Eligibility requirements and disabilities

The Supplement for Handicapped Children is governed by the  Taxation Act This link will open in a new window., more specifically by the rules prescribed in the Regulation respecting the Taxation Act.

  • Eligibility for the Supplement for Handicapped Children is first determined by verifying whether the child's condition meets certain requirements defined in Schedule A to the Regulation respecting the Taxation Act.
  • If none of the requirements apply to the child's condition, we will continue studying his or her eligibility for the Supplement for Handicapped Children by assessing the severity of the child's disability.

Analysis of eligibility: Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of the Regulation respecting the Taxation Act if his or her state of health meets one of the requirements for a period expected to last at least one year.

The requirements related to impairments are effective as of 1 July 2024. For more information, consult the Minister of Finance's Budget This link will open in a new window..

The requirements are excerpts from Schedule A to the Regulation respecting the Taxation Act.

The documents that the family and health or education professionals must enclose with the application are specified under each disability category.

Nutrition and digestion

A child whose state of health corresponds to the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to those cases, it is assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped in the following cases:
  1. the child receives daily enteral nutrition at home (gavage feedings), either gastric or jejunal (e.g. nasogastric tube or gastrostomy);
  2. the child receives parenteral nutrition at home (intravenous hyperalimentation);
  3. the child is less than 3 years of age and underwent surgery for a high-type anorectal congenital malformation or for Hirschsprung disease;
  4. the child has neurogenic bowel secondary to a spinal cord injury, and chronically receives medically prescribed retrograde intestinal irrigations, at least every 2 days;
  5. the child chronically receives medically prescribed antegrade intestinal irrigations through a stoma, at least every 2 days, related to fecal continence problems;
  6. the child has a colostomy or ileostomy;
  7. the child is on the waiting list for a liver or intestinal transplant or has received one;
  8. the child follows a prescribed gluten-free diet related to diagnosed celiac disease.
Assessment parameters

In the case of an anorectal malformation, the specific type of malformation must be indicated in the assessment report.

For the purposes of the analysis of a case prescribed in paragraph g for a child placed on the transplant waiting list, he or she must have been placed on the list after being assessed by a transplant team.

Special rule

The expected duration of the treatments specified must be at least one year based on the frequency indicated.

Documents to provide if the child has an impairment related to nutrition and digestion

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • The medical follow-up of the last year for the nutrition or digestion condition, including nutritional assessments;
  • The occupational therapy and speech-language therapy assessment report related to the eating disorder, if the child was assessed;
  • For cases of celiac disease, the biopsy report and laboratory tests.

Metabolic, hematological or hereditary abnormalities

A child whose state of health corresponds to one of the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to those cases, it is assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped in the following cases:
  1. the child has been diagnosed with cystic fibrosis and, in the last 12 months, he or she required a daily pancreatic enzyme supplement treatments and therapeutic interventions related to documented pulmonary complications;
  2. the child has been diagnosed with inborn errors of metabolism resulting in the deficit of an essential metabolite, an accumulation of toxic metabolites, insufficient energy production or a deficiency in the synthesis or catabolism of complex molecules, and
    • despite receiving the recommended treatment, the child is at a high risk of developing, in connection with that diagnosis, severe metabolic decompensation, within the next year as a result of physical or metabolic stress, requiring emergency medical intervention, and the risk will persist over the next few years;
    • the diagnosis requires a diet of proteins, lipids or carbohydrates of a particular type or in closely monitored proportions, which prevents him or her from eating like those around him or her, and failure to adhere to the diet could have serious consequences for his or her health or development; or
    • the diagnosis is associated with severe multisystem involvement that will persist despite receiving the recommended treatment, and that has been present from the first year of the child's life or before the diagnosis was made;
  3. the child is less than 7 years of age and has sickle cell disease related to HbSS, HbSC or HbSß-thalassemia hemoglobinopathies;
  4. the child has hemophilia with Factor VIII or IX activity of less than 1% and requires an intravenous administration of clotting factors chronically at least once a week;
  5. the child requires daily continuous insulin therapy or multiple daily insulin injections, as well as necessary diabetes-related care.
Assessment parameters

In the case of a child presenting an hemoglobinopathy, the abnormal hemoglobin forms must be specified in the medical report.

In the case of a child presenting a coagulation factor deficiency, the level of the deficient factor must be specified in the medical report.

Special rule

The expected duration of the treatments specified must be at least one year at the frequency indicated.

For the purposes of the analysis of a case prescribed in paragraph a, an uncomplicated upper respiratory tract infection does not represent a pulmonary complication, and preventive respiratory physiotherapy following a diagnosis of cystic fibrosis is not considered a therapeutic intervention related to documented pulmonary complications.

For the purposes of the analysis of a case prescribed in paragraph e, a once-daily injection of long-acting or ultra-long-acting insulin is not considered to be continuous insulin therapy.

Exclusion

A child with a metabolic abnormality that is corrected by medication, a vitamin, a dietary supplement or the simple exclusion of a food is not presumed to be handicapped due to the metabolic abnormality.

Documents to provide if the child has an impairment related to metabolic, hematological or hereditary abnormalities

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • Depending on the specialists with whom you have met, medical follow-ups for the past year, including reports of emergency room visits and hospitalization summary sheets, if applicable;
  • For cases of cystic fibrosis, the list of medications that were prescribed to the child (including refills) and obtained from a pharmacy within the last year.

Immune system abnormalities and neoplasia

A child whose state of health corresponds to one of the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to one of those cases, it will be assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped in the following cases:
  1. the child has food allergies and
    • follows a strict avoidance diet for at least 3 of the following allergen groups, one of which being cow's milk:
      1. cow's milk;
      2. eggs;
      3. peanuts and nuts;
      4. wheat, barley, oats and rye;
      5. other selected cereals: corn, rice and buckwheat;
      6. soya;
      7. other selected legumes: green peas, yellow peas, lentils and chickpeas,
      8. mustard;
      9. sesame;
      10. beef;
      11. chicken;
    • follows a strict avoidance diet for at least 3 of the allergen groups listed above and the risk of systemic reaction at a very low dose requiring the administration of epinephrine is present and demonstrated for a least 1 of the allergens; or
    • follows a strict avoidance diet for at least 4 of the allergen groups listed above;
  2. the child has significant prolonged immunosuppression related to a condition or treatment and, despite receiving the recommended treatment, has required at least 3 hospitalizations of 48 hours or more each in the last 12 months related to his or her immunosuppression or his or her underlying disease;
  3. the child has solid or hematological cancer requiring radiotherapy or oral (by mouth) or parenteral (e.g. intravenously) chemotherapy treatments;
  4. the child is on the waiting list for a stem cell transplant or has received one in the last 12 months.
Assessment parameters

In the case of a child presenting neoplasia, the assessment report must specify the type of neoplasia, the stage of the disease, the treatment plan and the response to treatment.

For the purposes of the analysis of a case prescribed in paragraph a, the medical report must include the clinical history with a detailed description of the signs and symptoms of previous allergic reactions, the interpretation of allergy test results for the allergens that are still causing problems, the progress of desensitization when such treatment is underway, and the level of avoidance required in the diet for the allergens that are still causing problems.

For the purposes of the analysis of a case prescribed in paragraph d for a child placed on the transplant waiting list, he or she must have been placed on the list after being assessed by a transplant team.

Special rule

The expected duration of the treatments specified, including avoidance diets, must be at least one year at the frequency indicated.

For the purposes of the analysis of a case prescribed in paragraph a, the following special rules apply:

  • the strict avoidance diet must be prescribed by a physician following an assessment confirming a medical condition for which the severity of the reactions requires such a diet on a long-term basis;
  • an avoidance diet is considered to be strict only when the child must avoid all traces of the allergen;
  • a child is not considered to require a strict avoidance diet regarding eggs if he or she can tolerate cooked eggs as part of the ingredients in a mixture;
  • food intolerance is not considered a condition requiring a strict avoidance diet for the food in question;
  • a child undergoing desensitization who is under maintenance dose for an allergen is no longer considered to require a strict avoidance diet for that allergen;
  • the very low dose mentioned refers to the lowest average trigger dose that causes a reaction in 5% of the population allergic to that allergen, or the ED05 value, as specified following a literature review by an international panel of experts.

For the purposes of the analysis of a case prescribed in paragraph b, hospitalizations during the child's first 6 months of life are not taken into account when calculating the number of hospitalizations.

Documents to provide if the child has an impairment related to immune system abnormalities

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • For cases of food allergies, the medical follow-up for the last year for food allergies, including all allergy tests carried out during this period and their interpretation;
  • For other cases, the medical follow-up for the last year, including consultations with an immunologist or an oncologist, reports of emergency room visits and hospitalization summary sheets, if applicable.

Nervous system abnormalities

A child whose state of health corresponds to one of the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to one of those cases, it will be assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped if he or she has drug-resistant epilepsy and, despite the receiving  optimal treatment, he or she is in one of the following situations:
  1. he or she required, in the last 12 months, at least 3 hospitalizations of 48 hours or more, each related to his or her epilepsy;
  2. he or she has generalized tonic-clonic seizures or seizures with loss of postural tone resulting in a fall, at a frequency equivalent to or greater than at least once a month for 3 consecutive months;
  3. he or she has epileptic seizures at a frequency equal to or greater than at least once a week for 3 consecutive months;
  4. classic ketogenic diet, managed by a multidisciplinary team specializing in neurology, is medically required to treat his or her epilepsy.
Assessment parameters

The assessment report must include the type, duration and frequency of the epileptic seizures, as well as the various past treatment attempts and the results obtained.

Documents to provide if the child has an impairment related to nervous system abnormalities

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • The medical follow-up for the last year for epilepsy.

Musculoskeletal system

A child whose state of health corresponds to one of the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to one of those cases, it will be assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped in the following cases:
  1. the child is less than 5 years of age, has significant motor disabilities secondary to an impairment and his or her gross or fine motor skills are less than those of the average healthy child half his or her age;
  2. the child has had complete brachial plexus palsy persisting for at least 3 months;
  3. the child is at least 2 years of age, has paresis or plegia of one or both upper limbs and, despite receiving the recommended treatments, he or she has either
    • an absence of a functional grasp regarding the affected upper limb; or
    • the inability to carry out bimanual activities;
  4. the child is at least 3 years of age, has significant motor disabilities secondary to an impairment and, as medically required for his or her condition, uses chronically and daily, for the majority of indoor and outdoor mobility, either
    • fixed or articulated bilateral high ankle foot orthoses; or
    • a wheelchair, a walker, bilateral quad canes (four-legged canes) or bilateral crutches;
  5. the child has an agenesis or amputation of a limb which, despite receiving the recommended treatments, is associated chronically and persistently to one of the following characteristics:
    • an absence of possible weight-bearing on the ground on the distal end of the affected lower limb when standing;
    • an absence of a functional grasp regarding the affected upper limb;
    • the inability to carry out bimanual activities;
  6. the child has acondroplasia.
Assessment parameters

Abnormalities in muscle tone, motor control, range of motion, coordination and balance, muscular strength and endurance must be described and commented on according to the limitations they entail when maintaining positions and carrying out locomotor, exploratory and manipulative activities.

Special rule

To assess the condition of a child born prematurely in relation to his or her growth and development, the child's age is adjusted by subtracting the number of weeks of prematurity, until the age of 36 months.

For the purposes of the analysis of a case prescribed in paragraph d, the expected duration of the treatments specified must be at least one year at the frequency indicated.

Documents to provide if the child has an impairment related to the musculoskeletal system

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • The recent assessment with an occupational therapist or physiotherapist, if the child was assessed.

Hearing

A child whose state of health corresponds to one of the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to one of those cases, it will be assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped in the following cases:
  1. the child has an average air conduction threshold (500, 1000, 2000 and 4000 Hz) greater than 70 dB in his or her better ear without a hearing aid or a cochlear implant;
  2. the child is less than 6 years of age and has an average air conduction threshold (500, 1000, 2000 and 4000 Hz) greater than 40 dB in his or her better ear without a hearing aid.
Assessment parameters

The hearing assessment must be carried out by an audiologist and comply with the applicable standards of practice. The audiogram indicates the hearing threshold of pure sounds at 500, 1000, 2000 and 4000 Hz for both ears and the results are indicated in dBeHL. The validity of the assessment must be specified in the audiologist's report.

The assessment must reflect the child's usual abilities. In the case of conductive hearing loss, the hearing loss resulting from it must not be temporary, as it is the case for otitis. In the case of progressive hearing loss, more than one audiogram may be required.

Exclusion

A child with an auditory processing disorder is not presumed to be handicapped due to hearing.

Documents to provide if the child has an impairment related to hearing

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • The assessment reports from the last 12 months in audiology, including the audiogram and the case history;
  • The speech-therapy assessment report if the child was assessed.

Other impairments or multiple impairments

A child whose state of health corresponds to one of the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to one of those cases, it will be assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped in the following cases:
  1. the child is less than 2 years of corrected age and he or she was born prematurely at 25 weeks and 6 days of gestation or less;
  2. the child receives skin care at home for a severe and generalized condition at high risk of pressure wounds, webbing (scar adhesions) and contractures (e.g. Harlequin ichthyosis, severe junctional epidermolysis bullosa);
  3. the child is undergoing chronic corticosteroid therapy (e.g. Prednisone, hydrocortisone) administered at least every 2 days, either orally (by mouth) or intravenously, in doses equal to or higher than physiologic replacement therapy doses for adrenal insufficiency.
Assessment parameters

For the purposes of the analysis of a case prescribed in paragraph a, the specific gestational age at birth must be indicated in the assessment report.

Special rule

The expected duration of the treatments specified must be at least one year at the frequency indicated.

Documents to provide if the child has an impairment related to other impairments or multiple impairments

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • For extreme skin conditions, the medical follow-up for the past year with a dermatologist, including reports of emergency room visits and hospitalization summary sheets, if applicable;
  • For children undergoing corticosteroid therapy, the list of medications that were prescribed to the child (including refills) and obtained from a pharmacy within the last year.
  • For other cases, depending on the specialists with which you have met:
    • the medical follow-up for the past year, including and hospitalization summary sheets, if applicable;
    • the most recent assessment in psychology, speech therapy, occupational therapy and physiotherapy.

Cardiovascular function

A child whose state of health corresponds to one of the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to one of those cases, it will be assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped in the following cases:
  1. the child chronically takes antivitamin K anticoagulants following a valve replacement surgery with mechanical prosthesis;
  2. the child is less than 3 years of age and he or she has a congenital heart disease that requires palliation by the creation of univentricular physiology;
  3. the child has either a post-correction or post-palliation status congenital heart defect, or a chronic non-congenital heart disease and, despite receiving the recommended treatment, he or she is in one of the following situations:
    • he or she has a resting baseline saturation in room air below 92%, chronically and persistently;
    • he or she has a left ventricular ejection fraction that remains chronically and persistently below 30%;
  4. the child has symptomatic chronic pulmonary hypertension for which he or she undergoes a long-term vasodilator treatment daily;
  5. the child receives intravenous inotropes at home;
  6. the child uses a ventricular assist device at home (artificial cardiac pump or artificial heart);
  7. the child is on the waiting list for a heart transplant or has received one.
Assessment parameters

The medical report must include the level of activity that triggers cyanosis, dyspnea or tachycardia and the medically prescribed activity restrictions.

For the purposes of the analysis of a case prescribed in paragraph c, it must be repeatedly shown by recognized assessment measures that the ejection fraction remains below 30%.

For the purposes of the analysis of a case prescribed in paragraph g for a child placed on the transplant waiting list, he or she must have been placed on the list after being assessed by a transplant team.

Special rule

The expected duration of the treatments specified must be at least one year at the frequency indicated.

Exclusion

The child who has a heart defect or a heart disease without receiving active treatments, involving only medically prescribed restrictions or limitations in playing sports, is not presumed to be handicapped due to the cardiovascular function.

Documents to provide if the child has an impairment related to the cardiovascular function

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • The medical follow-up for the past year for the heart condition.

Renal and urinary functions

A child whose state of health corresponds to one of the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to one of those cases, it will be assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped in the following cases:
  1. the child is aged 5 or over and, despite receiving the recommended treatments, his or her daytime urinary incontinence occurs daily, requiring care and the use of incontinence products;
  2. the child uses a urinary catheter daily;
  3. the child has a vesicostomy or ureterostomy;
  4. the child has a chronic kidney disease and, despite receiving the recommended treatment, he or she has chronic kidney disease (stage 4 or over), with a glomerular filtration rate less than 30 ml/min/1.73 m2;
  5. the child undergoes dialysis (hemodialysis or peritoneal dialysis) on a regular basis;
  6. the child is on the waiting list for a kidney transplant or has received one.
Assessment parameters

In the case of a child diagnosed with chronic kidney disease, the glomerular filtration rate and the stage of the chronic kidney disease must be specified in the assessment report.

For the purposes of the analysis of a case prescribed in paragraph f for a child placed on the transplant waiting list, he or she must have been placed on the list after being assessed by a transplant team.

Special rule

The expected duration of the treatments specified must be at least one year at the frequency indicated.

Documents to provide if the child has an impairment related to the renal and urinary functions

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • The medical follow-up for the past year for the renal or urinary condition.

Respiratory function

A child whose state of health corresponds to one of the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to one of those cases, it will be assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped in the following cases:
  1. the child has a chronic respiratory disease and, despite optimal treatment in accordance with the applicable standards of practice, he or she has complications related to his or her disease that required treatment within the last 12 months, either
    • at least 3 episodes of oral or intravenous glucocorticoid administration (e.g. prednisone or dexamethasone); or
    • at least 3 hospitalizations of 48 hours or more each;
  2. the child was diagnosed with cystic fibrosis or ciliary dyskinesia and either
    • has a FEV1 at 60% or less of the predicted value; or
    • due to chronic respiratory symptoms, he or she receives nebulizer treatments chronically and daily and requires respiratory physiotherapy treatments chronically and daily (e.g. clapping);
  3. the child has a restrictive syndrome that reduces his or her vital capacity to 50% or less of the predicted value;
  4. the child is less than 12 years of age and uses a CPAP machine daily at home;
  5. the child undergoes oxygen therapy daily at home;
  6. the child uses a BPAP machine or a high-flow nasal cannula therapy daily at home;
  7. the child has a tracheotomy or a tracheostomy;
  8. the child is on the waiting list for a lung transplant or has received one.
Assessment parameters

In the case of an asthmatic child, the fact that asthma is inadequately controlled must be demonstrated in the medical report, using measures appropriate for the child's age, including information on the frequency of daytime and nighttime symptoms, tolerance to physical activity, frequency of rescue bronchodilator needs, peak expiratory flow variability, and results of bronchial provocation tests and respiratory function tests.

When respiratory physiotherapy is prescribed, the type and frequency must be specified in the medical report.

For the purposes of the analysis of a case prescribed in paragraphs b and c, FEV1 and vital capacity measurements should be carried out when the condition is stable, without any infection or acute decompensation.

For the purposes of the analysis of a case prescribed in paragraph h for a child placed on the transplant waiting list, he or she must have been placed on the list after being assessed by a transplant team.

Special rule

The expected duration of the treatments specified must be at least one year at the frequency indicated.

Hospitalizations during the child's first 6 months of life are not taken into account when calculating the number of hospitalizations in the presumption that refers to symptomatic chronic respiratory diseases despite optimal treatment in accordance with the applicable standards of practice.

Daily chronic nebulizer treatments refer to daily treatment throughout the year, not only during periods of respiratory exacerbations.

Documents to provide if the child has an impairment related to the respiratory function

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • The list of medications that were prescribed to the child (including refills) and obtained from a pharmacy within the last year;
  • The medical follow-up for the past year for the respiratory condition, including consultations with a pneumologist, reports of emergency room visits and hospitalization summary sheets, if applicable.

Congenital malformations and chromosomal and genetic abnormalities

A child whose state of health corresponds to one of the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to one of those cases, it will be assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped if he or she has a non-mosaic autosomal chromosome trisomy (trisomy 13, 18 or 21).
Assessment parameters

The result of the cytogenetic analysis, such as the karyotype, QF-PCR, FISH or microarray CGH, is required.

In the case of a child presenting a syndrome in which the types of malformations or the severity of impairments are not uniform in all affected children, it is essential to provide a detailed description of the manifest impairments, the child's abilities and disabilities, and their consequences on his or her functioning.

Documents to provide if the child has an impairment related to congenital malformations and chromosomal abnormalities

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • The results of the karyotype examination;
  • The genetic assessment;
  • Depending on the specialists with whom you have met, the medical follow-up for the past year.

If language or cognitive development is impaired, or if there are behavioral difficulties, please refer to the Mental function disabilities section.

Eyesight

A child whose state of health corresponds to one of the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to one of those cases, it will be assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped in the following cases:
  1. the child is aged 1 or over, has an ocular disease and has a visual acuity of 6/21 or less in binocular vision after appropriate optical correction;
  2. the child has a field of vision for both eyes of less than 60 degrees at the widest diameter, measured by focusing on a central point, in binocular vision after appropriate optical correction (e.g. contact lenses or glasses).
Assessment parameters

Visual acuity must be measured in both eyes simultaneously, after correction with appropriate refractive lenses.

The method used to measure visual acuity must be specified in the expert's report.

The validity and reliability of the assessment, for both visual acuity and the fields of vision, must be specified in the expert's report. The assessment must reflect the child's visual abilities and the results must not be influenced by behavioural or cognitive difficulties.

Documents to provide if the child has an impairment related to eyesight

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • The assessment and follow-up with an optometrist or ophtalmologist in the last year;
  • The occupational therapy assessment report related to the visual impairment if the child was assessed.

The requirements are excerpts from Schedule A to the Regulation respecting the Taxation Act.

The documents that the family and health or education professionals must enclose with the application are specified under each disability category.

Intellectual impairment

A child whose state of health corresponds to one of the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to one of those cases, it will be assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped in the following cases:
  1. the child is at least six years of age and his or her global IQ is 50 or less, for a confidence interval of 95%;
  2. the child is at least six years of age and meets the following criteria:
    • his or her global IQ is in the 2nd percentile or below, for a confidence interval of 95%,
    • the assessment of his or her adaptive behaviour shows that the score on one of the three components assessed among the conceptual, social and practical components, or the overall score for these three components, is in the 2nd percentile or below, for a confidence interval of 95%, in at least two of the child's living environments.
Assessment parameters

Assessments must be conducted by the member of a professional order, through recognized standardized tests and in accordance with the applicable standards of practice, when the child is at least six years of age.

The professional's assessment report must describe the child's abilities and disabilities, present the professional's observations and enable Retraite Québec to rule on the validity of the results obtained.

Exclusion

A child who was not exposed on a sustained basis, for a period of at least two years, to the language used in the assessment tests is not presumed to be handicapped due to an intellectual impairment. In this respect, a child will be considered to be exposed on a sustained basis to the language used in a test if, for at least 40% of his or her waking hours, the child interacts with a person who is proficient in that language.

Documents to provide if the child has an intellectual impairment

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • The most recent assessment with a psychologist or neuropsychologist (intellectual and adaptive behaviour assessment, if it was carried out);
  • The most recent individual education plan, if any;
  • The most recent report card, if any.

Global developmental delay

A child whose state of health corresponds to one of the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to one of those cases, it will be assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped if he or she is at least two years of age and less than six years of age, and meets at least two of the following criteria:
  1. the child's global IQ or the score on a scale assessing his or her level of cognitive development is in the 2nd percentile or below, for a confidence interval of 95%;
  2. the overall result on a test of the child's gross and fine motor skills is in the 2nd percentile or below;
  3. the score on a receptive vocabulary test standardized for child's population group, is in the 2nd percentile or below.
Assessment parameters

Assessments must be conducted by the member of a professional order, through recognized standardized tests and in accordance with the applicable standards of practice, when the child is at least two years of age and less than six years of age.

The professional's assessment report must describe the child's abilities and disabilities, present the professional's observations and enable Retraite Québec to rule on the validity of the results obtained.

Exclusion

A child who was not exposed on a sustained basis, for a period of at least two years, to the language used in the assessment tests is not presumed to be handicapped due to a global developmental delay. In this respect, a child will be considered to be exposed on a sustained basis to the language used in a test if, for at least 40% of his or her waking hours, the child interacts with a person who is proficient in that language.

Documents to provide if the child has a global developmental delay

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • Depending on the specialists with whom you have met, the most recent assessment in occupational therapy, physiotherapy, speech therapy and psychology.

Serious behavioural disorders

A child whose state of health corresponds to one of the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to one of those cases, it will be assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped if the following criteria are met:
  1. the child is at least four years of age and displays at least two of the following behaviours:
    • physical aggression toward himself or herself, or others;
    • defiance of authority through an obstinate refusal to follow instructions and the rules in effect in a given environment;
    • temper tantrums that significantly exceed the norm for the child's stage of development;
    • deliberate engagement in vandalism;
  2. despite the implementation of therapeutic measures recommended by members of a professional order, displays of these behaviours present all of the following characteristics:
    • high level of intensity;
    • high frequency;
    • consistency, that is, the behaviours exist in the child's various living environments.
Assessment parameters

The professional's assessment report must describe the nature and seriousness of the disorder and its consequences from a school, family and social standpoint, as well as the child's abilities and disabilities and the professional's observations.

Exclusion

A child who presents with an attention deficit disorder with or without hyperactivity and whose symptoms are controlled through medication is not presumed to be handicapped due to a serious behavioural disorder.

Documents to provide if the child has a serious behavioural disorder

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • The list of medications that were prescribed to the child (including refills) and obtained from a pharmacy within the last year;
  • Depending on the specialists with whom you have met, the most recent assessment in neuropsychology, child psychiatry, psychologist and psycho-education;
  • The medical follow-up from the last 12 months for behavioural disorders.

Autism spectrum disorder (ASD)

A child whose state of health corresponds to one of the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to one of those cases, it will be assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped in the following cases:
  1. the child is at least two years of age, has been diagnosed with an autism spectrum disorder and presents at least four of the following characteristics:
    • does not use gestures to communicate;
    • does not show interest in others;
    • does not respond to social smiles, even with people he or she knows;
    • does not have fun with others, even with people he or she knows;
    • does not share interests with others by showing or bringing objects;
    • does not pay attention to an object pointed to by another person;
    • does not respond verbally or non-verbally to verbal  messages;
    • does not imitate the behaviour of others;
    • does not engage in functional play;
  2. the child is at least three years of age, has been diagnosed with autism spectrum disorder and is non-verbal;
  3. the child is at least three years of age and less than six years of age, has been diagnosed with autism spectrum disorder and meets at least two of the following criteria:
    • his or her global IQ or the score on a scale assessing the child's level of cognitive development is at least 1.5 standard deviations below average;
    • the global result on a test of the child's gross and fine motor skills is at least 1.5 standard deviations below average;
    • the scores on all receptive language tests are at least 1.5 standard deviations below average;
  4. the child is at least five years of age, has been diagnosed with an autism spectrum disorder and his or her global IQ is in the 5th percentile or below, for a confidence interval of 95%;
  5. the child is at least four years of age, has been diagnosed with an autism spectrum disorder and, despite the implementation of therapeutic measures recommended by members of a professional order:
    • has temper tantrums in his or her various living environments, the frequency, duration and intensity of which are high and significantly exceed the norm for the child's stage of development; or
    • displays physical aggression toward himself or herself, or others, in his or her various living environments, the frequency and intensity of which are high and significantly exceed the norm for the child's stage of development.
Assessment parameters

An assessment that results in the diagnosis of an autism spectrum disorder must be conducted when the child is at least two years of age. The disorder must be confirmed in an assessment report by the member of a professional order.

The professional's assessment report must describe the child's abilities and disabilities, present the professional's observations and, where applicable, enable Retraite Québec to rule on the validity of the results obtained.

For the purpose of analysis of a case set forth in paragraph (a), information on communication and social interaction must be corroborated by more than one source, such as by observations by the parents and childcare workers or school social workers presented in the professionals' assessment reports, and by those of professionals during their interactions with the child.

For the purpose of analysis of a case set forth in paragraph (c), assessments must be conducted by the member of a professional order, through recognized standardized tests and in accordance with applicable standards of practice, when the child is at least three years of age and less than six years of age, and the professional's assessment report must enable Retraite Québec to rule on the validity of the results obtained.

For the purpose of analysis of a case set forth in paragraph (d), an assessment must be conducted by the member of a professional order, through recognized standardized tests and in accordance with applicable standards of practice, when the child is at least five years of age, and the professional's assessment report must enable Retraite Québec to rule on the validity of the results obtained.

For the purpose of analysis of a case set forth in paragraph (e), information on the nature, intensity, duration and frequency of the disruptive behaviour must be corroborated by more than one source, such as by observations by the parents and childcare workers or school social workers presented in the professionals' assessment reports and progress notes, and by intervention plans at a daycare, school or rehabilitation centre.

Exclusion

In the cases set forth in paragraphs (c) and (d), a child who was not exposed on a sustained basis, for a period of at least two years, to the language used in the assessment tests is not presumed to be handicapped due to autism spectrum disorder. In this respect, a child will be considered to be exposed on a sustained basis to the language used in a test if, for at least 40% of his or her waking hours, the child interacts with a person who is proficient in that language.

Documents to provide if the child has an autism spectrum disorder

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • The complete assessment report that led to the diagnosis of ASD;
  • Depending on the specialists with whom you have met, the most recent assessment in psychology, neuropsychology, speech therapy, occupational therapy and physiotherapy.

Language disorders

A child whose state of health corresponds to one of the cases mentioned below is presumed to be handicapped. If his or her condition does not correspond to one of those cases, it will be assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

A child is presumed to be handicapped in the following cases:
  1. the child is over age two and does not have at least four of the following pre-language skills:
    • joint attention;
    • motor imitation;
    • verbal imitation;
    • use of gestures to communicate;
    • turn-taking in conversation;
  2. the child is aged three or over and, in various contexts, expresses him- or herself with single words, and it is shown that he or she cannot understand simple questions such as "who?", what?", and "where?" in relation to familiar objects or people present in the child's immediate environment;
  3. the child is aged three or over and is persistently unable to pronounce words with two different syllables;
  4. the child is at least four years of age and less than six years of age and the scores on formal assessment tests are corroborated by a qualitative analysis of his or her day-to-day language skills and:
    • with respect to receptive language, the child obtains scores equal to or below the 5th percentile on at least three tests standardized for the child's population group, and obtains no scores above the 5th percentile on any other test; or
    • with respect to expressive language, at least two of the following language components are impaired:
      • regarding vocabulary, the child obtains scores equal to or below the 5th percentile on at least one test standardized for the child's population group;
      • regarding production of sounds, the child persistently makes a wide range of mistakes that are frequent and unusual for his or her age, making the child's speech unintelligible most of the time;
      • regarding sentence structure, the child's sentences are ungrammatical and no more than three or four words long;
  5. the child is age six or over, the scores on formal assessment tests are corroborated by a qualitative analysis of his or her day-to-day language skills and:
    • with respect to receptive language, the child obtains scores equal to or below the 5th percentile on at least three tests standardized for the child's population group, and obtains no scores above the 5th percentile on any other test; or
    • with respect to expressive language, at least two of the following language components are impaired:
      • regarding vocabulary, the child obtains scores equal to or below the 5th percentile on at least one test standardized for the child's population group;
      • regarding production of sounds, the child persistently makes a wide range of mistakes that are frequent and unusual for his or her age, making the child's speech unintelligible most of the time;
      • regarding sentence structure, the child uses simple syntactic structures, mostly without grammatical markers, and cannot use complex syntactic structures;
  6. the child is at least nine years of age and less than 15 years of age, and his oral or written language disorder delay his or her acquisition of reading and mathematics skills, with the result that they are below those of a child two-thirds his or her age;
  7. the child is at least 15 years of age, and his or her oral or written language disorder delay his or her acquisition of reading and mathematics skills, which are no longer progressing beyond the second cycle of elementary school despite the child's still being in school.
Assessment parameters

A language disorder must be assessed by a speech therapist, in accordance with the applicable standards of practice.

A speech therapist's report for a particular case must describe the child's language skills for a period that may not precede the time the child reaches the minimum age provided for in regard to that case. It must also describe interpreted data of the assessment of communication, speech and all components of receptive and expressive language. This analysis must be corroborated by more than one document, such as by intervention plans at a daycare, school or rehabilitation centre.

In the cases set forth in paragraphs d) and e), the three formal tests referred to respecting receptive language must demonstrate different aspects of comprehension. In this regard, a subtest that demonstrates a specific aspect of comprehension may count as a test.

In the case of children exposed to more than one language, the attending speech therapist interprets the language data for the child, taking explicit account of the multilingual context, and the following information must be on file:

  • mother tongue or tongues, language or languages spoken at home and dominant language or languages;
  • the age of exposure, and the duration and percentage of exposure, to each of the languages.
Exclusion

A child who is assessed in a single language he or she is learning is not presumed to be handicapped due to a language disorder, unless the child was exposed to that language on a sustained basis for a period of at least two years. In this regard, a child will be considered to be have been exposed on a sustained basis to the language he or she is learning if, for at least 40% of his or her waking hours, the child interacts with a person who is proficient in that language.

Documents to provide if the child has a language disorder

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • The recent and complete speech-therapy assessment, including the case history;
  • The speech therapy progress notes, if any;
  • The most recent individual education plan, if any;
  • The most recent report card, if any.

Psychopathological disorders

There are no presumed cases of psychopathological disorders. The child's condition is assessed based on the severity of his or her limitations with regard to carrying out life habits for a period expected to last at least one year. The assessment takes into account the disabilities resulting from the impairment or mental function disability, as well as factors in the child's environment that facilitate or inhibit his or her ability to carry out his or her life habits. The severity of the limitations is assessed after treatments and measures likely to improve the child's condition have started.

Documents to provide if the child has a psychopathological disorder

Document the parent must provide:

If you have the following documents on hand, you can also enclose them with your application:

  • The list of medications that were prescribed to the child (including refills) and obtained from a pharmacy within the last year;
  • The most recent child psychiatry or psychology assessment, if the child was assessed;
  • The medical follow-up from the last 12 months for psychopathological disorders.

Analysis of eligibility: Assessment of the severity of the disability

If none of the requirements of Schedule A to the Regulation respecting the Taxation Act apply to the child's condition, the analysis will be continued with an assessment of the severity of the disability. The assessment is not based on a diagnosis only. A child who has a physical impairment or a mental function disability may be eligible for the Supplement for Handicapped Children if he or she has significant limitations in carrying out his or her life habits compared with what is expected of a child his or her age. These limitations must be present for a foreseeable period of at least one year, despite implemented facilitators and treatments. The child's functioning in his or her various living environments is taken into account in the assessment.

Disabilities and severity of limitations

A child is disabled if there is a discrepancy between the level of carrying out his or her daily life habits and the level expected for a child of his or her age who does not have any physical impairment or mental function disability. Where the discrepancy related to the standard becomes significant, the child's situation can entitle him or her to the Supplement for Handicapped Children based on defined rules.

The five following elements are taken into account to assess the child's limitations in carrying out his or her life habits:

  • The assessment of the limitations considers the child's abilities and disabilities regarding various physical and mental skills.
    • The child's disabilities can be improved with age and stimulation or following therapeutic interventions.
    • New disabilities can be pointed out over time.
    • For the same diagnosis, two children can have different abilities and disabilities.
    • The disabilities related to all the diagnoses of the child are taken into account.
  • The more the child has disabilities (in numbers and severity), the greater the level of his or her limitations in carrying out his or her life habits according to what is expected from a child of his or her age will be.

  • Between a child's birth and age 18, a child with no health problems goes from being totally dependent on an adult to being completely autonomous in carrying out life habits. The expectations regarding his or her participation are very different depending on the child's age.
  • Certain disabilities can have different consequences if we compare a newborn with a child of school age or a teenager.
    • Example: a two-year-old child who is still not toilet trained will not be limited as compared to a 12-year-old child in the same situation.

  • The child's various living environments can include, as the case may be, his or her family environment, daycare, school, etc.

  • A facilitator is an environmental factor (physical or social) which facilitates the ability to carry out life habits.
  • An obstacle is an environmental factor (physical or social) that inhibits the ability to carry out life habits.

  • The child's significant limitations in carrying out his or her life habits are assessed after treatments and measures likely to improve the child's state of health have started.
  • A child cannot be considered to be eligible if the treatments or measures likely to improve his or her state of health are not applied, without good reason.

Life habits taken into consideration

The life habits taken into consideration when processing applications are those that a child should be able to carry out, depending on his or her age, with respect to his or her personal care and social life. The life habits are the following:

Depending on the child's age, this includes the following activities:

  • Breastfeeding or drinking from a baby bottle, a sippy cup or straw, a bottle, a mug or a glass.
  • Eating enough food to ensure his or her growth.
  • Swallowing liquids and foods of different textures and consistencies without severe choking or aspiration pneumonia.
  • Bringing food to the mouth with his or her fingers.
  • Using different utensils (the child's ability to use them is what will be taken into account, not his or her choice to do so).
  • Opening containers, having a snack or helping prepare a simple meal (bowl of cereal or sandwich).
  • Using a toaster, microwave and other kitchen tools.

Depending on the child's age, this includes the following activities:

  • Becoming toilet trained for urine and bowel movements. Using the toilet.
  • Ensuring personal hygiene (washing hands and face, bathing or showering, brushing teeth, caring for hair, etc.).
  • Dressing and undressing himself or herself (upper and lower body).
  • Using sanitary pads or other menstrual hygiene products appropriately.
  • Participating in health care and following treatment instructions.

Depending on the child's age, this includes the following activities:

  • Lifting his or her head;
  • Turning onto his or her back when on his or her stomach and vice versa;
  • Assuming and maintaining a sitting position;
  • Crawling;
  • Rising from the floor or a chair;
  • Standing;
  • Moving from one position to another;
  • Walking;
  • Using stairs.

Depending on the child's age, this includes the following activities:

  • Seeing and hearing.
  • Being attentive to verbal messages.
  • Understanding and using gestures.
  • Understanding pictograms (images) and using them to communicate.
  • Understanding verbal instructions (simple and complex).
  • Expressing himself or herself verbally using words and sentences.
  • Expressing himself or herself in a way that others can understand.
  • Speaking to communicate with another person (greeting and naming a person, making comments and requests, protesting, answering, asking questions, telling stories or recounting an event, providing explanations, arguing, discussing, etc.).

Depending on the child's age, this includes the following activities:

  • Connecting with others.
  • Sharing interests with others.
  • Showing interest in others.
  • Taking into account what others say.
  • Maintaining affective relationships with his or her family (parents, brothers and sisters).
  • Building and maintaining bonds with other children.
  • Participating in group activities and working as a team.
  • Maintaining relationships with adults other than his or her parents.
  • Adapting his or her behaviour in relationships with others (respecting authority, avoiding aggressive and disrespectful behaviour, etc.).
  • Complying with social conventions (greeting people, using appropriate language, respecting rules in different contexts, respecting others' personal space, etc.).

Depending on the child's age, this includes the following activities:

  • Having the ability to adapt to different environments.
  • Memorizing information to use in everyday life (basic personal information, simple instructions, steps in routines, routes between familiar places, etc.).
  • Understanding and respecting rules and safety instructions.
  • Collaborating in activities and tasks expected of him or her, according to his or her age and environment.
  • Developing his or her autonomy regarding daily routines, tasks and activities.
  • Being able to ask for help when necessary.
  • Controlling his or her behaviour and not endangering others or himself or herself.
  • Solving everyday problems (reacting to unexpected situations, trying out solutions when facing difficulties, etc.).
  • Staying alone for short periods of time.
  • Recognizing the value of money, making small purchases, etc.

Depending on the child's age, this includes the following activities:

  • Being able to interact with his or her environment (exploration, appropriate use of toys and objects).
  • Developing play skills (block games, puzzles, role play or pretend play, board games, etc.).
  • Developing preschool skills (drawing, cutting, crafts, knowledge of colors and shapes, etc.).
  • Learning school notions (reading, writing, calculating, etc.).
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