Lebanon's War Exacerbates Challenges for Autistic and ADHD Youth

Beirut, Lebanon – For Lena Kouyoumjian, the return to her parents' home in Mazraat Yachouh after her husband's death in 2020 was a difficult adjustment. However, she accepted the need for assistance in caring for her 20-year-old daughter, Vana, who is autistic and non-verbal. Lena first observed Vana's symptoms at the age of two. Although Vana cannot verbally express her feelings, her mother strives to understand her needs. Like many neurodivergent individuals, Vana thrives in a supportive, stable environment with a structured routine.

Lebanon has been embroiled in conflict since October 2023, with nationwide bombings and an ongoing economic crisis profoundly affecting all Lebanese, especially neurodivergent individuals. When Israel intensified its attacks on southern Lebanon in March, Lena, a trainer for children with disabilities, recognized the potential impact on her autistic daughter. "Any sudden change in routine, loud noises, fear, or uncertainty can increase their anxiety and make them feel unsafe," Lena shared with 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."

The symptoms of autism and attention-deficit/hyperactivity disorder (ADHD), which can vary significantly, often include sensory sensitivities and emotional dysregulation. ADHD and autism frequently co-occur, leading to AuDHD, a condition exhibiting traits of both. Individuals with these neurodevelopmental conditions often face societal stigma in Lebanon and elsewhere. While the war and displacement have caused psychological distress for many, neurodivergent individuals are particularly vulnerable due to their reliance on 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," Lena admitted. The Autism Awareness Association (AAA) in Lebanon has provided vital support for both Lena and Vana. Vana has attended classes at AAA, a non-profit organization in Antelias, for six years, functioning as an alternative school for young autistic individuals. However, escalating costs in Lebanon amid the war have made regular attendance challenging. "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 stated.

Ghada Hayek Makhoul, who co-founded AAA in 2015 with other parents, highlighted the organization's continuous efforts to raise awareness about autism 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. Ghada's son, Anthony, a 27-year-old autistic and non-verbal man, relies on assistance. Although unable to speak, his distress is evident, often indicated by him covering his ears due to sensory discomfort. Autistic individuals can experience heightened sensitivity to sounds compared to neurotypical individuals. The war has subjected people in Lebanon to intense sounds, from bombings to the sonic booms of warplanes. "So, imagine the drones all the time, the bombs, and the vibration of the bombs… all of this that we were hearing, so of course it affected him a lot," Ghada explained. "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 noted that he senses tension and anxiety, even with limited comprehension. "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 lamented. "I don’t know what changed. Because it’s outside? Because of the sound? I don’t know."

Israel's war in Lebanon has directly impacted the financial stability of AAA and other organizations offering support for neurodivergent and psychological needs. Lebanon's economic crisis, with potential inflation reaching 17 percent, has also led to a significant emigration of professionals skilled in supporting neurodivergent individuals. AAA serves as a critical support system for families with autistic children, but the cost of $700 per month for full-time attendance is prohibitive for many, given that 80 percent of the population lives in poverty. "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," Ghada stated. "Things are in crisis mode for everybody during the war."

Similar challenges are faced by other mental health services. While many NGOs offer free therapy, private consultations can exceed $100 for a single 50-minute session. Nour Toukan, a public health researcher at Enmaeya, a media platform focused on sustainable development, described care for individuals with autism or ADHD as "very much an out-of-pocket expense." Although the government introduced a National Disability Allowance in 2023, funded by the European Union and UNICEF, the $40 monthly allowance is insufficient for basic needs in Lebanon. Individuals with autism can obtain a personal disability card from the Ministry of Social Affairs for support eligibility, but those with ADHD cannot. Lebanon's National Mental Health Programme, established in 2014 by the Ministry of Public Health, aims to address service gaps caused by economic and geographic factors. Dr. Rabih El Chammay, the program's founder and director, indicated that a national mental health strategy for children and adolescents is nearing completion. "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."

Displaced populations have been the most severely affected, but disruptions to schooling and routines have impacted all individuals in Lebanon. Adham Faraj, a 23-year-old psychology student at the Lebanese American University in Beirut, diagnosed with ADHD in 2024, found himself spending more time at home when his classes moved online due to the war. "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. The intensity of Israeli air strikes and concerns about rising medication costs also unsettled him. "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," Adham noted.

Rim Ajjour, a psychologist and psychotherapist in Beirut specializing in young people with autism, has observed a regression in skills acquired by neurodivergent individuals before the war. "With the limited resources available in Lebanon and the shift in people’s priorities, there has been more limited access to therapy," she stated. Rim mentioned that her clinic and others are making efforts to maintain therapy accessibility by freezing consultation fees, despite rising operational costs. With ongoing Israeli attacks in southern Lebanon, many fear the potential impact on their work should a full-scale war resume. "I don’t know how we’ll be able to take it again," Rim expressed.