Autism In Singapore: How Much Can Parents Expect To Spend On Their Autistic Child During Preschooling Years

This article was contributed to us by Julia Chan. Information and views shared in this article are based on her own personal experience.

In a 2016 article, TODAY reported a jump in pre-schoolers diagnosed with developmental issues, including autism. Increasingly, Singaporeans are also gaining more awareness about autism and the challenges it presents.

However, there is still a big gap in understanding what a child with autism and his/her family go through emotionally and financially.

For instance, some families are unsure about whether seeking a confirmed diagnosis and putting their child “in the system” to receive early intervention is really the right choice. In addition, there isn’t much information online about how much early intervention for a child with autism actually costs.

Not knowing the roadmap ahead can cause families a significant amount of stress, adding to the fear that they cannot cope with the social stigma and financial costs of autism.

I’ve been down this road before a few years ago. And what I want to share with you today (I hope) will help you plan your financial roadmap ahead.

*All costs have been rounded to the nearest dollar.

What Are The Upfront Costs Of Diagnosing Autism?

When I first learnt that my son had suspected autism, my initial reaction was disbelief and denial.

However, I didn’t want to live with my head stuck in sand, pretending his autistic traits would disappear as he grew up. So I called the nearby polyclinic to make an appointment and obtain a referral letter to KK Hospital’s (KKH) Child Development Unit.

Together with a letter from his preschool, we made that first visit to KKH to see a specialist who gave a first diagnosis, followed by a second visit to KKH to see another specialist who gave us a second opinion.

As both specialists’ opinions concurred, we were then scheduled for the following:

– A formal psychological assessment to officially diagnose him

– An occupational therapy (OT) assessment to diagnose his OT needs

– A parent training workshop called Talkers to teach us on speech therapy

Finally, we went to visit one of the KKH specialists a third time to give us the results of the psychological assessment, which turned out to be a positive diagnosis.

All these happened within the span of half a year. Naturally, I had to take leave on seven different days to get him officially diagnosed and attend a speech therapy workshop. The prices below are from 2016 and costs may have risen since.

Cost Of Diagnosis

	Item	Description	Location	Estimated time	Fees	Government subsidy	Subsidised cost
1	Polyclinic	Get referral letter for KKH	Polyclinic	20 min	$7^	N.A	$7
2	Specialist	First visit (for first opinion)	KKH	1 hour	$93	$56	$37
		Second visit (for second opinion)	KKH	30 min	$68	$41	$27
		Third visit (for results of psychological assessment)	KKH	30 min	$75	$45	$30
3	Tests	Psychological Assessment (official diagnosis)	KKH	2 hours	$459	$229	$230
4	Therapy	Occupational Therapy (assessment)	KKH	45 min	$82	$41	$41
5	Training	Talkers workshop (speech therapy)*	KKH	3 hours	$77	$66	$11
		TOTAL			$861	$478	$383

* The workshop fee of $66 was covered under the Caregivers Training Grant (which has a budget of $200 every financial year for us to use).

^ We could not find information on the amount of government subsidies for child patients at polyclinics.

The Interim Before Getting A Place In An EIPIC Centre

Just because your child has autism doesn’t mean there’s automatically a spot for him/her in an EIPIC centre.

EIPIC stands for Early Intervention Programme for Infants and Children. If I can give an analogy, this programme is like a CCA to mainstream preschools where students learn coping strategies with their unique conditions.

In 2016, we were informed that the waiting time to enrol my son in an EIPIC centre was 6 to 18 months, so while waiting for a place, we sent him for monthly occupational and speech therapy sessions run by KKH.

My husband and I also attended the Next Step workshop and Signposts workshop, which help parents understand the EIPIC system and interventions we can apply as a family to help our child.

The EIPIC centre we applied for did their own assessment of my son’s suitability for their courses, before placing him on the waitlist.

	Item	Description	Location	Estimated time	Fees	Government subsidy	Subsidised cost
1	Therapy	Occupational Therapy (Session 1)	KKH	45 min	$82	$41	$41
		Occupational Therapy (Session 2)	KKH	45 min	$82	$41	$41
		Speech Therapy (assessment)	KKH	45 min	$82	$41	$41
		Speech Therapy (Session 1)	KKH	45 min	$82	$41	$41
2	Training	Next Step workshop (introduction to EIPIC and Signposts)	KKH	Half Day	$0	$0	$0
		Signposts workshop (5 lessons)	KKH	2.5h x 5 lessons	$395	$316	$79
3	EIPIC	Pre-enrolment assessment	EIPIC	45 min	$32	$0	$32
		TOTAL			$755	$480	$275

 

Earlier this year, TODAY reported that the average waiting time to enrol is less than five months. The Ministry for Social and Family Development also announced that there are 500 more EIPIC spaces in 2018, for a total of 3,200 infants and young children. So it’s possible that you won’t have to wait that long to enrol your child in an EIPIC Centre.

MSF also offers other options such as the Enhanced Pilot for Private Intervention Providers (Enhanced PPIP) and the Integrated Child Care Programme (ICCP).

EIPIC Costs

Depending on which EIPIC centre you enrol your child in, the centre will have its own policies and additional charges.

The EIPIC centre my son went to requires a one month deposit, additional outing fees and insurance.

Although we can take back the deposit, there are instances where it will be forfeited e.g. withdrawal from the EIPIC centre without advance notice.

	Item	Description	Where	Estimated time	Fees	Government subsidy	Subsidised cost
1	EIPIC	Deposit (1 month)	EIPIC		$824	$0	$824
		Intervention fees (27 months)	EIPIC	6 hours a week	$35,599	$16,796	$18,803
		Outing fees (9 terms)	EIPIC	once a term	$320	$0	$320
		Insurance (3 calendar years)	EIPIC	once a year	$15	$0	$15
		TOTAL			$36,758	$16,796	$19,962

 

Many of the EIPIC Centres charge $770 (before GST) a month, after taking into account the $500/month government subsidy for Singapore citizens.

Families with lower household income can apply for additional MSF subsidies via means testing. But for the average dual income family where both parents earn a median salary, they may not receive additional subsidies.

The intervention classes are usually held during office hours, and some do not provide school buses, meaning parents (or caregivers) need to accompany their children to the centre. Some centres require parents to participate or observe the classes on a regular basis too.

One important thing parents should note is: EIPIC centres also follow MOE school terms – this means that intervention classes only run during school term (and not during school holidays).

However you still have to pay EIPIC fees during the school holidays, the same way that primary and secondary schools also charge during school holidays.

On top of this, as EIPIC lessons are only a few hours a week, parents still need to pay for childcare fees.

Families with caregiver help can save some money by enrolling their children in kindergarten or half day childcare.

However families without caregiver help will still need to pay full day childcare fees (as on days without EIPIC lessons, these families still need childcare help) and especially during school holidays.

By the way, the median full day childcare fees (not included in our tally for this article on autism) is $883 a month before government subsidies.

Follow-Up And Preparation For Primary School

Whilst all of the above are going on, you’ll still need to take your child to meet the specialist doctor around once to twice a year.

You’ll also have to send your child for another psychological assessment which is required by a SPED (aka special education) school if you don’t intend to enrol your child in a mainstream primary school.

	Item	Description	Location	Estimated time	Fees	Government subsidy	Subsidised cost
1	Specialist	Repeat visit (follow up – 2017)	KKH	30 min	$83	$50	$33
		Repeat visit (follow up – 2018)	KKH	30 min	$93	$37	$56
		Repeat visit (second follow up – 2018)	KKH	30 min	$93	$37	$56
2	Tests	Psychological Assessment (for Primary 1 SPED application)	KKH	2 hours	$558	$279	$279
		SPED school application	SPED	2 hours	$0	$0	$0
		TOTAL			$827	$403	$424

 

In addition, some parents send their preschoolers to additional private intervention classes such as occupational therapy, speech therapy and social classes. These classes can range from $30 to $200 an hour, depending on the type of intervention, the experience of the therapist/teacher and school.

Conclusion

In summary, this is what you can expect to spend on autism for your preschooler (based on my own expenses):

– Listed costs (before subsidies): $39,201

– Government subsidies: $18,157

– Expected costs (after government subsidy): $21,044

Another hidden cost is the time that parents spend on taking their preschooler to the doctor, for tests, to intervention classes and outings, and other miscellaneous activities that are required when you’re “in the system”.

This places a heavy burden on working class families who either 1) depend on a single income, or 2) put pressure on dual income families (who don’t have additional caregivers) to find time during working hours to accompany their children to these various activities.

If you don’t have the option of flexible working hours (via flexi-work arrangements, part time, freelance employment), be prepared to give up your career progression and/or even your job.

Whilst the government is funding about 46% of the costs, forking out more than $20,000 is still financially a huge challenge for many parents. However, that’s just the way it is in Singapore, at least for now.

Julia Chan is a working mother who intends to survive till she can retire and travel around the world. She likes to explore diverse perspectives and uncover hidden treasures on her blog Jules of Singapore.

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