Policy Responses to Rising Autism Diagnoses in Childhood

Annex C. Detailed financial benefits and services tables

Table A C.1. Carer allowances in comparison

		Australia	Denmark	Estonia	France	Germany	Sweden	United Kingdom	United States (California)
ALLOWANCE 1	Name Responsible institution Levels Means-testing	Carer Allowance Services Australia Fortnightly payment of AUD 159.30; set rate – does not vary based on individual circumstances Partially means-tested (max. income AUD 250 000 annual)	Compensation for Lost Earnings (Tabt arbejdsfortjeneste) Local municipalities Compensation for lost earnings is determined on the basis of the previous gross income, however, at a maximum of DKK 36 622 per month. Parents receive a percentage of their lost income. Partially means-tested (income‑based)	Caregiver’s Allowance for Parents (hooldajatoetus) Local municipalities Municipalities determine the exact amount on a case‐by‐case basis; on average EUR 90 per month. Usually not means-tested	Education Allowance for Disabled Children (Allocation d’éducation de l’enfant handicap, AEEH) Department for the Disabled (Maison Départementale des Personnes Handicapées, MDPH) AEEH is made up of a monthly basic allocation (EUR 151.80) plus a complementary amount that varies depending on parents’ capacity to engage in work: 2) EUR 460.14 (total) 3) EUR 588.22 (total) 4) EUR 828.11 (total) 5) EUR 1 016.15 (total) 6) EUR 1 439.94 (total) Not means-tested	Care Allowance (Pflegegeld) Long-term Care Insurance (Pflegekasse) Pflegegrad levels 1‑5 depending on the child’s care dependency 1) not eligible 2) EUR 347 3) EUR 599 4) EUR 800 5) EUR 990 Not means-tested	Care Allowance (Omvårdnadsbidrag) Swedish Social Insurance Agency (Försäkringskassan) Four levels depending on child’s care needs: 1) SEK 3 063 2) SEK 6 125 3) SEK 9 188 4) SEK 12 250 Not means-tested	Carer’s Allowance Department for Work and Pensions (DWP); Social Security Scotland Flat rate of GBP 81.90 per week Means-tested: working carers earning more than GBP 196 per week after deductions are ineligible for the benefit	In-Home Supportive Services (IHSS) Program California Department of Social Services (CDSS) Financial assistance based on the number of authorised service hours, which are determined through an assessment of the child’s needs. The payment to caregivers is calculated by multiplying the authorised hours by the applicable hourly wage, which varies by county. Means-tested
	Eligibility assessment	Formal medical diagnosis required. Eligibility is determined by considering both the medical diagnosis and the support needs. A medically documented disability alone is not sufficient; the child’s daily care needs and the impact on the carer’s capacity to engage in employment are also crucial factors. However, conditions on the List of Recognised Disabilities are automatically guaranteed access to the Carer Allowance, pending an official diagnosis. ASD features on that list.	Entirely based on an assessment of the child’s support and care needs, and limitations in daily life. Formal medical diagnosis is not required but parents usually provide supporting medical evidence – such as reports from healthcare professionals.	Primarily based on an assessment of the child’s daily support and care needs. Formal diagnosis not required; supporting medical documentation (e.g. specialist reports) is necessary to determine the severity of the child’s disability. Assessment procedures vary by municipality; usually relies on assessment conducted by the Social Insurance Board.	AEEH eligibility requires that the child’s impairment be acknowledged as causing a disability; allowance is not automatically granted based on a diagnostic label alone. Benefit decisions are based on an assessment of the child’s support needs and subsequent disability severity. MDPH evaluates the child and assigns a taux d’incapacité (disability rating) reflecting how much ASD limits daily life of the child and what support is required. Complementary allowance level depends on the child’s care needs and subsequent care burden on parents.	Medical documentation is necessary, but a formal medical diagnosis is neither mandatory nor does it alone guarantee entitlement. Eligibility is determined by the assessed level of care dependency. The Medical Service of the Long-term Care Insurance assesses the child’s abilities and practical support needs in daily life (usually in-person visits).	Does not require a formal medical diagnosis. The child must demonstrate needs for extra care or supervision due to disability or a medical condition. Parents complete an application form indicating their child’s care and supervision needs. Additionally, the treating doctor completes a medical report.	No separate assessment of the child for Carer’s Allowance. Eligibility is based on the child’s Disability Living Allowance (DLA) status: To qualify, the child must be receiving DLA at the middle or highest rate for the care component, which indicates significant care needs. Additionally, the carer needs to spend at least 35 hours a week caring for the child.	A medical diagnosis is required to establish the child’s disability. Additional medical documentation from healthcare providers that details the child’s need for in-home supportive services is required. An IHSS social worker conducts an in-person assessment to evaluate the child’s functional limitations and the level of assistance required. This assessment focusses on the child’s ability to perform activities of daily living.
	Further details	The child’s care needs are assessed through the Disability Care Load Assessment (Child) (DCLA) The DCLA covers the following three domains: behaviour, functional abilities, and special care needs Typically, no in-person assessment; decisions are made based on completed application form and supporting medical evidence For children under 16 years of age No periodic reassessments Child Disability Assistance Payment: an annual lump‐sum payment of AUD 1 000 if carer receives the Carer Allowance for a child under 16 years of age on 1 July	Assessments vary by municipality Assessment relies both on documentary evidence (e.g. school reports, medical certificates…) and an in-person evaluation (often conducted by the Pædagogisk Psykologisk Rådgivning, PPR)	Assessments focus on the child’s care needs in everyday life and the carer’s ability to provide adequate care Evaluation is primarily based on documentary evidence but may include an in-person assessment by the Social Insurance Board (or local municipalities) Usually only granted to parents of children with severe or profound disability Usually for children aged three – 18 years Regular reassessments (usually after six months – three years)	Assessment includes an evaluation of the child’s support needs in daily life and its impact on carer’s capacity to engage in employment Assessment carried out by a multi-disciplinary team from the MDPH, typically using a standardised evaluation tool (e.g. GEVA guide) Involves both in-person evaluation and review of documentary evidence Level 6 is equivalent to full-time care For children under 20 years of age Periodic reassessments (typically every two to five years) For single parents, a supplement is available	Activities assessed: mobility, cognitive and communicative abilities, behaviour and psychological issues, self-care, managing illnesses and therapies, social participation and structuring daily life A standardised evaluation conducted by the Medical Service No age restrictions; available to individuals of all ages Periodic reassessments; frequency depends on individual circumstances (typically every two years for children) An additional Relief Amount (Entlastungsbetrag) is available for all care levels (1‑5); it is not paid out directly but rather reimburses up to EUR 131/month for extra daily support or short-term care Individual federal states might provide supplements (e.g. Bavaria EUR 1 000 annually for care need Level 2 and higher)	Parents describe their child’s needs across key areas of daily life, including practical everyday support, communication and social interaction, and school-related needs Case administrator typically schedules a follow-up call with the parents to discuss the child’s needs in detail Available for children up to and including June of the year in which the child turns 19 Reassessments are normally carried out every two years	For children, the allowance is linked to the child receiving DLA which typically applies to those under 16 After age 16, if the child transitions to receiving Personal Independence Payment (PIP) at the relevant care rate, the carer may continue to claim Carer’s Allowance	Targets low-income families (receipt of SSI means automatic eligibility) Assessment relies on documentary evidence, as well as in-person evaluation of the child IHSS is available to individuals of all ages Annual reassessments by a social worker
ALLOWANCE 2	Name Responsible institution Levels Means-testing	Carer Payment Services Australia Fortnightly payment with maximum at: AUD 1 149 for a single carer AUD 1 732.2 for a couple if both care full-time. Benefit is income‐tested, it begins to be reduced once the adjusted family net income exceeds a specified threshold; benefit can be reduced gradually down to AUD 0. Means-tested	Care Leave Scheme (Pasning af nærtstående) Local municipalities Carer is entitled to leave from work. During the leave, the carer will be employed by the municipality and receive a salary of DKK 27 033 per month. However, this amount cannot be greater than the salary the carer would receive from their employer. Partially means-tested (income‑based)	Care Allowance for Temporary Incapacity for Work (hooldushüvitis) Estonian Health Insurance Fund (Tervisekassa) 80% of the previous labour income Partially means-tested (income‑based)	Leave Allowance (Allocation Journalière de Présence Parentale, AJPP) Family Allowance Fund (Caisse d’Allocations Familiales, CAF) Full day: EUR 65.80 Half day: EUR 32.90 Plus possible monthly supplement: EUR 126.20 Partially means-tested (daily allowance No; monthly supplement Yes)		Assistance Allowance (Assistansersättning) Swedish Social Insurance Agency (Försäkringskassan) Benefit is calculated based on the approved number of assistance hours and a standardised hourly rate. Standardised hourly rate is SEK 342.60 per hour. Not means-tested	Universal Credit – Carer’s Element Department for Work and Pensions (DWP) Flat rate of GBP 198.31 per month Means-tested
	Eligibility assessment	Formal medical diagnosis required. Eligibility is determined by considering both the medical diagnosis and a support needs assessment that considers the child’s daily care needs and functional impairments. The extent of care required and how it impacts the carer’s capacity to engage in employment are critical. Child’s care needs have to require full-time care.	Based on an assessment of the child’s support and care needs, and limitations in daily life. Formal medical diagnosis is not required but parents usually provide supporting medical evidence – such as reports from healthcare professionals. An additional condition: the alternative to home care is a 24‑hour stay outside the home or the need for care is equivalent to a full-time job.	Primarily based on an evaluation of the child’s need for continuous care (including details of diagnosis and severity). Requires a medical certificate from a healthcare professional that explains the nature of the impairment, its impact on daily functioning, and the expected period during which care is required.	Formal diagnosis not strictly required but a medical certificate from the child’s treating physician is needed. The certificate must state that the child’s disability necessitates continuous parental presence and specify the care required. CAF evaluates whether child’s condition requires sustained care, justifying the parent’s temporary cessation or reduction of work. Assessment does not involve a detailed support needs evaluation like that used for the AEEH.		Does not necessarily require a formal medical diagnosis. Child must meet eligibility criteria under LSS Act. To qualify under eligibility group 1 of LSS, the child would need a medical diagnosis of ASD. The child’s impairment must cause significant difficulties in daily life to receive the allowance. Eligibility depends on whether their support needs require assistance for more than 20 hours per week.	No separate assessment of the child for UC Carer’s Element. Eligibility is based on the child’s DLA status: To qualify, the child must be receiving DLA at the middle or highest rate for the care component, which indicates significant care needs. Additionally, the carer needs to spend at least 35 hours a week caring for the child.
	Further details	To be eligible, the carer must provide constant care, which is roughly equal to a normal working day and stops the carer from working full time Carer may still get allowance when they do paid work or are self-employed for up to 100 hours in a four‑week period The child’s care needs are assessed through the Disability Care Load Assessment (Child) (DCLA) The DCLA covers the following three domains: behaviour, functional abilities, and special care needs Carer Supplement: an annual lump-sum payment of AUD 600 if carer receives the Carer Payment or Carer Allowance on 1 July	Assessments vary by municipality Assessment relies both on documentary evidence (e.g. school reports, medical certificates…) and an in-person evaluation (often conducted by the Pædagogisk Psykologisk Rådgivning, PPR) Maximum duration: up to six months; if special circumstances warrant it, period may be extended for another three months Care Leave Scheme can also be shared by several people	Assessment relies almost exclusively on medical documentation; normally no in-person evaluations conducted For children under 19 years of age: up to 60 days of paid leave from work	Purpose: support parents that are forced to temporarily leave work to care for their child (max. 22 days per month) Eligibility is based primarily on a medical certificate confirming that the child’s condition requires sustained parental presence Evaluation relies exclusively on documentary evidence For children under 20 years of age Benefit is granted for a maximum period (typically up to three years), with renewal possible if the need persists Not compatible with the top-ups of the AEEH		Parents complete a form specifying the number of assistance hours needed and, if possible, the types of activities for which support is required Child must need assistance for at least 20 hours per week to meet severity threshold for eligibility Case administrator typically schedules a follow-up call with the parents to discuss the child’s needs in detail Parents can be hired as their child’s assistant Available also for adults up to age 66 Reassessments are triggered by significant changes of the child’s needs	Carer’s Element is provided as a flat rate addition to a claimant’s Universal Credit award Universal Credit is a means-tested benefit for low-income individuals; income affects eligibility and the overall amount awarded, including the Carer’s Element

Source: Information collected by the Secretariat and verified in discussions with national autism organisations.

Table A C.2. Disabled child allowances in comparison

		Canada (Ontario)	Estonia	France	Israel	Netherlands	United Kingdom	United States (California)
ALLOWANCE 1	Name Responsible institution Levels Means-testing	Child Disability Benefit (CDB) Canada Revenue Agency Eligible families can receive up to CAD 3 322 per year (or about CAD 276.83 per month) for each child who qualifies for the Disability Tax Credit (DTC) (June 2025). Benefit is income‐tested, it begins to be reduced once the adjusted family net income exceeds a specified threshold; benefit can be reduced gradually down to CAD 0. Means-tested	Disabled Child Allowance (Puudega lapse toetus) Social Insurance Board (Sotsiaalkindlustusamet) Three levels depending on severity: 1) moderate disability: EUR 138 2) severe disability: EUR 161 3) profound disability: EUR 242 Not means-tested	Education Allowance for Disabled Children (Allocation d’éducation de l’enfant handicap, AEEH) Department for the Disabled (Maison Départementale des Personnes Handicapées, MDPH) AEEH monthly basic rate is at EUR 151.80. Top-ups (six levels) are determined by assessing additional expenses related to the disability and whether the child’s care needs compel parents to reduce or stop working. Not means-tested	Disabled Child Allowance (קצבת ילד נכה) National Insurance Institute (Bituach Leumi) Five levels 1. 50% – NIS 1 880 2. 100% – NIS 3 694 3. 112% – NIS 4 352 4. 188% – NIS 6 947 5. 235% – NIS 8 828 Child with ASD automatically entitled to 100% but can receive higher rate (up to 235%) if has co-morbidities and/or high dependency on others. Family with two children with disability or more is entitled to a benefit increased by 50% for each child Not means-tested	Double Child Benefit (Dubbele Kinderbijslag) Dutch Social Insurance Bank (Sociale Verzekeringsbank, SVB) Quarterly payments; three levels according to child’s age: 1. 0‑5 years: EUR 583 2. 6‑11 years: EUR 708 3. 12‑17 years: EUR 833 Not means-tested	Disability Living Allowance (DLA) Department for Work and Pensions (DWP); Social Security Scotland; Department for Communities (DfC) Weekly rates; two components; rates based on the child’s support needs. Care component: Lowest GBP 28.70 Middle GBP 72.65 Highest GBP 108.55 Mobility component: Lower GBP 28.70 Higher GBP 75.75 Not means-tested	Federal Supplemental Security Income (SSI) & California State Supplementary Payment (SSP) Social Security Administration (SSA) Eligible families can receive up to USD 747.20 per month (SSI + California SSP). Benefit is income‐tested, it begins to be reduced once the family income exceeds a specified threshold; benefit can be reduced gradually down to USD 0. Means-tested
	Eligibility assessment	A formal medical diagnosis is not strictly required. To qualify for CDB, the child must be assessed by a health professional who documents that the child has a severe, prolonged impairment on Form T2201 (Disability Tax Credit Certificate). This form details the diagnosis, support needs in daily activities, and the expected duration of the disability.	Formal medical diagnosis is not mandatory if the submitted medical documentation sufficiently demonstrates the disability and its severity. Child must undergo an official disability assessment by the Social Insurance Board. An expert panel reviews medical information and the child’s support needs in daily life to determine degree of severity of disability. ASD is evaluated under the category of mental or neurodevelopmental disorders for this purpose.	AEEH eligibility requires that the child’s impairment be acknowledged as causing a disability; allowance is not automatically granted based on a diagnostic label alone. Benefit decisions are based on an assessment of the child’s support needs and resulting disability severity. MDPH evaluates the child and assigns a taux d’incapacité (disability rating) reflecting how much the impairment limits the daily life of the child and what support is required.	Formal ASD diagnosis required (“double diagnosis”): a) medical diagnosis from a qualified physician (child psychiatrist, developmental paediatrician, or neurologist) b) psychological assessment from a qualified psychologist (clinical, developmental, or educational) ASD diagnosis leads to automatic entitlement. Care needs assessment conducted by NII’s Medical Board only to determine higher than standard rate because of high dependency on others.	Eligibility for the benefit depends on whether the child’s care requirements are intensive. This must be confirmed through a formal evaluation by the Care Needs Assessment Centre (CIZ). The child must either hold an existing long-term care indication (Wet langdurige zorg, Wlz), as determined by the CIZ, or meet the eligibility threshold in a care and supervision assessment. In this assessment, the CIZ applies a two‑component framework – care and supervision – each divided into five functional domains. Parents must hand in documentation from the child’s treating physician confirming the child’s diagnosis. They also complete a questionnaire describing their child’s everyday care and supervision needs.	Entirely based on an assessment of the child’s support needs. Formal medical diagnosis is not required but parents usually need to provide supporting evidence – such as reports from healthcare professionals. The eligibility evaluation process involves completing a detailed questionnaire that assesses the child’s care and mobility needs.	Medical documentation of a condition is necessary, but a formal medical diagnosis alone does not guarantee an allowance. The medical condition has to cause “marked and severe functional limitations”. Disability Determination Services (DDS) review all documentary evidence to assess how the impairment impacts the child’s daily functioning.
	Further details	Assessment focusses on whether child’s impairment severely limits essential activities; however, the process does not include a detailed needs assessment but is based on a physician’s assessment For children under 18 years of age Allowance can be paid retroactively for the current and up to ten previous benefit years Benefit amount is recalculated annually (every July) using updated income information, and the child’s DTC status must remain current Some provinces offer additional allowances (some specific to autism); provincial programmes require proof of ASD diagnosis from a specialist; some, like Ontario Autism Program, use needs-based assessments to determine funding amounts	Assessment covers amongst others: child’s overall state of health and operational capacity, need for personal assistance or supervision, child’s living environment and extra expenses caused by the disability Assessment relies primarily on documentary evidence (e.g. from psychologist, social worker, teacher) and may include an in‐person visit if needed Allowance is paid until 16 years of age (note: recent proposal to extend the age limit to 18 from Feb 2027) The degree of severity of a child’s disability is determined for fixed periods (e.g. six months, one year, two years, or three years) and is subject to periodic reassessment when that period expires	Assessment covers amongst others: daily living, communication skills, social interactions, cognitive development Assessment carried out by a multi-disciplinary team from the MDPH typically using a standardised evaluation tool (e.g. GEVA guide) Involves both in-person evaluation and review of documentary evidence Base AEEH is awarded based on the child’s disability level (minimum disability rating of 80% or 50‑79% with additional conditions) For children under 20 years of age Periodic reassessments (typically every two to five years)	A child with ASD is entitled to allowance from the age of 91 days to 18 years and three months Allowance is paid retroactively for up to one year prior to the date of claim submission Assessment relies almost exclusively on documentary evidence but may include an in-person visit/or third doctor’s evaluation if needed Child diagnosed before three years old: will be granted eligibility until age ten when a re‑assessment will be needed Child diagnosed after three years old: will be granted automatic and permanent eligibility up to age 18 and three months Standardised NII tool for care needs assessment available	Care: personal hygiene, toileting, eating and drinking, mobility, medical care Supervision: behaviour, communication, being home alone, supervision outside the home, engagement and guidance Assessment relies primarily on documentary evidence and may include an in‐person visit if needed Periodic reassessments are typically not conducted Extra, means-tested payment for children with extensive care needs (paid once a year ~ EUR 2 702) available if receive Double Child Benefit for a full year	Assesses the child’s care and mobility needs, with specific focus on how child’s impairment affects their ability to carry out daily activities Primarily based on a detailed claim form/questionnaire completed by the parent/carer Supporting documentary evidence (e.g. medical reports, school records) is required to detail the child’s needs In some cases, in-person assessment with a healthcare professional For children under 16 years of age No regular reassessments (only if there is a significant change in circumstances)	SSI is foremost a federal benefit for low-income individuals California’s SSP adds a state supplement to SSI recipients Max. benefits for a child with disability living with parents: SSI USD 644.67 + SSP USD 102.53 SSA/DDS review of medical records, diagnostic reports, educational records, etc. to determine whether/how the medical condition limits the child’s daily functioning (communication, self-care, mobility…) Assessment relies primarily on documentary evidence; may include an in-person visit if needed Allowance is paid until 18 years of age Periodic reassessments every few years (usually every three years)
ALLOWANCE 2	Name Responsible institution Levels Means-testing						Universal Credit (UC) – Disabled Child Element Department for Work and Pensions (DWP) Two levels: 1. Lower Rate Addition: GBP 156.11 per month 2. Higher Rate Addition: GBP 487.58 per month (if child receives the highest rate of DLA care component) Means-tested
	Eligibility assessment						Eligibility is based on the child’s DLA status, with rates corresponding to the level of DLA received. It does not require the carer to provide a specific number of care hours.
	Further details						Disabled Child Addition is provided as a flat rate addition to a claimant’s Universal Credit (UC) award UC is a means-tested benefit for low-income individuals; income affects eligibility and the overall amount awarded, including the Disabled Child Addition A child receiving any rate of DLA (care or mobility component) qualifies for the lower rate of the UC Disabled Child Addition A child receiving the highest rate care component of DLA qualifies for the higher rate of the Disabled Child Addition If a child is registered blind, they also qualify for the higher rate

Source: Information collected by the Secretariat and verified in discussions with national autism organisations.

Table A C.3. Additional cost allowances in comparison

		Australia	Canada (Ontario)	Denmark	France	Germany	Netherlands	Sweden	United Kingdom
ALLOWANCE 1	Name Responsible institution Levels Means-testing	National Disability Insurance Scheme (NDIS) National Disability Insurance Agency (NDIA) No standardised levels; amount varies depending on individual support needs; in 2025, average annual NDIS budget of AUD 24 000 for a child with ASD Not means-tested	Ontario Autism Program (OAP) AccessOAP, an independent intake organisation – previously Ontario’s Ministry of Children, Community and Social Services OAP’s funding for Core Clinical Services and Supports is divided in four age groups (0‑3 years; 4‑9 years; 10‑14 years; 15‑17 years) and three levels of support needs ranging from limited, to moderate, to extensive. Children aged 15‑17 with limited support needs receive the smallest annual budget (CAD 6 600), while children aged 3‑9 with extensive support needs receive the biggest annual budget (CAD 65 000). Not means-tested	Additional Expenses Allowance (Merudgiftsydelse) Local municipalities Allowance covers necessary additional costs directly attributable to the child’s disability. The specific amount is determined based on documented additional expenses and must exceed the annual minimum threshold of DKK 5 718 to qualify. Not means-tested	Education Allowance for Disabled Children (Allocation d’éducation de l’enfant handicap, AEEH) Department for the Disabled (Maison Départementale des Personnes Handicapées, MDPH) AEEH is made up of a basic allocation (EUR 151.80) plus a complementary amount that varies depending on additional expenses caused by the disability: 1. EUR 265.65 (total) 2. EUR 460.14 (total) 3. EUR 588.22 (total) 4. EUR 828.11 (total) Not means-tested	Integration Assistance (Eingliederungshilfe) Typically Youth Welfare Office (Jugendamt) No predefined levels; funding is tailored individually based on assessed support needs. Options: either services or a Personal Budget (Persönliches Budget) – a full-choice, self-managed monthly cash allowance Partially means-tested	Personal Budget (Persoonsgebonden Budget, PGB) Typically local municipalities Allocated budget depends on assessed support needs and individual municipality rates. Benefit allows parents to arrange customised care and other assistance (material or personnel) Not means-tested	Additional Cost Allowance (Merkostnadsersättning) Swedish Social Insurance Agency (Försäkringskassan) Five levels – amount depends on actually incurred additional costs: 1. Costs are at least SEK 14 700 per year: receive SEK 1 470 per month. 2. Costs are at least SEK 20 580 per year: receive SEK 1 960 per month. 3. Costs are at least SEK 26 460 per year: receive SEK 2 450 per month. 4. Costs are at least SEK 32 340 per year: receive SEK 2 940 per month. 5. Costs are at least SEK 38 220 per year: receive a maximum amount of SEK 3 430 per month. Not means-tested	Direct Payments Local authorities No standardised payment amount; amount depends on individual care needs and the cost of services required Means-tested
	Eligibility assessment	To enter the NDIS system, a formal medical diagnosis is not strictly required. A child must have an impairment that is likely to be permanent and causes a substantial reduction in functional capacity. Early intervention supports can also be provided for eligible children with likely permanent impairment or children younger than six with developmental delay, where the supports are likely to benefit the person and reduce the impact of their impairment. Children with a diagnosis of ASD at Level 2 or 3 have so far had easier access to the NDIS, as these two levels of ASD are on the NDIS’ Access List A.	A formal medical ASD diagnosis is required. After registering with the required diagnostic documentation through AccessOAP, an OAP care co‑ordinator (often a clinical professional or programme advisor) reviews the submitted materials and carries out a Determination of Needs assessment. This process involves interviewing the child’s parents and reviewing relevant documents, such as diagnostic evaluations and school reports, to assess the child’s support needs and determine the corresponding level of funding.	Entirely based on an assessment of the child’s support and care needs, and limitations in daily life. Formal medical diagnosis is not required but parents usually provide supporting medical evidence – such as reports from healthcare professionals.	AEEH eligibility requires that the child’s impairment be acknowledged as causing a disability; allowance is not automatically granted based on a diagnostic label alone. Benefit decisions are based on an assessment of the child’s support needs and resulting disability severity. MDPH evaluates the child and assigns a taux d’incapacité (disability rating) reflecting how much the impairment limits the daily life of the child and what support is required. The complementary allowance level depends on the amount of extra costs parents incur because of the child’s disability.	A formal medical diagnosis is required. Additionally, the responsible agency (e.g. Youth Welfare Office) carries out a participation and needs assessment. It is a collaborative assessment and planning process in which social workers, the child (and family) review all evidence (medical/psychological reports, school reports, etc.) to map out the child’s functional needs. The assessment is person-centred, based on the WHO’s ICF framework, and looks at how the impairment affects daily life (self-care, mobility, communication, learning, social interaction) and what supports are required.	Depending on the child’s situation, the responsible authority is either the local municipality or the Care Needs Assessment Centre (CIZ). Evaluation involves reviewing medical reports and professional assessments. The process focusses on evaluating the child’s care needs rather than the specific diagnosis – a formal medical diagnosis is not necessarily required.	A formal medical diagnosis is not required but the treating doctor must complete a medical report. Eligibility depends on whether the family incurs extra costs because of the child’s disability or medical condition, compared to a child without disability of the same age.	While a formal medical diagnosis can support the assessment, it is not strictly required. Eligibility focusses on the child’s support needs in daily life. Assessment evaluates the child’s abilities and challenges in daily activities; it also considers the family’s needs as a whole, not just the child’s needs.
	Further details	NDIS provides individualised funding packages which are used to purchase supports and services such as therapies, equipment, personal care, and training Eligibility is based on reduced functional capacity in one or more of the following areas: moving around, communicating, socializing, learning, or undertaking self-care or self-management tasks To determine funding package: NDIS planners/local area co‑ordinators evaluate the child’s needs Children diagnosed with Level 2 (Requiring substantial support) or Level 3 (Requiring very substantial support) ASD considered likely to meet eligibility criteria (see List A) Support needs and functioning evaluation relies mostly on documentary evidence provided by the applicant Children aged 0‑9 years can also access NDIS support through an “early childhood approach” NDIS is available to all Australians under 65 years of age	OAP’s services and funding fall into five core categories: 1) foundational family services 2) caregiver-mediated early years programmes 3) core clinical services, 4) entry to school programme 5) urgent response services In some of these categories, services are provided completely free of charge, in other categories, parents purchase services privately (such as therapy sessions under Core Clinical Services) and are reimbursed for the approved expenses with the child’s allocated annual budget Determination of Needs covers the following ten key domains: communication, social interaction, play and leisure, activities of daily living, motor skills, cognitive skills, sensory system, interfering behaviours, mental health, and adaptability and resilience For children under 18 years of age Annual reassessment of child’s support needs by OAP care co‑ordinator	Conditions: additional costs must be attributable to the child’s disability and additional costs could not be avoided	Assessment includes an evaluation of the child’s support needs in daily life and the resulting extra expenses Assessment carried out by a multi-disciplinary team from the MDPH typically using a standardised evaluation tool (e.g. GEVA guide) Involves both in-person evaluation and review of documentary evidence E.g. Level 4 = child’s disability results in expenses equal to or greater than EUR 828.11 per month For children under 20 years of age Periodic reassessments (typically every two to five years) For single parents, a supplement is available	Allowance covers a wide range of participation services: medical (e.g. therapy), educational (e.g. school aides), vocational (e.g. workshops), mobility services, social-assistive services (e.g. personal assistants) etc. Individuals can choose a personal budget instead of direct services. In that case, they receive a cash budget or vouchers to purchase services themselves Needs assessments rely on documentary evidence (therapy reports, school evaluations, etc.) and in-person interviews or home visits No age restrictions; available to individuals of all ages Person’s income and savings beyond thresholds are taken into account when calculating co-payments. However, parents’ income is generally not considered for children Periodic reassessments, latest every two years	PGB is regulated under four separate legal frameworks, with the applicable law depending on the nature and intensity of the care required (Youth Act, Social Support Act, Health Insurance Act, Long-term Care Act) Purpose: budget to buy care, assistive devices, etc. to meet the child’s care needs Evaluation centres on the child’s support and care needs, such as assistance with daily activities, supervision, and medical support Relies on documentary evidence, as well as an in-person assessment Reassessments are triggered by any significant changes in the child’s care needs	Parents must complete an application form, in which they detail all additional expenses directly linked to their child’s disability and explain how these costs arise from the disability Case administrator typically schedules a follow-up call with the parents to discuss the child’s needs in detail Reassessments are normally conducted every four years	Direct Payments provide funding to arrange and manage personalised care and support services Typically, local authorities conduct in-person assessments to evaluate the child’s needs and the family’s circumstances; although procedures vary across local authorities Regular reassessments are foreseen
ALLOWANCE 2	Name Responsible institution Levels Means-testing		Ontario’s Assistance for Children with Severe Disabilities (ACSD) Ministry of Children, Community and Social Services (MCCSS), administered by regional MCCSS offices/family support units Monthly benefit ranges from CAD 25 to CAD 646, based on: Household income (max CAD 76 200 / year) Family size Severity of the child’s disability Extraordinary disability-related costs Means-tested		Disability Compensation Benefit (Prestation de compensation du handicap, PCH) Department for the Disabled (Maison Départementale des Personnes Handicapées, MDPH) 100% of extra expenses linked to the disability are reimbursed if the household’s annual income is EUR 30 398.54 or below. If annual household income is above, 80% of expenses are reimbursed Partially means-tested (income‑based)
	Eligibility assessment		Child must have a formal medical statement or psychological assessment confirming a severe impairment that significantly limits daily function (e.g. mobility, communication, personal care). Parents complete an Expense Report listing actual or expected disability-related costs (e.g. travel, equipment, respite). A Special Agreements Officer evaluates the severity of the disability, functional limitations, and extraordinary costs to determine eligibility and benefit level.		Eligible if already receives the AEEH.
	Further details		ACSD blends a medical-functional assessment (diagnosis & functional limitation) with a cost-based evaluation For children under 18 years of age Reassessments only if there are significant changes in household income, disability status, or extraordinary costs		The PCH comprises five forms of aid: Human assistance; Technical assistance; Accommodation adjustments or transportation costs; Specific or exceptional charges; Animal assistance Each form of aid has a ceiling amount

Source: Information collected by the Secretariat and verified in discussions with national autism organisations.

Table A C.4. Special educational support for children with SEN across countries

Country	General system structure	Assessment & decision making		Further details
Who	How
Australia	Most children with SEN attend regular schools where they receive additional support, such as additional resources and assistance tailored to their needs, including learning support staff. Children may also have the option to spend only part of their school day in a mainstream classroom, and the rest working in smaller groups or one‑to‑one with learning support staff. Some special education classes are offered specifically for children with ASD (though they may also include children with other neurodevelopmental or intellectual impairments). Usually, only students with intellectual disability and very intensive support needs opt for special schools.	Parents together with school/teachers ultimately decide on the child’s school placement – usually choice limited by school district.	A formal medical diagnosis is typically required to access specialised educational supports, including specialised classes and specialised schools. School administrators and specialised professionals (such as educational psychologists, special education teachers, and the child’s therapists) provide recommendations and advise parents based on their assessment of the child’s needs. There is no standardised assessment procedure. School decides on the concrete support measures for the child and details them in the child’s Individual Learning Plan.	Default option is to send a child with ASD to the local school (regular school); however, these may not always be well equipped to adequately support children with ASD Educational support is provided based on the individual needs of every child Four levels of adjustment for students with disability: a) support within quality differentiated teaching practice (QDTP) b) supplementary c) substantial d) extensive Certain schools have introduced Specialised Autism Learning Programs (SALP) Parents can also decide to homeschool their child
Canada	Most children with SEN attend regular schools where they receive additional support, such as access to therapies, additional resources, assistive technologies, and educational assistants. An Individual Education Plan (IEP) or an Individualised Program Plan (IPP) outlines personalised goals, accommodations, and modifications needed. Most provinces (especially Ontario) offer specialised classes and programmes specifically for children with ASD. Only few special education schools exist in Canada.	Provincial/territorial level committees (e.g. Ontario’s Identification, Placement and Review Committee which consists of at least three members) or even school-based multi-disciplinary teams which usually involve school representatives, special education experts, and parents.	A formal medical diagnosis is frequently required while placement and support decisions also consider the child’s support needs. These committees or school-based teams assess the child’s support needs through a review of primarily documentary evidence and subsequently decide on the child’s school placement and services package – the assessment typically culminates in an IEP or IPP that formalises the placement decision. The scope and reliance on diagnostic labels of these assessments may vary a lot across provinces. Parents usually play a key role in identifying their child’s needs and necessary special education services.	Schooling options may vary by province – e.g. in Ontario, there are five options: a) Regular class with indirect support b) Regular class with resource assistance c) Regular class with withdrawal assistance d) Special education class with partial integration e) Full-time special education class Usually regular reassessments, e.g. in Ontario, the Identification, Placement and Review Committee reviews the child at least once per school year
Denmark	Most children with SEN attend mainstream public schools (Folkeskole) where they can receive additional, individualised support which may include supplementary lessons, assistive technologies, one‑on-one assistance, or adapted teaching materials. Some municipalities also offer integrated classes (NEST) for children with and without ASD – small class size and taught after special pedagogical principles. Many municipalities have special education classes (specialklasser) within regular schools. Students may attend part of their school day in a specialised class and the rest in a regular classroom. Some municipalities offer specialised classes specifically for children with ASD. Usually, only students with very extensive support needs enrol for special schools. A particular form of specialised school are the so-called Treatment and Special Education schools (behandlings- og specialundervisningstilbud) which are specialised day-school programmes that combine therapeutic treatment and intensive special-education supports in a single, cohesive setting.	The main stakeholders involved are: child’s current school, Municipal Council, and municipality’s Educational-Psychological Counselling (Pædagogisk-Psykologisk Rådgivning, PPR) which may include psychologists, pedagogues, health professionals, and special education experts.	A formal medical diagnosis is not required – placement and support decisions are entirely based on a support needs assessment of the child. Municipal PPR undertakes the educational-psychological assessment (PPV) of the child, evaluating the child’s academic, personal and social skills and needs. It also proposes specific educational support services. The current school’s head teacher is then consulted to decide whether the child’s needs exceed what the current school can provide; if so, the Municipal Council (via a special committee) reviews the PPV and authorises to place the child in a special education class or school. Parents are involved in all these stages. Assessments typically rely on documentary evidence, as well as in-person evaluations of the child.	Special education classes and schools are usually reserved for children that require more than nine hours of extra-support per week Many municipalities provide specialised after-school programmes for children with significant support needs. These are tailored environments with trained staff and structured routines, sometimes co-located with special schools Therapies (e.g. speech or occupational therapy) are typically offered at specialised schools and classes but less frequently offered on-site at mainstream schools Usually, annual reassessment of the child
Estonia	Special education classes (Eriklass): only students with enhanced and special support needs may attend a specialised class. Some of these special education classes are ASD-specific. Special education schools (Erikool): only students with very extensive support needs attend these schools.	The main stakeholders involved are: school director, parents, specialised school support team, and a regional counselling committee under municipal co‑ordination. Each counselling committee (at regional centres, called Rajaleidja (Pathfinder Centres)) consists of at least five members, including special educator, speech therapist, school psychologist, social worker, and representative of the county or city government.	A formal medical diagnosis is not necessarily required – placement and support decisions are primarily based on an assessment of the child’s support needs. Multi-disciplinary school support team (pedagogue, psychologist, speech therapist, etc.) carries out a pedagogical-psychological assessment of the child’s learning, social and self-care needs and prepares recommendations, which the municipal Rajaleidja’s counselling committee then reviews (alongside medical certificates) to advise on school placement and support services; school director and parents together formalise the final decision. Parents must approve their child’s placement. Student can only receive special education support (e.g. attend a special education school) following the above described assessment conducted by Rajaleidja’s counselling committee.	Special education system based on a three‑tier support system: a) General Support (includes e.g. teaching assistant, extra time for completing exams, and individual curriculum) b) Enhanced Support (includes e.g. special education teacher, and therapies) c) Special Support (includes e.g. adjusted learning environment, specialised equipment, and intensive support sessions) Students with SEN can follow either: a) Regular national curriculum, which is adaptable to those with mild support needs b) Simplified curriculum, designed for students with significant support needs and again divided in two specific curriculum options – the “Curriculum for Coping” and the “Curriculum for Care” Students who follow simplified national curricula for coping or care may remain enrolled up to the age of 20
France	Students receive an individualised education plan (Projet personnalisé de scolarisation, PPS) which outlines their educational support needs. Special education classes (Unités Localisées pour l’Inclusion Scolaire, ULIS) typically offer teaching assistants, individualised learning plans, specialised instruction, allied health support (such as therapies). Autism-specific classes/units are also available (usually reserved for children with severe support needs): UEEA (Unité d’enseignement élémentaire autisme) for ages 6‑11. France offers different so-called medico-social establishments for children with very extensive support needs which provide integrated schooling, care and therapy.	The main stakeholders involved are: Department of the Disabled (Maison Départementale pour les Personnes Handicapées, MDPH), Multi-disciplinary Evaluation Team (Équipe Pluridisciplinaire d’Évaluation, EPE), Committee of Rights and Autonomy (Commission des Droits et de l’Autonomie, CDAPH), and School Monitoring Team (Équipe de Suivi de la Scolarisation, ESS). The EPE may include physicians, paramedical staff, teachers, social workers, etc.	A formal medical diagnosis is typically required – however, placement and support decisions are primarily based on an assessment of the child’s support needs. The Multi-disciplinary Evaluation Team (EPE) of the MDPH assesses these needs based on the GEVA/GEVA-Sco report (Guide d’évaluation des besoins de compensation en matière de scolarisation), which is prepared jointly by the School Monitoring Team (ESS) and the child’s parents. The evaluation draws on the report and other documentary evidence and, where appropriate, may include in-person observations through home or school visits. On the basis of this assessment, the decision making body (CDAPH) of the MDPH determines the child’s school placement and the educational support measures to be provided. Parents are typically most involved during the initial stages of the process, working with the school to compile the assessment report submitted to the MDPH.	Annual reassessments with subsequent annual update of the personalised education plan (Projet Personnalisé de Scolarisation, PPS) through the ESS (Équipe de Suivi de la Scolarisation) Children with disability may remain enrolled at school until 20 years of age
Germany	Special education schools (Förderschule) are relatively common and may focus on a type of need (e.g. learning, emotional/social, physical).	The main stakeholders involved are: parents, the local school authority (Schulaufsicht), the SEN Service (Sonderpädagogischer Dienst) of the local school authority, and the school’s teachers.	A formal medical diagnosis is not necessarily required – placement and support decisions are primarily based on an assessment of the child’s support needs. Such an assessment of the child’s educational support needs (sonderpädagogischer Förderbedarf) can be initiated by parents and teachers. A multi-disciplinary team (or individual) then reviews documentary evidence (reports, grades, medical records…) and conducts in-person observations and tests across functional domains (learning, communication, social-emotional, motor, self-care) to assess the child’s needs. The local school authority (Schulaufsicht) then issues recommendations on school placement and educational support provisions. Parents usually make the final decision regarding school placement.	If the school is not able to provide the child with the necessary supports, e.g. an integration assistant, parents can apply for Integration Assistance (Eingliederungshilfe) to cover the associated costs Integration Assistance (Eingliederungshilfe) may also fund additional therapy sessions and other educational supports if the school cannot provide them sufficiently At mainstream schools, school enrolment can be extended by up to two additional years, depending on the child’s development and needs At special education schools (Förderschulen), children can remain enrolled until age 21, and in some cases longer
Israel	Children with SEN may attend regular classes in regular schools where they benefit from a personal basket of service hours for extra support. Special education classes typically offer smaller class sizes, specialised equipment and assistive technologies, special education teachers and assistants, on-site therapy, personalised curricula, etc. Special education classes are always dedicated to one specific type of disability, e.g. children with Down Syndrome, ASD, or Cerebral Palsy & Severe Physical Disabilities (REB).	Eligibility and Characterization Committee for Special Education: operate at local level (approx. 369 in Israel), 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. These Committees have the authority to determine the student’s eligibility for special education. The parents, student, student’s teacher, and other professionals may be invited to join the meeting of the Committee. A Multi-disciplinary Team (including child’s teachers, parents, specialists, such as their therapists) decides on the composition of the services basket for the child.	A medical diagnosis of the disability is required. Eligibility and Characterization Committee evaluates the child’s support needs to determine eligibility for special educational support, recommends a suitable schooling option, and decides on the scope of the service basket available to the child. A Multi-disciplinary Team subsequently decides on the precise composition of the child’s services basket (e.g. what therapy and teaching materials) and creates the child’s Individual Education Program (IEP). Normally, the child’s teacher(s) complete a functioning questionnaire (RAMA) for the Committee’s consideration, however, the questionnaire is no longer consistently used. The Committee relies primarily on other documentary evidence from the child’s parents, psychologist, and teachers.	Specialised classes and specialised schools integrate therapies (such as occupational, speech, and psychotherapy) into school day Support needs divided in four levels of severity (level four = extensive support needs) Committee reassessments take place every three years Multi-disciplinary Team reassessments of the IEP take place annually
Netherlands	Children with disability are encouraged to attend regular schools where they receive additional, individualised support. There are two different types of special education schools depending on a child’s level of support needs: a) Special Primary Education (Speciaal Basisonderwijs, SBO) which offers the curriculum of regular primary schools, but class sizes are smaller, and children get more attention and support. This type of school is meant for children with learning and behavioural difficulties. b) Special Education Schools (Speciaal Onderwijs, SO, and Voortgezet Speciaal Onderwijs, VSO) which offer specialised teaching staff, adapted curricula and teaching methods, etc. They are divided in four clusters: Schools of Cluster 4 focus on behavioural and psychiatric disorders (such as ASD, ADHD, etc.).	The main stakeholders involved are: parents, teachers, independent experts, and regional school partnership groups (samenwerkingsverband) which include regional regular and special education schools.	A formal medical diagnosis is not necessarily required – placement decisions are primarily based on an assessment of the child’s support needs. If the regular school cannot provide the child with the support needed, the child can be referred to a special education school. For Cluster 3 and 4 special education schools, access is determined through a Declaration of Admissibility (toelaatbaarheidsverklaring, TLV) issued by the regional school partnership group (samenwerkingsverband). The assessment is primarily document-based (medical certificates, school reports, etc.), with in-person evaluations conducted if clarification is needed.	Children enrolled at SBO schools can attend those until age 14 (normally 12 years limit) SO/VSO are divided in four clusters: a)  Cluster 1: Visual impairments b) Cluster 2: Hearing impairments and speech-language difficulties c) Cluster 3: Physical disabilities and chronic illnesses d) Cluster 4: Behavioural and psychiatric disorders TLVs are granted for a fixed term (often two years) and specify how long placement in SO schools is approved When the TLV nears expiry, the school must review the child’s progress and support needs and decide whether to request a new TLV from the regional school partnership group
Sweden	Children with disability are encouraged to attend regular schools where they benefit from either a) Minor Adjustments, such as modified assignments, extra time, etc. or b) Special Support, individually specified in an Action Plan (åtgärdsprogram), which may include a personal assistant, assistive technology, flexible timetables, access to therapies, etc. Adapted Schools (anpassade skolan) are dedicated to children with intellectual disability and offer adapted curricula, specialised teaching staff, lower student/teacher ratio, allied health support (such as therapies), etc. Special Schools (specialskola) target specific groups: one school is designed for children with congenital deafblindness and hearing impairment with severe learning disorders; one school targets children with visual impairments combined with other disabilities; and two schools are for children with severe developmental language impairments.	The main stakeholders involved are: parents, school director, municipality, school’s teaching staff, and independent experts, such as psychologist and special education teachers.	A formal medical diagnosis is generally not required – placement and support decisions are based on an assessment of the child’s support needs. There are essentially three assessment procedures: one to determine the child’s need for special support at a regular school, one to determine the child’s need to attend an Adapted School, and one for attendance at a Special School. Assessment 1: When Minor Adjustments seem not to suffice and a need for Special Support is suspected – raised by teachers, parents or the child – the school principal must immediately commission a needs assessment (utredning av behov av särskilt stöd) led by special-education staff in collaboration with class teachers, school health professionals and, where relevant, external specialists. The assessment relies on both documentary evidence (e.g. school records, teacher observations, psychological reports) as well as in-school observations and interviews with the student and parents. The school principal makes the final decision on the provision of special support. Special Support measures are then specified in an individual Action Plan. Assessment 2: Before a child can be placed in an Adapted School, the municipality must carry out a Target-Group Investigation (utredning om målgruppstillhörighet). This investigation typically comprises four assessment parts – pedagogical, psychological (by a licensed psychologist), medical (by a physician) and social (by a school counsellor or equivalent) – and relies on documentary evidence as well as in-person observations and interviews with the student and parents. Once the multi-disciplinary report confirms the child meets the criteria (e.g. intellectual disability or equivalent severe needs), the municipality formally decides on placement in the Adapted School. Parents play a crucial role at all stages of the assessments and decision making.	Access to special education schools (adapted schools): “For the purposes of the Education Act, people with autism or autism-like conditions shall not be equated with people with intellectual disabilities unless they also have an intellectual disability or intellectual disability due to brain injury as described above.” (Sveriges Riksdag, 2010)
United Kingdom	Some schools offer specialised classes for specific types of SEN, e.g. specifically for children with ASD. Special education classes are usually meant for children with an Education, Health, and Care Plan (EHCP) but may also include children with SEN Support. Usually, only students with extensive support needs attend special schools – they are generally reserved for children with an EHCP.	The main stakeholders involved are: parents, school’s Special Educational Needs Co‑ordinator (SENCo), the local authority, and independent experts.	A formal medical diagnosis is not required – placement and SEN support/EHCP decisions are entirely based on an assessment of the child’s support needs. There are two assessment procedures, one to determine the child’s need for SEN support and one for an EHCP for children with extensive support needs. SEN support: The school’s SENCo in partnership with teachers, parents and, where necessary, local-authority specialists (e.g. educational psychologists or health professionals) assess the child’s support needs. They assess the child against four broad areas of needs and subsequently draft a SEN support plan, detailing the special educational measures that the child is entitled to. Assessment relies on documentary evidence and may also include in-person evaluations. EHCP: EHCP needs assessments are carried out by the local authority, which must gather information on the child’s educational, health and care needs from a range of professionals (parents, school’s SENCo, educational psychologist, healthcare practitioners, social worker, etc.). The assessment relies primarily on documentary evidence (e.g. school reports, medical and therapy records) but may also include in-person evaluations. Based on the gathered information, the local authority then decides whether the child requires an EHCP and, if so, drafts one which details the most suitable school setting and educational support. Parents play a crucial role at all stages, such as the finalisation of the EHCP.	Children can receive paramedical therapy, e.g. speech and language therapy, even without an official SEN support plan or EHCP if a teacher recommends it Annual reassessment and update of the EHCP Termly (i.e. every four months) reassessments and update of the SEN support plan Local authority may place a child in an independent (private) special education school if there is no availability in a public one Local authorities only initiate an assessment for an EHCP if there is sufficient evidence that existing interventions are not effective
United States (California)	Separate Classes or Special Day Classes: usually, only children with significant support needs attend those. Many such specialised classes are offered for specific types of SEN – some are specifically designed for children with ASD. Typically, only children with extensive support needs attend special education schools. There are some non-public (private) special education schools specifically designed for children with ASD.	Individualised Education Program (IEP) Team which includes the parents, special education teacher, regular education teacher, and a qualified representative of the school district.	A formal medical diagnosis is required – additionally, a comprehensive assessment of the child’s support needs is conducted to determine placement and support measures. Only children that meet one of the 13 disability categories in the Individuals with Disabilities Education Act (IDEA) (e.g. intellectual disability, visual impairment, deaf-blindness, autism, etc.) can be found eligible for special-education and receive IEP services. Decisions on school placement and services are described in the child’s Individualised Education Program (IEP), which is developed and reviewed by an IEP Team. Eligibility requires both (a) a formal disability determination (medical diagnosis) and (b) a multi-disciplinary needs assessment. A parent or teacher referral initiates a written request for assessment. The assessment covers a broad range of areas of the child’s life and relies on both documentary evidence (medical records, school reports, etc.) and in-person evaluations (e.g. standardised tests, interviews, observations). Parents play a crucial role at all stages of the assessment and IEP creation.	Child may be placed in a non-public (private) special education school if there is no availability in a public one Some schools offer ASD-specific support programmes and services, such as ABA therapy and ASD-specialised teaching staff Placement and services are reviewed at least annually, with full re‑evaluations every three years All children with special educational needs must obtain an IEP that details educational support and school placement

Source: Information collected by the Secretariat and verified in discussions with national autism organisations.

Table A C.5. Access to paramedical therapies for children with ASD/disability across countries

Country	Institution / Programme	Eligibility Criteria	Access Pathway	Therapy Hours / Limits	ASD-Specific
Australia	National Disability Insurance Scheme (NDIS) Medicare (limited coverage) Mainstream community health services or hospital-based community health Education system (depends on individual schools)	NDIS: permanent impairment that substantially reduced functional capacity OR likely permanent impairment or children younger than six with developmental delay, where the therapies are likely to benefit the person and reduce the impact of their impairment Community services: access varies considerably across regions In educational setting: formal medical diagnosis typically required	NDIA determines eligibility based on documentary evidence; subsequently parents meet with an NDIS Local Area Co‑ordinator to develop an individualised NDIS plan which determines therapy hours (NDIS budget management options: self-managed, NDIS-managed, or plan-managed) Medicare: GP referral Community services: access varies considerably across regions In educational setting: school evaluates child’s needs and decides on support services (incl. therapies)	NDIS budgets are individualised, i.e. no fixed hours Average NDIS budget of a child with ASD approximately AUD 24 000/year (buys about two h/week of therapy) but can vary widely Medicare: usually capped at ten h/year of psychotherapy	No ASD-specific programme For every child: therapy hours based on individual needs
Canada (Ontario)	Children’s Treatment Centres (CTCs) Ontario Autism Program (OAP) (parents purchase privately and get reimbursed) School-Based Rehabilitation Services (SBRS) via CTCs in partnership with school boards Ontario’s Preschool Speech and Language Program (PSLP)	CTCs: for children up to 19 years of age (or 21 years if in publicly funded school) with physical, developmental, communication challenges OAP: formal ASD diagnosis required; must register and undergo “Determination of Needs” assessment to receive a Core Clinical Services budget SBRS: formal medical diagnosis typically required	Families contact local CTC directly (no formal referral needed); waiting lists tend to be long For OAP: registration for OAP with an official ASD diagnosis, with subsequent “Determination of Needs” assessment facilitated by local care co‑ordinator, in order to receive fixed annual funding for Core Clinical Services (ABA, speech/occupational therapy, mental health services) SBRS: school referral to local CTC partner to provide speech/occupational/psychotherapy PSLP: for children from birth until they start school; parents register their child through the local PSLP provider	CTCs: no fixed hours; allocation according to available resources and child’s needs OAP: Core Clinical Services budget varies by child’s age and intensity of support needs; no predefined number of therapy hours but fixed budgets SBRS & PSLP: no fixed hours; allocation according to available resources and child’s needs	OAP is ASD-specific; children with other disabilities cannot access OAP CTCs, SBRS, and PSLP serve all children with disability
Denmark	Municipalities (primarily in educational setting)	Comprehensive PPR (Pedagogical Psychological Counselling) assessment determines eligibility No formal medical diagnosis required	Parental or school request initiates process: PPR (in each municipality) conducts a comprehensive educational, psychological assessment of the child’s needs through observations, interviews, and tests Once child’s needs are determined, municipality allocates special education support (which includes speech/occupational therapy) Therapies are typically integrated into educational setting or offered at specialised institutions (e.g. day treatment centres (dagbehandlingsskoler))	No fixed number of therapy hours; allocation according to available resources and child’s needs as determined by PPR	No ASD-specific programme For every child: municipalities allocate therapy hours based on individual needs
Estonia	Estonian Health Insurance Fund (Tervisekassa) Municipalities (for therapies in educational setting) Social Insurance Board (Sotsiaalkindlustusamet) for Social Rehabilitation Centres	Health insurance: family doctor or specialist referral In educational setting: formal medical diagnosis not necessarily required; municipal Pathfinder (Rajaleidja) Counselling Committee assessment Social Rehabilitation Centres (SRC): official “degree of disability” (moderate/severe/profound) issued by Social Insurance Board	Health insurance: doctor’s referral to contracted therapist In educational setting: multi-disciplinary school support team assesses child’s needs and issues recommendations, which the municipal Pathfinder Counselling Committee reviews (along with medical certificates) to advise on support services; speech therapy (if availability permits) then integrated into child’s school day SRC: application for an official “degree of disability” to the Social Insurance Board; subsequent application for SRC to the Social Insurance Board; once application approved, a multi-disciplinary team from SRC establishes a tailored therapy plan for the child	Health insurance: no fixed number of therapy hours; allocation according to child’s needs In educational setting: no fixed number of therapy hours; allocation according to available resources and child’s needs SRC: no fixed number of therapy hours but services are funded up to an annual limit of EUR 2 695 until the child turns 16	No ASD-specific programme For every child: therapy hours based on individual needs
France	Kindergarten/Elementary School Autism Units (UEMA/UEEA) Early Medical and Social Action Centres (Centres d’Action Médico-Sociale Précoce, CAMSP) Special Education and Home Care Services (Services d’Éducation Spéciale et de Soins à Domicile, SESSAD) National Health Insurance (Assurance Maladie) (for individual therapies) Early Intervention Package (forfait d’intervention précoce)	UEMA (ages 3‑6), UEEA (ages 6‑11): formal medical ASD diagnosis & recommendation by CDAPH (via MDPH) CAMSP (ages 0‑6): early screening by CAMSP teams; medical diagnosis helpful but not strictly required SESSAD (ages 0‑20): formal medical diagnosis & recommendation by CDAPH (via MDPH) Health insurance for individual therapies (speech/occupational therapy): doctor’s prescription Early Intervention Package (ages 0‑12): doctor prescribes a course of assessment and early intervention	Parents apply to departmental MDPH: multi-disciplinary evaluation team assesses the child’s needs and CDAPH makes the decision; child then placed in UEMA/UEEA or receives SESSAD as appropriate CAMSP: either direct access or referral by a paediatrician; to determine eligibility and therapy plan, child undergoes a comprehensive evaluation conducted by various specialists (a recommendation from MDPH becomes necessary beyond six months of care) For individual therapies: doctor’s prescription; family books therapist and health insurance reimburses (partially) Early Intervention Package: doctor prescribes a course of assessment and early intervention, and refers the child to the co‑ordination and guidance platform (PCO); PCO assesses whether child needs occupational therapists, psychologists or psychomotor therapists	UEMA/UEEA: child spends several hours each school day in a partial-day programme with embedded therapy; no fixed number of therapy hours (but bound by staff availability and resources) CAMSP: no fixed number of therapy hours, as based on individual needs SESSAD: no fixed number of therapy hours, as based on individual needs Individual therapies through health insurance: no fixed number of therapy hours, as based on individual needs Early Intervention Package: no fixed number of therapy hours, as based on individual needs, but available for a maximum of 18 months	Children with ASD have dedicated UEMA/UEEA units for early intervention Early Intervention Package also serves exclusively children with neurodevelopmental disorders, such as ASD CAMSP and SESSAD serve all children with disability: therapy hours based on individual needs National Health Insurance also serves all children: therapy hours based on individual needs
Germany	Statutory Health Insurance Integration Assistance (Eingliederungshilfe) for non-regular services or ASD-specific supports (e.g. at autism therapy centres) Education system (esp. special education schools typically integrate therapies in school day)	Statutory health insurance: doctor’s prescription and medical diagnosis Integration Assistance: formal medical diagnosis + comprehensive assessment of the child’s support needs In educational setting: school/teachers evaluation (formal medical diagnosis may be required if costs are to be covered by health insurance)	Statutory health insurance covers typical, doctor-prescribed therapies (speech/occupational/physio-/psychotherapy) Integration Assistance: family applies to relevant authority (usually Youth Welfare Office) with a formal medical diagnosis; multi-disciplinary ICF-based assessment of the child’s support needs (considering medical and non-medical reports); individual service package or personal budget granted In educational setting: multi-disciplinary team at school typically assesses the child’s needs, followed by the school authority making recommendations; individual support plan created by school (incl. therapies)	Applies to all pathways: no standard number of therapy hours, as based on individual needs (but bound by staff availability and e.g. school’s resources) Health insurance: therapists can often decide on frequency and length of individual sessions	No ASD-specific programme For every child: therapy hours based on individual needs
Israel	Public Health Insurance via Health Maintenance Organizations (HMOs) Early Childhood Program Education system (e.g. individual service baskets)	Official ASD diagnosis For 14 h/week early childhood programme: child with ASD aged 0‑6 For regular three h/week HMO services: ASD diagnosis and a doctor’s referral	HMO therapies (speech/occupation/physio-/psychotherapy): paediatrician/psychiatrist referral Early Childhood Program: Special daycare centres (<3 years): medical diagnosis and NII approval Kindergarten (3‑6 years): Eligibility and Characterization Committee assessment of child and approval for special kindergarten Individual services basket at school: Eligibility and Characterization Committee assessment of child’s support needs and approval	Early Childhood Program: 14 h/week (10.5 h direct + 3.5 h indirect team) for children 0‑6 with ASD Beyond age seven: through HMOs up to three h/week + SEN hours at school	Children with other disabilities get the same HMO three h/week basket of therapies but the Early Childhood Program offers up to 14 h/week of therapies exclusively for young children with ASD
Netherlands	Health Insurance, especially for speech and language therapy In-kind therapeutic services provided by municipalities Personal Budget (PGB) via Youth Act (Jeugdwet) or Long-Term Care Act (Wlz), especially for behavioural therapy Education system	Health insurance: often with GP/specialist referral PGB: medical diagnosis not necessarily required In educational setting: no formal medical diagnosis required per se	Health insurance: doctor’s referral if non-contracted therapist PGB: usually through municipality which assesses the child’s specific needs In educational setting: regular schools rarely offer therapy on-site; special education schools are much more likely to integrate therapeutic services into the child’s school schedule	Health insurance: no fixed number of therapy hours, as based on individual needs (some exceptions) PGB: no fixed number of therapy hours, as based on individual needs In educational setting: no fixed number of therapy hours, as based on individual needs (but bound by staff availability and resources)	No ASD-specific programme For every child: therapy hours based on individual needs
Sweden	Public Health System Municipalities and schools (speech/occupational therapists employed by municipalities and shared across schools or employed by individual schools)	Public health system: Referral by GP, school nurse, or child health centre (barnavårdscentralen) In educational setting: no medical diagnosis required; comprehensive support needs assessments	Public health system: GP/child health centre/school nurse refers child to a habilitation centre where a multi-disciplinary team creates an intervention plan In educational setting: student health team (school nurse, speech therapist, psychologist) and teachers assess the child’s support needs and integrate therapy in school day accordingly	No standard number of therapy hours, as based on individual needs	No ASD-specific programme For every child: therapy hours based on individual needs
United Kingdom	Educational provisions of Education, Health & Care Plan (EHCP) funded by local authority Health provisions of EHCP and individual therapies funded by National Health Service (NHS) Direct Payments provided by local authorities (to purchase outside services)	Through NHS: referral to NHS therapy services from GP or school staff Through EHCP: medical diagnosis not required Through Direct Payments: medical diagnosis not strictly required	NHS: GP or school refers child to NHS therapy services; waiting lists tend to be long EHCP process: local authority conducts comprehensive assessment of child’s support needs based on medical and non-medical reports; if eligible, authority drafts an EHCP, including therapy entitlements; therapies are funded either through local authority or NHS Direct Payments: local authority evaluates the child’s needs and family context; personal budget then used by parents to purchase therapies	No standard number of therapy hours, as based on individual needs	No ASD-specific programme For every child: therapy hours based on individual needs
United States (California)	Medi-Cal (California’s Medicaid) under EPSDT (Early & Periodic Screening, Diagnostic & Treatment) California Department of Education allocates funds to Special Education Local Plan Areas (SELPAs) which distribute resources to school districts for special education services, incl. therapies California’s Early Start Program (early intervention programme) administered by California’s Department of Developmental Services and California’s Department of Education through Regional Centres	Medi-Cal: for children under 21 years old, covers medically necessary therapies; child qualifies if family income = 138% of federal poverty level OR possibly via Home and Community-Based Services for the Developmentally Disabled (HCBS-DD) waiver regardless of income In educational setting: formal medical diagnosis required ES Program (ages 0‑3): documented assessment demonstrating child’s developmental delay	Medi-Cal: primary care provider referral; Medi-Cal Managed Care Plan reviews the request to determine medical necessity and authorises therapies accordingly In educational setting: school conducts a comprehensive support needs assessment of the child (typically completed by a school psychologist); if the child is found eligible, it receives an IEP, incl. speech/occupational therapies; school district usually co‑ordinates and schedules therapy sessions ES Program: One of California’s Regional Centres either conducts multi-disciplinary assessment of child itself or forwards to relevant agency; if deemed eligible, child receives speech/occupational/physical therapy; review every six months	Across all pathways: no fixed or standard number of therapy hours, as based on individual needs	No ASD-specific programme For every child: therapy hours based on individual needs

Source: Information collected by the Secretariat and verified in discussions with national autism organisations.