This chapter examines Israel’s policy framework for supporting children with ASD amid an eightfold increase in diagnoses between 2011 and 2024. Autism has been legally recognised as a disability in the late 1990s. Israel’s approach to services and benefits is highly standardised and diagnosis-driven: a formal medical diagnosis alone largely determines eligibility for financial benefits, therapeutic services, and educational supports. Children with ASD automatically qualify for 100% of the Disabled Child Allowance and access to therapy and special education, regardless of their level of support needs. While this model ensures broad coverage, it risks under-serving children with severe needs due to its uniform support structure. The increase in diagnoses has strained public resources, fuelled demand for private diagnostic services, and raised concerns about the sustainability and availability of services for the most vulnerable. The chapter highlights the need for more nuanced, needs-based policies to balance equity, efficiency, and fiscal sustainability.
Policy Responses to Rising Autism Diagnoses in Childhood
Abstract
Israel’s diagnosis-driven approach to autism support
Recognition of autism as a disability in the legal framework in Israel started in the late 1990s. Rights and entitlements of individuals with ASD have been regulated through law ever since.
The number of children with ASD has grown exponentially in the past 15 years and was eight times higher in 2024 than in 2011. Diagnosis rates vary among population groups, influenced by both socio‑economic status and religious and ethnic group. Unlike other OECD countries, rates tend to be higher in higher-status population groups.
Israel’s system of financial benefits and services for children with disability is highly standardised and medically driven. A child’s medical diagnosis alone largely determines their eligibility for, and the extent of, benefits and services they receive. This approach applies across the Disabled Child Allowance, special educational supports, and therapeutic services.
All children diagnosed with ASD are entitled to a uniform Disabled Child Allowance of 100% (NIS 3 694 in 2025) per month, irrespective of their level of needs. A higher rate may be granted if the child is deemed fully dependent but only few children with ASD fall into this group.
School-age children with ASD are entitled to a fixed package of three therapy hours per week (occupational, speech or psychotherapy). In early childhood, Israel offers a considerably more extensive early-intervention package with up to 14 therapy hours per week, but many children with ASD only retrieve a fraction of the services they would be entitled to.
An ASD diagnosis also provides near-automatic access to the full spectrum of special education supports. Although an Eligibility and Characterization Committee assesses the degree of functioning (Level 1 to 4), children with ASD can attend special communication classes and special schools regardless, with more extensive supports (e.g. longer school days, more comprehensive therapeutic support) than most other types of disability. Alternatively, parents may choose inclusion in a regular class with reasonable accommodations in the form of an individualised services basket.
This standardised, diagnosis-based approach makes Israel’s system comparatively generous for children with mild support needs but ungenerous for children with severe support needs, as benefits and services remain largely uniform across different levels.
Together with falling stigma and higher awareness of ASD, Israel’s approach has made seeking an autism diagnosis very attractive. Demand for diagnosis has overstretched the capacity of the public diagnosing system and has led to the development of a growing private diagnosing market. Privately sought diagnoses are fully accepted by the system without any public controls.
Israel’s diagnosis-based eligibility system combined with growing diagnosis rates is increasingly straining the public system’s capacity to deliver the support to which children are formally entitled. Persistent shortages of special education teachers and paramedical therapists have widened the gap between formal entitlements and actual service provision.
Rising ASD diagnosis rates have led to a substantial increase in public expenditure in recent years. In 2024, Israel spent NIS 4 619 million on special education, NIS 1 110 million on therapies in day-cares and kindergartens and NIS 2 513 million on the Disabled Child Allowance for children with ASD, together 0.41% of Israel’s GDP.
Rising ASD diagnosis rates are not the only driver of overall growth in public spending. While children with ASD now constitute 37% of all Child Disability Allowance recipients (up from 25% in 2012) and 33% of the corresponding spending (up from 27% in 2012), Israel has a broader problem of fast-growing expenditure on children with disability which is not discussed in this report but calls for an in-depth policy debate.
Israel has experienced a dramatic surge in autism spectrum disorder (ASD) diagnoses over the past 15 years, with the number of children diagnosed increasing eightfold between 2011 and 2024. This exponential growth has placed significant pressure on the country’s disability support systems, prompting a need to evaluate the effectiveness and sustainability of current policy strategies. Autism has been legally recognised as a disability in Israel since the late 1990s, and the country has developed a highly standardised, diagnosis-based framework for delivering financial benefits, therapeutic services, and educational support to children with disability.
The Israeli model is characterised by its predominantly medical approach, where a formal diagnosis largely determines eligibility for services, rather than assessed support needs. Children with ASD automatically qualify for the full Disabled Child Allowance, currently set at NIS 3 694 per month, and are entitled to a fixed package of therapeutic and educational services. While this system ensures broad access to support, especially for children with mild support needs, it has proven less responsive to those with more severe support requirements due to its uniform benefit structure.
This case study provides an overview of Israel’s policy framework for children with ASD, highlighting its strengths, limitations, and the challenges posed by rising diagnosis rates.
Autism and autism-like conditions have been a recognised disability in Israel since 1998 under the general umbrella disability law, the Equal Rights for Persons with Disabilities Law, 5758‑1998. The law defines a person with disability as “a person with a physical, mental or intellectual, including cognitive, impairment, whether permanent or temporary, which substantially limits their functioning in one or more of the central spheres of life” (Ministry of Justice, 2018[1]).
Even before the legal recognition, there were already efforts to provide support for children with autism and their families from the 1970s. The first autism-specific organisation, ALUT – the Israeli Society for Children and Adults with Autism – was founded in 1974 as a parents’ association with the goal to offer dedicated support and a positive housing environment for children with autism and their families (ALUT, n.d.[2]).
In 1988, the Knesset (Israel’s unicameral Parliament) adopted the Special Education Law, which guarantees free and accessible education for children with disability. Since 2002, the act includes explicitly autism-like conditions (at the time still referred to as pervasive developmental disorders) (Knesset, 2023[3]).
The main disability benefit provided for children with autism is the Disabled Child Allowance. Any child between the age of 91 days and 18 years and 3 months with an autism diagnosis, regardless of their level of need, is currently eligible for this allowance. The diagnostic requirements are set out in the Circular n°15 of 2013 of the Ministry of Health (Ministry of Health, 2013[4]).
In 2022, the Knesset introduced the Welfare Services for People with Disabilities Law, 5782‑2022. In force since January 2024, this law moved Israel towards a more person-centred rights-based framework for persons with disability in areas including housing, employment and community living (Knesset, 2024[5]).
In Israel, data on children diagnosed with ASD, many of whom receive state‑funded services, are collected by different agencies. The National Insurance Institute’s (Bituah Leumi, NII) registry of children eligible for the Disabled Child Allowance is one of the most reliable data sources, especially since this allowance is granted to all children diagnosed with ASD, regardless of their level of need or functioning. Thus, it is reasonable to assume that the NII’s registry covers a very high percentage of children diagnosed with autism in Israel, making it a good indicator for the rate of autism among children in Israel. According to this data, the number of children receiving a Disabled Child Allowance due to an autism diagnosis has been growing exponentially in the past 10‑15 years, from 7 292 in 2011 to 60 195 in 2024 (Figure 7.1). This growth is especially alarming in terms of sustainability of disability support, when considering that Israel has by far the highest fertility rate in the OECD; in 2022 this was almost double as the OECD average. Although the total fertility rate has been decreasing slightly over time – the rate changed from 3.14 in 1980 to 2.95 in 2000 and 2.9 in 2020 – the average number of children per woman remains quite high at 2.89 in 2022 compared to an OECD average of 1.51 (OECD, 2024[6]).
Children diagnosed with autism receiving the Disabled Child Allowance, Israel, 2011‑2024
Note: Autism includes both pervasive developmental disorder (DSM-IV) and autism spectrum disorder (DSM‑5). The number of children with autism is defined as the number of persons receiving the Disabled Child Allowance in Israel in a given year.
Source: Data provided by the Israeli national authorities.
Important differences exist in the diagnosis rate among the different population groups
Socio‑economic factors play an important role in ASD diagnosis rates among children. In Israel, receiving an ASD diagnosis can provide access to supports such as the Disabled Child Allowance, which may influence families’ incentives to seek diagnosis. Among the ten socio‑economic clusters identified, diagnosis rates are highest among children from socio‑economic clusters 4 to 9. In contrast, children in clusters 1 to 3 (the lowest socio‑economic levels) have considerably lower diagnosis rates. Diagnosis rates are also lower among children from the most affluent families (cluster 10), who may have less financial motivation to pursue a formal diagnosis, even if developmental concerns are present (Figure 7.2).
There are several possible explanations for lower diagnosis rates among children from lower-income families. These families may have limited access to diagnostic services (e.g. due to language for Arab populations). They may also have lower awareness of the benefits associated with receiving a diagnosis. Additionally, lower income is often linked with lower educational attainment, which can reduce parents’ ability to navigate the health, social care, and educational systems and to advocate for appropriate assessment and support for their child (Akiva et al., 2024[7]). Another explanation, related to all the other reasons, is the high share of specific ethnic and religious population groups in the lowest income deciles, as underlined by a recent study by Silverman, Amit and Sadaka (2026[8]). Their analysis, based on data from the National Insurance Institute, found significant gap in eligibility rates for the Disabled Child Allowance (which all Israeli children with an ASD diagnosis are entitled to) with notably fewer children diagnosed in the Arab sector and low-SES neighbourhoods compared to the general population. Children in Haredi neighbourhoods also face delay in the age they first enter the support system – on average at age 4.7 compared to an average of 2.7 years in the non-Haredi Jewish neighbourhoods), although this gap becomes smaller in higher socio‑economic clusters.
Share of children (aged 0‑18) diagnosed with ASD by socio‑economic status, 2023
ASD: autism spectrum disorder.
Note: Socio‑economic clusters 1‑10 represent the Israeli Central Bureau of Statistics’ classification of localities (or statistical areas) by socio‑economic status, based on a composite index of demographic, education, employment, income, and living-standards indicators. Cluster 1 denotes the lowest socio‑economic status and cluster 10 the highest.
Source: Data provided by the Israeli national authorities.
To qualify for relevant state aid, including the National Insurance Institute’s Disabled Child Allowance, a child’s autism diagnosis – regardless of whether that diagnosis was made in a public or private practice – must follow the requirements set out in the Ministry of Health Circular No. 15 of 2013. The Circular emphasises that a diagnosis should be based on a comprehensive view of the child, considering medical, emotional, communicative, social, cognitive and functional aspects (Ministry of Health, 2013[4]).
An ASD diagnosis should start with a medical evaluation and can only be made by a medical professional with specialisation in one of the following fields:
Child and adolescent psychiatry;
Developmental paediatrics (with at least three years of institutional experience);
Child development;
Neurology.
In addition to the medical evaluation, the diagnostic process must include an assessment conducted by an expert clinical psychologist trained in child or developmental psychology. Rehabilitation or educational psychologists may also conduct this assessment, provided they have documented training in autism diagnosis. Other health professionals may contribute to the diagnostic process as needed (Ministry of Health, 2013[4]).
The diagnosis must align with the DSM‑5 criteria and should reference the child’s developmental and cognitive level. The assessment should therefore include:
A developmental or cognitive evaluation;
A functional assessment;
An assessment of autism symptoms.
In Israel, concrete tools are recommended for each part of the assessment process but contrary to some other international guidelines (such as Germany’s S3 or the UK’s NICE guidelines), the Circular does not precise whether these tools should be complementary to the diagnostic process, or if they should be the main basis for the final diagnosis. Recommended assessment tools include:
Developmental/cognitive assessment:
Up to age 3 (developmental) diagnosis: MULLEN. If there is no familiarity with the tool, BAILEY‑III or BAILEY-II can be used.
Ages 3‑7 (cognitive diagnosis): WPPSI-III (or other alternative age‑appropriate cognitive tests).
Functional assessment:
VINELAND-II or ABAS-II
Assessment of autism symptoms:
Screening and assessment questionnaires:
Parent questionnaires e.g. SRS‑2, SCQ, CARS‑2
Kindergarten teacher/educator report e.g. SRS‑2
Diagnostic tools: ADOS, ADI-R (if necessary and provided that training is available).
The reports prepared by each professional must clearly state which assessment tools were used and describe the child’s strengths and difficulties. The diagnosis is recognised only when both the qualified medical professional and the psychologist agree on the diagnostic conclusion (Ministry of Health, 2013[4]). Diagnosis by both publicly and privately practising medical professionals need to follow these guidelines, but there is much less supervision and enforcement tools on the private ones. Anecdotal evidence has raised concerns about the validity of privately established diagnoses compared to publicly established ones, due to financial incentives potentially overriding diagnostic rigour as well as a lack of checks of these privately established diagnoses by the public institutions that decide eligibility for disability entitlements. According to some stakeholders interviewed by the OECD, private practitioners are more prone to be pressured to establish an ASD diagnosis so the family can access the Disabled Child Allowance – an allowance that is harder to access if the child has another disability – as well as other entitlements.
Children in Israel are diagnosed relatively early
Diagnosis in Israel is relatively early. A systematic review and meta‑analysis by van’t Hof et al. (2020[9]) showed that among 40 countries, Israel had the lowest mean age of diagnosis for children with autism, at 30.9 months. According to the meta‑analysis, the mean age of diagnosis across more than 30 studies was identified at 60.5 months, with a range of 30.9 to 235 months (van ’t Hof et al., 2020[9]).
The mean age of diagnosis of 30.9 months in Israel was identified by a study by Mishaal et al. (2014[10]). The Israeli study identified several key factors in early identification of ASD, including the education of parents and parental experience with typical development of an older sibling, among others (Mishaal, Ben-Itzchak and Zachor, 2014[10]). Other reasons for early diagnosis in Israel might include the Tipat Halav system and wide awareness of the generous disability package available for families of children with diagnosed ASD.
In a more recent study, Magen-Molho et al. (2020[11]) found that out of a cohort of 1 786 194 children – out of which 11 699 were diagnosed with ASD (rate of 655 per 100 000 children) – the average age of diagnosis was 3.5 years, with a distribution of 83.5% boys and 16.5% girls. Although higher than the average calculated for Israel by Mishaal et al. (2014[10]), 3.5 years (or 42 months) is still well below the average of 60.5 found by the international meta‑analysis (van ’t Hof et al., 2020[9]).
Another Israeli study found that ethnicity and socio‑economic status also had an effect on age of diagnosis. According to this study, those in higher SES, typically identifying as “secular and modern religious Jews” were diagnosed earlier, and population groups generally belonging to lower SES, such as Ultra-Orthodox Jews and Arabs were generally diagnosed later (Koller et al., 2019[12]). Data from a recent study (Silverman, Amit and Sadaka, 2026[8]) also shows that children from Haredi neighbourhoods are diagnosed later, especially when they belong to lower socio‑economic clusters (1‑4), but this gap becomes smaller in higher clusters (5‑8). On average, children with autism from Haredi neighbourhoods first enter the disability support system at age 4.7 compared to an average of 2.7 years among children with autism from non-Haredi Jewish neighbourhoods. Interestingly, at an average of 4.7 years, children from Haredi neighbourhoods get diagnosed relatively early, compared to the international average of 60.5 months (~5 years) identified by van t’ Hof et al. (2020[9]).
Israel’s Disabled Child Allowance (קצבת ילד נכה) is a monthly, untaxed, non-means-tested benefit provided to parents of a child with disability. Its purpose is to help alleviate the family’s financial burden and promote the child’s inclusion in society. The allowance can be paid retroactively for up to one year prior to the submission of the claim and typically applies to children up to the age of 18 years and three months.1 Administered by Israel’s National Insurance Institute, the benefit is structured into five payment tiers (NII, 2025[13]):
50% – NIS 1 880 in 2025 (~14% of average monthly wage in Israel in 2025 (Israel Central Bureau of Statistics, 2025[14]))
100% – NIS 3 694 in 2025 (~27% of average monthly wage (ibid.))
112% – NIS 4 352 in 2025 (~32% of average monthly wage (ibid.))
188% – NIS 6 947 in 2025 (~51% of average monthly wage (ibid.))
235% – NIS 8 828 in 2025 (~65% of average monthly wage (ibid.))
The allowance level allocated to a child is determined through a complex, standardised and largely diagnosis-based assessment system grounded in four statutory eligibility categories defined in the National Insurance Law and the Disabled Child Regulations: 1) a child requiring special medical treatment; 2) a child dependent on the assistance of others; 3) a child requiring supervision; and 4) a child with a “special impairment”. ASD constitutes a standalone statutory ground for eligibility as an explicit sub-category of the “special impairment” category, alongside a limited number of other clearly defined conditions, such as severe visual impairment, severe hearing impairment and moderate, severe or profound intellectual disability. Other conditions, such as epilepsy, are not defined as independent statutory grounds; entitlement in such cases is assessed under one of the other three eligibility categories, most commonly the “requiring supervision” or “special medical treatment” category. Eligibility categories may distinguish between different levels of severity, which determine the corresponding allowance rate. For example, a child with Down Syndrome would receive between 50% and 100% of the allowance depending on their age and level of support needs (NII, 2025[15]). By contrast, a diagnosis of ASD confers entitlement at the 100% rate, regardless of age and support needs (NII, 2025[16]).
Notably, in cases where a child has multiple qualifying conditions, the allowance is calculated according to the impairment that grants the highest benefit level. A family with two or more children with disability is entitled to a 50% increase in the benefit amount for each child, calculated according to the benefit rate determined for each individual child. For instance, if a family has two children with disability who are entitled to benefit rates of 100% and 50% respectively, each benefit will be increased by 50% – the first child will receive a benefit at a rate of 150%, and the second at a rate of 75% (NII, 2025[16]).
With a medical diagnosis, children with ASD automatically qualify for the allowance
Each eligibility category has its own eligibility criteria and documentation requirements, typically involving some form of medical certification. Compared to disability allowances in several other countries (see Chapter 3), where eligibility is determined primarily based on assessed support needs rather than a formal diagnosis, Israel’s Disabled Child Allowance adopts a distinctly medicalised approach. What particularly sets the Israeli system apart is that children with a formal medical diagnosis of ASD (for further details on the criteria a medical diagnosis must satisfy to be recognised by the NII, see above) automatically qualify for the 100% allowance rate, without any further assessment of their daily support needs. A child with ASD can receive the allowance from 91 days of age up to 18 years and three months (NII, 2025[16]).
To apply for the Disabled Child Allowance, parents or legal guardians of a child with ASD must submit the following documents to the National Insurance Institute (NII, 2025[16]):
Claim Form for Disabled Child Allowance (submitted online, by phone, or on paper);
Medical diagnosis from a child and adolescent psychiatrist, neurologist, or developmental paediatrician;
Psychological diagnosis from a clinical, developmental, educational, or rehabilitation psychologist, including a standardised psychological test appropriate to the child’s age;
Statement specifying the diagnostic tool used (e.g. CARS, ADOS, ADI-R);
School certificate form.
The school certificate form provides some details about the child’s behaviour and support needs in their daily school environment. Once submitted, the application documents are reviewed by a physician or other medical professional from the NII, who determines eligibility for the allowance. If the documentation is incomplete or uncertainties remain regarding eligibility or the appropriate allowance level, the child may be referred for an in-person assessment of their daily support needs by the NII Medical Board – a formal body composed of doctors and other medical professionals. However, for children with ASD, such in-person assessments are typically not conducted. Because a formal diagnosis automatically qualifies them for the allowance, the eligibility decision is based solely on the documents submitted by the parents or legal guardians, according to NII regulations.
In light of the marked increase in applications for the Disabled Child Allowance on the basis of ASD in recent years, coupled with a growing number of diagnoses that do not meet the standards set out in the Director General’s Circular of the Ministry of Health or the medical guidelines of the National Insurance Institute, referrals for re‑evaluation by professionals acting on behalf of the NII have become more frequent than in the past.
A higher than standard rate may be granted for children highly dependent on others
Although a child’s eligibility for the Disabled Child Allowance is primarily determined by their medical condition, their allowance rate may be higher than their condition’s standard rate if the child requires assistance with daily activities to a significantly greater extent than other children of the same age (eligibility category 2). For example, a child with Down Syndrome who needs intensive support in everyday activities may receive an allowance rate higher than the standard 50%‑100%. The same applies to children with ASD: while the automatic standard rate is 100%, children whose support and care needs are particularly extensive may receive up to 235%.
The support needs of a child with ASD do not determine whether they are eligible for the Disabled Child Allowance in the first place, but rather whether their level of dependency on others justifies a higher than standard benefit rate.
To assess entitlement to a higher rate, a child must undergo a dependency assessment, which is typically initiated at the request of the parents or legal guardians. This assessment is carried out in-person by the NII Medical Board. The Board’s medical staff evaluate the child’s functioning and support needs across five domains of daily living: mobility at home, dressing and undressing, bathing, eating and drinking, and personal hygiene. Each domain contains several levels of functioning, with age‑specific point values assigned based on the child’s degree of independence.2 The total score across all domains determines the benefit rate. If this rate exceeds the standard allowance rate that would otherwise be granted based on the child’s medical condition, the child receives this higher rate (NII, 2025[17]):
5‑7 points – 50% allowance rate
8‑9 points – 112% allowance rate
10‑12 points – 188% allowance rate
13 or more points – 235% allowance rate
Israel’s diagnosis-based approach to the Disabled Child Allowance, where benefit levels are tied to medical conditions and a comprehensive functioning and support needs assessment of the child is conducted only to determine a possible higher than standard rate, poses challenges, especially for conditions such as ASD that span a broad spectrum of severity. This reliance on diagnoses is unique among the countries studied.
Reassessments of children with ASD have become rare
Whether, and how often, a child receiving the Disabled Child Allowance is reassessed for continued eligibility – or for an increase or decrease of their allowance rate – is determined on a case‑by-case basis. The decision primarily depends on the child’s specific diagnosis, the duration of entitlement initially granted, and whether the NII considers the entitlement temporary or permanent. Whenever a child’s condition or circumstances change, a re‑evaluation is typically conducted, requiring updated medical certification.
For children diagnosed with ASD, a regulation introduced in 2022 stipulates that if the diagnosis is made after the age of three, eligibility for the allowance – once established – is automatically extended until the child reaches 18 years and three months, without any interim reassessment. For children diagnosed before the age of three, a re‑evaluation requiring updated medical certification around age ten is mandatory. The regulation was introduced to reduce the bureaucracy associated with repeated reassessments of children with ASD. It followed a survey conducted by the Disabilities and Rehabilitation Administration of the NII, which found that the eligibility status of 97% of surveyed children with ASD remained unchanged after they had been invited to a re‑evaluation by the Medical Board with updated medical documentation at age 7 (NII, n.d.[18]).
Children classified under the categories “autism” and “needs partial supervision” were the two largest groups by far among all recipients of a Disabled Child Allowance in 2024. In that year, 60 195 children with autism and 42 254 children requiring partial supervision received the allowance. By contrast, the number of children qualifying under other categories remains comparatively small (Figure 7.3).
Both the “autism” and “needs partial supervision” groups have grown substantially in recent years, driving much of the overall increase in the number of children receiving a Disabled Child Allowance (Figure 7.4). The total number of recipients rose from 33 308 in 2012 to 153 525 in 2024, while the share of children with ASD among all recipients increased from around 25% to approximately 39% over the same period. Growth in the “needs partial supervision” category is largely driven by payments granted to children with allergies. In 2012, only around 2% of children receiving the allowance fell into the “needs partial supervision” category, compared to a striking 28% in 2024.
The eight leading causes of allowance entitlement in Israel, 2024
Source: Data provided by the Israeli national authorities.
Children aged between 91 days and 18 years and three months who require the presence of an adult to prevent danger to a significantly greater extent than is typical for their age are eligible for the Disabled Child Allowance. The benefit amount depends on the degree of supervision required: parents receive a 50% rate (NIS 1 880 in 2025) if their child qualifies for Level 1 of the supervision category, or a 100% rate (NIS 3 694 in 2025) if the child meets the criteria for Level 2.
Level 1 – partial supervision – generally applies to children who need close supervision to protect themselves or others from harm due to a limited understanding of danger resulting from their disability, chronic disease, or disorder. This group includes, for example, children with life‑threatening allergies or severe behavioural disorders.
Level 2 – full supervision – covers children who require the constant presence of a parent to prevent dangerous situations arising from a severe illness, impairment, disorder, or disability. This may be because the child is unaware of imminent risks or because they experience medical incidents that demand immediate intervention.
When applying for the allowance, parents must submit a claim form, a recent educational report from the child’s school or special education institution, and a medical certificate from a relevant medical specialist detailing the child’s condition and explaining the need for enhanced supervision. If the submitted documentation is sufficiently comprehensive, the child may not be required to appear before the NII’s Medical Board for an in-person assessment.
The NII retains administrative discretion to determine which conditions require partial or full supervision, in contrast to certain other impairments that are explicitly classified by law as sub-categories within the “special impairments” eligibility category.
Source: Israel’s National Insurance Institute (2025[19]), Partial and full supervision, https://www.btl.gov.il/English%20Homepage/Benefits/Disabledchild/Who%20is%20entitled/Pages/Supervision.aspx.
Reflecting the broader upward trend in the number of children receiving a Disabled Child Allowance, total annual payments have risen sharply in recent years, particularly since 2021, reaching approximately NIS 7.4 billion in 2024 (Figure 7.5). Payments on children with ASD have increased in parallel, from about NIS 293 million in 2012 to NIS 2 513 million in 2024.
Importantly, Israel’s child population has continued to grow over the past decade – from around 2.96 million individuals under the age of 20 in 2014 to approximately 3.45 million in 2024 – in contrast to many other OECD countries where child populations have remained stable or declined (OECD, n.d.[20]). This demographic growth at least partly explains the absolute increase in the number of children accessing disability-related services and benefits in Israel. Nonetheless, there has been a substantial increase in the share of children with ASD and a Disabled Child Allowance of the total child population (under 20 years of age) in Israel, rising from 0.3% in 2012 to 1.44% in 2023.
Children receiving an allowance by diagnostic group and share of diagnostic groups of all children receiving an allowance, Israel, 2012‑2024
ASD: autism spectrum disorder, PDD: pervasive developmental disorder.
Note: Panel A: “autism” includes the category PDD only in 2024. Panel B: “autism” includes the category PDD.
Source: Data provided by the Israeli national authorities.
Disabled Child Allowance and ASD payments, Israel, 2012‑2024
ASD: autism spectrum disorder, NIS: new Israeli shekel, PDD: pervasive developmental disorder.
Source: Data provided by the Israeli national authorities.
Early childhood support for children with ASD is a core priority
Israel demonstrates a strong commitment to early childhood support, as reflected in its generous provision of therapeutic support for young children with ASD. Through its Early Childhood Programme, children with ASD aged 0‑3 years are entitled to receive up to 14 hours of therapy per week, including occupational therapy, speech and language therapy, and psychotherapy. Of these 14 hours, 10.5 hours are devoted to direct one‑on-one sessions, while 3.5 hours are provided indirectly, for instance on staff training (ALUT, 2021[21]).
Access to the Early Childhood Programme – offered exclusively to children with ASD – requires an official medical diagnosis of ASD. Children (ages 0‑3) typically receive the programme’s therapies at a special daycare centre, where therapy sessions are delivered on-site. Admission to a special daycare centre requires both a formal ASD diagnosis and approval from the National Insurance Institute.
Notably, children below the age of two for whom diagnostic uncertainty persists, or who are undergoing an extended diagnostic process, may access speech and occupational therapy without a formal diagnosis through health maintenance organisations, following referral from Child Development Clinics. In addition, Observation Preschools provide early intervention to children with developmental delays where the underlying condition has not yet been clearly identified, with some children later transitioning to diagnosis-specific special education settings, including those for ASD.
Children of kindergarten and school-age access therapy services primarily through the education system
A child with ASD of kindergarten age (4‑6 years) may either attend a special “communication” kindergarten, where they receive the same 14 weekly hours of therapy provided under the Early Childhood Programme directly on-site, or attend a regular kindergarten and receive a personalised “basket of services” that may include therapy sessions (ALUT, 2021[21]). In both cases, access is contingent upon an assessment and approval by the Eligibility and Characterization Committee, which authorises not only attendance at a special kindergarten but also determines a child’s individual service basket size when they attend a regular kindergarten, thereby defining the number of therapy hours a child in a regular setting can receive per week.
From the age of seven onwards, children with ASD, like children with other disabilities, can access a maximum of three hours of therapy per week through the public health system, which provides these services via Health Maintenance Organisations (ALUT, 2021[21]). To receive these therapies which include occupational, speech and language, and psychotherapy, children with ASD must present an official medical diagnosis and obtain a referral from either a paediatrician or a psychiatrist. According to anecdotal evidence, however, children with ASD on average receive only one of the three weekly therapy hours from the HMOs they are formally entitled to. This low take‑up rate may suggest either that relatively few children require the full three hours – for example, because they already receive an adequate number of therapy sessions at school – or that parents face substantial challenges in co‑ordinating therapy sessions and integrating them into family life, or that limited availability of qualified therapists constrains access to the full range of therapeutic services. Notably, once therapy has commenced, parents typically schedule a structured series of treatment sessions. While shortages of qualified therapists contribute to waiting times prior to treatment initiation, such shortages generally play a smaller role once a treatment plan is underway.
Children with ASD or other disabilities of school-age can receive more than the standard three hours of weekly therapy provided through HMOs by accessing additional therapeutic support via the education system. This can occur in two main ways, similar to the kindergarten system: through an individualised basket of service hours for students in regular classes, or through enrolment in a special education (“communication”) class within either a mainstream or special education school, where therapies are integrated into the school day. A child with ASD would receive three hours of therapeutic support per week in a special education class. To receive therapies through any of these educational pathways, a child must present an official medical diagnosis and approval by the Eligibility and Characterization Committee (see below for details).
Therapists providing services to children in kindergartens and schools are employed by the Ministry of Education. In practice, they typically prioritise children enrolled in special kindergartens or special education classes before attending to those in mainstream educational settings. According to anecdotal evidence, there is a general shortage of therapists within the education system for children with disability, which often results in limited access to therapy for children integrated into regular classrooms or kindergartens.
Israel offers three schooling options for children with SEN
Some flexibility exists in the number of therapy hours a child with disability may receive through the education system. While the size of a child’s services basket – i.e. the number of weekly service hours available to children attending a mainstream class – is determined by the Eligibility and Characterization Committee, the basket’s specific composition is typically agreed upon jointly by the child’s parents and the school staff.
For instance, a service basket of 8.2 hours per week entitles the child to funding equal to the cost of 8.2 hours of a personal teacher per week. However, the family is not obliged to use these hours exclusively for a personal teacher. Instead, they may allocate the corresponding budget toward hiring a teaching assistant who is generally less costly, thereby allowing the child to receive a greater number of support hours overall. The same budget may also be used to fund therapeutic services, such as occupational or speech therapy. In practice, such decisions on service basket composition are heavily influenced by professional staff availability. While the service basket provides some flexibility in how special education support is delivered, these services, such as therapy, ultimately remain subject to a weekly hourly ceiling.
As an alternative to receiving therapy through a personal services basket in an inclusive school setting, a child may instead access therapeutic support by attending a special education class either at a mainstream school or at a special education school. In a special education (“communication”) class, for example, a child with ASD benefits from a personalised curriculum, extended school hours compared to a regular class, a vacation schedule, organised transportation to and from school, and therapeutic support amounting to three hours per week. In practice, a special education class within a mainstream school offers nearly identical levels of support to those provided in a special education school, while allowing integration into a regular classroom for certain subjects as appropriate for the individual child. Children with ASD can remain enrolled in such settings until the age of 21.
A high degree of standardisation characterises Israel’s special education system
What sets Israel’s special education system apart is the decisive role that medical diagnoses play in determining both school placement and the range of educational supports available to a child with SEN. Not only is medical documentation required to access special education, whether in the form of a personal support basket or through attendance in a special education class, but each class is specifically designated for one type of medical condition or disability. For instance, there are separate special education classes for children with ASD, developmental delay, speech delay, mild intellectual disability, hearing impairment, cerebral palsy, rare diseases, and borderline intellectual functioning, among others.
Each class type is governed by precise national standards that define, in detail, the start and end time of the school day, the number of therapy hours provided to each child, the maximum class size, the staffing ratios, and the total number of teaching hours per week. This high degree of standardisation ensures uniformity across the country, though it leaves limited room for individualised flexibility.
The same meticulous approach extends to the personal service baskets available to children in mainstream education. Every child is categorised according to their specific medical condition or disability, and combined with their assessed level of functioning, this classification determines the exact number of weekly support hours they are entitled to. In other words, there is a predefined allocation of support hours for each disability type across four functional levels (see Figure 7.6 for children with ASD and Figure 7.7 for other diagnostic categories). Notably, some categories do not entitle to any service hours at functioning Level 1 – such is the case for children with mental disorders and developmental delay.
Note: The lists of special education services are not exhaustive. In Israel, a regular school day typically ends between 14:00 and 15:00.
Source: Information collected by the Secretariat.
Such a highly standardised, diagnosis-based approach to special education as well as therapeutic service provision is unmatched in any other OECD country analysed in this report. Israel’s model risks creating imbalances in service distribution, potentially leading to over-servicing of children with relatively low support needs, while under-servicing those with more substantial needs. This risk is particularly likely to materialise for conditions such as ASD, which encompass a wide spectrum of functional abilities and support needs. This model also risks under-servicing children with other disabilities in the context of constrained resources. Anecdotal evidence suggests that families of children with disabilities other than ASD often perceive that children with ASD benefit from preferential access to supports, while they encounter comparatively greater barriers in accessing similar services. Where the provision of services is not aligned with the actual needs of children, existing shortages of special education teachers and paramedical professionals are further exacerbated, thereby undermining the availability and effectiveness of services for all eligible students.
Note: h/w = hours per week
Source: Information provided by national authorities.
An Eligibility and Characterisation Committee must approve special education support
In Israel, Eligibility and Characterization Committees are entrusted with the authority to determine a child’s eligibility for special education services, characterise the child’s disability, and determine their level of functioning and scope of services basket. Operating at the local level – there are approximately 369 such Committees across the country – each Committee is composed of five members: representatives of the Ministry of Education, the local authority, and the superintendent of Special Needs Education, a parent of a child with special educational needs, and an educational psychologist.
Together, these members assess each child’s level of functioning, ranging from (1) mild to (4) very extensive support needs, and determine eligibility for special education placement as well as the size of a “basket of services”. Decisions are based primarily on documentary evidence, although the child, their parents, teacher, and other professionals may be invited to attend the Committee meeting. Referrals to the Committee can be made by the child or their parent, a recognised educational institution, the education department of the local municipality, or a representative of a public organisation. The final decision regarding school placement ultimately rests with the parents.
The documentation submitted to the Committee typically includes medical and psychological reports establishing the child’s medical condition or disability, and a RAMA (National Authority for Measurement and Evaluation in Education) questionnaire completed by the child’s teacher. The RAMA questionnaire evaluates multiple dimensions of the child’s functioning, including cognitive ability, communication and social interaction, emotional regulation, and functional independence and organisation. However, according to anecdotal evidence, the RAMA questionnaire is no longer consistently applied, as it was found to be too lengthy and of limited reliability. Anecdotal evidence further suggests that the majority of children with ASD are classified by the questionnaire and followingly the Committees as Level 3 or 4, a pattern that may not accurately reflect the wide range of support needs encompassed by autism spectrum disorder.
While a child’s disability, in combination with their assessed level of functioning, is intended to determine the type of schooling and support they are entitled to, in practice, a child’s level of functioning does not always influence these entitlements. For instance, a child with ASD, regardless of their assessed level of functioning – even at Level 1 – is automatically eligible to attend a special education class at either a mainstream or special education school (see Figure 7.6 for details). In contrast, a child with ADHD can only access such classes if they are assessed at Level 3 or 4 of support needs.
When a child has been granted a personal services basket, the parents, together with the child’s teachers and, where relevant, other school staff, collaborate to design and review the child’s Individual Education Plan (IEP). The IEP specifies the type and frequency of support the child will receive, for instance, whether the allocated service hours will be used for a personal teacher, a teaching assistant, or therapy sessions. The IEP is reviewed annually, while reassessments by the Eligibility and Characterization Committee take place every three years.
The number of children receiving special educational support in Israel has risen steadily since 2014, more than doubling from around 100 000 in 2014 to approximately 220 000 in 2024 (Figure 7.8, Panel A). While some categories, such as learning disabilities – though among the largest categories – have remained relatively stable over time, others have driven much of this growth, notably children with ASD and those with severe behavioural or emotional disorders. In 2014, only about 10 000 children with ASD received special education support, whether through placement in a special education school, a special education class, or via an individual services basket. By 2024, this number had increased more than fourfold to roughly 44 000. A nearly identical growth pattern is observed among children with severe behavioural or emotional disorders.
For children with ASD, the increase has occurred across all types of SEN supports – special schools, special classes, and regular classes with individualised service baskets (Figure 7.8, Panel B). The most pronounced rise, however, appears to be among those attending special education schools, growing from roughly 4 000 in 2014 to about 18 000 in 2024. Since children with ASD are eligible for placement in special education schools and “communication” classes regardless of their assessed level of support needs, the large share enrolled in special education settings likely reflects not only higher support needs but also comparatively greater resources and quality of support available in these special schools and classes. The fact that therapists first serve children at special schools and special classes before attending to those in regular classes supports this observation. Parents’ preference for special education settings may thus reflect an imbalance of SEN supports available across the three schooling settings.
Notably, the share of all children with SEN included in mainstream classes with personalised service baskets has grown from about 24% in 2016 to 40% in 2024. The distribution of children with ASD across the three school settings, however, has remained relatively stable during this period (Figure 7.9). In 2018, Israel introduced a special education reform that replaced the former Placement Committees with Eligibility and Characterization Committees, expanded parental choice in decisions regarding school placement, and promoted inclusion in mainstream classrooms rather than special education settings (Silverman and Blass, 2025[22]). Figure 7.9 suggests that the reform has contributed to increased enrolment of students with SEN in regular classes overall but has had little to no effect for students with SEN and ASD. Research indicates that significant gaps persist between the reform’s legislative objectives and parents’ experiences of the education system (Huri and Shoshana, 2023[23]).
Children with SEN by type of disability and those with ASD by type of SEN school setting, 2014‑2024
ASD: autism spectrum disorder, SEN: special educational needs.
Note: The data only covers children that receive one of the three forms of special education support, i.e. those with an approval for special education from the Eligibility and Characterization Committee.
Source: Data provided by the Israeli national authorities.
Many children with ASD receive a Disabled Child Allowance but no SEN support
Among children with SEN, the largest group consists of those with learning disabilities, followed by children with ASD and those with severe behavioural or emotional disorders. In 2023, approximately 36 700 children with ASD received some form of special education support, compared to around 48 300 children with ASD receiving a Disabled Child Allowance. This suggests that roughly 11 600 children with ASD received the allowance but did not access any form of SEN support. Given that an official ASD diagnosis automatically qualifies a child for an allowance, as well as SEN supports, this likely implies that many of these 11 600 children have relatively low support needs and can participate in mainstream education without additional assistance. At the same time, it may also indicate that some children face structural barriers in accessing SEN support despite their formal eligibility. A study by the Taub Center (Silverman and Blass, 2025[22]) in Israel found that while preschool special education enrolment has risen sharply in recent years, this growth is accompanied by structural inequities in who has access to evaluations, diagnoses, and support. The researchers identify substantial barriers facing Arab, Bedouin, Haredi, and low‑SES communities, who are underrepresented in all forms of preschool special education despite having equal or even higher developmental risk factors. This pattern suggests that structural aspects rather than solely underlying need shape who receives SEN support, raising concerns about the equity and inclusiveness of Israel’s preschool special education system.
Distribution of children with ASD and all children with SEN across school settings in 2016, 2020 and 2024
ASD: autism spectrum disorder, SEN: special educational needs.
Note: Children with SEN are all those that have an approval for special education from the Eligibility and Characterization Committee. Children with ASD are also only those with an approval for special education from the Committee.
Source: Data provided by the Israeli national authorities.
Costs per student with ASD are the highest among all students with SEN
The comparatively extensive special education supports provided to children with ASD are also reflected in the annual costs per student, which are the highest for students with ASD, followed by those with severe mental disorders and those with severe or profound disability (Table 7.1). Across these categories – as well as most other categories – annual costs for students receiving support through a personal services basket in a regular class are lower than those for students in special education schools or classes. This likely reflects the generally lower support needs of children with SEN included in mainstream settings but may also indicate that comparatively fewer resources are allocated to inclusive education. In total, Israel spent approximately NIS 4 619 million on SEN supports for children with ASD in 2024 (Figure 7.10).
Average annual costs in NIS per student for the three most expensive categories of disability, Israel, 2024
NIS: new Israeli shekel.
Source: Data provided by the Israeli national authorities.
Annual spending in millions of NIS on SEN supports for children with ASD in Israel, 2024
ASD: autism spectrum disorder, NIS: new Israeli shekel, SEN: special educational needs
Source: Data provided by the Israeli national authorities.
In addition to therapeutic and educational services, children with ASD and their families have access to a broad range of social services, some of which are aimed directly at the child and others designed to assist their parents and caregivers. Among the parent-oriented services are counselling programmes, as well as up to 18 paid childcare leave days per year (18 for each parent and 36 for single parents). Parents of a child with ASD receiving a Disabled Child Allowance are also automatically eligible for discounts on water bills and local property taxes, as well as tax credits and reduced car registration fees, which together can amount to several thousand NIS in annual savings (ALUT, 2021[21]). Additionally, respite care services provide parents with temporary relief from caregiving responsibilities through short-term stays for children with disability in specialised facilities offering professional care and supervision.
Child-focussed social supports include free transportation to and from school, kindergarten, or daycare for children with SEN supports approved by the Eligibility and Characterization Committee, and subsidised or free of charge after-school programmes and school holiday camps, administered by the Ministry of Labour and Welfare (ALUT, 2021[21]). In addition, children with ASD who experience significant communication difficulties can obtain supportive or alternative communication devices through Israel’s Health Maintenance Organisations.
Israel’s distinctive approach to determining eligibility for allowances and services – based almost exclusively on medical diagnoses rather than assessed support needs – means that children with ASD can access a wide range of benefits and services solely based on a formal ASD diagnosis. This structure results in comparatively generous support for children with mild support needs. For instance, families of a child with ASD and mild support needs receive a Disabled Child Allowance equal to 100% (NIS 3 694 per month in 2025), representing approximately 27% of the average monthly wage in Israel in 2025 (Israel Central Bureau of Statistics, 2025[14]). In addition, nearly all services relevant to children with ASD, including therapeutic and educational supports, are provided free of charge. Children with ASD and mild support needs may access up to three hours of HMO-funded therapy per week, as well as special education support, with the choice between inclusion in a regular classroom with a personal services basket, attendance in a communication class at a mainstream school, or enrolment in a special education school. Taken together, total monthly public expenditure on allowances, SEN supports, and therapeutic services for a child with mild support needs is estimated at NIS 12 859, representing 94% of the average monthly wage (ibid.).
Because eligibility and levels of the Disabled Child Allowance are not differentiated by the severity of support needs, a child with ASD and moderate support needs receives the same monthly allowance as well as access to public therapies and SEN supports as a child with mild support needs. Differences in total monthly expenditure between mild and moderate support needs (see Table 7.2) arise from school placement choices, as it can reasonably be expected that a child with ASD and moderate support needs would rather attend a special education class or special education school where SEN supports are more extensive and therapeutic services are guaranteed.
The generosity of support for children with mild support needs diminishes for families of children with severe support needs, where one parent had to stop working entirely to provide full-time care. In such cases, a Disabled Child Allowance of 188% (NIS 6 947 in 2025) replaces only about 51% of the income of a parent previously earning the national average wage (Israel Central Bureau of Statistics, 2025[14]). Moreover, therapeutic and educational support levels remain unchanged compared to those for children with mild or moderate support needs. As Israel considers the medical diagnosis rather than the support needs of a child with ASD to assess entitlement to benefit and services (with the exception of a higher allowance rate because of dependency on others), the overall level of public support varies little across different levels of support needs.
Although Israel’s monthly allowance for children with ASD and mild support needs is comparatively generous by OECD standards, its financial benefit for children with ASD and severe needs aligns closely with that of other OECD countries (see Chapter 3). However, a cross-country comparison including all benefits and services is challenging, as most other countries tend to offer flexible and potentially more intensive therapeutic services through their public health systems, which do not impose strict hourly limits, especially for children with severe support needs. The lack of precise data in such more flexible systems makes it difficult to quantify differences in services offer and cost.
Monthly spending on a child with ASD in Israel by spending category and support needs, 2025
NIS: new Israeli shekel, PPP = purchasing power parities.
Note: Average annual wages of 2023.
1. Financial benefit: Disabled Child Allowance.
2. Those three hours/week of therapy that are provided through HMOs. One hour of therapy costs NIS 142 in 2025.
3. Education spending only includes the costs per student with SEN supports.
Core assumptions:
a. Parental care – one parent reduces working hours in line with care needs (0%, 50% and 100%).
b. Parents earn the average annual wage and work full-time in baseline scenario.
c. 12‑year‑old child with formal ASD diagnosis, attending secondary school.
d. A child with severe support needs is assumed to receive a higher than standard rate because of their dependency on others.
e. A child with mild support needs can be expected to attend a regular class with a personal basket of services, while a child with moderate or severe support needs will most likely opt for a special class or special school where more extensive support is offered.
Source: OECD (2025[24]), Annual Purchasing Power Parities and exchange rates (dataset), https://data-explorer.oecd.org/s/3sp. OECD (2025[25]), Average annual wages: https://data-explorer.oecd.org/s/3sq. Compilation of OECD material and data provided by the Israeli national authorities.
Israel’s experience reflects a highly standardised and diagnosis-based approach to supporting children with autism within its disability policy framework. Over the past decades, the country has expanded access to financial benefits, therapeutic services, and special education, ensuring that families receive comprehensive support once a formal diagnosis is established. This model has facilitated early identification and generous entitlements, particularly for children with mild needs, but its reliance on medical diagnosis rather than assessed support needs limits flexibility and responsiveness for those with more complex requirements.
The uniform structure of benefits and services, combined with rising diagnosis rates, has driven significant increases in public expenditure and raised questions about long-term sustainability. Moving forward, introducing greater differentiation based on functional needs, addressing shortages in therapeutic provision, and promoting balanced inclusion across educational settings will be critical to ensuring that Israel’s system remains equitable, effective, and financially viable in meeting the diverse needs of children with ASD and their families.
References
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← 1. The exact age limits for eligibility vary depending on the child’s specific medical condition, impairment, or treatment. For example, a child with Down Syndrome may receive the allowance from birth, whereas a child diagnosed with ASD becomes eligible from 91 days of age.
← 2. See https://www.btl.gov.il/English%20Homepage/Benefits/Disabledchild/Pages/vaadatlut.aspx for additional details on the NII’s dependency assessment.