אבחון התאמות ותמיכה בוויסות חושי בקרב אוטיסטים - למאמר בעברית In the previous post, we took a closer look at the key aspects of sensory processing and regulation in autistic people. This time, we will discuss how sensory regulation is assessed and supported in order to improve autistic people’s quality of life. Assessing the Sensory Profile of Autistic People Several tools are available for assessing sensory processing in autism: The Short Sensory Profile (SSP) and Sensory Profile 2 are caregiver or parent report questionnaires designed for children aged 3 years to 14 years and 11 months. They provide a comprehensive picture of how the child processes sensory input in their natural environment, at home or in an educational setting, and how this affects daily functioning. The Adolescent/Adult Sensory Profile (AASP) is a 60-item self-report questionnaire for individuals aged 11 to 65 years and older. It enables individuals to assess their own sensory preferences, sensitivities, and response patterns, providing important insights into self-regulation and the management of their academic, occupational, and personal lives. However, researchers caution that caregiver or parent reports may capture only the most extreme or distressing sensory differences and may be influenced by the child’s communication abilities or language level. This is particularly important for autistic people with minimal spoken language, whose internal sensory experiences may be underrepresented in caregiver or parent reports. The gap may be even more pronounced among adults, who may mask or compensate for their sensory differences. A 2017 review found that although growing evidence suggests that sensory symptoms persist into adolescence and adulthood, normative data for older age groups remain limited, and pediatric assessments may not focus on functional outcomes or environments relevant to adults. In summary, to obtain a reliable and accurate understanding of each person’s individual sensory profile, it is recommended to combine an age-appropriate sensory questionnaire with a clinical assessment conducted by an experienced professional. An accurate understanding can guide appropriate accommodations and support, helping improve the quality of life of the child and their family. אבחון התאמות ותמיכה בוויסות חושי בקרב אוטיסטים - למאמר בעברית Support, Accommodations, and Interventions Environmental Accommodations Environmental modifications are among the most commonly recommended forms of support. Examples include: Dimming or adjusting lighting and reducing exposure to fluorescent lighting. Creating designated sensory break spaces, such as a quiet room. Reducing visual clutter in classrooms and workplaces. Using noise-canceling headphones or earplugs in noisy environments. Providing advance notice of transitions and sensory changes. Offering sensory-friendly alternatives, such as adapted food textures or seamless clothing. These accommodations are intended to reduce the mismatch between the individual’s sensory needs and their environment, rather than to change the person’s sensory processing. Ayres Sensory Integration Therapy Ayres Sensory Integration is a play-based therapeutic approach that uses individually tailored sensory and motor activities to address sensory processing difficulties. A 2024 systematic review evaluated the effectiveness of this intervention for autistic children and reported moderate support for its ability to help some children achieve individualized functional outcomes, including improvements in behavior, daily functioning, communication, social participation, motor skills, and adaptive responses. Multisensory Environments Multisensory environments, such as Snoezelen rooms, provide controlled sensory stimulation and have been studied as an intervention for autistic children. A 2024 study examined the effects of an intervention involving controlled sensory stimulation on sensory behaviors in autistic children and reported some positive outcomes. However, the evidence base remains limited, and further controlled studies are needed before firm conclusions can be drawn. What the Evidence Does Not Support It is important to note that many commonly used sensory interventions lack strong evidence. Sensory diets, which are individualized schedules of activities intended to address sensory needs, weighted blankets, and other sensory products are widely used in practice, but the available high-quality evidence supporting them remains limited. In summary, interventions should be individually tailored rather than presented as universally beneficial. At the “Bishvil Hakochav” Center, as part of the developmental assessment provided to children and adolescents in individual sessions, a comprehensive evaluation of each person’s sensory profile is conducted when needed, followed by the development of a personalized intervention plan. אבחון התאמות ותמיכה בוויסות חושי בקרב אוטיסטים - למאמר בעברית References: Camino-Alarcón, J., Robles-Bello, M. A., Valencia-Naranjo, N., & Sarhani-Robles, A. (2024). A systematic review of treatment for children with autism spectrum disorder: The sensory processing and sensory integration approach. Children, 11(10), 1222.‏ De Domenico, C., Di Cara, M., Piccolo, A., Settimo, C., Leonardi, S., Giuffrè, G., ... & Cucinotta, F. (2024). Exploring the usefulness of a multi-sensory environment on sensory behaviors in children with autism spectrum disorder. Journal of Clinical Medicine, 13(14), 4162.‏ DuBois, D., Lymer, E., Gibson, B. E., Desarkar, P., & Nalder, E. (2017). Assessing sensory processing dysfunction in adults and adolescents with autism spectrum disorder: A scoping review. Brain sciences, 7(8), 108. ‏ 🟢 For all updates on autism and events at our center, join our quiet WhatsApp group 🟢

עיבוד וויסות חושי בקרב אוטיסטים - למאמר בעברית Sensory processing and regulation are neurological bodily processes that occur in every person. When there is an increased amount of sensory input, our brain uses regulatory mechanisms to manage these stimuli and maintain a level of arousal that allows us to function. When there are challenges or difficulties in this regulation, sensory overload may occur, leading to impaired functioning and difficulties with sensory regulation. Sensory processing is not limited to sensitivity to noise or aversion to certain textures. It involves a fundamentally different pattern of neural wiring that affects the way the brain receives, interprets, and responds to stimuli from both the external environment and the body itself. For many years, sensory characteristics were regarded only as secondary symptoms. Today, scientific research recognizes that distinct sensory processing is a central core feature of autism. This understanding was also formally recognized in the American diagnostic manual, the DSM-5, which included hyperreactivity, hyporeactivity, and sensory-seeking behaviors among the diagnostic criteria for autism. In the past, difficulties with sensory regulation were often perceived as behavioral problems in autistic individuals. Today, we know that differences in sensory processing are a core neurological characteristic of autism, affecting between 70% and 90% of autistic children and adults. Sensory Processing To understand sensory regulation, it is important to be familiar not only with the primary senses (vision, hearing, taste, smell, and touch) but also with three important internal senses: The vestibular sense: Responsible for balance, head movement, motion, spatial orientation, and the sense of gravity. The proprioceptive sense: Receptors in the muscles and joints provide the brain with information about where the body is in space and how much force is being used. Interoception: Internal bodily sensations, such as heartbeat, hunger, thirst, pain, or the need to use the bathroom. In addition, there are the more familiar senses: Vision: Detects light, patterns of movement, and visual overload. Hearing: Processes sounds, pitch, and background noise. Touch and pain/temperature: Includes touch, texture, pressure, the perception of heat and cold, and the sensation of pain. Oral sensation/taste/smell: Includes taste, smell, and oral textures. Sensory processing is not a single ability. It includes detection (noticing a stimulus), regulation (adjusting the intensity of the response), discrimination (distinguishing between stimuli), and integration (combining information from different senses). Difficulties may occur at any of these levels and may vary across different sensory systems within the same person. עיבוד וויסות חושי בקרב אוטיסטים - למאמר בעברית Three Main Sensory Response Patterns in Autism Research The literature on sensory processing in autism generally identifies three main response patterns: Hyperreactivity: An excessive or heightened response to sensory input. A person may be disturbed by sounds that others barely notice, become overwhelmed by fluorescent lighting, or be unable to tolerate certain clothing textures. Hyporeactivity: A reduced, delayed, or absent response to sensory input. A person may not notice when their name is called, may respond slowly to pain, or may not detect changes in temperature. Sensory seeking: The active pursuit of sensory input. This may include seeking deep pressure, repetitive movement, strong flavors, or visual stimulation. The same person may simultaneously display hyperreactivity to sound, hyporeactivity to pain, and sensory-seeking behavior related to touch. Dunn’s Four-Quadrant Model A widely used sensory processing model that supports clinical assessment and treatment is Winnie Dunn’s Four-Quadrant Model. The model organizes sensory responses along two continua: Neurological threshold: high versus low, that is, how much sensory input is required for a person to notice a stimulus. Behavioral response style, active versus passive. The interaction between these two dimensions produces four quadrants: Sensory Processing vs. Sensory Regulation A distinction that can sometimes be confusing is the difference between sensory processing (how the nervous system detects and responds to sensory input) and sensory regulation (how a person responds to or maintains a level of arousal that enables functioning when sensory input becomes excessive, insufficient, unpredictable, or difficult to integrate). Sensory regulation includes both conscious and unconscious strategies that a person uses to manage their physiological and sensory state. Examples: Repetitive movements (stimming): Hand flapping, rocking, pacing, or vocal repetition. These movements often serve a self-regulatory function by providing predictable and controllable sensory input. Seeking deep pressure: Using weighted blankets, tight-fitting clothing, or firm hugs to calm the nervous system. Environmental control and routines: Insisting on using the same cup, taking the same route, or sitting in the same seat, strategies that reduce sensory uncertainty. Withdrawal and avoidance: Moving away from noisy environments, avoiding certain textures or foods, or limiting social exposure. Shutdowns and meltdowns: These are involuntary nervous-system responses to acute distress. When the sensory system becomes overwhelmed and is unable to regulate the incoming stimuli, the brain may interpret the situation as an immediate and tangible threat. This activates the sympathetic nervous system (the fight-or-flight response) which may lead either to withdrawal from the environment and a loss of functioning (shutdown) or to outwardly expressed distress involving a loss of behavioral control (meltdown). These are not behavioral problems. They indicate that the nervous system’s capacity for regulation has been overwhelmed. Understanding sensory regulation sheds a different light on many behaviors that are often classified as pathological. Avoidance, repetitive behavior, and insistence on routines are frequently adaptive regulatory strategies, representing attempts to manage a nervous system that experiences the sensory world differently. The relationship between sensory processing and emotional regulation is bidirectional. Sensory differences may increase anxiety and emotional dysregulation. Conversely, heightened stress and anxiety may further increase sensory sensitivity, creating a cycle that can make everyday functioning particularly challenging. עיבוד וויסות חושי בקרב אוטיסטים - למאמר בעברית The Importance of Understanding Sensory Processing and Regulation in Autism The goal of understanding sensory processing and regulation in autism is not to normalize sensory responses. Sensory differences among autistic people are part of autism. They can be a source of distress, but they can also be a source of deep engagement, intense interest, and a unique perceptual experience. Some sensory seeking behaviors are viewed positively by autistic people themselves. The most effective and recommended approach is to understand each person’s unique pattern, including their sensitivities, sensory seeking, thresholds, and regulation strategies across each sensory system. Once the individual sensory profile has been understood, the goal is to reduce the mismatch between the person’s nervous system and the environments they navigate. This means shifting the focus away from correcting the individual’s sensory responses and toward adapting environments, expanding access to regulation strategies, and respecting the legitimate communicative and regulatory functions of autistic sensory behaviors. In the next post, we will discuss general strategies and adaptations for the different sensory systems in greater detail. References: Dunn, W. (2014). Sensory profile 2. Bloomington, MN, USA: Psych Corporation.‏ Fabbri-Destro, M., Maugeri, F., Ianni, C., Corsini, S., Di Stefano, E., Scatigna, S., ... & Narzisi, A. (2022). Early sensory profile in autism spectrum disorders predicts emotional and behavioral issues. Journal of Personalized Medicine, 12(10), 1593.‏ Patil, O., Kaple, M., & Kaple, M. N. (2023). Sensory processing differences in individuals with autism spectrum disorder: a narrative review of underlying mechanisms and sensory-based interventions. Cureus, 15(10).‏ Schaaf, R. C., Puts, N. A., Williams, Z. J., & Woynaroski, T. (2024). Forwarding the science of sensory features in autism and related conditions. Journal of autism and developmental disorders, 54(7), 2663-2667.‏ Williams, Z. J., Schaaf, R., Ausderau, K. K., Baranek, G. T., Barrett, D. J., Cascio, C. J., ... & Woynaroski, T. G. (2023). Examining the latent structure and correlates of sensory reactivity in autism: a multi-site integrative data analysis by the autism sensory research consortium. Molecular Autism, 14(1), 31. ‏ 🟢 For all updates on autism and events at our center, join our quiet WhatsApp group 🟢

אבחון אוטיזם ואבני דרך התפתחותיות - למאמר בעברית A formal autism diagnosis is typically made around the age of two to three years. However, the first red flags and parental concerns often emerge during the first year of life, particularly in areas such as language and social communication. Since there are currently no biological markers for diagnosing autism, and the diagnosis is based solely on clinical and descriptive criteria, the early identification of patterns in the acquisition of developmental milestones is critical for taking advantage of the therapeutic window of opportunity. In other words, if parents and developmental professionals know which developmental patterns may indicate an increased likelihood of an autism diagnosis, they will be better able to refer the child for an early assessment and, consequently, early intervention. Early intervention is highly valuable for two main reasons: First, due to brain plasticity, the younger the toddler is, the greater the potential for neurophysiological changes in the brain, and the more significantly the child’s future functional prognosis may improve. An example of this can be found in data from the Koegel Autism Center, whose researchers developed Pivotal Response Treatment (PRT). Approximately 95% of children who received PRT before the age of three developed spoken language. In contrast, this percentage drops to approximately 20% among children who began treatment after the age of five. Second, the earlier a toddler receives appropriate support, the earlier they can learn to communicate in an adaptive and effective way within their social environment. For example, when the child is in pain, they may learn to communicate this to an adult and receive help, rather than responding by crying or having an outburst. The earlier intervention begins, the greater the likelihood that the child will acquire effective adaptive behaviors. Several studies in the professional literature have examined the early identification of autism through developmental milestones and have reached interesting conclusions. These findings may help both parents and professionals identify red flags and, consequently, refer children to the appropriate professionals in order to receive support at an earlier age. The Developmental Milestones Study in Portugal A recently published study examined 127 children from Porto, Portugal, with an autism diagnosis and a mean age of 34 months. The study assessed six developmental milestones that parents can recall relatively reliably: Social smiling Sitting steadily without support Independent walking First words First word combinations or sentences Daytime toilet training or daytime bladder and bowel control A delay was defined as acquiring a milestone at or above the 95th percentile compared with normative developmental data, or as not having acquired the milestone at all by the time of data collection. Language regression was also assessed and was defined as the consistent loss of at least five words for a period of at least three months. The data presented in the article reveal a clear dichotomy between early motor development and communication and adaptive functioning: Sitting: Most children acquired independent sitting on time, with only 2.5% showing a delay. Social smiling: Social smiling was acquired on time by 79.5% of the children, while 20.5% showed a delay. Independent walking: This milestone showed a more substantial delay, with 38.6% of the children experiencing delayed acquisition of independent walking. Communication, language, and daily living skills: The most pronounced differences from the general population were found in these areas: 62.6% experienced a delay in producing their first words, and 11.1% did not speak at all. 96.8% experienced a delay in producing their first sentences, while 73% of the entire sample had not acquired this milestone at all by the time of assessment. 85.2% experienced a delay in achieving daytime bladder and bowel control, and 64.8% had not achieved daytime continence at all. Language regression: Language regression was identified in 11% of the children, at a mean age of approximately 20 months. אבחון אוטיזם ואבני דרך התפתחותיות - למאמר בעברית The Motor Milestones Study in Israel In the context of motor development, a large-scale Israeli study conducted at the Child Development Center at Sheba Medical Center, Tel Hashomer, by Prof. Lidia Gabis and her team sheds new light on the close association between early motor delay and a later autism diagnosis. The study was based on a retrospective analysis of the medical records of 467 children diagnosed with autism. The sample included 356 boys (76%) and 111 girls (24%), a gender ratio that approximately reflects the distribution of autism diagnoses in the general population. The children were diagnosed at a mean age of 3.4 years. Approximately 20% of the children in the sample were born prematurely and received routine follow-up care at a preterm infant clinic. The study found that most children diagnosed with autism did acquire their motor skills within the broad limits of the normative range. However, the researchers identified a significant tendency toward the later end of that range. Consistent with the findings of the Portuguese study, independent walking provides an excellent example of this pattern. Although walking by 18 months of age is considered medically within the typical range, most typically developing children begin walking before 16 months. In this study, the mean age of walking among children diagnosed with autism was later than usual: approximately 16 months for boys and nearly 18 months, specifically 17.9 months, for girls. Another notable finding of the study was the gender difference. Motor delay was identified in 60% of the girls diagnosed with autism, compared with only 47% of the boys. Approximately half of the entire sample experienced global developmental delay, defined as a significant delay in two or more developmental domains. The gender difference was also evident in this area: 49% of the girls showed global developmental delay, compared with 36% of the boys. The researchers explain that autistic girls often display early social and communication abilities that may mask their difficulties during the early stages of development. As a result, they are more likely to be missed by standard screening tools. Therefore, the presence of motor delay, particularly delayed independent walking, constitutes a critical red flag in girls and should prompt an immediate comprehensive communication assessment. Among the subgroup of children born prematurely, who comprised approximately 20% of the sample, both the severity and prevalence of motor and global developmental delays were even greater. Within this group, the delay was especially pronounced among girls born prematurely, who showed the latest mean age of independent walking, at 18.79 months. Comorbidities The highest prevalence of comorbid conditions was found in the area of sensory regulation. A total of 92.9% of the children were diagnosed with sensory processing disorder (SPD), primarily involving the vestibular system, which is located in the inner ear and is responsible, among other functions, for balance, and the tactile system, which relates to touch. In addition, sleep disorders were reported in 18.1% of the children, hypotonia in 7.1%, and epilepsy in 3.1%. A total of 15.7% of the children had a family history of autism in a first- or second-degree relative. Predictive Value of the Different Developmental Milestones: Daytime bladder and bowel control: This milestone had the broadest predictive effect. The researchers emphasize that a delay in achieving daytime continence serves as a strong indicator of lower overall intellectual abilities. Social smiling: A delay in social smiling was directly and significantly associated with a lower score on the personal-social scale at a later stage. Language (words and sentences_: Delays in producing first words and first sentences significantly predicted lower scores on the personal-social scale, which assesses daily living skills, social learning, and interactions with peers. Independent walking: A delay in walking did not affect language abilities but was significantly associated with poorer performance in nonverbal cognitive skills. אבחון אוטיזם ואבני דרך התפתחותיות - למאמר בעברית Key Clinical Insights from the Scientific Literature The early motor profile: Unlike language and social communication, gross motor milestones during the first year of life, such as sitting, generally remain within the typical range among autistic children. However, independent walking tends to be delayed and may serve as an early indicator of later difficulties in nonverbal cognitive functioning. Motor delay as a gender-related red flag, particularly in girls: The findings of Prof. Gabis and colleagues emphasize that motor delay and global developmental delay are significantly more common among autistic girls than among autistic boys. Motor delay was identified in 60% of the girls, compared with 47% of the boys. Because girls often display social abilities that may mask their communication difficulties, delayed independent walking, especially among girls born prematurely, should be regarded as a major red flag requiring immediate referral for a comprehensive communication assessment. Preventing a diagnosis of global developmental delay alone: Children with combined motor and language delays are sometimes diagnosed with global developmental delay, with no further assessment conducted. Recognizing that motor delays may be an integral part of the physical presentation of autism is essential for preventing a missed autism diagnosis and enabling the child to receive communication-focused interventions at an early stage. The predictive value of daytime continence: The study emphasizes that difficulty achieving daytime toilet training is not merely an isolated adaptive issue. Rather, it may serve as a powerful diagnostic indicator associated with the overall severity of cognitive, language, and social delays. The importance of retrospective clinical documentation: Careful monitoring and accurate collection of developmental history regarding the ages at which milestones were acquired, particularly social smiling, language, and daytime continence, are essential for developing early, individualized, and goal-oriented intervention plans. References: Gabis, L. V., Attia, O. L., Roth-Hanania, R., & Foss-Feig, J. (2020). Motor delay-An early and more common" red flag" in girls rather than boys with autism spectrum disorder. Research in Developmental Disabilities, 104, 103702.‏ https://doi.org/10.1016/j.ridd.2020.103702 Sousa, D., Queirós, J. C., Tavares, T., Soares, S., Matos, I. V., Prior, C., ... & Prior Sr, C. (2025). Early Neurodevelopmental Milestones in Children With Autism Spectrum Disorder: A Retrospective Observational Study. Cureus, 17(12).‏ DOI: 10.7759/cureus.99042 🟢 For all updates on autism and events at our center, join our quiet WhatsApp group 🟢.

מודל דנבר - למאמר בעברית The Early Start Denver Model (ESDM) is a comprehensive early intervention approach, based on play and enjoyment, designed for autistic children in early childhood. It is one of the world’s leading science-based approaches for supporting autistic children. The approach is grounded in developmental and behavioral principles within the child’s natural environment, and offers a holistic intervention program that views the child as a whole and focuses on multiple developmental domains. The central goal of the model is to identify the early challenges children experience during the first stages of development and provide them with targeted support. The model places special emphasis on building a strong foundation for social learning, based on the understanding that young autistic children may experience challenges in social reciprocity, communication, and language. Implementation of the Approach The intervention is implemented through play, with shared enjoyment between the child and the therapist serving as the central engine for learning. The therapy is based on the child’s initiatives and free choices. The adult follows the child’s lead, joins them, and uses their areas of interest to promote new skills. Learning takes place in a variety of playful situations and is smoothly integrated into the child’s daily routine, for example during meals or bath time. Throughout the activity, the therapist is highly attuned to the child’s emotional and verbal expressions, and makes sure to allow time for rest and regulation when needed. Areas of Intervention in the Treatment Program The model addresses the child’s challenges in a broad and comprehensive way, and assesses the child’s abilities across key developmental domains: Communication and language: receptive communication (language comprehension), expressive communication (language expression), with a special emphasis on pre-linguistic skills and nonverbal communication. Social learning: joint attention, imitation, play, sharing emotions, and social skills. Additional skills: cognition, fine motor skills, gross motor skills, behavior, and independence in daily life. מודל דנבר - למאמר בעברית Building an Individual Profile and a Dynamic Program To ensure that every certified therapist works according to the same high international standards, the model uses a structured skills checklist known as the Curriculum Checklist. The skills checklist is divided into four levels according to the child’s developmental age. The work process includes several stages: Comprehensive assessment: The therapist conducts a developmental assessment through play-based sessions, together with parent reports, in order to gain the broadest possible picture of the child’s developmental profile. Mapping abilities: Since most children present a mixed profile of abilities, the mapping shows exactly which skills the child has already acquired, which skills are emerging and appear inconsistently, and in which areas the child needs greater support. Setting focused goals: Based on the individual profile, the therapist and parents jointly determine the therapeutic priorities. Each goal includes a clear criterion for success, and the steps are formulated in an accessible and gradual way. Periodic reassessment: From time to time, a reassessment is conducted in order to update and refine the program, which is dynamic and accompanied by ongoing monitoring of the child’s progress. Flexibility and Collaboration One of the major advantages of the ESDM model is its flexibility. The approach can be implemented in the clinic, at home, in kindergarten, or in daycare. Parents are an integral part of the process and receive practical tools to continue applying the principles at home. For example, parents learn how to turn everyday routines into meaningful learning opportunities. This is done through shared, child-centered play, focusing on the child’s specific interests, and creating experiences of mutual enjoyment that naturally and intuitively encourage communication and connection. The sessions themselves are individual, and the therapist has broad knowledge across different developmental domains and collaborates with paramedical professionals according to the child’s needs. מודל דנבר - למאמר בעברית A Research-Based Approach The ESDM model is supported by a broad body of research indicating its effectiveness in supporting young autistic children. Studies show that children who received intervention based on this approach demonstrated stronger cognitive and adaptive abilities, alongside significant improvements in language comprehension, social skills, communication, and play. The model was developed by two leading researchers in the field: Professor Sally Rogers: Professor of Psychiatry at the MIND Institute at the University of California. Professor Geraldine Dawson: Professor of Psychiatry and Behavioral Sciences at Duke University School of Medicine, and Director of the Duke Center for Autism and Brain Development. This approach, alongside the PRT approach, serves as an additional tool in our center’s therapeutic toolbox and is part of our perspective that views each child as a whole. Therefore, we take a comprehensive look at all areas of the child’s development and strive to get to know each child deeply, identify their unique strengths, and use them as a gateway into their world. References: Reichow, B., Doehring, P., & Volkmar, F. R. (Eds.). (2025). Handbook of evidence-based practices in autism spectrum disorder. Springer. ‏ 🟢 For all updates on autism and events at our center, join our quiet WhatsApp group 🟢

שחיקה בקרב אוטיסטים - למאמר בעברית One of the most discussed phenomena in recent autism research, as well as among autistic people themselves, is autistic burnout. Autistic burnout is characterized by extreme exhaustion, loss of functioning, and increased sensory sensitivity, resulting from the accumulated stress involved in navigating a world that is largely non-autistic. Based on the perspectives and lived experiences of autistic adults, subsequent qualitative studies have examined potential risk factors and protective factors associated with autistic burnout. For example, a study conducted in 2021 analyzed 1,127 online posts from a Twitter forum community intended for autistic people, in order to explore risk factors, protective factors, and consequences of autistic burnout. Based on their findings, the researchers emphasized camouflaging or masking, meaning the use of social strategies to minimize the visibility of autistic characteristics in order to fit in and avoid exclusion or harm in a society that is largely neurotypical, as a central risk factor for autistic burnout. As a further development of their earlier work, in 2022 the same researchers proposed a model of autistic burnout that encompasses various individual, social, and environmental risk factors, such as social stressors experienced by autistic people (for example stigmatization and lack of support) as antecedent risk factors, alongside consequences such as depression and anxiety. These qualitative studies were the first to examine the conceptual structure, characteristics, and lived experiences of autistic burnout in the research literature. In order to further investigate the experiences of autistic burnout, its risk and protective factors, and its associations with mental health outcomes, there arose a need for quantitative research using valid and reliable measurement tools for autistic burnout. In addition, the ability to identify autistic burnout in a valid and reliable way is highly important, given the consequences mentioned earlier. To date, two measures of autistic burnout have been developed: The Autistic Burnout Measure (ABM) - a 27-item questionnaire developed by the Academic Autism Spectrum Partnership in Research and Education (AASPIRE), a team that includes autistic people, academic researchers, family members, disability professionals, and clinicians. Subsequently, in 2023, the initial development and validation data for a second measure, the Autistic Burnout Severity Items (ABSI), were published. שחיקה בקרב אוטיסטים - למאמר בעברית A recent study published in 2026 examined the first measure of autistic burnout, the Autistic Burnout Measure (ABM), among 379 autistic adults aged 18–77, and found it to be a strong, relatively stable, and primarily unidimensional tool. In other words, the questionnaire mainly measures one central construct: the extent to which a person is experiencing autistic burnout. This means that many of the different items essentially point to the same general phenomenon, rather than to several entirely separate difficulties. Even if a person’s condition changes over time, the questionnaire is still stable enough to indicate who is generally experiencing greater distress and who is experiencing less. The questionnaire was also found to have excellent internal consistency, meaning that the items work well together. A person who reports difficulty on one item is likely to report difficulty on other items as well, in a way that suggests reliable measurement. We have attached the questionnaire here: First, it is important to note that the questionnaire was examined among autistic adults over the age of 18. Autistic burnout can also occur among children and adolescents, but it was not examined in the specific studies discussed in this post. Second, the questionnaire can help assess the risk level and severity of autistic burnout, but it cannot determine a diagnosis on its own. How to use the questionnaire: Each of the 27 items is scored from 0 to 4 (where 0 represents no agreement with the statement and 4 represents full agreement). The scores are then summed to produce a total score ranging from 0 to 108. The higher the score, the higher the level of autistic burnout. Trouble thinking clearly Harder time making decisions for myself Harder time solving challenging problems Harder time holding information in my mind for short periods of time Harder time recalling things I know Harder time controlling my impulses More moody Feeling more irritable Harder time tolerating sensory input Harder time preventing sensory overstimulation Had more, or more severe, meltdowns Had more, or more severe, shutdowns Harder time ignoring unimportant sensory input Harder time deciding what is and is not important to pay attention to Harder time getting along with people I know well Harder time getting along with people at work, school, or in other community settings Harder time communicating my point to others Harder time finding the right words to communicate what I mean Harder time doing basic day-to-day activities Harder time managing work or school Harder time managing the steps I need to take to complete tasks Avoiding social situations Isolate myself from others Avoiding stimulating environments Avoiding activities that require effort Felt more mentally exhausted Felt more physically exhausted It is important to note that autistic burnout can look different from person to person. On the one hand, it can vary in intensity, but on the other hand, it also includes shared characteristics that have been incorporated into the questionnaire in order to help individuals better understand themselves, and to help those around them identify and understand why their functioning may suddenly change. When there is an understanding that something like this may be approaching or already happening, it is recommended to provide the person with support that is tailored to them. The general principles of support may be similar, but they should of course be personally adapted to each individual. שחיקה בקרב אוטיסטים - למאמר בעברית What is recommended if autistic burnout is suspected? The main goal is to allow the nervous system, which has been highly overwhelmed, to recover. It is recommended to seek a clinical or psychological assessment from a professional who is familiar with autism in adults. It is also important to examine whether depression or anxiety are present and require additional treatment. Functional, social, and sensory demands should be reduced as much as possible: -Reducing masking means reducing situations in which the person feels they constantly have to appear neurotypical, thereby decreasing accumulated effort. -Sensory accommodations, such as reducing noise, bright light, crowding, and overwhelming stimuli, may help reduce sensory load. -Accommodations at work, in education, and at home, including flexibility, reducing unnecessary demands, and creating clear arrangements, may reduce the risk of burnout. It is also important to strengthen support, rest, and clear communication in the person’s close environment: -Quiet time, breaks, temporarily reduced demands, and sufficient sleep may help the nervous system recover. -An accepting and non-judgmental environment, in which the person is accepted as they are, can help reduce accumulated load. -Monotonous computer games, or any activity the person initiates in order to self-regulate and ease their distress, may also be supportive. Finally, it is important to monitor functioning over time, rather than focusing only on one peak moment. This is a process that can take time and requires patience. Refrences: Bougoure, M., Zhuang, S., Brett, J. D., Maybery, M. T., English, M. C., Tan, D. W., & Magiati, I. (2026). Measuring autistic burnout: A psychometric validation of the AASPIRE Autistic Burnout Measure in autistic adults. Autism, 30(1), 20-36.‏ https://doi.org/10.1177/13623613251355255 Mantzalas J., Richdale A. L., Dissanayake C. (2022). A conceptual model of risk and protective factors for autistic burnout. Autism Research, 15(6), 976–987. https://doi.org/10.1002/aur.2722 Mantzalas J., Richdale A., Adikari A., Lowe J., Dissanayake C. (2021). What is autistic burnout? A thematic analysis of posts on two online platforms. Autism in Adulthood, 4. https://doi.org/10.1089/aut.2021.0021 Arnold S. R. C., Higgins J. M., Weise J., Desai A., Pellicano E., Trollor J. N. (2023b). Towards the measurement of autistic burnout. Autism, 27, 1933–1984. https://doi.org/10.1177/13623613221147401 🟢 For all updates on autism and events at our center, join our quiet WhatsApp group 🟢

האם עוד טיפול לילדים שווה יותר התקדמות? - למאמר בעברית One of the questions every parent asks themselves is what amount of therapy their child needs in order to make progress. Recently, this topic has been receiving increasing attention in research. At the most recent INSAR conference, a special panel was held on this topic. The dosage of therapy is reflected in several elements: Daily intensity = number of hours per day Duration of the intervention = total number of days of intervention Cumulative intensity of therapy = total number of therapy hours One of the prominent articles on this topic is a comprehensive study published in 2024, in which the authors conducted a meta-analysis of 144 studies that included 9,038 young autistic children (up to age 8). The study examined whether more hours, longer duration, or a higher cumulative dosage of intervention are actually associated with better outcomes among autistic children. The main conclusion is that no reliable association of this kind was found across most types of interventions, and therefore there is no strong basis for the assumption that greater intensity = greater benefit. In this study, common intervention approaches were examined, including behavioral approaches such as ABA, developmental approaches such as DIR, NDBI approaches such as PRT, ESDM, and JASPER, and technology-based approaches such as computer games. It should be noted that there are several other high-quality studies with smaller sample sizes that support the same view: that more hours do not necessarily lead to better outcomes. One of the prominent studies on this topic is a 2021 study by Prof. Sally Rogers, which examined the effect of 25 hours of therapy compared with 15 hours of therapy per week. The intervention itself was provided for one year, and the children were followed for up to two years. There were four study groups: Children who received 15 hours per week of behavioral intervention. Children who received 25 hours per week of behavioral intervention. Children who received 15 hours per week of ESDM intervention. Children who received 25 hours per week of ESDM intervention. The bottom line is that here too, no significant differences were found in treatment outcomes, neither between the approaches nor between the treatment dosages. In other words, 25 hours per week were not better than 15 hours of therapy per week. האם עוד טיפול לילדים שווה יותר התקדמות? - למאמר בעברית The clinical implication The practical message is that we should be cautious about making a blanket recommendation of 20-40 hours of therapy per week simply because "more is better." Beyond the fact that more therapy hours do not necessarily have a significant clinical effect, a blanket recommendation for so many hours of therapy per week is not practical for many families. In some cases, it can create unnecessary stress, feelings of guilt, and a negative atmosphere that may interfere with the family’s ability to support the child effectively. The researchers emphasize that the absence of evidence for a positive association does not mean that intervention is not beneficial at all, but rather that there is no strong support for the idea that increasing the amount, in and of itself, improves outcomes. Therefore, it is recommended to think about quality, individualized fit, and a reasonable level of burden on the family and the child, rather than focusing only on the number of hours or the number of therapy sessions the child receives. In the expert panel at the conference, emphasis was placed on the number of learning opportunities provided to the child during intervention and on their quality, rather than necessarily on the number of therapy hours. References: Rogers, S. J., Yoder, P., Estes, A., Warren, Z., McEachin, J., Munson, J., ... & Whelan, F. (2021). A multisite randomized controlled trial comparing the effects of intervention intensity and intervention style on outcomes for young children with autism. Journal of the American Academy of Child & Adolescent Psychiatry, 60(6), 710-722.‏ https://doi.org/10.1016/j.jaac.2020.06.013 Sandbank, M., Pustejovsky, J. E., Bottema-Beutel, K., Caldwell, N., Feldman, J. I., Crowley LaPoint, S., & Woynaroski, T. (2024). Determining associations between intervention amount and outcomes for young autistic children: A meta-analysis. JAMA pediatrics, 178(8), 763-773.‏ doi:10.1001/jamapediatrics.2024.1832 🟢 For all updates on autism and events at our center, join our quiet WhatsApp group 🟢

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   🟢