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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   🟢

גמישות מחשבתית בקרב אוטיסטים - למאמר בעברית What is Cognitive Flexibility? Cognitive flexibility is part of the executive functions . It refers to the ability to “shift gears” in our thinking and behavior, move between rules, tasks, or different points of view, and adapt ourselves to changes in the environment. It is the ability to set aside a familiar habit and try a new approach, for example, when rules in a game change, or when something in the daily routine does not go as expected. Difficulties with cognitive flexibility in autism may appear as challenges with changes in routine, strict adherence to rules, or difficulty shifting from one task to another. Among autistic individuals, difficulties in cognitive flexibility have been linked to increased social difficulties, higher levels of restricted and repetitive behaviors , and the presence of co-occurring symptoms such as anxiety and low mood. In addition, growing evidence suggests that cognitive flexibility plays a central role in various functional outcomes, including academic achievement, adaptive behavior, and overall quality of life. A recent and comprehensive meta-analysis (2024), in which the researchers aggregated dozens of studies including hundreds of autistic participants and age and IQ matched comparison groups, found that autistic children, adolescents, and adults show greater difficulties in cognitive flexibility compared to non-autistic groups, and that this gap appears consistently across studies and tasks. Importantly, the gap remained even after controlling for factors such as IQ. In other words, difficulties in cognitive flexibility among autistic children are not solely explained by intellectual ability, but may be more strongly related to core characteristics of autism. Cognitive Flexibility in Autism – Examples גמישות מחשבתית בקרב אוטיסטים - למאמר בעברית Daily routines and changes A strong need for predictable routines: even small, unexpected changes (a different route to school, a schedule change) may lead to intense distress or a meltdown. Difficulty transitioning from a preferred activity to a new one (for example, moving from screen time to dinner), sometimes leading to outbursts or lengthy negotiations, not due to stubbornness, but because the mental shift is hard. Thinking style and problem-solving “All or nothing” or very literal thinking, such as rigid rules about what is right or wrong, and difficulty considering grey areas or alternative solutions. Getting “stuck” on a single way of playing or completing a task, and struggling to try a new strategy even when the first approach isn’t working (for example, insisting on arranging toys in one precise pattern every time). Interests, focus, and attention Very intense focus on specific interests and difficulty shifting conversation or play away from the topic, even when others try to change it. Over-focus on details (parts of objects) and difficulty seeing the bigger picture, which makes it hard to shift attention flexibly between different aspects of a situation. Social communication and play Sticking to one script in conversations (repeating the same questions, stories, or jokes) and difficulty adjusting language to different people or contexts. Repetitive and less varied play (repeating the same scene, game rules, or sequence of actions) and difficulty engaging in imaginative play that changes rapidly. Emotions and coping Increased stress when sudden changes occur, because it is difficult to update expectations quickly and form a new plan. Using the same coping strategy repeatedly (for example, leaving the room or repeating a phrase) and difficulty finding alternative ways to self-soothe or resolve interpersonal conflicts. These patterns relate to a different cognitive style, not to a lack of intelligence or motivation, and many autistic people can become more flexible with explicit support, preparation for change, and practice in safe and predictable contexts. Does Cognitive Flexibility Improve With Age in Autism? גמישות מחשבתית בקרב אוטיסטים - למאמר בעברית A recent 2025 study examined cognitive flexibility in autistic adults aged 18-45, and compared them to adults who are not autistic. The study included 263 adults who completed a rule-switching task: each trial required them to respond according to a different rule, sometimes based on a letter and sometimes based on a number that appeared together on the screen. The predictability of the rule-switch varied between unexpected, partially expected, and highly expected conditions, without participants being aware of this manipulation. Researchers measured reaction time and accuracy. The findings showed that when the task became more predictable, all participants, autistic and non-autistic, responded faster and with higher accuracy. However, the gap in reaction time between autistic and non-autistic adults actually increased under the highly predictable condition. This suggests that autistic individuals tend to rely less on “predicting ahead” and more on processing information moment by moment. Gender differences were also observed: within the autistic group, women tended to be more accurate than men, whereas in the non-autistic group men were more accurate than women. The task did indeed measure cognitive flexibility, as switching between rules slowed response times and reduced accuracy, which is an expected outcome in tasks of this type. Overall, the findings strengthen the understanding that autistic people have a different processing style, particularly in structured and predictable contexts, and that difficulties in cognitive flexibility may persist into adulthood if not supported through appropriate intervention and guidance. What can parents take away about cognitive flexibility in autism? גמישות מחשבתית בקרב אוטיסטים - למאמר בעברית The findings do not suggest that something is “wrong” with the child, but rather describe a different style of information processing, with relatively greater difficulty in handling changes and shifting between rules. At the same time, many autistic individuals show strengths in areas such as accuracy, systematic thinking, and stability in routine, strengths that can be used to gradually teach more flexible ways of thinking and acting. Order, repetition, and routine can indeed help, yet even within a structured framework a child may respond differently than others. The reason is that they rely less on predicting what will happen next, and more on examining each situation anew, even if it is familiar and expected. This finding also has a deep emotional meaning: the need to reevaluate every situation reflects an inner experience of restlessness. For the individual, the unexpected is always present in the background, even within a known routine, which creates ongoing strain. Therefore, a task that seems to us like something the child “already knows by heart” may still feel stressful for them each time. Stress levels do not decrease automatically, and emotional effort is required again and again. It is also important to remember that there are differences between autistic boys and girls. Autistic girls may appear more flexible or better adjusted, while still exerting tremendous internal effort; therefore, it is crucial not to minimize their difficulties just because they function well outwardly. This aligns with the phenomenon of masking and the different presentation of autism in girls . For parents, understanding that the autistic brain works differently, not less effectively, can reduce guilt and pressure at home and help adjust expectations and support for their child. Tips for practicing cognitive flexibility in autism גמישות מחשבתית בקרב אוטיסטים - למאמר בעברית First, it should be noted that a tendency toward cognitive rigidity can also be an advantage in certain situations. for example, in tasks that require increased alertness to changes within predictable and routine contexts. For instance, in aerial photo interpretation, one must detect changes relative to a standard pattern, or in programming work where errors in code must be identified. Second, it is best to avoid impatient or angry responses such as “You’ve done this a hundred times already.” These will not help and will only increase stress levels. It is recommended to aim for tailored interventions such as preparing in advance for changes in routine, using visual cues, practicing graded transitions and rule changes within a safe and supportive environment. Start with events that are as predictable as possible and introduce one small change at a time. Praise effort in trying to make a change, even if the execution is not perfect. “I saw that it was hard for you, and you still tried to handle the change.” This builds resilience, not just compliance. Practice flexibility through play, games with changing rules, rotating roles, or open-ended endings. For example, asking “What else could happen now?” allows for natural, non-threatening practice. It is possible to reduce stress and make the environment more accessible and supportive for autistic individuals! References: Lacroix, A., Torija, E., Logemann, A., Baciu, M., Cserjesi, R., Dutheil, F., ... & Mermillod, M. (2025). Cognitive flexibility in autism: How task predictability and sex influence performances.  Autism Research ,  18 (2), 281-294.‏    https://doi.org/10.1002/aur.3281 Lage, C., Smith, E. S., & Lawson, R. P. (2024). A meta-analysis of cognitive flexibility in autism spectrum disorder.  Neuroscience & Biobehavioral Reviews ,  157 , 105511.‏  https://doi.org/10.1016/j.neubiorev.2023.105511 🟢  For all updates on autism and events at our center, join our   quiet WhatsApp group   🟢

דפוסי התנהגות חזרתיים ומוגבלים בקרב אוטיסטים - למאמר בעברית Repetitive and Restricted Behaviors (RRBs)  are patterns of behavior characterized by repetitiveness, inflexibility, rigidity, lack of contextual appropriateness, and often by the absence of a clear function or specific goal. These behaviors are part of the core characteristics and diagnostic criteria of autism. Testimonies from autistic individuals indicate that stereotyped behaviors help reduce anxiety, provide grounding, support emotional and sensory regulation, increase a sense of safety, or express excitement. Autistic individuals also describe these movements as comparable to scratching an itch or the urge to sneeze: attempting to forbid someone from engaging in them is similar to forbidding a person to scratch when they feel itchy, or telling them they are not allowed to sneeze. Consequently, interventions aimed at reducing these behaviors are not necessarily recommended, except in cases where they cause significant disruption to public order (such as public masturbation) or pose a substantial risk of self-injury (such as severe head banging). In addition, there are contexts in which vigorous hand-flapping or vocalizations may be inappropriate because they are socially unconventional and disturb others, for example, in a classroom setting or while waiting in line. When referring to stereotyped movements, the term describes repetitive movements, but it also encompasses additional characteristics beyond repetition alone: Repetitiveness - the same movement is repeated over and over (e.g., hand-flapping, finger-twirling, repetitive jumping). Fixed and predictable pattern - the movement is performed in the same manner, rhythm, and sequence. Inflexibility - the movement is difficult to modify or stop. Sometimes lacking a clear functional purpose - it does not serve an immediate, obvious practical goal. Sometimes associated with self-regulation or sensory experience, though not always. ⚠️ Important to distinguish: Not all repetition is stereotypy. For example, repetition for the purposes of learning, play, or practice is not necessarily stereotyped. Repetitive movements may also be ritualistic, sensory, or functional, and therefore are not always classified as stereotyped behaviors. . To date, the classification of repetitive and restricted behaviors remains a matter of debate. The Diagnostic and Statistical Manual of Mental Disorders  (DSM-5) describes four patterns of repetitive and restricted behaviors, including: Repetitive movements, repetitive use of objects or speech, or stereotyped behaviors. Rigidity, including insistence on sameness and ritualized or inflexible adherence to routines. Restricted behaviors, including restricted interests and highly fixated interests. Atypical sensory responses, including hypo-reactivity and hyper-reactivity to sensory input, as well as sensory-seeking behaviors. Repetitive and restricted behaviors   are commonly divided into two factors: Lower-order behaviors, characterized by repetitive actions, including stereotyped motor movements, repetitive manipulation of objects, and repetitive forms of self-injurious behavior. Higher-order behaviors, which include attachment to objects, insistence on routines, repetitive use of language, and restricted interests. Whereas lower-order repetitive behaviors are characterized by motor rigidity, higher-order repetitive behaviors are considered more complex and involve cognitive rigidity. Why does this occur? Possible mechanisms – brain, genetics, and the immune system דפוסי התנהגות חזרתיים ומוגבלים בקרב אוטיסטים - למאמר בעברית The literature describes evidence of disruptions in neural connectivity (for example, in cortico-striatal pathways and basal ganglia circuits) as a possible basis for these behaviors. In addition, findings indicate a strong genetic contribution, alterations in the excitation–inhibition balance, the involvement of neurotransmitters (dopamine, glutamate, GABA, serotonin), and a possible role of neuroinflammation and the immune system. Executive functions have been found to predict repetitive and restricted behaviors in autism and provide an explanation for difficulties such as the need for routines, adherence to repetitive behaviors, difficulties with transitions, and difficulty shifting attention between different stimuli. The executive functions most strongly associated with these behaviors are cognitive flexibility and response inhibition. In summary, the underlying causes are likely multisystemic, arising from interactions among neural networks, cognitive factors, sensory sensitivity, genetic influences, and immune system functioning. Treatment of Repetitive and Restricted Behaviors in Autism דפוסי התנהגות חזרתיים ומוגבלים בקרב אוטיסטים - למאמר בעברית 1. Behavioral Interventions Behavioral interventions and targeted protocols aimed at reducing stereotyped behaviors are often presented as a first-line approach, with evidence suggesting greater effectiveness when implemented at an early age. However, it is important to note that interventions designed specifically to reduce these behaviors are controversial and not always recommended. As noted earlier, testimonies from autistic adults indicate that these behaviors often help reduce anxiety and support sensory and emotional regulation; therefore, suppressing them may be counterproductive or even harmful. Practical strategies that may help include: Replacing one movement with another that is less conspicuous and more appropriate for a specific setting or time. Assessing whether environmental factors are contributing to distress and addressing the underlying cause (e.g., an overly crowded classroom, psychological stress, or fatigue). Allowing the autistic individual to move to a different space in order to self-regulate. Allowing the use of sensory tools that can meet the nervous system’s need for movement. Considering additional creative, individualized solutions tailored to the person’s specific needs.   In addition, as noted earlier, it is always recommended to evaluate each case individually. For example, in cases of severe self-injurious repetitive behaviors (such as repeated biting, self-hair pulling, or repeated striking of the face) or in behaviors that are morally or legally inappropriate, such as public masturbation, approaching strangers in an intrusive manner, or staring at others, behavioral interventions aimed at reducing or stopping these behaviors should certainly be considered. 2. Pharmacological Treatment and Additional Approaches In parallel, the scientific literature also describes pharmacological options and complementary approaches. These include the use of antipsychotic medications to reduce irritability, as well as trials of medications that affect glutamatergic and GABAergic systems, for example, N-acetylcysteine, with preliminary findings that are promising but inconsistent. In addition, early exploratory directions such as cell-based therapies (e.g., mesenchymal stem cells) are being investigated, with researchers emphasizing that the evidence is still preliminary and that large, well-controlled trials are required. Further elaboration on commonly used pharmacological treatment in Israel: (This does not constitute medical advice, and consultation with a physician is required before making any decision regarding medication use.) A very comprehensive meta-analysis examining treatments for repetitive and restricted behaviors in autism assessed the effects and efficacy of pharmacological interventions. The main conclusion is that existing medications have, at best, a limited benefit for treating repetitive and restricted behaviors, and that there is currently no well-established, highly effective pharmacological treatment for this domain. Antipsychotic medications (primarily risperidone and aripiprazole) have demonstrated a statistically significant but small improvement in repetitive and restricted behaviors in autism compared to placebo, indicating a modest clinical effect. In Israel, risperidone is marketed primarily under the following names (which may vary by health fund and manufacturer): Risperdal  – the most well-known and commonly used brand Rispone Risperidex / Risperidone Teva / Risperidone-Taro Aripiprazole is marketed in Israel under the following names: Abilify  – the most well-known brand Ariply / Aripiprazole Teva / Aripiprazole-Taro These medications are prescribed mainly to address irritability, aggression, and emotional dysregulation in autistic children and adolescents. Several other individual medications (such as fluvoxamine, buspirone, bumetanide, divalproex, guanfacine, and folinic acid) have shown positive results in single studies, but without replication in additional trials; therefore, conclusions regarding their effectiveness remain cautious. Medication classes that have been extensively studied, such as oxytocin, omega-3 fatty acids, SSRIs, and methylphenidate, have not demonstrated a significant advantage over placebo in reducing repetitive and restricted behaviors in autism. 3. Physical Activity Previous comprehensive studies have found that 15 minutes of moderate-to-high intensity physical activity significantly reduced stereotyped behaviors in autistic individuals. Across these interventions, the emphasis was on increasing heart rate through activities such as trampoline jumping, walking, running, ball games, and stationary cycling. A recent meta-analysis (2026) found that physical activity helps reduce repetitive and restricted behaviors in autism. Activities shown to be beneficial included ball games, karate training, and cycling, with ball games found to be the most effective for children aged 5–8 years when implemented for more than 9 weeks. In summary, repetitive and restricted behaviors in autism have been studied less extensively than the social-communication domain, and consequently there is relatively limited available evidence. At present, both their classification and treatment remain controversial and not highly effective, and there is also debate regarding whether these behaviors should be reduced or eliminated at all. A balanced approach is therefore most appropriate: each case should be evaluated individually, considering whether these behaviors support the child’s emotional and social functioning or, alternatively, pose risks and compromise the child’s safety. References: Chaxiong, P., Dimian, A. F., & Wolff, J. J. (2022). Restricted and repetitive behavior in children with autism during the first three years of life: A systematic review.  Frontiers in Psychology ,  13 , 986876. https://doi.org/10.3389/fpsyg.2022.986876 ‏ Tian, J., Gao, X., & Yang, L. (2022). Repetitive restricted behaviors in autism spectrum disorder: From mechanism to development of therapeutics.  Frontiers in Neuroscience ,  16 , 780407. doi:  10.3389/fnins.2022.780407 Wang, K., Qiu, F., Liu, J., & Yang, X. (2026). The effects of exercise intervention for restricted and repetitive behavior in children with autism spectrum disorder: A network meta- analysis.  Journal of Behavioral and Cognitive Therapy ,  36 (1), 100549. ‏  https://doi.org/10.1016/j.jbct.2025.100549 Zhou, M. S., Nasir, M., Farhat, L. C., Kook, M., Artukoglu, B. B., & Bloch, M. H. (2021). Meta-analysis: pharmacologic treatment of restricted and repetitive behaviors in autism spectrum disorders.  Journal of the American Academy of Child & Adolescent Psychiatry ,  60 (1), 35-45. https://doi.org/10.1016/j.jaac.2020.03.007 ‏     🟢  For all updates on autism and events at our center, join our   quiet WhatsApp group   🟢

קשיי התארגנות אצל אוטיסטים למאמר בעברית Organization may sometimes seem like a simple action: getting dressed, packing a bag, tidying a room, or starting homework. But for autistic children and adults, it is often one of the most complex tasks, as it requires coordination between multiple systems. In this post, we will explore what causes this challenge, how it appears in daily life, and offer practical tools to improve this skill. ⭐ Why do autistic children and adults struggle with organization? קשיי התארגנות אצל אוטיסטים למאמר בעברית Organization difficulties don’t stem from a single cause, they are the result of an interplay between multiple abilities. When one of these abilities is challenged, the task becomes harder. When several are affected, organization can sometimes ‘break down’ entirely. Research shows that autistic children and adults experience a higher rate of: Challenges in executive functions - Executive functions are the brain’s control system. When there are difficulties in these functions, it can show up in organization challenges such as: ✔ Difficulty with planning Trouble anticipating the steps needed to complete an organization task. For example: What do we do first? Where do we start? What do we need to bring? ✔ Difficulty with organization Organizing objects, a school bag, a room, or the sequence of actions. Beyond the motor and practical execution, there is also internal organization: The ability to create “order in the mind” The ability to distinguish between what’s important and less important Managing emotional overload and avoiding mental burden When internal order is disrupted, external chaos often appears too. ✔ Difficulty with initiation and motivation The child knows what they need to do, but can’t start. Sometimes the challenge isn’t the ability itself, but the motivation behind it: The task isn’t interesting It lacks internal meaning or purpose There’s no immediate gain or reward The workload feels overwhelming or intimidating The result: avoidance and feeling ‘stuck’ or unable to move forward. ✔ Difficulty maintaining sequence The child starts a task but stops at each step because transitioning to the next one is hard. This is also linked to the executive function of working memory, which involves temporarily holding and processing information in the mind in order to complete complex tasks and sustain activity. Organization requires remembering multiple steps at once, for example: ‘Put socks on → shoes on → bring your bag → check you have water’ When working memory is limited, the child may lose track of steps, forget, repeat actions, go backward, and feel overwhelmed. ✔ Difficulty with inhibition and attention Being pulled toward other stimuli, distractibility, and difficulty completing a task. ✔ Cognitive flexibility a key component of organization. It is necessary for: Changing the order of steps Problem-solving when something is missing or can’t be found Adapting to new or unfamiliar situations Difficulty with flexibility → even a small obstacle can cause the entire process to come to a stop. Difficulties in motor planning - Some autistic children and adults experience challenges in motor planning, that is, difficulty planning, organizing, and executing a sequence of complex movements. ✔ Organization is a complex motor task Getting dressed, packing a bag, or organizing a room are all tasks that require: Breaking the task into steps Initiating movement Organizing the sequence of actions Coordination between hands, eyes, and body Precision in each step When motor planning is difficult, the child knows what needs to be done, but the body cannot organize itself to do it. ✔ Motor–cognitive load Organization requires both executive functions (the “planning brain”) and motor abilities (the “doing body”). When both are challenged → the effort level becomes very high. The child cannot figure out the first step → executive-function difficulty Even after understanding it, performing the sequence is hard → motor-planning difficulty The whole situation feels “too big” → overwhelm In the end: frustration, avoidance, slowing down, and increased dependence on an adult. Sensory regulation - Children with sensory regulation or sensory processing difficulties may struggle to organize movement efficiently, which can lead to confusion, slowness, and overload during daily organization tasks. Difficulty tolerating certain clothing → stops the dressing process Distracted by noise or movement → loses the sequence Sensory seeking → disconnects from the task Sensory overload → freezing or avoidance Organization is a sensory–motor task, and when the sensory system is overwhelmed, functioning is affected. Visual and spatial perception  - These abilities are essential for effective organization: Knowing where things are Understanding what belongs with what Visualizing how a packed or organized bag should  look Arranging space on a table or shelf Difficulties in visual perception often lead to chronic messiness and inefficient organization. Processing speed Autistic children often process information more slowly, which means: Every action takes longer Transitions between steps are slower Time pressure (like school-morning routines) increases overload Time becomes a significant source of stress. Emotional regulation The moment frustration appears, the organization process can fall apart. Feeling of failure → the child gets stuck Tasks that require sustained effort → emotional fatigue Small changes in the plan → overwhelm Emotions play a major role in the ability to persist through a complex task. ⭐ What do organization difficulties look like in the daily life of autistic children and adults? קשיי התארגנות אצל אוטיסטים למאמר בעברית The child starts getting dressed and suddenly stops halfway. Slow pace in getting ready, for example, mornings take a very long time before leaving the house. A messy or disorganized bag or room. The child goes to the room to get something and forgets what they wanted. Items frequently get lost. Emotional overwhelm when there are many steps or time pressure. Difficulty starting tasks, the child knows what to do but doesn’t know how to begin. Needing external guidance for every multi-step task. Difficulty packing a bag, organizing a desk, or preparing for a lesson. Motor overload, such as “I don’t know where my hands are supposed to be” , for example, trying to arrange the bag while holding a book instead of putting it down to free both hands for organizing. ⭐ Practical Tips for Parents: What Can You Do at Home? קשיי התארגנות אצל אוטיסטים למאמר בעברית Here are tools that have been tested in real-life settings and are helpful for most autistic children and adults: Breaking tasks into steps Turn every task into a series of clear, simple actions. For example: Morning dressing → shirt → pants → socks → shoes. Tip: You can print or photograph the steps. Using pictures or visual schedules Visual information is often more helpful than verbal instructions for most autistic children. Tip:   Create boards such as “Morning Routine,” “Getting Ready to Leave the House,”  or “Bedtime Routine.” Visual timer Helps the child understand time in a concrete rather than abstract way. Tip: Use a “pie timer” or an hourglass-style timer that shows the remaining time. Organized and predictable environment and creating consistent routines Every item has a designated place. Less clutter = less overwhelm. A consistent sequence supports motor planning, reduces cognitive load, and creates a sense of control. Give the child one clear starting point The main difficulty is often getting started. Offer just the first step: “Put on your shirt, I’m right here with you.” Reduce sensory stimuli during organization Less noise, fewer toys around, and less movement in the environment. Teach internal self-talk strategies Using simple phrases such as: “What am I doing now?”“ What’s the next step?” Tip: You can practice saying it together out loud. Avoid rushing, yelling, or criticizing Most children are not being “difficult” on purpose. They are genuinely struggling. A calm response helps regulate their whole system. Motor practice Practice the specific motor actions required for the task. For example, when organizing a school bag, teach how to position the hands to open the zipper (one hand stabilizing, the other moving). Focusing on small motor details helps children learn the task more efficiently. Practice the specific task during calm moments, when there is no time pressure. To sum up Organization is a multi-system task that involves executive functions, motor planning, sensory processing, emotional regulation, and more. When an autistic child or adult struggles, it is not laziness and not lack of motivation, it is a genuine difficulty within a complex system. With the right tools, visual supports, tailored guidance, practice, and understanding, everyday organization tasks can become manageable, and even help build a stronger sense of competence and capability. 🟢  For all updates on autism and events at our center, join our   quiet WhatsApp group   🟢

What are executive functions? Executive functions are a set of higher-order cognitive abilities essential for goal-directed behavior, self-control, and adapting to changing situations. They support planning, decision-making, problem-solving, and regulating emotional and behavioral responses. Types of Executive Functions Inhibitory Control: The ability to suppress automatic responses, focus on relevant information, and regulate impulses. Working Memory: Holding and manipulating information in mind in order to perform complex tasks and maintain engagement. Cognitive Flexibility: The ability to adapt to changes, shift between tasks or strategies, and view situations from different perspectives. Planning and Organization: Setting goals, creating strategies to organize information or actions, and carrying out steps to achieve objectives. Self-Monitoring: Assessing one’s own performance, recognizing errors, and making adjustments as needed. Initiation: Beginning tasks or actions independently and generating new ideas. Emotional Control: Regulating emotional responses in changing situations and maintaining adaptive functioning. Executive Functions and Autism Research findings show that autistic individuals often experience executive function difficulties, particularly in cognitive flexibility, working memory, and planning. Difficulties often appear in adapting to change, staying organized, shifting between tasks or environments, and engaging in repetitive behaviors. They may also struggle to initiate actions or ideas, recognize mistakes, and make self-corrections. Emotion regulation can be more difficult as well, sometimes leading to intense emotional reactions to change. Executive functions have been shown to predict repetitive behaviors as well as social abilities and understanding (core challenges in autism). Examples of how executive function difficulties may appear in autism: Difficulty suppressing repetitive behaviors or thought patterns, such as intense interests or frequent focus on unusual topics or objects. Difficulty shifting between tasks, environments, or routine changes, as well as challenges interpreting different social situations. Difficulties remembering sequences of actions, for example during morning routines or learning from mistakes. Challenges in planning actions, organizing tasks, and setting priorities. Emotional regulation difficulties, which may manifest as strong emotional reactions to change or frustration. Recent studies show a strong link between the severity of executive function difficulties and the level of social challenges in autistic individuals. Targeted improvement of these skills may enhance adaptive behavior and overall wellbeing. From Research to Practice - What Can Be Done? Executive functions are a critical component of daily functioning for everyone, and especially for autistic individuals. Understanding executive functions in autism helps guide more precise interventions that support daily and social functioning. In the upcoming posts, we will take a deeper look at how each executive function appears in daily life and share practical tips for improving them. References: https://pmc.ncbi.nlm.nih.gov/articles/PMC4084861/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4789148/ https://www.nature.com/articles/s41598-025-94334-1 https://pmc.ncbi.nlm.nih.gov/articles/PMC8882695/   🟢  For all updates on autism and events at our center, join our   quiet WhatsApp group   🟢

Experiences, Insights, and Field-Based Conclusions of Autistic Adults Social anxiety and managing interpersonal relationships constitute a major challenge for autistic adults. In recent years, adapted cognitive-behavioral therapies (CBT) have become the standard for addressing these difficulties, yet there remains a lack of studies that deeply explore participants’ own experiences in such group-based treatments and their effectiveness for this unique population. An innovative qualitative study conducted at the University of Sydney examined in depth the experiences of 27 autistic adults (ages 18–38, mean age 25) who participated in a dedicated group CBT program for addressing social anxiety. All participants were diagnosed as autistic and met the criteria for social anxiety disorder. The group incorporated structured adaptations: consideration of sensory needs, the option for diverse communication methods, simple language, and a consistent format. Main Findings: Social connection and reduced loneliness: Most participants emphasized the great value of learning and sharing within a group of peers who face similar experiences, strengthening their sense of belonging and their social self-confidence. A safe and supportive environment: The group was characterized by a supportive and accommodating atmosphere, with an emphasis on self-acceptance and practicing social skills without pressure to mask autistic traits. Cognitive and sensory accommodations: The structure of the sessions allowed flexibility according to individual needs, including attention to sensory sensitivities, opportunities for breaks, and the use of visual supports. The participants emphasized the importance of an adapted therapeutic approach that respects the unique needs of autistic adults, offering flexibility and the development of individualized tools rather than efforts toward “normalization.” Real-world application: About 70% reported an increase in social confidence and in their ability to cope with everyday social situations while applying the strategies they learned in the group. Challenges: About 18% of the participants noted difficulties in applying the tools outside the group, especially in emotionally volatile social situations in which social anxiety is connected to experiences of rejection or to past negative events. Some also noted difficulty coping with sensory aspects such as noise, light, or the length of the session. Future Directions: The study recommends continuing to adapt group therapy frameworks for autistic adults, with an emphasis on collaboration, a supportive environment, sensory diversity, expectation-setting, and attention to personal background. Additionally, increasing awareness among professionals regarding the importance of improving accessibility and fostering a safe space may empower the autistic community and contribute to the effectiveness of treatment, to inclusion, to acceptance of differences, and to positive outcomes in the way autistic adults cope with social anxiety. ​ For the full article: https://journals.sagepub.com/doi/pdf/10.1177/13623613251377930 🟢  For all updates on autism and events at our center, join our   quiet WhatsApp group   🟢