How Israel’s war on Lebanon has cost young people with autism and ADHD

Beirut, Lebanon – After her husband died from COVID-۱۹ in ۲۰۲۰, Lena Kouyoumjian moved back to her parents’ house in Mazraat Yachouh, a village ۲۰ minutes’ drive from Beirut. For Lena, energetic and outgoing, the move was difficult, but she accepted that she needed help to care for her ۲۰-year-old daughter, Vana, who is autistic and non-verbal.

Lena first noticed her daughter’s symptoms when she was two years old. Vana is still unable to communicate verbally how she feels, but her mother does her best to understand her.

Like many autistic individuals – and neurodivergent people in general – Vana needs a supportive and stable environment, alongside a structured routine, to feel well.

Lebanon has been engulfed in war since October ۲۰۲۳, with bombings across the country and an economic crisis continuing to impact all Lebanese, particularly neurodivergent people.

When Israel escalated its attacks on southern Lebanon in March, as a trainer for children with disabilities, Lena understood that this could impact her autistic daughter.

“Any sudden change in routine, loud noises, fear, or uncertainty can increase their anxiety and make them feel unsafe,” Lena told Al Jazeera.

“I can see this in my daughter. Since the situation became more difficult, she has become more anxious and sensitive to the changes happening around her.”

Challenging a social stigma

The symptoms of autism and attention-deficit/hyperactivity disorder (ADHD) vary depending on the person and condition, but they frequently include sensory issues and emotional dysregulation. ADHD and autism often occur together, combining to make AuDHD, where traits from both conditions can be seen.

People with these neurodevelopmental conditions are often stigmatised by societies that do not fully understand them, including in Lebanon.

While the pressures caused by Israel’s war on Lebanon and mass displacement have led to psychological issues for many, neurodivergent people are more vulnerable due to their need for consistent support and routine.

“Being a parent of an autistic child isn’t something every parent can handle. A challenge I often face is deciding the amount of time and energy I should allocate to my child,” said Lena.

Lebanon’s Autism Awareness Association (AAA) has provided support for both mother and child. Vana has attended classes at AAA, a nonprofit based in Antelias, outside Beirut, for the past six years, which serves as an alternative school for young autistic people.

But rising costs in Lebanon during the war have prevented Vana from attending classes regularly. “Even transportation to her centre became very difficult, especially with the increasing financial challenges. At times, it became impossible for her to go, so she had to stay home,” Lena said.

Ghada Hayek Makhoul, who co-founded AAA with other parents of autistic children in ۲۰۱۵, said the group has made constant efforts to increase awareness about the condition in Lebanon.

“Many people don’t know what autism really is. They don’t know the spectrum; how it can vary from mild to moderate to severe,” Ghada told Al Jazeera.

Sensory overload

Ghada’s son, Anthony, is a calm ۲۷-year-old autistic, non-verbal man who relies heavily on helpers. Although he is unable to speak, his mother said it is clear when he is distressed, putting his hands over his ears when he is in pain due to sensory discomfort.

Autistic people can be more sensitive to noises than neurotypical people. During the war, people in Lebanon have been subjected to a harrowing range of sounds, from Israeli bombs exploding on the ground to the sonic booms of warplanes flying overhead.

“So, imagine the drones all the time [for autistic people], the bombs, and the vibration of the bombs … all of this that we were hearing, so of course it affected him a lot,” Ghada said.

“My son can’t listen to the TV any more due to the news. He switches it off and removes the remote control. It’s too triggering for him.”

Anthony’s mother said he senses tension and anxiety, even if his understanding of what is being said or happening is limited.

“[It affects] all the senses, everything. He doesn’t want to go into a pool any more. He used to love the water. And now, he doesn’t want to go into the pool any more,” Ghada said.

“I don’t know what changed. Because it’s outside? Because of the sound? I don’t know.”

Mental health support as a luxury

Israel’s war on Lebanon has had a direct economic impact on the AAA and other organisations providing neurodivergent or psychological support.

Lebanon’s economic crisis, with inflation potentially reaching ۱۷ percent this year, has also led to a brain drain of professionals who could support neurodivergent people.

AAA is a crucial support base for families with autistic children. But it comes at a significant cost of $۷۰۰ per month for children attending five days a week. With ۸۰ percent of the population living in poverty, few can afford such services.

“We need more trained staff, and we also need to keep the staff that are leaving the country. So, we need to have better salaries, but we cannot afford it, because we will have to increase the load on the parents,” said Ghada. “Things are in crisis mode for everybody during the war.”

The same thing is being seen with other mental health services. While many nongovernmental organisations (NGOs) provide free therapy, private consultations can cost more than $۱۰۰ for a single ۵۰-minute session.

Nour Toukan, a public health researcher at Enmaeya, a media platform focused on sustainable development, told Al Jazeera that care for people with autism or even for ADHD is “very much an out-of-pocket expense.”

While the government did launch a National Disability Allowance in ۲۰۲۳, with funding from the European Union and the United Nations Children’s Fund (UNICEF), the allowance of $۴۰ per month is not enough to cover even the basics in Lebanon. People with autism can get a personal disability card, issued by the Ministry of Social Affairs, making them eligible for support, but those with ADHD cannot.

Lebanon’s National Mental Health Programme, established in ۲۰۱۴ by the Ministry of Public Health, is trying to bridge gaps in support caused by economic and geographic variables.

Dr Rabih El Chammay, the founder and director of the programme, told Al Jazeera a national mental health strategy for children and teenagers is being finalised.

“National studies addressing autism and ADHD have also been conducted, providing evidence to inform this work. We are meeting with several organisations, particularly organisations representing families of persons with autism, to understand priorities and build momentum for further coordinated action,” Dr Rabih said. “War makes this work more difficult because it can increase support needs while disrupting the services people depend on.”

Developmental regression

Displaced people have been the most impacted, but all of those in Lebanon whose schooling and routines have been disrupted are affected.

Adham Faraj, a ۲۳-year-old psychology student at the Lebanese American University in Beirut, who was diagnosed with ADHD in ۲۰۲۴, said that when his classes moved online due to the war, he found himself staying at home more and more.

“It’s less engaging, especially if you struggle with attention. You’re less motivated to go out, so you just attend classes from bed,” Adham said.

Adham said the intensity of Israeli air strikes in Lebanon unsettled him, along with concerns about the rising price of medicine.

“There’s always a cheaper alternative, but it depends on people’s social class. Maybe an $۱۱ box of medication is affordable for some, but not for everyone,” he said.

Rim Ajjour, a psychologist and psychotherapist in Beirut, whose work focuses on young people with autism, has seen that many of the skills neurodivergent people learned before the war are now being lost.

“With the limited resources available in Lebanon and the shift in people’s priorities, there has been more limited access to therapy,” she said.

Rim said that her clinic and others are doing their utmost to keep therapy accessible by freezing consultation fees, even when their own expenses are increasing.

With Israeli attacks continuing in southern Lebanon, which remains occupied by Israeli forces, in violation of a US-brokered June ceasefire, many fear the impact on their work in case of a return to full-scale war.

“I don’t know how we’ll be able to take it again,” Rim said.