”Why did they qualify but I didn’t?” – A diagnosis of ADHD is not an automatic guarantee of qualifying for disability allowance

Disability allowance can be paid for a child under 16 who has an illness or disability that puts a strain on the child’s parents or guardians for a period of at least six months. Once the child turns 16, they must submit a new application for disability allowance. At that point, the qualifying criteria will be tighter. In order to qualify, the applicant themselves must experience significant, long-term strain on account of their illness or disability.

Two illustrative examples where a young person applies for disability allowance for persons aged 16 or over

In the first case, the application for disability allowance is approved, while in the second, it is denied. In each case, the applicant is a 17-year-old who attends vocational school.

Application is approved (Person A)

• Person A has difficulties with time management. Person A gets up in time but is easily distracted by other things and leaves home late for school. Person A’s mother calls every morning to remind them that it is time to leave for school. Person A may forget to have breakfast or wash up.
• Person A has been treated in an inpatient setting due to anxiety and moderate depression. Person A is on medication and has regular consultations with a psychiatric nurse. Person A has problems with sleep and school because of their anxiety, but they respond well to encouragement.
• Person A’s ADHD medication helps with school, but the effect wears off in the evening, weakening their concentration and emotional control.
• Person A has been in occupational therapy for two years. They received small-group instruction while in comprehensive school, but now that they are in vocational school, Person A attends language instruction in a workshop setting. Person A is allowed to take longer to complete their vocational qualification if needed, and their coordinating teacher is supportive.

Application is denied (Person B)

• Person B stays up late and is tired in the morning. Person B’s parents try to instil good sleeping habits but to no avail.
• Person B has a few friends at school but is uncomfortable in social situations. They have difficulty controlling their emotions and no longer go in for sport.
• Person B is doing well in school and is interested in learning an occupation. Their parents keep reminding them to do their school work, but Person B is easily distracted by more pleasant things.
• Person B received small-group instruction while in comprehensive school, but they have now transferred to a larger group. Person B has been prescribed ADHD medication but does not want to take it.

How do the two cases differ?

The key difference is the type of impairment caused by the illness or disability. The allowance cannot be granted without a significant degree of impairment. To determine this, Kela uses the classification of impairment also used by insurance companies, specifically the section on limited function/disability, not otherwise specified. The degree of impairment is assessed primarily by doctors in their role as medical advisors, but follow-up decisions may also be made by Kela employees who process benefit applications. As a general rule, to meet the requirement of significant impairment one must have a moderate functional limitation.

In the two illustrative cases, the person whose application was approved (Person A) is in contact with and undergoing treatment provided by adolescent psychiatry services. Person A has also been depressive, and they have received therapy and been put on medication, but they still need support and guidance on a continuous basis. The person whose application was denied (Person B), on the other hand, was deemed not to need such support because their situation is somewhat less difficult.

The illness or disability must also be treated appropriately. Medication is not a requirement, but there must be a good reason for not taking prescribed medication.

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