-014-2222-7 ‏ Walton, K. M., & Ingersoll, B. R. (2012). Evaluation of a sibling-mediated imitation intervention for young children with autism. Journal of Positive Behavior Interventions , 14 (4), 241-253. doi: 10.1177/1098300712437044 ‏ Wolff, B., Magiati, I., Roberts, R., Pellicano, E., & Glasson, E. J. (2022). Risk and resilience factors impacting the mental health and wellbeing of siblings of individuals with neurodevelopmental conditions: A mixed methods systematic review. Clinical psychology review , 98 , 102217. https://doi.org/10.1016/j.cpr.2022.102217 ‏ ‏   🟢  For all updates on autism and events at our center, join our   quiet WhatsApp group   🟢

השפעות מלחמה על ילדים עם צרכים מיוחדים ודרכי התמודדות מבוססות מדע - למאמר בעברית Most of the current scientific knowledge regarding how children with special needs cope during war comes from two countries, Ukraine and Israel. Recently several studies have been published that examined the impact of war on children, with an emphasis on children with special needs and the effective ways of coping in this complex situation, as well as ways to protect the mental well being of children. Children with special needs in war zones Children with special needs in war zones show higher rates of distress and mental health disorders compared to their peers, but there are evidence based ways to reduce risks and support coping for both children and caregivers. What do we know about the impact? Autistic children in Israel after October 7 2023: A study from 2025 examined 228 Israeli children (134 autistic, 94 non autistic) within 30 days of the October 7 2023 attack and the war that followed. Almost all children had some form of war related exposure, but autistic children showed greater worsening in anxiety, especially fear of physical injury, panic attacks and agoraphobia, fear of public places. Parents of autistic children reported depression, anxiety and stress significantly higher than parents of non autistic children, at levels 2–4 times higher than groups of parents of autistic children before the war, highlighting the need for early identification and targeted support for this group. In another Israeli study from 2024 of parents of autistic children (ages 3–17 years), 81%-88% scored above the clinical cutoff for post traumatic stress on a child and adolescent trauma screening questionnaire, with autistic preschool children showing significantly higher symptoms than their non autistic peers. Disruptions such as school closures (23% of autistic children were not in an educational setting) and interruptions in therapies (47%) increased vulnerability, highlighting the importance of maintaining routine and providing adapted support. Information from around the world: Across different wars exposure has been consistently associated with post traumatic stress disorder anxiety depression aggressiveness anger physical or verbal violence and increased attention symptoms similar to ADHD among children and adolescents. Data from conflict zones indicate that PTSD rates among children exposed to war can reach 30%–70% especially under conditions of repeated exposure and displacement from their homes. Children with developmental disabilities including autism are described as a particularly vulnerable subgroup. A mapping study on the Russia Ukraine war highlights that children with disabilities living in institutions are at very high risk of exclusion from services and basic protections which requires active identification and adapted support. Why are children with special needs particularly vulnerable? Autistic children often have increased sensory sensitivity a strong need for routine and communication challenges. These characteristics make sirens explosions crowding and displacement from home factors that disrupt regulation in these children. Children’s reliance on structured routines familiar caregivers and specialized educational settings means that school closures evacuation and staff turnover remove key regulatory supports exactly at the moment when stress is at its peak. Children with disabilities living in institutions are at particular risk when institutions suffer from shortages of resources are evacuated chaotically or become disconnected from supply chains (from research conducted in Ukraine). השפעות מלחמה על ילדים עם צרכים מיוחדים ודרכי התמודדות מבוססות מדע - למאמר בעברית What helps? Evidence based principles Several important principles have been identified in order to maintain children’s mental health during war: Safety - refers both to physical safety and emotional safety: Physical safety: A protected and accessible place that the child knows and understands where to go during a siren who is responsible for them and where there is no immediate danger such as shooting violence or neglect. For example in many cases children sleeping in the protected room greatly contributes to their sense of physical safety. Emotional safety: As much as possible familiar figures such as parents caregivers and familiar staff create emotional safety. The adults around the children should as much as possible convey relative control consistency and a calming stance. Not denying fear but also not collapsing in front of it. It is important to provide protection from information overload difficult images background news and disturbing videos on WhatsApp and similar sources. For autistic children safety also includes sensory protection reducing noise as much as possible for example lowering the alert sound on the phone visual overload or unexpected touch. Predictable routine - A child’s mind and emotional state are calmer when the child knows what is going to happen especially during war situations in which everything feels chaotic. Here are several principles for a daily routine at home or in a residential setting: - A fixed time for waking up changing clothes not staying in pajamas and eating breakfast. - Studying in Israel learning during emergency periods takes place on Zoom. Although the learning is not always effective from a didactic perspective the regular and stable meeting in which children see familiar faces of friends and educational staff has very important psychological value. It is an event that creates an island of stability during a chaotic event such as war. For autistic children continuity of educational and therapeutic frameworks even in a reduced form or remotely has been found to be critical for maintaining family quality of life. - Board games or shared movement activities can reduce tension and improve mood. - Screen time is a sensitive issue in routine and even more so during emergencies. Children will spend more time than usual on screens this is okay natural and human and parents also need quiet and rest. At the same time it is recommended to set fixed times even if they are longer than usual. Screen time can also be divided into defined periods in the morning at noon and in the evening. - It is recommended to maintain the regular bedtime routine including a shower dinner and if customary reading a story or in the case of older children reading a book independently before sleep. The goal is to create stability within chaos even if there are sirens and evacuation there are parts of the day that are predictable and consistent. Responsive and sensitive parents - The child needs an adult who notices signals of distress understands their needs and responds to them in a timely and adapted way. This is one of the central components in maintaining children’s psychological resilience during war and these are the recommended principles and emphases: Recognizing the signs: identifying that the child is overwhelmed distressed withdrawn struggling to regulate not only when they already explode. Interpreting the signs: understanding whether it is anxiety sensory overload difficulty with change hunger or fatigue. Parents know their children best!! Responding in an adapted way: sitting next to the child speaking calmly and quietly touching only if it helps them. Offering choices such as "do you want to lie down with a blanket or sit next to me?", "do you want headphones or to put on quiet music?". Regulating together: breathing a familiar game or a transitional object. For children with communication difficulties: Use alternative communication methods (pictures a communication board gestures) to understand what the child feels and wants. Pay special attention to changes in behavior as a sign of distress such as increased aggression avoidance or an increase in repetitive movements. The goal: that the child does not feel alone with the anxiety. There is a consistent figure who responds to them and does not ignore collapse or become frightened by them. Health and nutrition as a foundation for mental health in emergencies This may sound technical and obvious but for developing brains and especially in situations of trauma it is a foundation for mental health. Health: - Access to regular medications ADHD epilepsy psychiatric medications and maintaining treatment continuity as much as possible in order not to add further difficulties in regulation. - Treatment of acute illnesses such as tooth pain stomach pain asthma. Physical pain can mix with anxiety. - Sleep is very important for mental health therefore as much as possible it is recommended to maintain fixed sleep times a bedtime routine and reduce screens about two hours before sleep. Nutrition: - Regular meals as balanced as possible with fluids even if the menu is limited. - For children who are selective in eating it is recommended to prepare in advance foods that the children are willing to eat even in an emergency. - Avoiding as much as possible excessive consumption of sugar and caffeine which may increase hyperactivity and anxiety. If the child does not sleep is hungry is sick or without medication any emotional intervention will be much less effective.   Protecting parents - - Reviews show that parents mental health and quality of caregiving are key protective factors that buffer between exposure to war and child symptoms. - Receiving psychosocial support maintaining social connections and economic security are the factors found to be most important in protecting parents mental health. השפעות מלחמה על ילדים עם צרכים מיוחדים ודרכי התמודדות מבוססות מדע - למאמר בעברית References: Barbic, S., Lochman, J. E., Tol, W. A., Jordans, M. J. D., et al. (2026). Evidence-based mental health interventions for children in fragile and humanitarian settings: An individual participant data meta-analysis.  Evidence-Based Mental Health . Advance online publication.​ Doron, G., Gordon, I., Tenenbaum, E. J., & colleagues. (2025). Psychological distress in autistic and non-autistic Israeli children following terrorism and war.  European Child & Adolescent Psychiatry . Advance online publication. Hunt, X., Betancourt, T., Pacione, L., Elsabbagh, M., & Servili, C. (2021). Commentary: children with developmental disorders in humanitarian settings: a call for evidence and action.‏ DOI: https://doi.org/10.33682/6vgm-5n34 Karni-Visel, Y., Roth, D., Lev, S., & Werbeloff, N. (2025). Quality of life and mental health in families of children with developmental disabilities during wartime.  Psychological Trauma: Theory, Research, Practice, and Policy, 17 (7), 1434–1442.  https://doi.org/10.1037/tra0001941 ​ Kovacs, M., Dovbysh, S., & colleagues. (2023). Change in child mental health during the Ukraine war.  European Child & Adolescent Psychiatry, 32 (7). McElroy, E., Hyland, P., Shevlin, M., Karatzias, T., Vallières, F., Ben-Ezra, M., ... & Martsenkovskyi, D. (2024). Change in child mental health during the Ukraine war: evidence from a large sample of parents.  European child & adolescent psychiatry ,  33 (5), 1495-1502.‏ doi:  10.1007/s00787-023-02255-z Rachamim, L., Aloni, R., Mualem-Taylor, H., Glickman, O., Goodman, A., & Laor, N. (2025). “Children of war”: examining the associations between war exposure, maternal PTSD, and continuous traumatic stress on Israeli children’s PTSD.  Research on Child and Adolescent Psychopathology ,  53 (7), 1047-1059.‏ doi:  10.1007/s10802-025-01321-1 Rozenblat, S., Nitzan, T., Matz Vaisman, T., Shusel, R., Rum, Y., Ashtamker, M., Golan, O., Dinstein, I., & Koller, J. (2024). Autistic children and their parents in the context of war: Preliminary findings.  Stress and Health, 40 (5), e3442.  https://doi.org/10.1002/smi.3442 ​ Sennersten, F., Frogh, S., Påhlsson, S., Wladis, A., Alvinius, A., & Bäckström, D. (2025). The Russo-Ukrainian War’s toll on paediatric health during the first two years and future research directions: a scoping review.  Communications Medicine ,  5 (1), 431.‏ doi:  10.1038/s43856-025-01190-1 Shaked-Ashkenazi, S., Bar, I., Oliver-Aronson, L., Horesh, D., Eden, S., & Golan, O. (2025). Psychological distress in autistic and non-autistic Israeli children exposed to war and terrorism.  Journal of Psychiatric Research ,  188 , 266-270.‏ DOI:  10.1016/j.jpsychires.2025.05.073 Yildirim, S., Gutierrez-Torres, M. A., Byansi, W., Ventevogel, P., Bosqui, T., & Betancourt, T. S. (2026). Evidence based mental health interventions for children in fragile and conflict affected settings: expanding reach and system strengthening.  bmj ,  392 .‏ doi:  10.1136/bmj-2025-086043 🟢  For all updates on autism and events at our center, join our   quiet WhatsApp group   🟢

Purim brings joy, costumes, noise-makers, and a lot of sensory input, which can be especially challenging for autistic children. Purim is a very confusing holiday: suddenly, people don’t look the way they usually do. They have the same voice but a different appearance. There are many changes and sensory stimuli, which can lead to sensory overload. Coping with all this requires a lot of energy. Here are some key tips to help make the holiday a more pleasant and adapted experience: 🎭 Choosing the Right Costume ✔ Comfortable materials : Choose a costume made from soft, non-irritating fabrics, without itchy tags or uncomfortable accessories. ✔ Allowing control : If a child doesn’t want to dress up, consider a symbolic item like a hat or a T-shirt with a favorite character. You can also send the costume to school or kindergarten so they can try it on when they feel ready. ✔ Gradual exposure : Introduce the costume in advance through play, gradual try-ons, or even a story about the character. 🔊 Coping with Noise and Sensory Stimuli ✔ Noise-canceling headphones  🎧 can be helpful in noisy environments (noise-makers, parties). ✔ Preparation in advance : Show pictures or videos of Purim events and explain what will happen to reduce anxiety. ✔ Planning breaks : Identify a quiet place in advance where the children can retreat if they feel overwhelmed. 🗓 Maintaining Routine and a Sense of Control ✔ Create a clear schedule : Explain in advance what the child can expect on Purim. ✔ Choosing activities : Participation is not mandatory; allow children to decide which activities suit them best. 🎁 Personalized Mishloach Manot (Gift Packages) ✔ For children with food sensitivities, prepare a package with their favorite snacks or small toys instead of candy. 💡 The most important thing is to listen to the child and respect their needs! Go at their pace. Costumes are not a must. Purim can be a fun and positive experience when planned with the right adaptations. Don't hesitate to adjust and find what works best for your child. 🎉 Wishing everyone a happy and customized Purim!  🎉 🟢  For all updates on autism and events at our center, join our   quiet WhatsApp group   🟢

התנהגויות מאתגרות בקרב אוטיסטים - למאמר בעברית Have you ever felt trapped inside a body that does not listen to you, while those around you speak to you as if you are a baby? For many children with communication and motor difficulties, this is their everyday reality. When we encounter challenging behaviors at home, in the classroom, and outside: Shouting, hitting, outbursts, and self-injury, it is easy for us to focus on putting out fires and reacting to violence. But what if we change our perspective and become detectives? Much of what is shared in this post is drawn from the experiences of non-speaking autistic individuals who were able to express their feelings through typing or writing. התנהגויות מאתגרות בקרב אוטיסטים - למאמר בעברית The Iceberg Model: What lies beneath the surface? Violent behavior is only the tip of the iceberg, above the water we see the act, but beneath it lies an entire world of frustration: Helplessness and lack of control: A child who feels they have no influence over their reality (when they eat, what they learn, who touches them, when something ends) accumulates frustration that can turn into violence as an attempt to regain control. Absence of language: Imagine you are thirsty or in pain and have no way to say it. Without tools for augmentative and alternative communication (AAC), the frustration can turn into a physical outburst. Sensory overload: Sometimes the lights are too bright, the scraping of chairs is too loud, or the texture of the food is aversive. Emotional load from home or the educational setting: It is important to recognize that not everything is within our control. A child arrives carrying an emotional state from home or from the educational setting or transportation (a sleepless night, family tension, absence of regular staff).  The proposed starting point as a key to change in addressing challenging behaviors in autism: the presumption of competence It is worth considering a shift in our starting point. The presumption of competence suggests assuming that the person understands everything. Even if their body betrays them, they perceive our words, the meaning, our tone, and our attitude. When we relate to children according to their chronological age rather than their apparent level of functioning, their level of stress may decrease. Instead of coloring pages for a 17 year old teenager, we can offer materials that respect their intelligence, such as National Geographic magazines or contemporary music. Imagine being trapped inside a body that does not respond to you, while the people around you speak to you as if you are a baby, this is a tremendous source of frustration, anger, and violence. התנהגויות מאתגרות בקרב אוטיסטים - למאמר בעברית How do we move toward preventing challenging behaviors? Practical tools To create a safe and respectful environment, it is worth adopting several tools: Medical checkups: Ensure routine screening for possible sources of pain and discomfort: dental checkups, screening for nutritional deficiencies, monitoring constipation, monitoring dry mouth which may be caused by medication, itchy bites and allergies, possible anxiety or fears. Careful observation: Try to identify and isolate the antecedent to the challenging behavior and the response to it. Also try to identify the antecedent to positive behavior in order to discover patterns and regularities. Based on what is revealed, consider changing something in the equation. Building routine and preparation: A visual schedule. Words are spoken and disappear, visual support creates security and stability and may therefore reduce anxiety. This way the child knows what to expect, even when the routine is similar. Visual support addresses the need to know when something ends. A visual structure within an activity is also recommended for some children. Preparation. Prepare for any change and prevent surprises. Tell the child what is about to happen: "soon we are finishing ___ and moving to ___". Use of social stories. link to post on social stories according to clear guidelines. A story with photos of the child, the people around them, and their environment allows clarity in ambiguous situations, situations of change, new situations, or situations in which a specific behavior is required. Use of augmentative and alternative communication . link to post on AAC Offer accessible symbols, an alphabet board, offer typing, single message voice output. Gesture, adapt the communication method to the child. Search and keep searching until something fits. A sensory and physically regulating environment: it is recommended to relate to all senses, for example: Hearing, is it too noisy? Is someone shouting? The sound of chairs scraping? Vision, are the lights too bright? Is fluorescent lighting flickering? Touch, is the texture of the food aversive? Is there a demand to touch unpleasant materials? Perhaps after a certain food there is always an outburst? Perhaps every time there is no schnitzel there is an outburst? What can be done? Create a quiet space with a beanbag or curtain that the child can access before losing control. Planned breaks for walks, jumping, time in the yard, retreating to a small space, deep pressure or wrapping. Use of supports such as headphones, sunglasses, chew tools. Focusing on the positive : Provide reinforcement that encourages positive behavior, preferably not edible reinforcers and not exaggerated rewards. Positive attention, if the child loves newspapers, give them a new newspaper. Reinforcement that is age appropriate and respectful of their interests. התנהגויות מאתגרות בקרב אוטיסטים - למאמר בעברית Reflection questionnaire presumption of competence test The next time you find yourself facing challenging behaviors, ask yourself: ➤ Tone and language test: When I spoke to the child during the incident or before it, did I use the tone and language I would use with a teenager their age without a disability, or did I speak to them as if they were a baby? ➤ The "why" test: Did I interpret the violence as bad behavior or as deliberate defiance, or did I try to understand what the child is trying to tell me but does not have the language ability to express? ➤ Educational content test: Was the task the child refused to do that led to the outburst truly respectful of their intelligence, or was it too boring or too childish for them? ➤ Space and touch test : Did I respect their personal space, or did I enter their bubble touch, hug, move their chair without asking permission or preparing them for what was about to happen? ➤ Voice test: Did I provide an alternative way alphabet board, symbols, typing, objects for them to express their resistance before it became physical? For example offering a choice of food before serving it on the plate. The questionnaire is not a magic solution and there will still be many questions and frustrations, but it offers a shift in perspective. Remember: your children may not be able to speak, but they are listening to every word. They have a rich inner world that is just waiting for us to find the key to it. Do not give up on them, they are there inside. 🟢  For all updates on autism and events at our center, join our   quiet WhatsApp group   🟢

היבטים רגשיים סביב אנקופרזיס באוטיזם - למאמר בעברית This week a conference was held on emotional aspects surrounding encopresis, organized by the Emotional Developmental Clinic at the Child Development Institute at Sheba Medical Center, Tel Hashomer. Toilet training challenges may present as constipation, encopresis, toilet refusal, and more. Toilet training challenges in autistic children can be particularly complex. We chose to share with you 15 key points that emerged from the conference regarding your child’s toilet training process. The diaper-to-toilet transition is a family project . Challenges may arise along the way and there are ways to address them and help children move to using the toilet but the most important message the child receives from their parents is we are in this together ! The process can be challenging demanding and intensive and may bring up many family difficulties. You are already carrying a lot so it is important to seek support for yourselves. Guidance from a professional whether from the educational setting or your broader therapeutic circle is extremely important. You need containment and support in this process in order to help your child get through this stage which has a significant impact on your family’s quality of life. Disruptions in the diaper-to-toilet transition are a complex issue. They can be understood as psychological physiological and behavioral in nature. Treatment should be creative and include attention to all of these areas at minimum. A child going through the diaper-to-toilet transition is moving from the world of little children to the world of big children. This is a meaningful developmental process that supports growth and the ability to gain control over important aspects of life. Parental guidance that is both firm and nurturing is essential for the success of the process. Parental fear of frustrating the child or entering the process can have a negative impact. Once the decision is made parents should support the child with determination and sensitivity. You are in this together.  Recently there has been a significant increase in Israel in cases where children urinate independently in the toilet but pass stool in their clothes or require a diaper. Data show that nearly one in four children behaves this way. You are not alone and there are ways to help. When there are no medical causes, and sometimes alongside them, a link is found between toileting difficulties and children who experience separation difficulties in general children who "punish" parents following prolonged military service parental absence or a move. In autistic children it is very common that even a single experience such as a painful bowel movement due to constipation or very hard stool or an incident in which a child was sitting on the toilet and was interrupted for example by other children entering from the kindergarten can disrupt or delay the toileting process. At times a connection is also found between sexual trauma experienced by one of the parents and toileting difficulties in their children. It is important to try to identify the cause of the toileting difficulty but once this is done the event itself is no longer relevant to the toileting process. Encopresis and autism. Some characteristics of autism such as difficulties with cognitive flexibility difficulty with change and strong attachment to familiar routines and rituals absence of speech and high or low sensory sensitivity to smells noises and bodily sensations can make the toileting process more difficult particularly in relation to constipation and the transition from stooling in a diaper to stooling in the toilet. These factors should be taken into account when building an individualized toileting plan for the child. In addition because there are difficulties in identifying internal bodily sensations and because internal sensations are often experienced differently than they are by neurotypical individuals behavioral expressions of constipation pain gas abdominal bloating or the need to have a bowel movement may appear in an autistic child as increased vocalizations more bouncing movements or stretching the body in different ways. These expressions are often not understood by the environment in the appropriate context and therefore important signals in the process may be missed. In addition research shows that the problem does not resolve with age. Toileting difficulties require intervention. The recommendation is to address the issue as early as possible with the understanding that the process does not follow a typical intuitive path. You can play with poop! There are dedicated games available on the market and it is possible and even recommended to lighten the process through playful and humorous games such as fishing for poop aiming poop into the toilet or driving poop and stopping it like a remote control car. Constipation not just what you thought. Even a child who has a bowel movement every day can suffer from constipation. Even a child who soils their underwear several times a day can suffer from constipation. Even a child with diarrhea can suffer from constipation. Constipation is one of the central factors in toileting difficulties and there is a lot that can be done. It is important to identify what exactly is happening for each child. There is a poop scale! The Bristol Stool Scale is a professional medical tool that helps assess the situation and tailor the appropriate solution. It is important to look at the stool and yes sometimes we will ask you to photograph it. Medications such as Normlax and others do not cause dependence. Their use supports the process is not addictive and is not dangerous. It helps. It is true that if the underlying problem is not resolved and the medication is stopped the constipation may return but this is not bodily dependence. Medication should be adjusted and prescribed by a professional. Here’s an interesting nutritional fact. Take a very green banana. With the peel. Boil it in water for about 10 minutes until it is very soft. Peel off the skin, and grind it in a blender. The resulting mass is tasteless and odorless. Cool it down completely, it can be frozen in an ice tray in a small amount of a teaspoon. Once cold or frozen, you can add a teaspoon to a shake, a snack, yogurt, or pasta sauce. Do not reheat. This is Type 3 resistant starch which was found in research to be a powerful prebiotic, and it can literally cause a laxative effect, it is worth trying for the treatment of constipation. Gradually if there is a need, you can increase up to a tablespoon. Also 2 kiwis a day is considered to have an effect on bowel movements. It is important to note that these additions are not suitable for use during the first stage of treatment; the gut must be acclimated to changes rather than overloaded. Additions should be made gradually and in consultation with a professional. Visual supports: such as symbols a personalized social story tracking charts and various reinforcers greatly help illustrate and support the process. Different physical exercises motor games yoga poses and the use of supportive tools can also promote progress. Each tool supports a different area providing emotional visual or bodily support. For a psychological physiological or behavioral difficulty we offer a creative and dynamic solution. The pediatrician is the first stop. If there was constipation in the first two weeks of life or difficulty passing meconium this should be reported. If needed there are gastroenterologists who specialize in gut motility and there are important tests that can be done to rule out certain conditions. If you are told that your child has functional constipation this does not mean there is nothing to do. There is a lot that can be done! היבטים רגשיים סביב אנקופרזיס באוטיזם - למאמר בעברית In summary Toileting independence is one of the factors that most strongly affects the quality of life of a child an adult and the entire family. Autistic children who require different levels of support can transition out of diapers. From our experience many children are capable of far more than we assume and more than they are able to initiate on their own at this moment. When we start from an assumption of capability and show them the way success can follow.   🟢  For all updates on autism and events at our center, join our   quiet WhatsApp group   🟢

אינטרוספציה ואוטיזם - למאמר בעברית Our brain receives information from eight senses: sight, hearing, taste, smell, touch, proprioception (the sense of body position in space), balance, and interoception. Interoception is a sense that is less known, discussed, and researched. A fascinating new article provides an in-depth review of interoception and its link to autism, offering guidelines and recommendations for dealing with interoceptive difficulties. What is Interoception? Imagine the body has an internal alert system that tells us: "I'm hungry," "I'm cold," "My heart is beating fast because I’m stressed." This system is called interoception. For many autistic people, this alert system works a bit differently: Sometimes they do not feel the signal (for example, they don't feel thirsty until they are severely dehydrated). Sometimes they feel it too strongly. For example, a normal heartbeat feels to them like loud and frightening heart palpitations. Interoception is defined as the ability to sense, interpret, and integrate internal signals from the body (heart, lungs, digestive system, pain, temperature, immune system, and hormones). It is the basis for the sense of self, emotions, and independent management of daily needs. The ability and right to make independent decisions about one's body may often be impaired in autistic people due to interoceptive differences that make it difficult to respond in time to physical needs. Testimonies from autistic individuals describe daily difficulties in identifying sensations such as thirst, the need for the bathroom, illness, or pain, which prevent the development of vital skills for independent and fulfilling lives. אינטרוספציה ואוטיזם - למאמר בעברית Current Research Findings and Their Problems Most research to date has been based on group comparisons using tasks and questionnaires developed for non-autistic populations. It treats any deviation from the non-autistic norm as a deficit, despite there being no clear definition of what optimal interoception is, and without a strong link to functioning in daily life. The complexity and criticism of measuring interoception can be demonstrated in objective tasks, such as cardiac interoception. Two situations are usually tested: Heartbeat counting:  The participant is asked to listen to their heart and quietly count how many beats they feel during short intervals (e.g., 25, 35, 45 seconds), without feeling their pulse by hand or neck. Simultaneously, the actual pulse is measured via ECG or a heart rate sensor. The proximity of the subjective count to the actual number of beats is then calculated; this is the measure of "interoceptive accuracy" according to the classical definition. Synchronous discrimination tasks:  The participant hears a sound (beep) in real-time, and the goal is to judge whether the sound is synchronized with their heartbeat or not. For example, short series of beeps are given either very close to each heartbeat (synchronous) or with a certain delay (asynchronous). After each series, the subject answers if the sound was with the heart or out of rhythm. This tests the ability to identify a connection between an internal signal (heartbeat) and an external stimulus (beep), and how much the person feels the pulse at the resolution of sync/out of sync distinctions. Autistic people often identify fewer heartbeats in the counting task, but in discrimination tasks (sound-heartbeat synchronization), they are often similar to non-autistic people. Self-report questionnaires show a complex picture: autistic people may report high attention to the body in questionnaires measuring hyper vigilance and anxiety, but lower attention in questionnaires measuring a sense of body safety. This means that more attention to internal sensations is not necessarily adaptive interoception, the kind that improves daily functioning. Very few measurement tools were originally developed for autistic people. However, in tools that were, a wide range of experiences is seen, including under or over awareness of various signals, showing that simple more/less models are insufficient. אינטרוספציה ואוטיזם - למאמר בעברית Neglected Aspects of Interoception in Autism The extensive focus on the heart likely hides more important areas such as the digestive system, connective tissue disorders, pain, menstruation, immune systems, and hormones areas where the prevalence of difficulties among autistic people is high and are closely related to daily functions like bathroom use, nutrition, and hydration. Chronic illnesses causing pain and discomfort may lead to a reduction in signal levels from these areas. This has broad implications for functioning, such as a lack of awareness of constipation, pain, or satiety until a late stage. Neurodevelopmental comorbidities, ADHD, sensory regulation disorders, tics, DCD (Developmental Coordination Disorder), and more, are also linked to interoceptive variance, but are rarely taken into account when analyzing the autistic profile. Alexithymia and Interoception in Autism Sometimes the problem is not the sensation itself, but the translation. Alexithymia describes a condition where a person struggles with processing, identifying, and verbally describing emotions. A child feels something in their stomach, but they don't know how to say if it is hunger, a need to use the bathroom, butterflies from excitement, or a stomach ache from fear. Because they don't know how to name it, it often bursts out as restlessness, crying, or accidents in their clothes, simply because they are overwhelmed by a sensation they don't understand. How is it related to autism? In the past, it was thought to be an inseparable part of autism, but today it is understood that this is not always the case: Approximately half of autistic people experience this difficulty in identifying emotions (alexithymia). For many children, the difficulty is verbal, the tasks given to them to check their sensations require them to speak and explain, which is a challenge in itself. What can be done at home? Instead of waiting for the child to say "I'm thirsty" or "I'm stressed," we can help them connect external signs to an internal sensation: "I see your lips are a bit dry, maybe your body is signaling that it's thirsty?" "Your heart is beating fast now; that happens sometimes when we are excited or a bit worried." Using emotion boards or sensation intensity thermometers can help them show us what they feel without needing complex words. It is also possible that alexithymia, as a difficulty in giving verbal expression to internal states, explains a significant portion of the variance in standard interoceptive tasks, as the tasks themselves require participants to verbally describe their internal (interoceptive) states. However, the question of whether this means autism is not linked to interoceptive variance has yet to be unequivocally proven. Examining the distinctness of these concepts and how they relate to interoception is a key question for future research. אינטרוספציה ואוטיזם - למאמר בעברית Monotropism and Interoception in Autism Monotropism, a theory developed by autistic individuals, describes a tendency for narrow and intense attentional focus. Consequently, other stimuli, including signals from the body, fail to penetrate when attention is absorbed in an area of interest. According to this approach, many interoceptive difficulties stem not from a lack of signals but from reduced accessibility to them while attention is directed elsewhere. Reports from autistic people about being immersed in an activity to the point of forgetting to eat, drink, use the bathroom, sleep, or change position well demonstrate this mechanism. The monotropism model predicts significant intra individual variance: in situations where body attention is encouraged, such as a quiet lab task, performance can appear typical. Conversely, in states of high engagement in action where there are many stimuli, body awareness drops, which may explain some of the contradictions in research findings. Links to Emotional Regulation, Health, and Sexuality Interoception is presented as the basis for emotional regulation: identifying an internal change, integrating it with context, mobilizing a response (autonomic, hormonal, behavioral), and monitoring it. In autistic people, there are likely differences in several stages of this chain, while pain, fatigue, and unmet needs further weaken the ability to regulate. Interoceptive difficulties may contribute to: Meltdowns  (a state of temporary loss of control due to overload; expressed in crying, shouting, etc.). Shutdowns  (instead of exploding, the body simply "turns off the lights" to protect itself from overload). Self-harming behavior. This occurs both through missing early warning signs and through increased physical distress. Thus, movement, searching, pressure, or self harm can be attempts at regulation or communication about pain. Interoception is also essential for identifying and treating medical illnesses, against a background of high rates of chronic diseases, shortened life expectancy, and increased mortality in autism. Autistic people report doubts about when to seek treatment and difficulty describing body sensations to professionals. Sexuality is presented as another interoceptive field: although autistic people describe needs and desires similar to non autistic people, studies point to lower sexual well-being, more loneliness, and fewer intimate relationships. Qualitative reports include difficulty identifying sexual desire and genital sensations, pointing to an interoceptive contribution that has not yet been examined in depth. Critique of Measurement and Normalization Normal ranges in interoception are not well defined even in non autistic populations, and many do not feel their pulse at all under laboratory conditions. Therefore, it is difficult to interpret average differences as a clear deficit. Researchers ask whether an optimal uniform interoception even exists, or if it is an individual balance depending on context, physical history, and the person's needs. For example, for a person with chronic pain, reducing some of the signals may be adaptive and efficient for better functioning. Existing tools hardly measure the areas of interoception that autistic people themselves identify as significant (such as thirst, bathroom use, early detection of illness), and therefore their contribution to improving quality of life is limited. Support Strategies and Clinical Implications Some existing treatments aim to reduce visible autistic behaviors, whereas strengthening bodily autonomy might sometimes be more appropriate. The authors argue that interoceptive interventions should be community led, personalized, and aimed at improving the interpretation and use of body signals, not just increasing attention to them. They warn that increasing body awareness (especially of the heart) could exacerbate anxiety if not accompanied by teaching understanding and context, as seen in other anxious populations with high physical alertness. אינטרוספציה ואוטיזם - למאמר בעברית Practical example regarding drinking: For autistic people who struggle to identify their thirst sensation, they are sometimes instructed to drink at fixed time intervals, according to a clock or timer, to prevent dehydration. While this strategy ensures sufficient fluid intake, it contributes almost nothing to improving interoception, the ability to pick up and interpret signals from the body. An alternative strategy that supports improving interoceptive skills would encourage the creation of links between physical signals and their meaning over time. In the case of thirst, we could guide the person to monitor the color of their urine or its smell, and pay attention to body sensations (e.g., dry mouth, lips, or throat; headache; dizziness; or slowness and lack of energy). The goal is that over time, the person will begin to link darker urine or a stronger smell to the appearance or worsening of certain physical sensations. Eventually, even subtle sensations may encourage drinking without the need for direct urine monitoring. There is a nice mantra (In Hebrew): "Clear pee is healthy for the body, yellow pee is not so good and you need to drink." Conclusion Due to sensory variance, autistic people who do report physical ailments are often dismissed by their environment. A feeling of cold and dressing in long clothes might be dismissed by the environment based on a neurotypical interpretation: "It isn't cold now." Complaints of back pain might be dismissed after a superficial check as "nothing is wrong with the back," while the autistic person feels pain originating in the stomach differently and doesn't know how to explain it properly, leading to improper treatment. Therefore, even when they feel something and report it, they encounter dismissal, leading them to stop reporting or become frustrated, receiving the message that their sensations are wrong. The message is to believe the autistic person who does report, and to question and check more broadly. Sources: Palser, E. R., Lawson, W. B., Goodall, E., & Pellicano, E. Interoception in Autism, Pitfalls, and Promise: A Participatory Research Perspective.  Autism in Adulthood , 25739581251414545.‏  https://doi.org/10.1177/25739581251414545     🟢  For all updates on autism and events at our center, join our   quiet WhatsApp group   🟢

שימוש בסיפורים חברתיים באוטיזם - למאמר בעברית For many children, and especially autistic children, the world in general, and the social world in particular, can feel confusing and unclear. Everyday situations that may seem self-evident to us often contain critical social information that is not stated explicitly. This is where social stories come in: a meaningful educational and therapeutic tool designed to make the world more predictable, understandable, and safe. What Is a Social Story? The tool was developed in 1991 by Carol Gray, a teacher who recognized that her students were missing social cues and needed everyday situations to be made more accessible. The goal is to understand the individual’s point of view, reduce anxiety, and provide advance knowledge about what to expect and what is socially accepted in a given situation. A social story is not a set of operating instructions or a tool for controlling or changing behavior. It does not dictate emotions or demand compliance, but rather focuses on reflection and providing tools. The story includes real photographs of the child and their environment and serves as a support tool for resolving moments of stuckness, reducing anxiety, and legitimizing difference. In addition, it is used to provide the individual with advance knowledge about what to expect, what is considered acceptable, and what can be done in the situation. Even in situations where control and decision making are not in the child’s hands. The Central Message: The story is intended to make the world more predictable and understandable for the learner, with full respect for their subjective experience, and to offer coping strategies that allow for a calmer and more manageable experience. שימוש בסיפורים חברתיים באוטיזם - למאמר בעברית Social Stories and Autism Why Does It Work? Visual accessibility:  Words are heard and then disappear, but images remain and help support information processing. Priming to reduce anxiety:  Uncertainty creates anxiety, while the story creates structure and predictability. Processing during calm moments:  Learning takes place when the child is emotionally available, not during moments of crisis. Validation:  The child feels that their difficulty is seen and acknowledged. Social Stories and Autism Examples One common mistake is writing a story that tries to force or dictate emotions to the child. Such a story may cause the child to disconnect from themselves in order to please their environment. Below is an analysis of a problematic example compared to a respectful and accessible approach: “Dana went to the dentist, and even though she was very afraid, she overcame it and did not cry. Dana sat nicely on the chair. It was not very pleasant for Dana, but it did not hurt. In the end, Mom bought her a gift.” How It Should Be Written Possible Interpretation for the Student Why Is This Problematic? What Is Written in the Story? “Sometimes we feel fear or want to cry. Our body reacts this way when something is unpleasant.”  Learns that crying or expressing pain is a failure Emotional suppression “She overcame it and did not cry” “Sometimes the treatment can feel uncomfortable or painful. I can ask for a break if I need one.”   Invalidates sensory differences; undermines trust in the adult Lack of credibility / Gaslighting “It didn’t hurt” “I try to sit still so the doctor can finish more quickly. I can hold a squeeze ball while sitting in the chair.” Focus on external appearance instead of internal well-being Demand for obedience / compliance “She sat nicely” “When the treatment is over, we will go home.” Turns emotional difficulty into a manipulative transaction Bribery and external reinforcement “They bought her a gift” Recommended Structural Principles To be effective, a social story should combine several types of sentences: Descriptive sentences:  Objective facts (who, what, where). Perspective sentences:  What others may think or feel (without guessing the student’s thoughts). Directive sentences:  Suggestions for possible actions (“I can try…”). Affirmative sentences:  Reinforcing the central value (“It’s okay to rest when feeling overwhelmed”). Let’s illustrate this using examples from a social story whose goal is to help a child understand the fact that Dad is going to reserve military service: Descriptive sentences: Perspective sentences: Directive sentences:   Affirmative sentences:   It is important to remember that social stories can be adapted both to significant life events and to everyday, simple situations. They can be used at any developmental stage, according to the child’s age and abilities. There is no single correct way to write a social story. The goal is to create a personal story that is tailored to your child, their world, and the specific need they are coping with. שימוש בסיפורים חברתיים באוטיזם - למאמר בעברית How Do We Know If the Story Is Good? The success of a social story is not measured by how quiet the child or adolescent becomes, but by the extent to which their level of anxiety decreases. When the world becomes more predictable, the need for expressions of distress, resistance, or avoidance naturally decreases.   🟢  For all updates on autism and events at our center, join our   quiet WhatsApp group   🟢

תרגול קשר עין-יד בקרב אוטיסטים - למאמר בעברית Last week we talked about the factors behind challenges in eye hand coordination in autistic individuals and how they are expressed in everyday life. This week we move from theory to the practical aspect and talk about practicing eye hand coordination in autistic individuals. Understanding the mechanism underlying eye hand coordination in autistic individuals allows us to develop more tailored therapeutic strategies. The key to improvement is not only strengthening the muscles, but improving the synchronization between the eye and the hand. We wrote several practice approaches and practical tips for parents and therapists, combining autistic individuals’ firsthand accounts on the topic and based on the principles of feedforward (prediction) and reducing feedback load, which we discussed in the previous post: תרגול קשר עין-יד בקרב אוטיסטים - למאמר בעברית Finding motivation Tasks that require eye-hand coordination demand far more effort than what is required of the average child or person. The more motivation a child has to perform an activity, the more interest it holds for them and the more it serves as a motivating factor, the greater the effort they will invest. If the child enjoys cooking, practice through kitchen tasks. If the child likes numbers and calculations, practice through activities of that kind. Tasks such as eating with a fork or putting socks on the right way are less motivating, and therefore less effort is usually invested in them. Adapting task demands and learning materials to the student’s age Imagine a student who receives the same tasks over and over again due to repeated failures. Their frustration grows, and their responses become increasingly intense and resistant. Testimonies from autistic individuals who learned to communicate through letter boards or typing show that they wished they had been taught using age-appropriate learning materials. It is recommended to start from the assumption that the student understands, and to look for an appropriate way for them to demonstrate this, while maintaining age-appropriate learning materials that encourage motivation and effort. Reducing environmental visual load A 2025 review on the topic emphasizes that complex tasks place a very high load on autistic children. The tip: when practicing a new skill (such as writing or cutting), make sure the work environment is free of unnecessary visual stimuli. Visual “noise” makes it harder for the brain to synchronize between the target and the hand. Adaptation: use worksheets with very clear and highly contrasted lines, to help the eyes “lock onto” the target.   “Eye first, then hand” technique In everyday tasks, encourage the child to pause briefly before starting the movement. The tip: “First find it with your eyes, then reach with your hand”. In tasks such as threading beads or building with Lego, ask the child to look at the exact spot where they want to place the piece, and only then place it. Why can this help? It strengthens the prediction strategy (the eye leads) and reduces the need for the eyes to track the hand during movement. Using alternative sensory feedback Sometimes, when the visual system is overloaded, touch can be used as support. The tip: let the child feel the texture of the target (for example, raised letters or a rough surface). Sensory information from the fingers can compensate for difficulties in visual synchronization and help the brain build a better movement plan. Do not require the child to look, for example during dressing tasks. Allow them to feel the texture of the clothes and, through this channel, choose their clothes and get dressed. Physical activity and water-based activity In water, bodily input is clearer due to the pressure of the water on the body. Therefore, there is a better ability to perform motor activities that require eye-hand coordination. In water, the need to look at body parts in order to understand how to move them in the desired direction is reduced. It is recommended to combine physical activity and time in the water while working on physical strengthening. Light arm support Due to the difficulty in synchronizing the brain’s intention with the body’s response, the body may sometimes react differently and the hand may move in the wrong direction. Light support to the arm can help release this “stuck” moment and allow the hand to move toward where the child is trying to reach. This is gentle support, not moving the hand for them. In addition, children often use adults’ hands, guiding or pulling them toward the object they want. A different perspective suggests that children are seeking a possible way to reach the object they see and want, but are unable to synchronize eye and hand, extend the arm, and grasp. Allow them to use your support, while gradually trying to find ways toward independent access. Practicing gaze disengagement (working on the gap effect) Since research has shown that autistic children have difficulty transferring the advantage of “stimulus disappearance” to the hand, this skill can be practiced intentionally. The exercise: play a game in which the child needs to touch a target that appears on the side. Just before the side target appears, physically remove (or turn off) the central stimulus the child was previously looking at. The goal: to help the brain “let go” of the previous stimulus and move more quickly to the next hand movement. Training with moving targets (gradually) Because the main difficulty lies in complex and dynamic tasks: The exercise: start with pointing to stationary targets, and only when this becomes smooth and improves, move on to slowly moving targets, such as soap bubbles or passing a balloon. As this improves, progress to faster-moving targets, first a large ball and then a smaller one. תרגול קשר עין-יד בקרב אוטיסטים - למאמר בעברית An important message for parents It is important to remember that what may look like clumsiness or slowness is often the result of sensory overload (cognitive, motor, sensory, and emotional). Children are performing complex calculations with every movement. Providing extra time, a calm environment, and focused practice on gaze disengagement can make a meaningful functional difference and strengthen children’s sense of competence.     🟢  For all updates on autism and events at our center, join our   quiet WhatsApp group   🟢

קשר עין-יד באוטיזם - למאמר בעברית For most of us, the action of reaching for a glass of water or typing on a keyboard seems completely automatic. But behind the scenes, the brain performs a complex coordination that integrates visual input with precise motor movement of the hand. This process is called hand–eye coordination. Research from recent years sheds new light on how this process operates in children with typical development compared to autistic children. It turns out that the differences are not found only in movement accuracy, but in the neural strategy that guides it. Hand–eye coordination in children with typical development? In children with typical development, the system operates according to a predictive (feedforward) model. The eyes act as commanders: they land on the target about 50 to 200 milliseconds before the hand even begins to move. This lead allows the brain to plan the hand movement in advance and execute it in a very smooth and highly synchronized manner. Hand–eye coordination in autistic individuals? קשר עין-יד באוטיזם - למאמר בעברית Contrary to what one might assume, autistic individuals do not necessarily have a problem with eye movement speed. A study from 2013 showed that in simple tasks, the gaze speed of autistic children was completely typical. The challenge lies in the synchronization between the systems. Key findings from recent studies (including a 2025 systematic review) point to several critical differences: Absence of the “gap effect” in the hand What exactly is the “gap effect”? To understand the impairment, imagine that you are sitting in front of a screen. At the center of the screen there is a red dot that you are looking at. Suddenly, a blue target appears on the side of the screen. Your task is simple: shift your gaze and point to the blue target as quickly as you can. The researchers examined two conditions, as described in a 2013 study: The overlap condition: the blue target appears on the side, but the red dot in the center remains on. In this condition, the brain has to work harder to disengage from the central dot and move to the side. The gap condition: the red dot in the center disappears, and only after a brief moment (the gap) does the blue target appear on the side. What happens in most people? When the central dot disappears (the gap condition), the motor system receives something like a green light. The brain understands that it is free from the previous target, and therefore both the eye and the hand respond much faster to the new target. This is the “gap effect”, the boost in reaction speed when the path is cleared. What was found in autistic children? This is where the fascinating finding emerges: in autistic children, the eyes actually responded faster in the gap condition (that is, eye movement was typical), but the hand did not receive the message. Despite the fact that the stimulus at the center of the screen was cleared, the hand did not speed up its response as expected. Why is this important? It shows that communication between the visual system (the eye) and the motor system (the hand) is impaired. The information that the eye perceives (the center is clear, you can move!) is not translated into a rapid command to the hand. In everyday life, this means that even if the child sees that something is happening, their physical response will be less synchronized and less efficient. Planning ahead (Feedforward) versus correcting during movement (feedback) Think about the difference between a skilled painter and someone trying to copy a drawing using transparent tracing paper. The skilled painter (Feedforward): looks at the page, the brain builds a map of the line, and the hand simply moves forward confidently. The eye is already at the next point before the pencil has even reached it. The person tracing with transparent paper (feedback): he cannot rush ahead. He has to look at the tip of the pencil every split second to make sure it is exactly on the line underneath. He moves slowly and carefully, and his eyes are stuck on the hand instead of leading it. In children with typical development, the brain works like the painter. The eyes scan the target in advance and send the hand a ready-made action plan. In autistic children, the brain has difficulty trusting the advance plan. Instead, it works like the tracer: the eyes must accompany the hand step by step (feedback) to make sure it does not make a mistake. Why is this exhausting? Because instead of the action being automatic and fluid, the child invests enormous concentration effort in every small movement. This is why a simple action like writing a line in a notebook, putting on a coat, or eating with a fork can leave an autistic child exhausted, they have simply invested focused energy that most of us do not need to activate. Increasing difficulty in complex tasks As the task requires greater integration (such as catching a moving object or performing multi-step tasks), the gaps become more pronounced. More substantial delays in reaction times and poorer coordination between the eye trajectory and the hand trajectory have been observed. Effects on daily life The challenges in hand–eye coordination in autistic individuals do not remain in the laboratory. They significantly affect everyday functioning: Learning skills: difficulties with writing, drawing, or copying from the board, which require rapid and synchronized shifting between gaze and movement. Functional independence: actions such as writing, drawing, buttoning buttons, dressing, tying shoelaces, or using eating utensils become more complex and more tiring due to the need for constant visual monitoring of the hands. Social interaction: a link has been found between the severity of motor impairments and he degree of social withdrawal, as ball games or shared activities require fast and accurate hand–eye coordination. The challenge of nonverbal children קשר עין-יד באוטיזם - למאמר בעברית For a nonverbal child, pointing is not just a movement, it is their voice. When an examiner asks, “Point to the hat,” they are testing the child on two levels at the same time: Cognitive level: does the child recognize what a hat is? Visual–motor level: is the brain able to synchronize the gaze on the hat with a command for the hand to move precisely toward it? The diagnosis that may be mistaken: “He doesn’t understand” As noted earlier, in autistic children there is sometimes a disruption in synchronization. The child looks at the hat (it may be that they know the answer!), but because of the absence of the "gap effect" and the difficulty in movement prediction, their hand gets stuck or is sent in the wrong direction.   Here, a critical error may occur: the examiner or therapist sees that the child did not point, or pointed incorrectly, and may therefore draw a cognitive conclusion, “the child doesn’t know what a hat is,” “they are unable to understand instructions,” or “the child does not want to cooperate.” In reality, the barrier is motor–executive, not a lack of understanding or willingness. The result may be the construction of a treatment program that does not match the child’s developmental age and cognitive abilities → leading to a cycle of intense frustration expressed in protest behaviors and emotional distress → parents experience despair and frustration and turn to professionals → professionals may make diagnoses that are not necessarily accurate → treatment programs stagnate → the child responds with further frustration, and the cycle begins again. Of course, not every case originates from a hand–eye coordination difficulty, but it is a skill that should certainly be taken into account when a child fails to progress in a treatment program or shows significant clumsiness and genuine frustration with tasks that are relatively simple for their age. Next week, we will take a deeper look at coping strategies and offer practical tips for practice in order to improve hand–eye coordination.   References: Abid, M., Poitras, I., Gagnon, M., & Mercier, C. (2025). Eye-hand coordination during upper limb motor tasks in individuals with or without a neurodevelopmental disorder: a systematic review.  Frontiers in Neurology ,  16 , 1569438.‏  https://doi.org/10.3389/fneur.2025.1569438 Crippa, A., Forti, S., Perego, P., & Molteni, M. (2013). Eye-hand coordination in children with high functioning autism and Asperger’s disorder using a gap-overlap paradigm.  Journal of autism and developmental disorders ,  43 (4), 841-850.‏  DOI:  10.1007/s10803-012-1623-8   🟢  For all updates on autism and events at our center, join our   quiet WhatsApp group   🟢