Autism Therapy in the Time of War

Natalia Ukrainets, who lives in Kyiv, Ukraine, began her journey as an autism therapist in the spring of 2021 when her son, Vladyslav, was diagnosed with autism. Her research on evidence-based autism interventions led her to seek training with a naturalistic developmental behavioral intervention called the Early Start Denver Model (ESDM).

“I fell in love with ESDM and wanted to work with my son and other children as well,” she explains. With a background in special education, she resolved to become an ESDM autism therapist.

Ukrainets completed basic training in ESDM online after the start of the full-scale war on February 24, 2022. On March 6 of that year, Ukrainets fled Kyiv with her two sons and found refuge with friends of her ESDM trainer in Poland. By April 2022, she learned of Kyiv’s liberation. The intense fighting had left much of Kyiv destroyed. Despite this, Ukrainets immediately returned to her homeland with her children. She notes,

“Leaving my country and not living in my native land was one of the biggest challenges for me. The war has toughened my character, but it has also increased my sorrow. The loss of close friends, both military and civilian, has become a frequent part of my life, as it has for every Ukrainian.”

During this turmoil, Ukrainets persevered, completing her ESDM training online and eventually becoming certified as an ESDM therapist. Her ESDM training was provided in Russian, as materials were unavailable in Ukrainian. Ukrainets hopes to contribute to a Ukrainian translation in the future.

For the past 18 months, Ukrainets has dedicated herself to providing therapy to one to four-year-old autistic children and coaching parents in home-based interventions. She works closely with two other ESDM therapists to offer services at an eight-room center, Beautifuls, located in the Darnytskyi District of Kyiv. They have created checklists for parents to use at home and a website that allows parents to access educational materials remotely.

The war has had a profound impact on their work. Ukrainets explains, “It was especially dreadful in the winters of 2022 and 2023 because of the frequent missile attacks.” The energy infrastructure was destroyed, and the center where Ukrainets works is often without electricity. The therapists and children can continue therapy with the children without light, but the center also often lacks heat.

She remarks, “We play active games with the children to keep warm.” During air raids, it is not possible to continue therapy; they must descend into the basement for shelter. Ukrainets describes, “There have been moments when Russian missiles hit residential buildings within 200-500 meters from my office where we were working.”

A recent shift to shelling during nighttime has caused increased strain, depriving Ukrainets, her coworkers, and the children and their families of restful sleep. Yet Ukrainets shoulders on, stating, “In the morning, it’s time for work. We need to work, pay taxes, support the economy and the country’s army, help children and their families.”

The war’s impact on children and their families is tremendous. Families who remain in occupied territories are unable to receive any assistance. Many autism specialists have left Ukraine, further compounding the dearth of trained therapists. Mothers are often separated from their husbands who are serving in the armed forces. Ukrainets observes the toll the constant nighttime shelling has taken on parents and their children, who arrive at the center tired and stressed.

Nevertheless, Ukrainets is inspired by the resilience of her colleagues and the families they support. “I am motivated by the happy eyes of parents when they witness a child’s first sounds,” she remarks. “I am motivated by my own child, the struggle of our army, and the volunteers who are helping us. If they are fighting, then so will I.”