This chapter compares how OECD countries determine eligibility and deliver services for children with ASD, showing that needs‑based assessment is central across education, health, and social services. It examines the wide variation in how countries conduct support‑needs assessments – from highly standardised, multi-disciplinary procedures to more flexible, school‑ or family‑led approaches – and how these differences shape access to services. The chapter also highlights cross‑country differences in educational inclusiveness, noting that although many countries aim to expand inclusion in regular schools, substantial shares of children with SEN, and especially those with ASD, continue to be educated in special education classes or schools. The chapter also contrasts limits of Israel’s diagnosis‑linked therapy with more flexible, needs‑driven models used elsewhere. Finally, it reviews the breadth of social services available across countries offering support to children as well as their families.
Policy Responses to Rising Autism Diagnoses in Childhood
Abstract
Education, health and social support for children with autism
Access to services for children with ASD varies widely across countries, but one principle is common: eligibility is primarily based on assessed needs rather than diagnosis alone. Services typically span education, health, and social support, aiming to promote development, autonomy and inclusion. Needs assessments are therefore central to determining what support a child receives and in what setting.
Education systems illustrate the diversity of approaches. While international frameworks such as the UNCRPD advocate for inclusive education, countries differ substantially in how far they have moved from segregated to mainstream schooling for children with special educational needs (SEN). Most countries offer a continuum of options – from dedicated schools to integrated classes. In some countries, such as France and Sweden, fewer than 20% of children with SEN attend special schools, while in others, like Israel, more than half of children with autism are enrolled in special education settings. In Australia most children with autism are in regular classes, although they are more likely to be educated in special settings than other children with disability. These differences reflect not only policy choices but also resource availability and the capacity of mainstream schools to provide individualised support.
Support needs assessments are central to determining entitlement for SEN services, but their depth and standardisation vary widely. Some systems rely on flexible, school‑ or parent‑led decision making, while others, such as France, the United Kingdom and Estonia, use regulated multi-disciplinary procedures that may include in‑person observations. Countries also differ in the role that medical diagnoses play; in many systems, assessed needs alone determine eligibility, while in places such as Canada, the United States, France, and Israel a formal diagnosis acts as a gatekeeping requirement.
Therapy services follow a similar pattern of variation. Children may access speech, occupational, and other paramedical therapies through public health systems, educational settings, or dedicated disability programmes. In most countries, the primary route is the public health system, typically requiring a doctor’s referral, whereas schemes such as Australia’s NDIS and Ontario’s Autism Program provide individualised budgets that allow families to purchase the services they need. Across all systems, early intervention is strongly emphasised, and many countries deliberately waive diagnostic requirements in early childhood to avoid delays in support, reflecting a shared commitment to fostering better developmental outcomes for young children.
Social services complement education and health supports, offering measures such as respite care, specialist transport, and parent training. Although often administered locally and varying in availability and scope, these services play a crucial role in easing the caregiving burden on families and supporting children’s autonomy and participation in community activities.
Services for children with ASD may be grouped into three broad categories: educational services; health and medical services; and social services. The comparison of the policy setup in 11 selected OECD countries demonstrates that, in most countries, needs assessments are essential for determining entitlement not only to financial benefits, as discussed above, but even more so to services of any kind. To be effective and meaningful, services packages are adapted to the child’s specific needs and abilities, making needs assessments an integral part of eligibility procedures. Services generally aim to promote the personal development of children with disability through targeted, individualised support, and to enable them to lead as autonomous a life as possible. Certain policies for children with disability also extend beyond the individual child to address systemic barriers and foster an inclusive society.
Countries offer a continuum of inclusion in education for children with SEN
The UNCRPD calls for the implementation of inclusive education policies (Article 24) that genuinely integrate children with disability into the regular education system, with any reasonable accommodations they may require to develop and learn on an equal basis with their peers (United Nations, 2006[1]). The OECD supports this shift towards more inclusive education systems (OECD, 2025[2]).
Across OECD countries, children with special educational needs (SEN) typically have access to a range of schooling options that differ in their degree of inclusiveness. In previous work, the OECD has identified six broad categories that capture the most common types of educational provision for children with SEN: (i) dedicated schools, (ii) dedicated classes, (iii) regular classes with indirect support, (iv) regular classes with resource support, (v) integrated classes, and (vi) withdrawal classes (OECD, 2023[3]). This six‑tier framework may not always correspond precisely to how national education systems for children with SEN are organised in practice, as some OECD countries do not provide the full range of these options but offer a more streamlined model. For instance, Israel operates with a three‑tier model for children with SEN: 1) regular classes at mainstream schools, with personalised support; 2) special education classes at mainstream schools; and 3) special education schools.
Special education schools are often criticised for creating a parallel education system for children with SEN, thereby promoting segregation rather than inclusion (Mezzanotte, 2022[4]). While these schools may offer more extensive and specialised support, such as increased and specialised teaching staff, adapted materials and environments, individualised curricula, and on-site therapies, they do so at the expense of an inclusive system, limiting shared learning experiences and interaction between children with and without SEN. Most countries offer special education schools that cater to specific types of SEN, most commonly schools for blind or vision-impaired children and children with severe learning disabilities.
An alternative to special schools are special education classes in regular schools, often offering smaller class sizes, specialised teaching staff, and adjusted curricula, while children can simultaneously interact and learn with peers without SEN during certain classes, breaks, and other school activities.
In the most inclusive option – integrating a child with SEN into a regular class within a mainstream school – the child usually receives additional individualised support. This often includes Individualised Education Plans (IEPs), a teaching assistant who may accompany the child for some hours or the entire school day, and assistive technologies that facilitate full and equal participation in education alongside peers. The use of AI plays an increasingly relevant role in such individualised support (Linsenmayer, 2025[5]). AI tools are used to support students with ASD by personalising feedback and strengthening communication and social skills – areas that are often particularly challenging for many children with autism (ibid.).
While the UNCRPD calls upon countries to transition from special education settings to the integration of children with disability into mainstream settings (United Nations, 2006[1]), the practical implementation of such a shift is complex and requires careful planning. The success of educational inclusion hinges on a multitude of factors, such as the availability of sufficient resources, specialised expertise to ensure quality support, capacity building, and monitoring and evaluation (OECD, 2023[3]). Therefore, policies encouraging integration in mainstream classes and schools must, amongst others, be accompanied by a corresponding shift of resources and expertise to mainstream settings to ensure children with special educational needs are adequately accommodated (Taub Center, 2022[6]).
Enrolment patterns across schooling options differ significantly between countries
Despite growing international consensus on the benefits of inclusive education, countries continue to vary significantly in the extent to which they encourage placement in regular schools and invest in individualised educational supports within those settings. Figure 4.1 illustrates semi-comparative data on the distribution of children with SEN and ASD in Israel, children with ASD and with all types of disability in Australia, and children officially recognised with SEN status in the European countries across three broad schooling options: regular classes, special education classes, and special education schools.
Children with disability and those identified as having special educational needs do not always represent the same group; a child may have a disability without being classified as having SEN, and vice versa. Cross-country comparability is further complicated by substantial variation in how SEN is defined and operationalised, with some countries applying relatively narrow criteria. From a policy perspective, this heterogeneity limits the ability to evaluate education settings and interventions and compare outcomes across countries. A general recommendation for OECD countries is therefore to work towards greater harmonisation of definitions and reporting standards, alongside strengthening the institutional infrastructure needed to collect high-quality, internationally comparable data on SEN.
To a certain extent, the distribution across different educational settings reflects the inclusiveness of a country’s educational policy framework and the quality and quantity of supports available in regular classes. In each of the European countries – except the Netherlands – more than 50% of children with SEN are enrolled in mainstream schools, either in regular or special education classes. In the Netherlands, the allocation of additional support within mainstream schools is managed by the school itself in collaboration with the regional level through school alliances (samenwerkingsverband). Because such provision of extra support in a mainstream setting is not centrally recorded as a formal determination of SEN status, data from the European Agency for Special Needs and Inclusive Education capture only those children whose SEN status is formally recognised through eligibility for admission to special education schools (Toelaatbaarheidsverklaring, TLV). Consequently, Figure 4.1 indicates that 100% of children officially identified as having SEN in the Netherlands attend special education schools.
France and Sweden report the lowest shares of children with SEN status in special education schools among the selected countries, each below 20%. In Sweden, however, data are not disaggregated by class type within mainstream schools. In Germany, available data only capture enrolment in regular classes in mainstream schools – including slightly more than 50% of children with SEN status. Such lack of disaggregated data also illustrates how the availability of specific schooling options may not always be officially or systematically recorded at the national level, as these may be administered regionally, locally or even left to the discretion of individual schools.
Regarding placement within mainstream schools, the United Kingdom and Denmark take notably different approaches. In the United Kingdom, most children with SEND1 status enrolled in regular schools are placed in regular classes, whereas in Denmark, the majority attends special education classes within mainstream schools. Estonia shows a relatively balanced distribution, with roughly one‑third of children with SEN status placed in each of the three settings. In Israel, the pattern is reversed when comparing all children with SEN to those with SEN and ASD. While most children with SEN attend a mainstream class (around 40%) and roughly 30% are enrolled in special schools, children with SEN and ASD are more likely to attend special schools (approximately 40%) and only about 30% are in mainstream classes within mainstream schools.
In Australia, the proportion of children with ASD enrolled in special education schools is nearly half of that in Israel, at around 20%. However, the share of children with ASD in special classes resembles Israel’s. Australian data further indicate that children with ASD are more likely to be placed in special education settings, both schools and classes, than children with disability overall – an observation that also applies to Israel. In Australia, only about 55% of children with ASD are enrolled in mainstream classes, compared to about 70% of all children with disability. Additionally, the proportion of children with ASD in special schools (20%) is double that of all children with disability (10%). Anecdotal evidence suggests a similar pattern might exist in the Netherlands, where children with ASD are reportedly entering special education schools in growing numbers.
Share of children with special educational needs by type of school or class, latest available year
ASD: autism spectrum disorder, SEN: special educational needs, SEND: special educational needs and disability.
Note: Data only covers children enrolled in school.
Australia: children with (ASD and) reported disability; ages 5‑20; year 2022.
European countries: children with SEN(D); International Standard Classification of Education (ISCED) Level 1 (primary education) and 2 (lower-secondary education); year 2021/22. European Agency for Special Needs and Inclusive Education: Question 2.3a “All children/learners with an official decision of SEN educated with their peers in mainstream groups/classes for 80% or more of the time” = regular class; Question 2.3b “All children/learners with an official decision of SEN educated in separate groups/classes, spending less than 80% of the time with their peers in mainstream groups/classes” = special class.
Israel: all children with SEN, as well as those with SEN and ASD; all school forms (pre‑primary, primary, post-primary); year 2024.
Source: Data for Israel provided by national authorities. Data for European countries based on European Agency for Special Needs and Inclusive Education (2025[7]), Data tables and background information, https://www.european-agency.org/activities/data/data-tables-background-information. Data for Australia based on Australian Bureau of Statistics (2024[8]), Autism in Australia, 2022, https://www.abs.gov.au/articles/autism-australia-2022#data-downloads.
Some ASD-specific educational supports exist
The special educational support that Israel provides to children with ASD is relatively extensive. In particular, “communication classes” – which are special education classes specifically designed for children with ASD and commonly available in Israel (>150) – offer robust support, including on-site therapies, very small class sizes, and ASD-specialised teaching staff and assistants. While most other countries, such as Australia, Canada, Denmark, Estonia, France, the United Kingdom and California (United States) also offer specialised classes or programmes for children with ASD, these vary in availability and structure. Such programmes typically include specially trained teachers, adapted learning environments and materials, and access to on-site therapies like occupational or speech therapy.
Australia even offers a very small number of ASD-specific schools. Across the countries reviewed, such ASD-specialised schools do exist but are typically private rather than public. For example, in California (United States) and the United Kingdom, public authorities may place a child with SEN(D) status in a private special education school if no suitable place is available in the public system. However, aside from the relatively rare ASD-specific schools and more commonly available ASD-specific support classes – in most countries, specialised classes for specific types of SEN exist – children with ASD are not generally entitled to more generous or distinct services than those provided to children with other disabilities.
Children with ASD are typically covered by the same policy framework that applies to all children with SEN. In Israel, the situation looks somewhat different: school-aged children with ASD can access special educational settings based solely on their diagnosis. They are expected to undergo an assessment of their support needs and be placed into one of four predefined support levels, which determine their eligibility for special education and the scope of their personal services basket, as is the case for other children with disability. However, children with ASD at any support need level can access a dedicated special education class.
Depth and standardisation of support needs assessments vary across countries
The main aim in OECD countries is that children with ASD, like children with other disabilities, benefit from educational support measures and services adapted to their individual needs (see Table A C.4 for detailed country-specific information on special education). Assessments of each child’s support needs are thus a core component of eligibility determination procedures for special education services in almost all countries selected for comparison. However, these assessments vary significantly across countries. In some countries, they are less standardised and regulated but more individualised; for example, in Australia, the child’s school placement and support measures are typically determined jointly by the parents and the school; in California (United States), an Individualised Education Program (IEP) Team, comprising the child’s parents, a special education teacher, a regular education teacher, and a qualified representative of the school district, assesses the child and decides on school placement and appropriate special educational services, which are then outlined in the child’s IEP.
In some other countries, children’s needs assessments are much more regulated. In France, the child’s teacher completes the GEVA-Sco guide (Guide d’évaluation des besoins de compensation en matière de scolarisation) to document the student’s support needs. The report is subsequently discussed in a meeting typically involving the school director, parents, teachers and, where relevant, other professionals, after which the report is finalised by the designated reference teacher and submitted to the MDPH. A multi-disciplinary evaluation team (équipe pluridisciplinaire d’évaluation, EPE) of the MDPH then reviews the submitted documentation and, if necessary, conducts home or school visits to assess the child in-person. Based on their assessment, the decision-making body (Commission des droits et de l’autonomie des personnes handicapées, CDAPH) of the MDPH determines school placement and educational support services for the child. In Estonia, the support needs assessment is also relatively standardised: a multi-disciplinary school support team (including pedagogue, psychologist, speech therapist, etc.) carries out a pedagogical-psychological assessment of the child’s learning, social and self-care needs and prepares recommendations, which the municipal counselling committee reviews (alongside medical certificates and reports) to advise on school placement and support services; the child’s school director and parents formalise the final decision together. Effective co‑ordination and sufficient staffing for such in-depth assessments are essential to minimising waiting times for educational services.
These assessments do not always involve in-person evaluations. In most cases, support needs assessments are primarily based on documentary evidence, such as medical reports and educational records, while in-person observations and interviews are only carried out when uncertainty remains. In some countries, however, such as Sweden and Denmark, in-person evaluations are a standard component of a child’s needs assessment.
The types of documents considered, and the experts involved in support needs assessments also vary across countries. While all countries incorporate the perspectives of different types of professionals, such as special education teachers, social workers, or pedagogues – thus going beyond purely medical considerations – how much emphasis they place on these professional opinions relative to medical perspectives differs. In most countries, a formal medical diagnosis is in fact not required to access special educational support; while some form of medical documentation may be requested, the child’s actual support needs are the decisive factor for eligibility and the nature of the services provided. A medical diagnosis often offers limited insight into a child’s needs, especially in the educational setting. Ideally, every child that needs special education support to fully and equally participate in education should receive that support. However, in some countries, such as Israel, Canada, California (United States), and France, a formal medical diagnosis is considered a prerequisite for access to special education services. In these systems, diagnoses function as gatekeeping mechanisms, even if the special educational support ultimately offered is adapted to the individual needs of the child. A diagnosis may, however, also be required in other countries, such as Estonia, to access special education classes specifically designed for certain types of SEN, including ASD-specific classrooms. Outside of these specific cases, access to and the composition of special education support services are based on the individual support needs of the child.
In Israel, parents play a central role in the application and decision-making process of their child’s SEN supports. They participate in the Eligibility and Characterization Committee, the body authorizing SEN supports and special education placements, by providing input and documentation. Parents also collaborate closely with the multi-disciplinary team at school to help design and review their child’s Individual Education Plan (IEP). It is indeed crucial to incorporate the perspectives and wishes of parents in decisions related to special educational support for their children with SEN. In Australia, Estonia, and Germany, parents usually decide on or must approve their child’s school placement. In all other countries reviewed, parents may not officially be the ones to make that decision, but they are typically closely involved in both the assessment process and the placement decision. For instance, in California (United States), parents are part of the IEP team that evaluates the child and determines support services. In Sweden, parental input is actively incorporated during the needs assessment process, which relies on documentary evidence, as well as in-person evaluations, including observations and interviews with the parents.
Three special education funding models – input, throughput, and output funding
Countries also differ in how they are funding special education and allocating resources for special education provisions. According to a classification framework initially proposed by the European Agency for Special Needs and Inclusive Education (European Agency for Special Needs and Inclusive Education, 2016[9]) and already applied by the OECD (Brussino, 2020[10]), there are three general funding models for special education: 1) input funding; 2) throughput funding; and 3) output funding.
1. Input funding follows a demand-driven logic – typically, a specific amount of funding is allocated to schools for each student identified with SEN status, sometimes weighted according to the severity of the child’s support needs. Australia and Israel largely follow this approach. In Israel, each child eligible for special education support is allocated a personal basket of support hours, including instructional, therapeutic, and aide hours, based on their assessed level of needs and diagnosis. These personal service baskets are converted into earmarked monetary budgets that are allocated to the children’s schools. In Australia, schools receive per-student funding under the Schooling Resource Standard (SRS), with an additional percentage loading for students with disability. The level of loading depends on the student’s support needs, classified into four categories: 1) quality-differentiated teaching practice; 2) supplementary; 3) substantial; and 4) extensive support. Students at the lowest level of need do not actually qualify for a disability loading.
2. Throughput funding, which is less commonly used, follows a more supply-driven logic. In this model, schools receive lump-sum budgets to deliver specified services, regardless of the precise number of students with SEN status or the severity of their needs. Sweden’s system incorporates elements of both input and throughput funding. Schools receive a lump-sum budget based on total enrolment and are responsible for allocating resources, including for SEN provisions. For pupils with extensive support needs that exceed what can normally be provided, schools may apply for additional funding from the municipality. Both schools and municipalities can also apply for targeted grants from the National Agency for Special Needs Education and Schools (Specialpedagogiska skolmyndigheten, SPSM) for specific initiatives. The Netherlands likewise adopts a mixed-model approach, in which the Ministry of Education provides lump-sum funding to regional school alliances (samenwerkingsverbanden), which in turn allocate resources to individual mainstream and special education schools. With this funding, regular schools are required to ensure that pupils with SEN receive appropriate educational support and may request additional funding from the school alliance only if they are unable to meet a student’s needs with their existing resources.
3. The third approach, output funding, allocates budgets based on students’ educational outcomes, such as the educational progress made by students with SEN status. This model, however, remains the least commonly used of the three (Brussino, 2020[10]).
Special educational needs (SEN) support
SEN support means support that is additional to, or different from, the support generally made for other children of the same age in a school. It is provided for pupils who are identified as having a learning difficulty or a disability that requires extra or different help to that normally provided as part of the school’s usual curriculum offer. A pupil with SEN support will not have an education, health and care plan. (Department for Education, 2025[11])
SEN support is delivered directly by the school and may include a range of measures, such as differentiated instruction and additional teaching support (Brereton, 2025[12]). A formal medical diagnosis is not a requirement to receive SEN support. The school’s Special Educational Needs Co‑ordinator (SENCo), working in partnership with teachers, parents, and – where relevant – local authority specialists (e.g. educational psychologists or health professionals), assesses the child’s needs and prepares an individual SEN Support Plan. These plans follow a graduated “assess-plan-do-review” cycle and set out the specific adjustments and supports required (Scope, n.d.[13]). All costs associated with SEN support are typically financed from the school’s regular budget (Brereton, 2025[12]).
Education, Health and Care Plans (EHCPs)
A local authority may issue an EHC plan for a pupil who needs more support than is available through SEN support. This will follow a statutory assessment process whereby the local authority considers the pupil’s special educational needs and any relevant health and social care needs; sets out long term outcomes; and specifies provision which will deliver additional support to meet those needs. (Department for Education, 2025[11])
EHC Plans are not only more comprehensive and specific than SEN support, but children with an EHC Plan also have a statutory right to receive all the support detailed in the plan from their local authority (Brereton, 2025[12]). A request for an EHC Plan can be submitted by anyone who considers it necessary – including parents, teachers, or GPs – provided there is sufficient evidence that existing interventions have not been effective (Council for Disabled Children, n.d.[14]). A formal medical diagnosis is not required; instead, eligibility is based on a holistic assessment of the child’s needs. EHC needs assessments are carried out by the local authority, which must gather information on the child’s educational, health, and care needs from a range of actors (parents, school’s SENCo, educational psychologist, healthcare practitioners, social worker, etc.). The assessment relies primarily on documentary evidence (e.g. school reports, medical and therapy records) but may also include in-person evaluations. Based on the gathered information, the local authority decides whether the child requires an EHC plan and, if so, drafts one which parents then review before final approval by the local authority (IPSEA, n.d.[15]).
Children with ASD as their primary type of need represent a substantial share of all children with SEN
The numbers of children receiving SEN support and those with an EHC plan have risen almost in parallel since 2017/18, reaching a combined total of nearly 1.7 million pupils with SEN in England by 2024/25 (Figure 4.2, Panel A). The number of children whose primary need is ASD has also increased steadily across both groups. In 2024/25, pupils with ASD as their primary type of need accounted for around 10% of those receiving SEN support but represented almost 34% of all pupils with an EHC plan.
Panel C provides further context by showing that, after ASD, the most common needs among pupils with an EHC plan are “Speech, Language and Communication Needs” and “Social, Emotional and Mental Health”, both of which are also the predominant categories among pupils receiving SEN support. For these latter two groups, the numbers of pupils receiving SEN support, however, are nearly twice as large as those with ASD. Notably, more than half of the children with ASD and SEND require substantial educational support that cannot be met through schools’ SEN support alone and instead necessitates an EHC plan (Panel C). Taken together, these figures indicate that children with ASD as their primary type of need are much more likely to require or receive extensive support, beyond what schools can provide through SEN support alone, compared with pupils with other types of needs.
This observation aligns with Panel B, which shows that children with ASD as their type of need and an EHC plan are more likely to attend special schools than the average pupil with an EHC plan – 35% compared with 30% in 2024/25. At the same time, Panel B highlights a positive trend: increasing inclusion in mainstream education. The proportion of all pupils with an EHC plan attending mainstream schools has grown from about 40% in 2018/19 to roughly 44% in 2024/25, while the share in special schools declined from 40% to 30% over the same period. However, this trend may also reflect an increase in the number of children with comparatively lower levels of need being issued an EHC plan.
ASD: autism spectrum disorder, EHC: education, health and care, SEN: special educational needs.
Note: Panels A and C: Includes state‑funded nursery, primary, secondary and special schools, non-maintained special schools and state‑funded alternative provision schools. Does not include independent schools. Panel C excludes the category “Missing”, as numbers were negligible. Panel B: Includes also independent schools.
Source: Government of the United Kingdom (2025[16]), Explore educational statistics – Special educational needs in England, https://explore-education-statistics.service.gov.uk/data-tables/special-educational-needs-in-england. Government of the United Kingdom (2025[17]), Explore educational statistics – Education, health and care plans, https://explore-education-statistics.service.gov.uk/data-tables/education-health-and-care-plans.
Children with disability can access therapies through different pathways
Countries typically offer multiple pathways for children with disability to access paramedical therapies such as speech, occupational, or psychotherapy (see Table A C.5 for detailed information on access to therapies across countries). These channels generally fall into three categories: 1) coverage through the public health system, usually contingent on a doctor’s referral; 2) specialised support programmes or institutions for people with disability, such as Australia’s NDIS or Ontario’s Autism Program; and 3) the education system, where special education services often include paramedical therapies, particularly speech and occupational therapy, delivered on-site and integrated into the child’s school day.
In Israel, for instance, children with ASD can access therapies through several routes. One option is via Israel’s public health system through Health Maintenance Organisations (HMOs),2 with an official ASD diagnosis and a referral from a paediatrician or psychiatrist. Subject to availability, this pathway provides up to three hours of therapy per week. Another key access point is the education system: children with ASD who receive a positive decision from the Eligibility and Characterization Committee – responsible for assessing SEN and eligibility – can either access therapies through their personal services basket when they are in mainstream education or attend a special education setting in which therapy hours are integrated into the child’s school day. Additionally, Israel offers an Early Childhood Program specifically for children with ASD aged 0‑6, providing up to 14 hours of therapy per week. To qualify for this early intervention program, the child must have a formal medical ASD diagnosis.
The most common approach across countries for accessing therapies is through a prescription and/or referral from a doctor to a therapist, with the costs covered by public health insurance. This model is used in countries such as Estonia, Germany, the Netherlands, Sweden, and the United Kingdom. While these systems are generally more accessible, they may also be more susceptible to longer waiting times, for example, in the United Kingdom’s National Health Service (NHS).
Denmark takes a distinct approach compared to the standard access pathways described above. In Denmark, the responsibility for allocating and funding paramedical therapies for children with disability lies with municipalities. These therapies are typically integrated into the child’s school day. Each municipality operates a Pedagogical Psychological Counselling service (Pædagogisk Psykologisk Rådgivning, PPR), which is tasked with assessing a child’s need for special educational support, including therapies such as speech and language therapy, through a thorough evaluation of the child’s academic, personal, and social development. If therapy is deemed necessary, it is usually delivered within the child’s educational setting. This central role played by municipalities in Denmark resembles the approach in Sweden where rather than being hired directly by individual schools, therapists are typically employed by municipalities and shared across multiple schools and daycare centres.
A child’s therapy hours are typically tailored to their needs
Again, Israel somewhat stands out in its approach to therapeutic services for children with ASD due to its uniquely standardised allocation of therapy hours. Unlike other countries, where children receive as many hours of therapy as they need, Israel sets fixed weekly limits for publicly funded therapies based on medical diagnosis – for instance, children with ASD are entitled to exactly three hours of therapy per week through HMOs. No other country reviewed predefines therapy hour limits by diagnosis. One partial exception is Ontario (Canada), whose Autism Program does not specify the number of therapy hours a child may receive, but instead allocates fixed budgets based on the child’s age and assessed support needs. In practice, this also limits the number of therapy hours parents can afford to purchase. Australia’s NDIS follows a similar approach: the NDIA first assesses a child’s support needs to determine the scope of the child’s individualised budget across various support categories; the number of therapy hours funded is then established within that budgetary envelope.
The predefined weekly therapy limits in Israel are noteworthy, particularly given the relatively low take‑up rate – according to anecdotal evidence, on average, children with ASD receive only one out of the three therapy hours they are entitled to each week. This may reflect a child’s limited need for additional therapy, but it could also point to challenges faced by parents in co‑ordinating therapy sessions or a shortage of available therapists, preventing children with ASD from accessing the full range of paramedical services they are officially eligible for. Furthermore, this standardised approach and heavy reliance on medical diagnoses may result in an imbalance of service provision, potentially leading to over-servicing of children with lower support needs, while under-serving those with higher support needs who may require more than three hours of therapy per week. Especially in a context of constrained resources, Israel’s approach risks insufficient service provision for children with disability with the highest levels of need.
OECD countries recognise the importance of early childhood support
Another distinctive feature of Israel’s approach is its ASD-specific Early Childhood Programme, which offers up to 14 hours of therapy per week. The only other country with a somewhat comparable programme is France, which has established special units, which are ASD-specific classrooms within mainstream kindergartens and elementary schools, respectively. These units deliver specialised support to young children with ASD (ages 3‑11). Unlike in Israel, therapy hours in France – even in these ASD-specific units – are determined entirely by each child’s individual needs and available resources rather than by a fixed limit. However, it is important to note that individual therapies outside of specific provisions, such as the early intervention package (forfait d’intervention précoce), are not always fully but rather partially reimbursed by France’s national health insurance scheme. Furthermore, France’s approach may create unintended disparities in therapy provision depending on the local resources available.
Inequalities in service access are also shaped by socio‑economic factors, as suggested by Salomone et al. (2015[18]). In their cross-country survey of parents in 20 European countries on early intervention for children with ASD – covering both public and private therapy provision – one in ten parents reported that their child was not currently receiving any type of therapy intervention. These children who were not receiving intervention did not differ by age or verbal ability; however, this group included significantly more children whose parents had a lower level of education. Their findings also highlight pronounced cross-country disparities. While children with ASD up to age seven received on average 16 hours of therapy per week in Denmark, they received around ten hours in France and only about four hours in Germany. Across all European countries covered by the survey, children received an average of around nine hours of early intervention per week, with speech and language therapy being the most common intervention for the majority of children.
As a growing body of research demonstrates the importance of early intervention, several European countries recommend early intervention in national autism guidelines (Salomone et al., 2015[18]), such as those issued by the National Institute for Health and Care Excellence (NICE) in the United Kingdom and France’s national strategy for neurodevelopmental disorders, which includes conditions such as autism, ADHD, dissociative identity disorder and learning disorders (Box 4.2).
Since 2018, France has continuously invested in a national strategy for autism and other neurodevelopmental disorders. Defining main areas of focus (commitments), the strategy also includes specific measures to respond to issues persons with autism and other NDDs may face. The first four‑year strategy was launched in 2018, followed by a second four‑year strategy in 2023.
The new national strategy for neurodevelopmental disorders (2023‑2027)
The new strategy currently in place is running from 2023 through 2027 and includes all NDDs from the previous strategy (autism spectrum disorder, intellectual disability, specific learning disorders (SLDs) – dyslexia, dysgraphia, dyscalculia, dyspraxia, dysphasia, dysorthographia – and attention-deficit/hyperactivity disorder), as well as dissociative identity disorder (DID). It is interesting to note that the epidemiological data cited by the new strategy were higher than those cited by the previous strategy. Among the key numbers, autism was now thought to affect 1‑2% of the population, whereas the 2018 strategy only put this number at maximum 1%; estimated numbers for the other NDDs were also higher.
The current strategy is also larger than the previous one, with six key commitments including 81 measures, compared to only five commitment areas and 20 measures in 2018. The six commitment areas in the current strategy are:
Commitment 1: Expanding research on neurodevelopmental disorders and accelerating knowledge dissemination to all stakeholders;
Commitment 2: Guaranteeing support for every individual, high-quality interventions through the lifespan, and intensifying training for professionals;
Commitment 3: Advancing the age of detection and diagnosis and intensifying early interventions;
Commitment 4: Adapting education to the specific needs of students from pre‑school to higher education;
Commitment 5: Supporting adolescents and adults during major life stages, particularly those who are the most vulnerable;
Commitment 6: Making life easier for individuals and their families, and raising societal awareness of neurodevelopmental disorders.
Concrete measures – a total of 81, each embedded within one of the six commitment areas – include creating a “Child Brain Institute” (Commitment 1); reinforcing the professionals and expert structures in charge of diagnosing ASD, ADHD, DID, and SLDs (Commitment 2); offering to all parents of children with ASD, ADHD, DID or SLDs training to help them understand how their child functions and how to support their development (Commitment 3); continuing to support specialised full-time education of children with autism in pre‑school from the age of 3 (Commitment 4); creating more inclusive housing and providing the necessary adaption to the specific needs of persons with autism (Commitment 5); and revising the guidelines to better assess individuals’ support needs and implement the disability compensation benefit (prestation de compensation du handicap, PCH) for human assistance for NDDs (Commitment 6); among others.
In November 2023, an interministerial delegation responsible for the strategy was named under the purview of the Ministry of Health, Family, Autonomy and Disabled Persons, underlying the importance France gives to the strategy and to addressing the needs of people with neurodevelopmental disorders, including persons with autism.
Note: ASD: autism spectrum disorder; DID: dissociative identity disorder; NDD: neurodevelopmental disorder; PCH: prestation du compensation du handicap (disability compensation benefit); SLD: specific learning disorder.
Source: Ministère de la santé, des familles, de l’autonomie et des personnes handicapées (2021[19]), La stratégie nationale autisme et troubles du neurodéveloppement (2018‑2022), https://handicap.gouv.fr/la-strategie-nationale-autisme-et-troubles-du-neurodeveloppement-2018-2022; Secrétariat d’état chargé des personnes handicapées (2018[20]), Stratégie nationale pour l’Autisme au sein des troubles du neuro-développement, https://handicap.gouv.fr/sites/handicap/files/files-spip/pdf/strategie_nationale_autisme_2018.pdf; Ministère de la santé, des familles, de l’autonomie et des personnes handicapées (2023[21]), Nouvelle stratégie nationale pour les troubles du neurodéveloppement : autisme, Dys, TDAH, TDI, https://handicap.gouv.fr/nouvelle-strategie-nationale-pour-les-troubles-du-neurodeveloppement-autisme-dys-tdah-tdi; Délégation interministérielle à la stratégie nationale pour les troubles du neurodéveloppement : Autisme, Dys, TDAH, TDI (2023[22]), Stratégie nationale 2023‑2027 pour les troubles du neurodéveloppement: Autisme, DYS, TDAH, TDI, https://handicap.gouv.fr/sites/handicap/files/2025-11/DP-strategie-nationale-TND-2023-2027.pdf.
An emphasis on early intervention programmes for children with disability – often without the requirement of a formal medical diagnosis – can be observed in many of the countries reviewed in this report. For instance, in the United States, California’s Early Start programme provides, among other services, occupational and physical therapy to children with developmental delays without requiring an official medical diagnosis. Similarly, under the early intervention criteria, Australia’s NDIS offers services and funding to children with developmental delay, only requiring proof of such developmental delay. Ontario (Canada) follows a comparable approach, as its Preschool Speech and Language Program does not require children to have a formal medical diagnosis to access support. The widespread availability of such early intervention programmes in countries including France and Israel reflects a shared recognition of the strong potential of early paramedical therapies, such as speech and occupational therapy, to positively influence the developmental outcomes of young children with developmental delay, including those with ASD (Rogers and Vismara, 2008[23]). For example, in their study, Soref et al. (2023[24]) find that 9‑12 sessions of occupational therapy already promote greater participation in daily activities and substantively improve sensory-motor skills of preschool-aged children with developmental disability. Driven by such recognition of the effectiveness of early therapeutic support, many countries intentionally waive the requirement for a formal medical diagnosis to access early intervention therapies, to ensure that young children with developmental disability can access these essential services as early as possible without any undue delays – often caused by long waiting lists for a formal diagnosis.
The list of social services presented in Table 4.1 is non-exhaustive and provides only a glimpse of the wide range of supports available to children with disability in the countries reviewed in this report. One of the most common services provided is free or subsidised access to public transport. In some cases, such as Sweden, alternative transport services are available for children with disability who are unable to use public transport. Additionally, many countries offer free transportation to school or daycare facilities. For example, in Israel, municipalities provide special transport to daycare centres and schools for children with SEN.
In addition to these child-focussed services, many countries also offer services aimed at supporting parents of children with disability. One key example is respite care which gives parents a planned break by providing qualified care and supervision for children with disability – either at home or through short-term out-of-home stays – thereby temporarily relieving parents of caregiving responsibilities. Such a third-party care service can range from a few hours of in-home supervision to multi-day residential stays. Most countries offer both, in-home and out-of-home respite care options, though some provide only one form of care – for example Israel which offers only short-term stays in specialised facilities. Funding for these services can be either direct, where the government (often through local authorities) arranges and pays for the respite service, or indirect, where parents receive funding to purchase the service themselves. Examples of indirect funding include Australia’s NDIS and Germany’s care insurance, both of which provide dedicated payments to parents for in-home respite care for their child with disability. Typically, the duration of such respite care services is based on individual needs and circumstances, although some countries set limits. For instance, Germany allows up to eight weeks of respite care per year.
Another parent-focussed support is the provision of extra paid leave. In Israel, parents of children with ASD are entitled to 18 paid leave days for ASD-related appointments and care annually; in Estonia, parents may take ten working days of childcare leave per year until their child reaches the age of 17 (compared to age 14 for parents of children without disability); and in Sweden, parents can also receive ten days of extra paid leave per year.
A third common parent-focussed service – often provided locally, such as by municipalities – includes training courses, parent support groups and counselling for parents. While these programmes are frequently ASD-specific, equipping parents with skills and knowledge tailored to caring for a child with ASD, most other social services are generally available to all children with disability, although eligibility and scope typically depend on the child’s level of support needs.
Social services, along with educational and health services as well as financial benefits described in this report, are needed by children with ASD to varying degrees. For example, children with severe support needs and their parents may find it essential to have access to free special transport for school and after-school therapies or activities. Without this, parents would need to either personally bring their child or privately arrange transport, which could become unmanageable, especially given the high number of therapy sessions and other appointments likely required. In contrast, children with mild support needs who are able to take regular public transport and attend only occasional therapy sessions may not require special transport services. Similarly, children with severe support needs typically require a higher number of therapy hours and more extensive special educational support, whereas those with milder needs might manage well in mainstream classrooms with just a few hours of weekly assistance from a teaching aide and perhaps one hour of speech therapy to address minor difficulties. Financial benefits also play a different role depending on the level of support needs: parents of children with severe support needs who had to leave the workforce would rely heavily on financial supports to compensate for lost earnings, whereas parents of children with milder needs who maintained full-time employment or only slightly reduced hours might not depend on financial benefits for financial stability.
Note: The enumeration of countries’ social services is non-exhaustive; several additional services available are not included in this table.
Source: Information collected by the Secretariat and verified in discussions with national autism organisations.
References
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[1] United Nations (2006), Convention on the Rights of Persons with Disabilities and Optional Protocol.
← 1. The United Kingdom has generally replaced the term SEN (Special Educational Needs) with the broader term SEND (Special Educational Needs and Disabilities) in its education policy.
← 2. A Health Maintenance Organisation is a medical insurance group that provides healthcare services. HMOs usually have their own network of doctors, hospitals and other healthcare providers who have agreed to accept payment at a certain level of any services they provide.