This chapter analyses the Netherlands’ multi-layered approach to autism policy, combining strong legal protections, comprehensive healthcare provisions, and targeted social benefits. It outlines the country’s disability rights framework anchored in the Equal Treatment Act, the Participation Act, and the United Nations Convention on the Rights of Persons with Disabilities. Clinical practice is guided by national guidelines and the Autism Care Standard, ensuring structured diagnostic and treatment pathways. The chapter reviews financial supports such as the Double Child Benefit and the Personal Budget (PGB), highlighting strict eligibility criteria and regional variations that affect equitable access. It also examines therapeutic coverage under statutory health insurance and municipal Youth Care, alongside reforms introduced by the 2014 Act on Appropriate Education to promote inclusion. Finally, it considers persistent challenges, including gaps in service co‑ordination, regional disparities, and the need for improved data collection to inform evidence‑based policymaking.
Policy Responses to Rising Autism Diagnoses in Childhood
Abstract
Autism policy in the Netherlands: Legal frameworks and available supports
The Netherlands has a strong disability rights framework, anchored in the Equal Treatment Act (2003), the Participation Act (2015), and the United Nations Convention on the Rights of Persons with Disabilities (which it ratified in 2016), ensuring equal access and support across employment, healthcare, and daily life.
Recent data from the National Health Survey show that, between 2022 and 2024, an average of 3% of the population reported having autism, a high share in international comparison.
The Dutch Association of Psychiatry, in collaboration with other professional bodies, has developed comprehensive guidelines for ASD diagnosis and treatment. These guidelines emphasise multi-disciplinary assessment, developmental history, behavioural observation, and the use of standardised tools as supportive – but not standalone – measures.
Two benefits are particularly relevant for families of a child with disability in the Netherlands: Double Child Benefit and Personal Budget (PGB). PGB is an individualised budget that allows recipients – in this case, typically the child’s parents – to decide when, where, and by whom care services and other supports, such as assistive devices, are provided. PGB may also be used to compensate parents for the care they themselves provide to their child, provided that this care is set out in a formal care agreement and only for a maximum of 40 hours per week. Eligibility for PGB is determined by the extent of a child’s care and support needs.
A medical diagnosis of ASD alone does not entitle a child/family to neither a PGB nor a Double Child Benefit. Eligibility for Double Child Benefit requires a child to demonstrate extensive care and supervision needs. Children with ASD rarely meet these stringent care criteria and therefore typically do not receive Double Child Benefit. Consequently, the recent increase in Double Child Benefit recipients – from 33 000 in March 2020 to 52 000 in September 2025 – is unlikely to be explained by rising ASD rates in the Netherlands.
The increase in ASD rates may have contributed to the moderate rise in enrolment in special schools (cluster 3 and cluster 4) in recent years, from 58 700 students in 2017/18 to 65 000 in 2023/24. These special schools, organised into four clusters corresponding to broad areas of need, serve children with extensive special educational needs. Cluster 4 schools cater to children with behavioural and psychiatric disorders, including ASD.
In contrast, enrolment in special primary schools – a separate type of special education school in the Netherlands designed for children with mild learning or behavioural difficulties – has remained relatively stable over the same period.
The Netherlands has developed an extensive and multi-layered approach to supporting individuals with autism spectrum disorder (ASD), combining strong legal protections, comprehensive healthcare provisions, and targeted social benefits. Autism is recognised as a mental health condition under Dutch law, and the country’s disability framework is anchored in key legislation such as the Equal Treatment Act, the Participation Act, and the United Nations Convention on the Rights of Persons with Disabilities. Support for individuals with autism spans four major laws – the Long-Term Care Act, Youth Act, Social Support Act, and Health Insurance Act – ensuring coverage across the lifespan. Clinical practice is guided by detailed national guidelines for diagnosis and treatment, complemented by the Autism Care Standard, which consolidates best practices for care delivery.
Beyond healthcare, the Netherlands provides financial assistance to families through two main instruments: Double Child Benefit, which offers additional support for children with extensive care needs, and a so-called Personal Budget (PGB), enabling families to purchase tailored care services and, in some cases, compensate informal caregivers. Therapeutic services such as speech and occupational therapy are primarily covered by statutory health insurance, though caps and variations in coverage often require supplementary municipal support through Youth Care or PGBs. In education, the 2014 Act on Appropriate Education introduced significant reforms to promote inclusive schooling for children with special educational needs (SEN), including children with autism. Regional school partnership groups play a central role in allocating resources and determining placements in special education settings when mainstream schools cannot meet a child’s needs.
Autism is a recognised disability under Dutch law and is generally treated as a mental health condition. Several legal acts form a strong disability framework in the Netherlands.
The Equal Treatment on the Grounds of Disability or Chronic Illness Act of 2003 (Wet gelijke behandeling op grond van handicap of chronische ziekte, WGBH/CZ) ensures equal rights for people with disabilities and chronic illnesses in employment, through the provision of goods and services, in their living situation, in public transport and in their private life (Staatsblad, 2003[1]).
In 2015, the Participation Act (Gevolgen Participatiewet) has replaced the previous Work and Social Assistance Act (Wet Werk en Bijstand, WsW) and in part, the Young Disabled Persons Act (Wajong). The Participation Act ensures support for people partially incapacitated for work for a longer period and employed by a regular employer. The Young Disabled Persons Act covers those who are fully and permanently incapacitated for work (NVA, 2019[2]; Rijksoverheid, 2019[3]).
In July 2016, the Netherlands also ratified the United Nations Convention on the Rights of Persons with Disabilities, extending equal access requirements to all areas of life.
The Netherlands recognises that autism can impact all areas of daily living, such as self-care, housing, school, work, and relationships. Support for autism can therefore fall under four separate laws depending on the age of the individual and their need for assistance. Depending on the law to which the support a person is receiving belongs, assistance is reimbursed or paid by different types of insurers. These four laws are the following (for more information see the section on Personal Budget) (Vanuit Autisme Bekeken, 2021[4]):
Long-term Care Act (Wet langdurige zorg, Wlz);
Youth Act (Jeugdwet, JW);
Social Support Act (Wet maatschappelijke ondersteuning, Wmo);
Health Insurance Act (Zorgverzekeringswet, Zvw).
The Netherlands has started collecting data on self-reported rates of autism only very recently and found that in the period of 2022‑2024, on average, 3% of the population reported having autism. The analysis based on the National Health Survey also looked at differences between age groups, incidence of co-morbid anxiety and depression, and the employment status of those reporting to have ASD (Statistics Netherlands, 2025[5]).
The Netherlands has some of the highest ASD rates among OECD countries
The Netherlands has started only recently to collect data on ASD rates. Data are collected annually through a population-level survey, the National Health Survey. In 2022, the question “Do you/does your child have autism spectrum disorder, or ASD, such as Asperger’s Syndrome or PDD-NOS?” was introduced, which in 2024 was simplified to: “Do you/does your child have autism spectrum disorder, or ASD?'' (Statistics Netherlands, 2025[5]).
Based on this self-reported measure, 3.4% of men and 1.7% of women reported having ASD on average between 2022-24 (Figure 8.1). Across age groups, 15-24-year-old self-reported the highest rate of autism (6.1%), followed by 12-14-year-olds (4.4%), both markedly higher than the average of 2.5% for the overall population (Statistics Netherlands, 2025[5]). The high self-reported rates are an indication of lower stigma than in the past but must also be compared with caution due to possible misreporting. According to one clinician, half of the cases where parents think their child has ASD end up not receiving a diagnosis.
Share of the population reporting to have ASD (self-reported) by age and sex, average 2022-2024
ASD: autism spectrum disorder.
Note: ASD is measured as the share of people who answered "yes" to the following question: "Do you/does your child have autism spectrum disorder, or ASD?''. Prior to 2024, the question was: "Do you/does your child have autism spectrum disorder, or ASD, such as Asperger’s Syndrome or PDD-NOS?"
Source: Statistics Netherlands (2025[5]), 3 percent of the population report having autism spectrum disorder, https://www.cbs.nl/en-gb/news/2025/14/3-percent-of-the-population-report-having-autism-spectrum-disorder.
Anxiety and feelings of depression are common among those with ASD
According to a recent analysis of Statistics Netherlands, those aged 12 years and above with ASD are much more likely to experience anxiety or feelings of depression than those without ASD – on average 74% of those with ASD reported having anxiety and feelings of depression in 2022-2024, compared to 42.6% of those without ASD (Figure 8.2). Women are generally more prone to reporting anxiety and feelings of depression, and this trend remains the same among those with ASD.
Share of persons aged 12 and over who reported feeling anxious or depressed, by reported ASD and sex, average 2022-2024
ASD = autism spectrum disorder.
Note: Whether a person experiences feelings of anxiety or depression is derived from a score of 76 or lower in people aged 12 years or older on the Mental Health Inventory (MHI-5) for adolescents and adults.
Source: Statistics Netherlands (2025[5]), 3 percent of the population report having autism spectrum disorder, https://www.cbs.nl/en-gb/news/2025/14/3-percent-of-the-population-report-having-autism-spectrum-disorder.
The Dutch Association of Psychiatry (Nederlandse Vereniging voor Psychiatrie, NVvP) has a leading role in developing and endorsing clinical guidelines for psychiatric and mental disorders that serve as industry best practice in psychiatry and mental healthcare. In co-operation with other professional associations, such as the Federation of Medical Specialists (Federatie Medisch Specialisten) and the Dutch Institute of Psychologists (Nederlands Instituut van Psychologen, NIP), the NVvP has developed guidelines for the diagnosis and treatment of ASD in both children and adults (NVvP, 2025[6]; NVvP and NIP, 2013[7]).
The latest clinical guideline for children and young people was published in May 2025 (NVvP, 2025[6]), an important update from the previous guideline dating back to 2009 (NVvP, 2009[8]). The guideline is based on the UK’s NICE and the European Society of Child and Adolescent Psychiatry (ESCAP)’s guidelines. The NVvP guideline suggests that a diagnostic assessment starts with information gathering to help gain a full understanding of the child’s development and concerns. This step may include information gathering about the following aspects (NVvP, 2025[6]):
Early development, including pre- and perinatal factors and course of development to date
Functioning of the child within the family
Previous diagnoses and interventions
Relevant family history
Following this, it is recommended to compare the behaviour of the child with their developmental age, intelligence level and language skills. This step can include several tests, such as a general developmental test, an intelligence test and a language test (NVvP, 2025[6]).
Combined with medical history, a physical examination is recommended to rule out any underlying co-morbid medical conditions. The physical examination can include the following (NVvP, 2025[6]):
Assessment of current and past physical health
Vision and hearing test
Genetic testing
To assess autistic traits (social communication skills, restricted and repetitive behaviour), the diagnosing professionals should – according to the guideline – gather information from direct interaction with the child, as well as from parents and carers about the child’s behaviour in diverse settings, e.g. home, day care, school. Behavioural observation should be done by a child psychiatrist, psychologist or developmental educationalist. The child’s functioning in different settings should also be observed (NVvP, 2025[6]).
The guideline also underlines that standardised tools may be used as a support but never as a substitute for the clinical diagnostic process. The guideline recommends the use of the following tools as a support instrument for assessment: Childhood Autism Rating Scale (CARS); Social Communication Questionnaire (SCQ); Autism Quotient - child module (AQ-child); Social Responsiveness Scale (SRS); and two Dutch measures, the Children's Social Behaviour Inventory Questionnaire (Vragenlijst voor Inventarisatie van Sociaal gedrag van Kinderen, VISK/CSBQ) and the Autism Spectrum Questionnaire (Autisme Spectrum Vragenlijst, ASV). Instruments recommended for children with intellectual disability are the appropriate modules of the Autism Diagnostic Observation Schedule (ADOS/ADOS-2) and the Autism Diagnostic Interview – Revised (ADI-R). Finally, DSM-5-TR criteria (or its Dutch equivalent, DC:0-5) should be used to assess ASD and other related psychiatric issues (NVvP, 2025[6]). Guidelines recommend that diagnosis is done by a specialist multi-disciplinary team, but in practice this is not always possible. Diagnosis is usually done through Health Maintenance Organisations (HMOs), by a healthcare psychologist or a child psychiatrist.
Autism Care Standard
In 2017, the Autism Care Standard (Zorgstandaard Autisme) was published for the first time by the Alliance for Quality in Mental Healthcare (Alliantie kwaliteit in de geestelijke gezondheidszorg, Akwa GGZ). Akwa GGZ is an alliance that comprises organisations representing patients, their families, professionals, as well as other industry organisations in the mental health sector, such as insurers and HMOs. Akwa GGZ develops standards of care for all areas of mental healthcare, gathers tools and evaluates care processes in the mental healthcare system. First created in 2017, and reviewed in 2022, the Autism Care Standard covers areas of early detection, diagnosis and monitoring, as well as treatment and organisation of care and, more generally, quality indicators. The care standard consolidates best practices across the lifespan and is widely accepted as the standard of care for autism in the Netherlands. The care standard is also in line with NVvP guidelines (Akwa GGZ, 2023[9]).
Families in the Netherlands receive a quarterly, non-means-tested Child Benefit for each child, with amounts differentiated across three age bands. Children that require extensive care – which may be the case for some children with ASD – entitle their parents to twice the standard rate, referred to as the Double Child Benefit (Dubbele Kinderbijslag) (Sociale Verzekeringsbank, n.d.[10]). As of July 2025, the quarterly rates of the Double Child Benefit, which is administered by the Dutch Social Insurance Bank (Sociale Verzekeringsbank, SVB) are:
Children aged 3-5: EUR 583
Children aged 6-11: EUR 708
Children aged 12-17: EUR 833
If a child has extensive care needs and the family has received the Double Child Benefit for a full year, parents may also qualify for an additional, means-tested annual payment of EUR 2 702 (in 2025) (Sociale Verzekeringsbank, n.d.[11]).
In addition, families can apply for a Personal Budget (Persoonsgebonden Budget, PGB) which is a benefit available to both adults and children. Eligibility assessment and approval for a PGB are conducted either by the municipality or another competent authority, depending on the type of care required. Unlike Double Child Benefit, PGB is not allocated according to predefined age-based tiers; rather, it is fully tailored to the child’s individual support needs. Its purpose is to help offset disability-related costs, such as specialized assistance or personnel, with a primary focus on funding care services. Neither Double Child Benefit nor PGB is means-tested (Government of the Netherlands: Ministry of Health, Welfare and Sport, n.d.[12]).
Double Child Benefit is available for children with extensive care needs
Parents of a child with extensive care needs may qualify for double the standard quarterly Child Benefit, providing additional financial support. Unlike the regular Child Benefit, which is available from birth until age 18, the Double Child Benefit is restricted to children from age 3 onwards (Sociale Verzekeringsbank, n.d.[13]). While a medical diagnosis alone, for example a diagnosis of ASD, does not confer entitlement, it is required within the care assessment process (Centrum Indicatiestelling Zorg, n.d.[14]). However, eligibility for the Double Child Benefit depends primarily on whether the child’s care requirements are extensive. This must be confirmed through a positive recommendation issued by the Care Needs Assessment Centre (Centrum Indicatiestelling Zorg, CIZ) which is the national authority responsible for determining the long-term care needs of individuals of all ages (Sociale Verzekeringsbank, n.d.[13]).
The CIZ issues a positive recommendation where the child either holds an existing long-term care indication under the Long-term Care Act (Wet langdurige zorg, Wlz), as determined by the CIZ, or meets the eligibility threshold under the care and supervision assessment framework for the Double Child Benefit. In the absence of a Wlz indication, the CIZ initiates the care and supervision assessment for the Double Child Benefit (Centrum Indicatiestelling Zorg, n.d.[15]). In recent years, administrative co-ordination has been streamlined: a positive Wlz indication can now be automatically shared with the SVB, and the SVB may in turn directly ask the CIZ for advice to determine whether the child indeed requires intensive care (Centrum Indicatiestelling Zorg, n.d.[14]).
To receive a Wlz indication for their child, parents may apply digitally or by post, enclosing documentation from the child’s treating physician or specialist confirming the child’s diagnosis, functional limitations, and ongoing and anticipated medical treatments. Additional reports from other professionals, such as teachers or therapists, may be provided to support the assessment. A Wlz indication can only be granted if the child:
has a formally diagnosed intellectual disability, physical illness or disability, or sensory impairment,
requires continuous supervision or proximity of a caregiver throughout day and night, and
care needs are expected to be lifelong (Centrum Indicatiestelling Zorg, n.d.[16]).
As mentioned above, if the child does not have a Wlz indication, they may still qualify for the Double Child Benefit, with eligibility determined through a care and supervision assessment conducted by the CIZ. In addition to handing in their child’s medical documentation, stating the child’s medical diagnosis, parents must complete a questionnaire describing their child’s everyday care and supervision needs and authorise the CIZ to consult professionals working with the child for further information (Centrum Indicatiestelling Zorg, n.d.[14]). If unclear or insufficient evidence is provided, the CIZ may request additional documents or conduct a video call with the parents and their child or a home visit.
In reviewing submitted information, particularly the parent questionnaire, the CIZ applies a two-component assessment framework – care and supervision – each divided into five functional domains:
Care: personal hygiene, toileting, eating and drinking, mobility, medical care
Supervision: behaviour, communication, being home alone, supervision outside the home, engagement and guidance
For each domain in which the CIZ finds intensive support is required, the child receives a score. To be deemed eligible, the minimum number of scored domains is:
At least 5 domains for children aged 3-5
4 domains for children aged 6-9
3 domains for children aged 10-17 (Centrum Indicatiestelling Zorg, n.d.[15])
According to anecdotal evidence, children with ASD often do not satisfy the strict criteria relating to continuous care and supervision, resulting in comparatively low eligibility for Double Child Benefit. Reassessments of a child’s care needs are generally not routine and conducted only in exceptional cases where the child’s condition has significantly changed.
Personal Budget offers funding to purchase disability-related services
Parents of a child with extensive care needs may also apply for a Personal Budget (Persoonsgebonden Budget). The PGB is an alternative to receiving care services from the municipality, a care administration office, or the health insurance fund. It provides individuals that require care with a budget that enables them to choose who delivers care and support, as well as when and where it is provided (Government of the Netherlands: Ministry of Health, Welfare and Sport, n.d.[17]). The PGB can also be used to cover other disability-related expenses, such as assistive equipment, residential modifications, household support, respite care, or mobility aids such as wheelchairs (Gemeente Amsterdam, n.d.[18]).
The PGB is regulated under four separate legal frameworks, with the applicable law depending on the nature and intensity of the care required:
Youth Act (Jeugdwet) – Governs most forms of care and support for children and adolescents under the age of 18, including, for example, day care and guidance.
Social Support Act (Wmo) – Aims to help people live independently at home for as long as possible and to promote the social participation of persons with disability. A PGB under the Wmo act may cover assistance with daily living, personal support, or domestic help.
Health Insurance Act (Zvw) – Applies to children and adults who require nursing or personal care for longer than one year, including palliative and terminal care.
Long-term Care Act (Wlz) – Designed for individuals with chronic illnesses or disability who require permanent supervision or intensive care. A PGB under the Wlz act can be used to purchase comprehensive personal and nursing care services (Government of the Netherlands, n.d.[19]).
Children with ASD would typically receive a PGB under the Youth Act, unless their care needs are so extensive that they require continuous supervision and qualify under the Wlz which remains relatively rare. PGBs under the Youth Act are administered by municipalities (Government of the Netherlands, n.d.[19]). Parents applying for a PGB must provide detailed information about their child’s daily care and support needs and the type of care and support required. The municipality reviews the documentation and conducts an in-person meeting to discuss the child’s needs in more detail before determining the size of the budget to be granted (PerSaldo, n.d.[20]). A formal medical diagnosis is not a strict requirement. Notably, assessment procedures, budget ceilings, and the hourly rates paid to caregivers under the Youth Act differ across municipalities (Government of the Netherlands, n.d.[21]).
Recipients of a PGB – or, in the case of children, their parents – must be proven capable of self-managing the budget, including contracting, scheduling, and supervising care providers. The PGB also allows for informal care arrangements, meaning that relatives or friends can provide care and be compensated through the PGB. Parents of a child with ASD can therefore receive payment for the care they provide themselves, subject to a formal care agreement specifying the type of care, duration, and hours, all of which require municipal approval. The hourly rate for such informal care is set by individual municipalities and typically corresponds to, or is close to, the statutory minimum wage. Formal caregivers hired through the PGB are remunerated at higher rates. Compensation for informal care is capped at 40 hours per week (Government of the Netherlands, n.d.[21]).
Expenditure on and uptake of Double Child Benefit has been increasing
While the number of Double Child Benefit recipients remained relatively stable until March 2022, it has risen steadily since then, reaching approximately 52 000 recipients in September 2025 compared with around 33 000 in March 2020 (Figure 8.3). This represents an increase of 57.6% in just five years. Total quarterly expenditure – covering both Child Benefit and Double Child Benefit – has grown in parallel. Quarterly spending increased from EUR 19.4 million in March 2020 to EUR 40.7 million in September 2025, thus, more than doubling over the same five-year period.
There is no data available on the diagnosis of children receiving Double Child Benefit. There is also a lack of longer-term trend data on ASD prevalence in children. Given consistent anecdotal evidence that children with ASD rarely meet the eligibility criteria for Double Child Benefit and will thus only receive the standard Child Benefit in most cases, the growth in the Double Child Benefit caseload in the Netherlands over the past five years is unlikely to be explained predominantly by increasing ASD rates.
Double Child Benefit recipients per quarter and total expenditure on Child Benefit and Double Child Benefits (March 2020 – September 2025)
Note: Combined quarterly expenditure on Child Benefit and Double Child Benefits.
Source: Data provided by the Dutch Social Insurance Bank (Sociale Verzekeringsbank).
Children who require therapeutic services, such as speech and occupational therapy, generally access these therapies in the Netherlands through one of three pathways: through statutory health insurance, through municipalities (either in-kind or via a PGB), and, in some cases, through school-based services. As in countries such as Germany, the most common coverage is through statutory health insurance which depends in part on whether the child receives therapy from a provider contracted by the health insurer or from a non-contracted provider. In the latter case, parents typically need to present a doctor’s referral confirming the child’s diagnosis and the medical necessity of the therapy for the insurer to cover the costs. Coverage also varies by type of therapy – for example, speech therapy is typically uncapped, while occupational therapy may be subject to annual limits, often around ten sessions per year – and by the chosen insurance provider and insurance plan (CAK, n.d.[22]; Child Development, n.d.[23]; HollandZorg, n.d.[24]). Overall, however, statutory health insurance is the primary mechanism for accessing and financing therapeutic services in the Netherlands.
If a child’s needs for therapy exceed what health insurance will cover, or if parents seek more specialised therapies, such as music therapy, they may request support from their municipality under Youth Care (Jeugdhulp). The municipality’s therapeutic services can be provided either in-kind or through a PGB (see details above), which enables families to purchase therapies directly. When applying for Youth Care, the first contact point is typically a youth or neighbourhood team, followed by an in-person meeting with a municipal professional to explore the child’s challenges and needs and determine the type and duration of services required. If in-kind provision of therapies is appropriate, parents are referred to contracted municipal providers; if not, a PGB may be granted. A medical diagnosis does not determine eligibility for Youth Care. Rather, the focus lies on the child’s individual needs and the supports required to address them (Government of the Netherlands, n.d.[25]; n.d.[26]; n.d.[27]; n.d.[28]).
Finally, although uncommon in regular schools, some special education schools employ in-house therapists who provide on-site therapeutic support. These services are financed directly by the school from its budget allocated by the Regional School Partnership Group (samenwerkingsverband). If a child’s need for therapy is determined, therapy sessions would be integrated into the school’s educational offer for the child. The availability of such services, however, varies across schools.
A reform in 2014 introduced significant changes to the Dutch education system
With the introduction of the Act on Appropriate Education in 2014, the Netherlands embarked on a more inclusive approach to supporting children with special educational needs. The Act places a duty of care on schools, requiring them to offer every student a learning environment suited to their needs – an approach referred to as “appropriate education” (passend onderwijs) (Inspectorate of Education, n.d.[29]). Its core objective is to promote inclusive learning environments at mainstream schools, encouraging students with SEN to attend regular schools rather than special education settings.
The Act also brought significant changes to the financing of special education support. Prior to 2014, schools received earmarked funding for each student with SEN. Since the reform, however, schools have been allocated a general budget intended to support inclusive education for all students (Eerste Kamer der Staten-Generaal, n.d.[30]). One of the drivers behind this shift was the rapidly rising cost of earmarked SEN budgets. By moving to a throughput funding model (see Chapter 4 for more information on funding models), the Netherlands aimed to ensure greater sustainability while enabling a larger number of students to receive support within an inclusive educational framework.
Children are placed in a special education school only when all other options have been exhausted
The allocation of funding to individual schools is managed through samenwerkingsverbanden (regional school partnership groups) that include all schools – mainstream and special – within their area. There are roughly 150 such school partnership groups across the Netherlands (Floor Kaspers, 2025[31]). One of their core responsibilities is to distribute the government’s funding among the schools they represent. Within each regional partnership group, schools jointly assess needs and determine how resources should be allocated. For example, a school with a significant number of students requiring special education support may request additional funding to better meet those pupils’ needs. Each regional group also decides autonomously whether to limit its role to funding allocation or to develop its own specialised expertise, such as teams of special education teachers or behavioural specialists, who can then be deployed to their schools as needed.
Since the introduction of the 2014 Act on Appropriate Education, children with SEN are increasingly encouraged to attend mainstream schools, where they should receive the support necessary to participate on an equal basis with their peers. Parents can choose their child’s school. The school then carries a statutory duty of care to provide appropriate support. The type or level of additional educational support that should be offered, such as for a child with ASD, is not regulated nationally; these decisions lie with individual schools. However, work is currently underway to define statutory minimum support standards for children with ASD. If a school lacks the expertise or resources required to accommodate a child’s needs, it may request additional support from its regional partnership group, such as extra funding for psychological services or specialist input. If, even with this support, the mainstream school cannot provide an adequate learning environment, it must find an alternative suitable school, which may involve a special education school (Inspectorate of Education, n.d.[29]).
The Netherlands distinguishes two types of special education schools: Special Primary Schools (Speciaal Basisonderwijs) and Special Schools (Speciaal Onderwijs). Special Primary Schools follow the curriculum of regular primary schools but offer smaller class sizes and more individualised support, primarily for children with mild learning or behavioural difficulties. Special Schools serve children with more substantial support needs and provide adapted curricula, specialised teaching methods and staff, and much smaller class sizes (Floor Kaspers, 2025[32]). These Special Schools are organised into four clusters, each corresponding to a broad area of need:
Cluster 1: Visual impairments
Cluster 2: Hearing impairments and speech-language difficulties
Cluster 3: Physical disabilities and chronic illnesses
Cluster 4: Behavioural and psychiatric disorders
A child with ASD, like a child with ADHD, who is assessed to be best placed in a Special School would typically attend a Cluster 4 school. Importantly, medical diagnoses alone do not determine access – in fact, a formal medical diagnosis is not even needed. Instead, placement in a Special School as well as in a Special Primary School requires a Declaration of Admissibility (toelaatbaarheidsverklaring, TLV), issued by the regional school partnership group after assessing the child’s support needs. Usually, the child’s regular school initiates the TLV request to a TLV-Commission within their partnership group, already specifying the child’s needs and support measures taken (Floor Kaspers, 2025[33]). These Commissions typically include educational, social, and health professionals (Partnership for primary education Amsterdam Diemen, n.d.[34]). Assessments are not standardised nationally – there are no uniform guidelines or assessment tools – and procedures may thus vary considerably across regional school groups. They are, however, mostly document-based, drawing on school reports and evaluations from professionals, with in-person meetings with teachers, parents, and the child conducted as deemed relevant. Parental involvement is central to the process (Partnership for primary education Amsterdam Diemen, n.d.[34]; Floor Kaspers, 2025[33]), though the degree of engagement may differ by region, too.
If the TLV-Commission concludes that a Special School is the most appropriate setting, it prepares an agreement outlining the child’s goals, required supports and level of funding. While such a Development Perspective Plan is recommended for mainstream schools when a child requires additional support, it is mandatory in Special Schools (Nederlands Jeugdinstituut, n.d.[35]). TLVs are issued for a fixed period, typically two years, and specify the approved duration of placement. As expiry approaches, the school must review the child’s progress and needs to determine whether to request a new TLV from their regional partnership group (Inspectorate of Education, n.d.[36]).
Enrolment in special education has remained relatively constant over recent years
While the overall share of students in Special Primary Education relative to those in Regular Primary Education appears slightly lower after the 2014 Act on Appropriate Education, the change is marginal (Figure 8.4). Between 2010 and 2024, the share of students in Special Primary Education has remained about 2.4%‑2.8% – i.e. a rather small share of students attending special education settings throughout the period. It is important to note that the Netherlands does not have a national definition of special educational needs. As a result, children in regular schools requiring additional educational support are not centrally registered, making systematic data collection on this group impossible.
Students in Special Primary Schools as a share of students in all primary schools (2010/11‑2023/24)
Note: Students in Special Primary Schools are those in Speciaal Basisonderwijs, i.e. not those in Speciaal Onderwijs.
Source: Based on Statistics Netherlands (2025[37]), StatLine, https://opendata.cbs.nl/#/CBS/nl/.
Figure 8.5 further demonstrates that enrolment in Special Primary Schools has remained relatively stable in recent years. By contrast, the total number of students in Special Schools (Speciaal Onderwijs) has increased moderately, from around 67 500 in 2017/18 to approximately 73 500 in 2023/24. This growth is driven by rising enrolments in Cluster 3 and Cluster 4 Special Schools. As noted earlier, ASD is assigned to Cluster 4. This aligns with anecdotal evidence suggesting that children with ASD are increasingly being educated in Special Schools rather than in mainstream settings in the Netherlands. Additional anecdotal evidence also points to rising enrolment in Cluster 3, as well as suggests that a substantial proportion of children currently out of school in the Netherlands are children with ASD.
Students by school type, the Netherlands, 2017‑2024
Note: ”Total Special Schools” covers all four Clusters of Speciaal Onderwijs at both the primary and secondary levels. Data for Cluster 1 and Cluster 2 Special Schools are not shown separately due to their small enrolment numbers, but the figure presents the combined category “Special Schools – Cluster 3 & 4”. The category “Total Special Primary Schools” refers to all Speciaal Basisonderwijs, which constitute a separate type of school distinct from Speciaal Onderwijs.
Source: Statistics Netherlands (2025[37]), StatLine, https://opendata.cbs.nl/#/CBS/nl/.
The Netherlands has established a strong foundation for effective support for children with ASD through comprehensive legislation, clinical guidelines, and care standards. Other countries can learn from the Netherlands’ integrated approach, which combines strong disability rights, detailed clinical guidance, and multi-tiered financial and educational support mechanisms. In particular, the Dutch system stands out for its non-means-tested allowances, such as the Personal Budget, which provides families with flexibility and autonomy in arranging care. Similarly, statutory health insurance ensures broad access to essential therapies like speech and occupational therapy, reducing financial barriers for most families.
Nevertheless, policy challenges persist across healthcare, social protection, and education. Financial supports, Double Child Benefit and the Personal Budget, provide important relief for families, yet strict eligibility criteria and significant regional variation in PGB administration limit equitable access. Similarly, while statutory health insurance covers core therapies, caps on certain services and inconsistent municipal provisions can leave gaps in care, particularly for families seeking specialised interventions. In education, the Act on Appropriate Education has advanced inclusion, but disparities in regional practices and the absence of national minimum standards for ASD-specific support hinder consistent implementation. Harmonising benefit eligibility and municipal procedures for Personal Budgets would seem desirable and improving data collection on autism prevalence, service uptake and outcomes would help guiding evidence‑based policymaking.
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