How war in Lebanon has cost young people with autism and ADHD

Experts warn that war takes a heavy toll on neurodivergent people, who often rely on routine.

Anthony, the 27-year-old non-verbal autistic son of AAA cofounder Ghada Hayek Makhoul, chooses colouring pencils with a teacher at the school for young autistic people in Lebanon [Alex Milan Durie/Al Jazeera]

Beirut, Lebanon – After her husband died from COVID-19 in 2020, Lena Kouyoumjian moved back to her parents’ house in Mazraat Yachouh, a village 20 minutes’ drive from Beirut. For Lena, energetic and outgoing, the move was difficult, but she accepted that she needed help to care for her 20-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.

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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 2023, 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.”

Lena Kouyoumjian poses for a selfie with her non-verbal autistic daugher Vana, whose symptoms have worsened due to Israel’s war in Lebanon, as the 20-year-old fears loud noises or “any sudden change in routine” [Courtesy of Lena Kouyoumjian]

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 2015, 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.

A teacher for young autistic people high-fives Anthony at the AAA after he scores a basket [Alex Milan Durie/Al Jazeera]

Ghada’s son, Anthony, is a calm 27-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.”

A non-verbal autistic girl practices her writing in French as a teacher at the AAA holds her hands to support her [Alex Milan Durie/Al Jazeera]

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 17 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 $700 per month for children attending five days a week. With 80 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 $100 for a single 50-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 2023, with funding from the European Union and the United Nations Children’s Fund (UNICEF), the allowance of $40 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 2014 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.”

Nour Toukan, a public health researcher at Enmaeya, a Lebanese media platform focused on sustainable development, told Al Jazeera that “at the moment, care for autism or even for ADHD is very much an out-of-pocket expense” [Alex Milan Durie/Al Jazeera]

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 23-year-old psychology student at the Lebanese American University in Beirut, who was diagnosed with ADHD in 2024, 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 $11 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.

专家警告说，战争对神经多样性人群造成了沉重打击，因为他们往往依赖常规的生活。

27岁的安东尼是AAA联合创始人加达·哈耶克·马胡尔（Ghada Hayek Makhoul）患有自闭症且不会说话。在黎巴嫩一所自闭症青少年学校，安东尼正在和老师一起挑选彩色铅笔。[Alex Milan Durie/半岛电视台]

黎巴嫩贝鲁特——2020年，莉娜·库尤姆吉安的丈夫因新冠肺炎去世后，她搬回了位于贝鲁特以西20分钟车程的马兹拉特·亚舒赫村的父母家。对于精力充沛、性格外向的莉娜来说，搬家并非易事，但她接受了自己需要帮助来照顾20岁的女儿瓦娜的事实。瓦娜患有自闭症，不会说话。

莉娜在女儿瓦娜两岁时第一次注意到她的症状。瓦娜至今仍无法用语言表达自己的感受，但她的母亲尽力去理解她。

（共3项，此为第1项）黎巴嫩儿童在以色列战争中面临身心创伤

（共3条）随着以色列战争摧毁黎巴嫩村庄，心理创伤日益加剧

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像许多自闭症患者——以及一般的神经多样性人群——一样，瓦娜需要一个支持性和稳定的环境，以及有规律的作息，才能感到舒适。

自 2023 年 10 月以来，黎巴嫩一直深陷战争泥潭，全国各地发生爆炸事件，经济危机持续影响着所有黎巴嫩人，尤其是神经多样性人群。

今年三月，以色列加大了对黎巴嫩南部的袭击力度。作为一名残疾儿童的培训师，莉娜明白这可能会影响到她患有自闭症的女儿。

“任何日常生活的突然改变、巨大的噪音、恐惧或不确定性都会加剧他们的焦虑，让他们感到不安全，”莉娜告诉半岛电视台。

“我能从女儿身上看出这一点。自从情况变得更糟以来，她变得更加焦虑，对周围发生的变化也更加敏感。”

莉娜·库尤姆吉安与她患有自闭症且不会说话的女儿瓦娜自拍。由于以色列在黎巴嫩的战争，瓦娜的症状加重了，这位20岁的女孩害怕巨响或“任何突然的作息改变”。[莉娜·库尤姆吉安供图]

挑战社会污名

自闭症和注意力缺陷/多动障碍（ADHD）的症状因人而异，但通常包括感觉统合障碍和情绪失调。ADHD和自闭症常常同时出现，合并为自闭症多动障碍（AuDHD），患者可能同时表现出两种疾病的特征。

患有这些神经发育障碍的人常常受到社会的歧视，因为社会对他们缺乏充分的了解，黎巴嫩就是其中之一。

以色列对黎巴嫩的战争和大规模流离失所造成的压力给许多人带来了心理问题，而神经多样性人群由于需要持续的支持和规律的生活，因此更容易受到这些问题的影响。

“养育自闭症儿童并非每个父母都能胜任。我经常面临的挑战是如何决定应该投入多少时间和精力在孩子身上，”莉娜说道。

黎巴嫩自闭症意识协会（AAA）为这对母女提供了支持。过去六年里，瓦娜一直在AAA上课。AAA是一家位于贝鲁特郊外安特利亚斯的非营利组织，为自闭症青少年提供替代教育。

但战争期间黎巴嫩物价飞涨，使得瓦娜无法定期上课。“就连去上课中心的交通都变得非常困难，尤其是在经济压力日益增大的情况下。有时候，她根本去不了，只能待在家里。”莉娜说道。

2015 年与其他自闭症儿童家长共同创立 AAA 的 Ghada Hayek Makhoul 表示，该组织一直在努力提高黎巴嫩民众对自闭症的认识。

“很多人并不了解自闭症究竟是什么。他们不了解自闭症谱系；不了解自闭症的严重程度可以从轻度到中度再到重度不等，”加达告诉半岛电视台。

在AAA比赛中，安东尼投篮得分后，一位自闭症儿童教师与他击掌庆祝。[Alex Milan Durie/半岛电视台]

加达的儿子安东尼今年27岁，患有自闭症，不会说话，性格沉稳，非常依赖他人的帮助。虽然他不会说话，但他的母亲说，当他感到痛苦时，人们很容易就能看出他的情绪，比如当他因感官不适而感到疼痛时，他会用手捂住耳朵。

自闭症患者对噪音的敏感度可能高于神经正常的人。战争期间，黎巴嫩人民饱受各种可怕噪音的折磨，从以色列炸弹在地面爆炸的声音到战机从头顶飞过时产生的音爆。

“所以，想象一下，对于自闭症患者来说，无人机、炸弹以及炸弹的震动……所有这些我们都能听到，所以当然对他影响很大，”加达说。

“我儿子因为新闻节目再也看不下去电视了。他会关掉电视，把遥控器也拿走。新闻对他来说太刺激了。”

安东尼的母亲说，他能感觉到紧张和焦虑，即使他对所说或所发生的事情的理解有限。

“（它影响了）他的所有感官，所有的一切。他再也不想进游泳池了。他以前很喜欢水。而现在，他再也不想进游泳池了，”加达说。

“我不知道发生了什么变化。是因为在室外吗？是因为声音吗？我不知道。”

一位不会说话的自闭症女孩正在练习用法语写作，一位老师在AAA（自闭症协会）握着她的手帮助她。[Alex Milan Durie/半岛电视台]

心理健康支持成为一种奢侈品

以色列对黎巴嫩的战争对 AAA 和其他提供神经多样性或心理支持的组织产生了直接的经济影响。

黎巴嫩的经济危机，以及今年可能高达 17% 的通货膨胀率，也导致了能够为神经多样性人群提供支持的专业人士的大量流失。

AAA为自闭症儿童家庭提供了至关重要的支持。但对于每周五天都参加AAA的孩子来说，每月700美元的费用相当高昂。由于80%的人口生活在贫困线以下，很少有人能够负担得起这样的服务。

“我们需要更多训练有素的员工，也需要留住那些离开这个国家的员工。所以，我们需要提高工资，但我们负担不起，因为那样会加重父母的负担，”加达说。“战争期间，每个人都面临着危机。”

其他心理健康服务领域也存在同样的问题。虽然许多非政府组织提供免费心理治疗，但私人咨询一次50分钟的疗程可能要花费100多美元。

专注于可持续发展的媒体平台 Enmaeya 的公共卫生研究员 Nour Toukan 告诉半岛电视台，照顾自闭症患者甚至多动症患者“很大程度上是一笔自费开支”。

尽管黎巴嫩政府在2023年启动了国家残疾津贴计划，资金来自欧盟和联合国儿童基金会（儿基会），但每月40美元的津贴甚至不足以支付黎巴嫩人的基本生活所需。自闭症患者可以获得由社会事务部颁发的个人残疾证，从而有资格获得援助，但多动症患者却无法获得此类援助。

黎巴嫩国家心理健康计划由公共卫生部于 2014 年设立，旨在弥合因经济和地理因素造成的援助缺口。

该项目的创始人兼主任拉比·埃尔·查迈博士告诉半岛电视台，一项针对儿童和青少年的国家心理健康战略正在最终确定中。

拉比博士表示：“我们还开展了针对自闭症和多动症的全国性研究，为这项工作提供了证据。我们正在与多个组织会面，特别是代表自闭症患者家庭的组织，以了解他们的优先事项，并为进一步的协调行动积蓄力量。战争使这项工作更加困难，因为它会增加支持需求，同时扰乱人们赖以生存的服务。”

黎巴嫩媒体平台 Enmaeya 的公共卫生研究员 Nour Toukan 告诉半岛电视台：“目前，自闭症甚至多动症的治疗费用很大程度上需要自费。”[Alex Milan Durie/半岛电视台]

发展倒退

流离失所者受到的影响最大，但黎巴嫩所有上学和日常生活受到干扰的人都受到了影响。

23 岁的 Adham Faraj 是贝鲁特黎巴嫩美国大学的一名心理学学生，他在 2024 年被诊断出患有 ADHD。他说，由于战争，他的课程转为线上授课，他发现自己待在家里的时间越来越多。

“这样参与度会降低，尤其如果你注意力不集中的话。你出门的动力也会降低，所以你只能躺在床上上课，”阿德汉姆说。

阿德哈姆表示，以色列对黎巴嫩的空袭强度让他感到不安，此外，药品价格上涨也令他担忧。

“总会有更便宜的替代品，但这取决于人们的社会阶层。也许11美元一盒的药对某些人来说可以负担得起，但并非人人都能负担得起，”他说。

贝鲁特的心理学家兼心理治疗师里姆·阿朱尔（Rim Ajjour）主要关注患有自闭症的年轻人，他发现许多神经多样性人群在战前习得的技能现在正在丧失。

她说：“由于黎巴嫩的资源有限，加上人们生活重心的转移，获得心理治疗的机会也更加有限。”

Rim表示，她的诊所和其他诊所正在尽最大努力冻结咨询费，以确保治疗费用能够得到保障，即使他们自己的开支也在增加。

以色列军队继续在黎巴嫩南部发动袭击，而黎巴嫩南部仍被以色列军队占领，这违反了美国斡旋达成的 6 月份停火协议。许多人担心，如果恢复全面战争，他们的工作将受到影响。

“我不知道我们还能不能再次承受这一切，”林说道。