17 – Child’s age: 11 years

2013/17 – Child’s age: 11 years

Diagnosis: Autism Spectrum Disorder / Asperger’s Syndrome

Assessment / reports submitted:

GP assessment re DCA claim
Consultant C&A Psychiatrist’s report
Consultant C&A Psychiatrist’s letter
OT Manager (HSE) letter

Background: The appellant made a claim for Domiciliary Care Allowance in respect of her son, [R], who is 11 years of age and has a diagnosis of Autism Spectrum Disorder, Asperger’s Syndrome. He is the eldest of three children. In the ability/disability profile, the family GP assessed the categories of Mental Health/Behaviour as Moderate, and Learning/Intelligence as Mild. He advised that [R] was attending the local Child and Adolescent Mental Health Service (CAMHS). Documentary evidence as outlined above was submitted. The claim was disallowed, and the appellant made an appeal. The appeal was disallowed initially by way of summary decision. Subsequently, solicitors acting for the appellant sought to have that decision reviewed. The Appeals Officer set aside his decision in favour of oral hearing.

Report of oral hearing: The appellant was accompanied by her husband. The Appeals Officer asked if they would outline those points which they would like to make in support of the appeal. They made reference to the following:

[R]’s behaviour is unpredictable and it is difficult to know how he will behave from one day to the next
He is big for his age and very strong physically and he can be hard to manage
He has had to be physically restrained on occasion, having lashed out and become violent – examples were cited
He gets ‘massive headaches’ after a stressful day
All their attention is focussed on [R] and their other two children are losing out
He cannot cope with change of any kind and ‘loses the head’ in strange environments so they cannot go on outings as a family
He is still on a waiting list for NEPS assessment and they have been advised by CAMHS that he may not be best served by attending mainstream secondary school
He cannot make decisions, cannot grasp the environment that he is in, has no sense of danger and cannot pay attention to anything
He is getting worse as he gets older as he does not understand why he cannot do things that his peers are allowed to do
He needs constant supervision and cannot play outside or in the homes of other children; on the odd occasion where this has happened, they have been phoned to collect him because of behavioural difficulties
He does not feel pain, and can bang his head, pull his hair or pinch himself if he becomes agitated and appears to feel nothing
He has been allocated 4.5 resource hours in school and has access to the class SNA
In line with the details outlined in the appeal submission, they said that [R]’s mood is always low (even on his birthday or special occasions) and that he has made suicidal statements
They cannot eat dinner until c. 11 p.m. when he is asleep in bed
They have both been prescribed anti-depressants and they both attend counselling, in an effort to cope

In conclusion, they spoke about the need to be constantly alert to cope with [R]’s behaviour and to protect their other two children from his outbursts.

Comments/Conclusions: The Appeals Officer noted that the appellant and her husband presented an account of a family trying to cope in a situation which they find extremely stressful. They referred to the need to be watchful constantly, during the day and at night. She noted that they had both suffered in terms of depression and that it was clear that [R]’s low moods and suicidal statements were a source of some considerable concern to them – in terms of the distress which it suggests he is experiencing and also the extent to which it heightens the need for their vigilance. She noted also their concern at the disproportionate amount of time and attention he commands, to the detriment of his younger siblings. In her view, they provided a compelling account of a situation where the child at issue requires continuous care and attention which may be held to be substantially in excess of that required by his peers, and in line with the qualifying criteria provided for in social welfare legislation.

Decision of the Appeals Officer: The appeal is allowed.

Note on decision reason(s): Having carefully examined all the evidence available, including that presented at the oral hearing, I have concluded that it has been established that the appellant’s son, [R], requires continuous care and attention which may be deemed to be substantially in excess of that normally required by his peers and accordingly that the qualifying criteria are met in this case. In the circumstances, the appeal succeeds.