SPEAKER_02 0:30

So this is a different time zone for us. I'm going to say good morning. I'm Dr. SD Hess. And I'm Dr. Ann Kirsch. And this is on and off the spectrum podcast. But the reason we are meeting this morning is because we are actually having the pleasure of entering of interviewing Dr. Boaz Barak, who is the head of the Autism Research Center at Tel Aviv University. I hope Boaz I got all the specifics correct. And um because we're actually speaking to you in Israel, there is an eight-hour time difference. So you're gracious that we are doing this early in the morning, and for you it's almost the end of your night. So thank you for meeting with us.

SPEAKER_01 1:13

Absolutely pleasure.

SPEAKER_02 1:15

And um, and I had the pleasure of of being part of a large audience when you spoke in the States uh not too long ago. And it was about uh the newest developments for autism in at specifically coming out of Tel Aviv University. Um and I think it's an important piece to uh uh to expand on so our viewers can understand what uh what are the top research projects that are currently being conducted in Israel in support of autism spectrum disorder?

SPEAKER_00 1:50

Right. Um I think the broad interest in general in autism is to better understand the genetics behind autism if there is. So nowadays we are familiar with about 25% of the cases with autism who are uh due to genetic condition, uh either heritability or the novel mutation in the patient. And we're trying to better understand the genetics and through that having a personalized medicine. So, for example, uh Israel is a global leader in studying the genetic causes of autism, including, for example, labs at Tel Aviv University, Hebrew University, Weizmann Institute, and so on. And there is a large family databases and national healthcare records that help us to identify risk genes. So we try to move toward personalized treatments instead of one size fits all. Um, and in addition to the genetics aspect, it's also that we are trying to better understand brain development and connectivity. So we try to understand which brain circuits develop differently in autism. Why is it? So we we we use imaging, we use stem cells, animal models, and so on to better understand uh the brain development uh aspects in autism. And we are trying to have better diagnosis, for example, early diagnosis and intervention, because the earlier you will diagnose autism in life, um, you can have better chances to improve the quality of life. And uh nowadays, including AI and digital tools to detect behavioral patterns, for example, earlier. Um last I would say thinking out of the box, which is very Israeli now, right? In order to stop thinking about only neurons that are responsible for autism as usually thought. Uh, we're trying to think outside of the box. Maybe it's not necessarily neurons. Maybe, for example, what we study in my lab is myelination. Uh, myelin is a thick, fatty layer that isolate the electrical activity of the neuron. And we discovered that this is affected in autism, and there are drugs that we can use in order to improve myelination and perhaps offering new sets of drugs and treatments for uh autism and to improve the quality of life.

SPEAKER_02 4:38

Um you've you've just said so much, and I think it's to give uh persons who have uh who are thinking of getting married and having children, and whether they are older adults and the risk being somewhat higher, or if there is a family member, first degree relative, that has autism and they may be hesitant to have a child on the spectrum that they are imagining they're gonna have a child on the spectrum. And then if such the case, what is the level that that child is going to be on? And to be able to have those kinds of potential answers because right now it is a little bit like I close my eyes and say, you know, put you know, put a pen in and say, let's see if indeed uh you know, if you have autism, then the chances are pretty high that your kid will probably have autism, and so maybe think about a different way of of you know conceiving. And to be able to say, no, we can actually create a model taking your specific genetics and tell you what we think is is the potential. Um and uh well, actually I had a question. Is it somewhat like eventually creating something like an amniocentesis that you do now for DOMS to be able to recognize, you know, certainly in the early uh months of fetal development, whether or not a child will be on the spectrum and then parents will have choices that they can make?

SPEAKER_00 6:00

Yeah, of course. I mean, that's something that, for example, in Israel it's very common to do because of the you know, Ashkenazi and Ashkenazi marriages and Moroccans married with Moroccans. So the the marriage between similar cultures and origins makes it important to look at the genetic background of including the fetus. So uh amniotic fluid test is something that we do, and also in the US, and then you can take from the amniotic fluid cells that are coming from the fetus and they are in the fluid, you can isolate those fetus cells, make uh the DNA out of it, and then sequence the DNA and see if there is an abnormal expression of a gene or any mutation or a missing gene. And then we can compare that to a normal or neurotypical genome and see if there is any genetic abnormalities. And then, based on the literature and research that we do in the lab, you can learn about the mutation and the consequences. So you can know nowadays, and many years already, before birth, whether there is a mutation and potentially what will be the consequences. Right.

SPEAKER_02 7:23

And so you're giving parents now um hope that there's an option, potentially, in terms of uh, you know, how to move forward uh or not, you know, with a pregnancy when we get to that kind of clarity. As now is sort of the case, I guess the most familiar would be something like Down syndrome. And so I think that's that's extraordinary. Um, but you know, you said something so powerful. You said Israel, you know, it's very Israeli to think outside the box. What why do you believe that Israel is so advanced when it comes for their thinking towards autism? Because I know recently I I delivered a paper in in Scotland, and um I was uh I always am very unfortunately surprised, I shouldn't be, but you know, by the lack of of general intervention, certainly on the early age, but certainly as somebody that gets to be older, it just is almost non-existent, and that's not the case for Israel. So I'm curious how does this how how does this evolve?

SPEAKER_00 8:28

Yeah. So the Israeli Chutzpah is uh is uh also an advantage, I would say. So you know it's a cultural, it's a culture of innovation. We're this we're the startup nation.

SPEAKER_02 8:43

We are used to think out of the you wanted to uh some of our audience may not understand what chutzpah is.

SPEAKER_00 8:50

Do you want to is uh you know Israelis are I wouldn't say rude, but they tell you what they think about you and ways to improve the outcomes or the research or the thoughts and so on.

SPEAKER_02 9:05

So upfront honesty, yeah.

SPEAKER_00 9:07

Yeah, yeah. And we believe that this is the way to improve the processes that we do, and we are happy to hear you know, criticism and so on. So, but in general, in Israel, it's the startup nation, you know. So Israelis are generally from daycare all the way through IDF and so on, we are encouraged to ask questions, to improvise and solve problems creatively. So, um, and in addition, it's a small country, so there is a strong collaboration between medicine and academia and technology and society and so on. And it's it's easier for us to do fast collaborations. We are familiar with each other, we work closely together, and um, in addition, we have a long-term medical data that helps us, the basic researchers, to follow development. For example, we know from um medical data and then from daycare or infancy and all the way through the IDF. So during your military service, you're doing some tests that are well organized in data sources, and we can do a follow-up studies very easily, and it enables us to do large-scale studies that are difficult elsewhere.

SPEAKER_02 10:34

I'm sorry to interrupt you, the IDF being the Israeli Defense Force.

SPEAKER_00 10:38

Right, right. So our army is uh the IDF, and then you are tested before joining the army and then during the army, and if you are doing reserves, you are also undergoing some tests. So all of these data can be accessible if you have the right to do so, and it's well organized and in large numbers. And I would say that in addition, the strong tech ecosystem of Israel, you know, with the AI and digital health and wearable devices and so on, so this mentality of startup nation applies to healthcare too, and that's what improves I think the autism research and treatment.

SPEAKER_02 11:23

I I think that's actually so important. Um, and I will tell you that it is an inspiration because I think outside of the United States, the only country that I really look to to have similar types of capacity is at this moment Israel, and the willingness to share the information with the world, which is you know incredible. One of the things that I think that and you and I have been talking about is the fact that Israel has created um kind of a normalization. Let's go back to the idea of the IDF, the the Israel Defense Force, that there are now divisions within the Army for persons who are impacted by autism. I I to me that's extraordinary because I think that there would be in the United States uh people who might be on the spectrum but still have a desire to be with At the moment. I don't believe that that's actually uh that that's actually encouraged. But it that is not only encouraged, it has been created. So you have the individuals have the pride of wearing the uniform of their country, being a participant, getting the uh all the benefits. And how did that happen and what does that look like now?

SPEAKER_00 12:41

So I think you saw that with the hostages in the terrible consequences we had uh a few months and years ago. Uh we never leave anyone behind, and that's the mentality, including in the society. So IDF is trying to include also autistic uh soldiers so that they are volunteering to the Army service, and the Army is trying to take advantage of the autistic features and trying to integrate those in IDF so that we will have uh we will focus on the strength and not the limitations. So, one of the key things in autism, as you know better than me, is the uh restricted interest or the ability to put uh attention to small details and so on. So there are well-organized programs, for example, one of them is called in Hebrew Go'im Rachok, which is uh seeing the horizon, I would say. And this program is trying to take an advantage of what many autistic individuals have, which is exceptional attention to details and you know, pattern recognition and focus and reliability and so on. So think about um if I need to take a picture of the missiles in Iran and I need to count now what happened a week ago, how many missiles were there in this base? And let's say there were 152 missiles, and today, if I'll take a picture and I'll count, I'll discover there are only 120. And this is uh the ability of autistic people to put attention into small details, and they are passionate about helping and so on. So, roles in the IDF include, for example, intelligence analysis, uh, this kind of visual scanning that I mentioned, um, technology and data-oriented tests and so on. And it gives meaningful participation and dignity to those with autism, and it builds independence and confidence, and it helps also with employment skills to uh after IDF service. Right.

SPEAKER_01 15:10

Um, sorry, we look here at um autism as a spectrum, autism spectrum disorder, right? And so, and you do too. So when you look at it as a spectrum, not everyone can look at it the way you were uh just just now discussing. Some people are are you wouldn't know that they had autism spectrum disorder, and other people would not be able to function in the army. So when you are doing the testing and you are uh looking for how this person could be helpful in the IDF, do you have a way of looking at the spectrum that you see and where people might be able to be helpful there? Because as you just said when I jumped in, this is a wonderful way for people to then leave the IDF and go out into the workforce and have something really stunningly amazing on their resume.

SPEAKER_00 16:25

Right, right. Yeah, so it it's not that every autistic person wants and can be suited for military service. These are uh individualized and supportive programs that are the result of a pre-screen, uh, we all have tests, physical, mental, motor, and others to assess our abilities, those with autism and those without. And based on mapping those skills and those advantages and so on, the IDF can put you in the right uh program. So if you have motor issues due to your autistic uh phenotypes and so on, then you will not be a technician of, I don't know, air forces, but you might be very good in visual scanning and so on. So there are tasks to assess the advantages and disadvantages and then to properly designate you to the right role in order to benefit from you and that you will feel safe and supported and will be beneficial and benefit from the IDF as well.

SPEAKER_01 17:37

I think it's terrific to know that there is a place for just about everyone in the IDF. I think that gives a lot of hope. We don't do that here right now in the United States, but the idea that that there can be hope for people, that they can feel like they are part of something that um that includes everything, everyone in every kind of service. I know I have relatives who are just now entering the IDF. So I've learned a lot about it, and hearing about uh not specifically what you're talking about, but about all the other ways that a person can be useful to their country is is amazing.

SPEAKER_00 18:27

Right, and it's not it's not only in the IDF, it's also later in university, for example. There are programs in the university that uh you have a mentor that guides you how to go to classes and how to learn and so on. So we try to follow up also after the Army service.

SPEAKER_02 18:45

I I think that's a complete, you know, the as they say in the United States, from cradle to grave type of awareness of the impact of a developmental delay and how to best support, and as you said, from from the earliest time on out. But but um Boaz, you did also mention Iran, you mentioned the Gaza uh attacks, and you know, certainly Israel since its inception. I know you recently celebrated the 78th year of uh independence. And it is a country that is that is more often at war, unfortunately, than otherwise. And it is, to my knowledge, for example, when I as a specialist in autism here in the States, I also came to help volunteer to help reduce trauma and address some of the special needs concerns. But I'm curious in terms of a country where you can't help but have a constant state of PTSD, post-traumatic stress disorder? Uh what kinds of supports are specifically being put into place for the special needs community so that parents, uh young children impacted, but even individuals who who are you know now uh able to navigate a little bit more independently. How do you deal with this constant state of uh you know looking over your shoulder because we all have to run to the shelters and this is a constant state of war and and so forth?

SPEAKER_00 20:18

Right. Yeah, I I fully agree. I mean, uh for neurotypicals, it's not easy to be in this kind of situation of constant war and so on. So, of course, autistic people with this kind of sudden change in routine, uh sirens and sensory overload, and and all of this difficulty to process all the uncertainty that we have, all of these lead to increased anxiety and regression. And um, so what we try to do in Israel is to have some kind of specialized trauma support so that um it will be adapted for autistic children and adults. It will be visual communication tools if there is an issue with the communication verbally and so on, and structured routines. It will be um there are shelters who are actually sensory-friendly shelters and calm rooms next to those shelters. Um, parents are being guided how to uh behave under CIREN and so on with autistic babies, which is a new situation for those parents. Uh, schools and community support. Uh there are emergency education frameworks, there are online therapies and so on. So, overall, communities become hopefully extraordinarily supportive during crisis, and the families hopefully are not felt alone, and the systems try to help them with managing this crazy situation. that we are having.

SPEAKER_01 22:02

It's remarkable to hear you say all of this because the I think one of the takeaways for people who are listening to us and watching how we're discussing this is that um from the beginning of life to the end of life people are being supported in Israel in every way that is possible. And the way that I that occurs to me that is really um a a wonderful thing and it's something that I work in in pre- and perinatal psychology is I'm I'm always talking to parents about how they need to be aware of their babies before they're born. They need to be aware of who they are who they might be not who you want them to be. So when they are born they see and can start to relate on a behavioral level and that's what I'm hearing you say is from the beginning we are watching we are taking care of and it's not a big brother it's a how can we help people from the beginning how can we help families how can we help grandparents how can we do that so that no matter where they turn out to be school whatever kind it is whatever kind of relationships they have they know more about themselves their families know about who they are and the parents know how to relate.

SPEAKER_00 23:49

Right yeah I think we are trying to help improving the quality of life of those with autism we're not trying to fix them we're not forcing them to join the army we're not forcing them to take medication we try to allow systems treatments understanding and so on to improve the quality of life that's an important change.

SPEAKER_02 24:12

I think that's a huge I just want to ask one last question because this has been such an interesting and more informative kind of interview today the people who are going ahead and supporting those who have trauma they themselves are traumatized right because you are also equally being exposed to having the the bombs fall and and running to the shelters and so forth. What kind of supports is being provided to clinical staff to make sure that they have a place to discharge this energy the concerns they have with their family members whether they're in the army whether they're children you know running to the shelters so that they can be the best that they can be in terms of being available to help support the larger community.

SPEAKER_00 25:03

Right. So I think we're all under stress in Israel we're all having major issues and so on but I'm not sure everybody are you know traumatic or having PDSD and so on. There are different levels of susceptibility and not everybody are indeed traumatized and having PDSD. But if a clinical staff is feeling anxious or needs help you know that routinely they meet with other clinical staff so they can discuss and decide if this is safe for them to continue and so on. And luckily and as an Israeli attitude there are many volunteers that volunteer nowadays to take part in processing together what we are having and helping those who need help. So we have a lot of clinicians and staff that can help and if someone needs a break he will take it and there will be someone else that will try to help. But not all of us are traumatized we're strong country strong people and we're trying to help each other and we will make it not worried.

SPEAKER_02 26:21

That's wonderful I I like this this this uh feel of unity not only not to leave anyone behind but the understanding that we are a community of of of um understanding that there is an awareness of of how the environment impacts us it's not a denial and that we are here for each other which I think is a wonderful message to to end this incredible interview. So I want to thank you again this is Dr. SD Hess.

SPEAKER_01 26:52

And I'm Dr.

SPEAKER_02 26:53

Ann Kirsch and thank you so much for all of this information that you have given us this is on and off the spectrum and we want to tell again our viewership if you liked what you heard today please do follow us. And if you think that you would be also a uh a good person for us to interview that like Professor Barak that you can share your wisdom too with the world please do so please reach out to us again it's on and off the the spectrum podcast and we thank you and again uh you have a wonderful day for those of us uh in this time zone but a wonderful evening on on your end so thank you very much please thank you very much for having me