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I-3, r. 1 - Regulation respecting the Taxation Act

Full text

In force date

2024-06-26 Show full text at this date

SCHEDULE A

(ss. 1029.8.61.19R2 and 1029.8.61.19R3)

TABLES OF PRESUMED CASES OF SERIOUS HANDICAP

(1) IMPAIRMENTS

1.1

Sight

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) 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;

(b) 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.

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.

1.2

Hearing

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child has an average air conduction threshold (500, 1,000, 2,000 and 4,000 Hz) greater than 70 dB in his or her better ear without a hearing aid or a cochlear implant;

(b) the child is less than 6 years of age and has an average air conduction threshold (500, 1,000, 2,000 and 4,000 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, 1,000, 2,000 and 4,000 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.

1.3	Musculoskeletal system

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) 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;

(b) the child has had complete brachial plexus palsy persisting for at least 3 months;

(c) the child is at least 2 years of age, has paresis or plegia of one or both upper limbs and, despite the application of 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;

(d) the child is at least 3 years of age, has significant motor disabilities secondary to an impairmentand, 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 or bilateral crutches;

(e) the child has an agenesis or amputation of a limb which, despite the application of 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;

(f) 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 rules

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.

1.4	Respiratory function

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) 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; or

— at least 3 hospitalizations of 48 hours or more each;

(b) 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;

(d) the child is less than 12 years of age and uses a CPAP machine daily at home;

(e) the child undergoes oxygen therapy daily at home;

(f) the child uses a BPAP machine or a high-flow nasal cannula therapy daily at home;

(g) the child has a tracheotomy or a tracheostomy;

(h) 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 rules

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.

1.5	Cardiovascular function

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child chronically takes antivitamin K anticoagulants following a valve replacement surgery with mechanical prosthesis;

(b) 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;

(c) the child has either a post-correction or post-palliation status congenital heart defect, or a chronic non-congenital heart disease and, despite the application of 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%;

(d) the child has symptomatic chronic pulmonary hypertension for which he or she undergoes a long-term vasodilator treatment daily;

(e) the child receives intravenous inotropes at home;

(f) the child uses a ventricular assist device at home;

(g) 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.

1.6	Nervous system abnormalities

Presumed case of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 if the child has drug-resistant epilepsy and, despite the application of optimal treatment, he or she is in one of the following situations:

(a) 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;

(b) 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;

(c) he or she has epileptic seizures at a frequency equal to or greater than at least once a week for 3 consecutive months;

(d) classic ketogenic diet, managed by a multidisciplinary team specializing in neurology, is medically required to treat his or her epilepsy.

Assessment parameter

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.

1.7	Nutrition and digestion

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child receives daily enteral nutrition at home, either gastric or jejunal;

(b) the child receives a parenteral nutrition at home;

(c) the child is less than 3 years of age and underwent surgery for a high-type anorectal congenital malformation or for Hirschsprung disease;

(d) the child has neurogenic bowel secondary to a spinal cord injury, and chronically receives medically prescribed retrograde intestinal irrigations, at least every 2 days;

(e) the child chronically receives medically prescribed antegrade intestinal irrigations through a stoma, at least every 2 days, related to fecal continence problems;

(f) the child has a colostomy or ileostomy;

(g) the child is on the waiting list for a liver or intestinal transplant or has received one;

(h) 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.

Special rule

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

1.8	Renal and urinary functions

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is aged 5 or over and, despite the application of the recommended treatments, his or her daytime urinary incontinence occurs daily, requiring care and the use of incontinence products;

(b) the child uses a urinary catheter daily;

(d) the child has a chronic kidney disease and, despite the application of 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;

(e) the child undergoes dialysis on a regular basis;

(f) 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.

1.9	Metabolic, hematological or hereditary abnormalities

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child has been diagnosed with cystic fibrosis and, in the last 12 months, he or she required a daily pancreatic enzyme supplements treatment and therapeutic interventions related to documented pulmonary complications;

(b) the child has been diagnosed with inborn errors of metabolism resulting in a 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 the application of 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 the application of the recommended treatment, and that has been present from the first year of the child’s life or before the diagnosis was made;

(c) the child is less than 7 years of age and has sickle cell disease related to HbSS, HbSC or HbSß-thalassemia hemoglobinopathies;

(d) 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;

(e) 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 rules

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.

1.10	Immune system abnormalities and neoplasia

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child has food allergies and

— follows a strict avoidance diet for at least 3 of the following allergen groups and one of which is cow’s milk:

– cow’s milk;

– eggs;

– peanuts and nuts;

– wheat, barley, oats and rye;

– other selected cereals: corn, rice and buckwheat;

– soya;

– other selected legumes: green peas, yellow peas, lentils and chickpeas,

– mustard;

– sesame;

– beef;

– 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;

(b) the child has significant prolonged immunosuppression related to a condition or treatment and, despite the application of 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;

(d) 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 rules

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.

1.11	Congenital malformations and chromosomal and genetic abnormalities

Presumed case of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 if the child has a non-mosaic autosomal chromosome trisomy.

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.

1.12	Other impairments or multiple impairments

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) 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;

(b) the child receives skin care at home for a severe and generalized condition at high risk of pressure wounds, webbing and contractures;

(c) the child is undergoing chronic corticosteroid therapy, administered at least every 2 days, either orally or intravenously, in doses equal to or higher than physiologic replacement therapy doses for adrenal insufficiency.

Assessment parameter

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.

2. MENTAL FUNCTION DISABILITIES

2.1 Global developmental delay

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 if the child is at least 2 years of age and less than 6 years of age and meets at least 2 of the following criteria:

(a) the child’s full scale intelligence quotient or the scale scores assessing the child’s level of cognitive development are in the 2nd percentile or below, for a confidence interval of 95%;

(b) the global scores on a test assessing the child’s global and fine motor skills are in the 2nd percentile or below; and

(c) the scores on a receptive vocabulary test normalized for the child’s population group are in the 2nd percentile or below.

Assessment parameters

The assessments must be conducted by a member of a professional order, through recognized normalized tests and in accordance with the applicable standards of practice, when the child is at least 2 years of age and less than 6 years of age.

The professional’s assessment report must contain a description of the child’s abilities and disabilities and the professional’s observations and enable Retraite Québec to rule on the validity of the scores obtained.

Exclusion

A child who has not been exposed on a sustained basis, for a period of at least 2 years, to the language used in the assessment tests is not presumed to be handicapped due to a global developmental delay. In that 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 the child’s waking hours, the child interacts with a person who is proficient in that language.

2.2 Intellectual disability

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is 6 years of age or over and has a full scale intellectual quotient of 50 or less, for a confidence interval of 95%; or

(b) the child is 6 years of age or over and meets the following criteria:

- the child’s full scale intellectual quotient is in the 2nd percentile or below, for a confidence interval of 95%;

- the assessment of the child’s adaptive behaviours shows that the score on one of the 3 components assessed among the conceptual, social and practical components, or the overall score of those 3 components, is in the 2nd percentile or below, for a confidence interval of 95%, in at least 2 of the child’s living environments.

Assessment parameters

Exclusion

A child who has not been exposed on a sustained basis, for a period of at least 2 years, to the language used in the assessment tests is not presumed to be handicapped due to an intellectual disability. In that 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 the child’s waking hours, the child interacts with a person who is proficient in that language.

2.3 Autism spectrum disorder

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is 2 years of age or over, has been diagnosed with an autism spectrum disorder and presents at least 4 of the following characteristics:

- the child does not use communicative gestures;

- the child does not show interest in other persons;

- the child does not respond to social smiles, even with people the child knows;

- the child does not have fun with others, even with people the child knows;

- the child does not share interests with other persons by showing or bringing objects;

- the child does not pay attention to an object that is pointed to by another person;

- the child does not respond verbally or non-verbally to verbal messages;

- the child does not imitate other people’s behaviours;

- the child does not engage in functional play;

(b) the child is 3 years of age or over, has been diagnosed with an autism spectrum disorder and does not speak;

(c) the child is at least 3 years of age and less than 6 years of age, has been diagnosed with an autism spectrum disorder and meets at least 2 of the following criteria:

- the child’s full scale intellectual quotient or the scale scores assessing the child’s level of cognitive development have a standard deviation of 1.5 or more below average;

- the global scores at a test assessing the child’s global and fine motor skills have a standard deviation of 1.5 or more below average;

- the scores of all the tests administered and assessing the receptive language have a standard deviation of 1.5 or more below average;

(d) the child is 5 years of age or over, has been diagnosed with an autism spectrum disorder and the child’s full scale intellectual quotient is in the 5th percentile or below, for a confidence interval of 95%; or

(e) the child is 4 years of age or over, has been diagnosed with an autism spectrum disorder and, despite the application of therapeutic measures recommended by members of a professional order, the child

- throws temper tantrums in his or her various living environments, and the frequency, duration and intensity of the tantrums are high and significantly exceed the norm for the child’s stage of development; or

- exhibits physically aggressive behaviours against 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

The assessment leading to the diagnosis of autism spectrum disorder must be conducted when the child is 2 years of age or over. The disorder must be confirmed by an assessment report made by a member of a professional order.

For the purposes of the analysis of a case prescribed in paragraph a, information on social communication and interactions must be corroborated by more than one source, in particular by the observations of the parents and childcare workers or school workers that are recorded in the professionals’ assessment reports and by the observations made by those professionals during their interactions with the child.

For the purposes of the analysis of a case prescribed in paragraph c, the assessments must be made by a member of a professional order, through recognized normalized tests and in accordance with the applicable standards of practice, when the child is at least 3 years of age and less than 6 years of age, and the professional’s assessment report must enable Retraite Québec to rule on the validity of the scores obtained.

For the purposes of the analysis of a case prescribed in paragraph d, the assessment must be made by a member of a professional order, through recognized normalized tests and in accordance with the applicable standards of practice, when the child is 5 years of age or over, and the professional’s assessment report must enable Retraite Québec to rule on the validity of the scores obtained.

For the purposes of the analysis of a case prescribed in paragraph e, information on the nature, intensity, duration and frequency of the disruptive behaviours must be corroborated by more than one source, in particular by the observations of the parents and childcare workers or school workers that are recorded in the professionals’ assessment reports and progress notes and by intervention plans at a childcare establishment, school or rehabilitation centre.

Exclusion

In the cases prescribed in paragraphs c and d, a child who has not been exposed on a sustained basis, for a period of at least 2 years, to the language used in the assessment tests is not presumed to be handicapped due to an autism spectrum disorder. In that 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 the child’s waking hours, the child interacts with a person who is proficient in that language.

2.4 Language disorders

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is 2 years of age or over and does not have at least 4 of the following prelinguistic skills:

- joint attention;

- motor imitation;

- oral imitation;

- use of communicative gestures;

- taking turns in communication;

(b) the child is 3 years of age or over and, in various contexts, expresses himself or herself by using isolated words, and it has been shown that the child does not understand the simple questions “who?”, “what?” and “where?” in relation to familiar objects or persons present in the immediate environment;

(d) the child is at least 4 years of age and less than 6 years of age, the scores obtained on formal assessment tests are corroborated by a qualitative analysis of the child’s daily language skills and

- with respect to receptive language, the child obtains scores that are equal to or below the 5th percentile on at least 3 tests normalized 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 2 of the following language components are impaired:

• regarding vocabulary, the child obtains scores that are equal to or below the 5th percentile on at least one test normalized for the child’s population group;

• regarding production of sounds, the child persistently and frequently makes a wide range of mistakes that are unusual for his or her age, making the child’s speech unintelligible most of the time;

• regarding sentence structure, the child’s statements are agrammatical and do not contain more than 3 or 4 words;

(e) the child is 6 years of age or over, the scores obtained on formal assessment tests are corroborated by a qualitative analysis of the child’s daily language skills and

- with respect to expressive language, at least 2 of the following language components are impaired:

• regarding vocabulary, the child obtains scores that are equal to or below the 5th percentile on at least one test normalized for the child’s population group;

• regarding sentence structure, the child uses simple syntactic structures, mostly without grammatical markers, and cannot use complex syntactic structures;

(f) the child is at least 9 years of age and less than 15 years of age and the child’s oral or written language disorder delays 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;

(g) the child is at least 15 years of age and the child’s oral or written language disorder delays his or her acquisition of reading and mathematics skills, which are no longer progressing beyond the second cycle of elementary education despite continuous schooling.

Assessment parameters

The language disorder must be assessed by a speech-language pathologist in accordance with the applicable standards of practice.

A speech-language pathology 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 prescribed for that case. The report must also describe interpreted data of the assessment of communication, speech and all the components of receptive and expressive language. The analysis is corroborated by more than one document, in particular by intervention plans at a childcare establishment, school or rehabilitation centre.

In the cases prescribed in paragraphs d and e, the 3 formal tests referred to respecting receptive language must demonstrate different aspects of comprehension. In that respect, a subtest that allows demonstrating a specific aspect of comprehension may count as a test.

In the case of children exposed to more than one language, the attending speech-language pathologist interprets the child’s language data by taking explicit account of the multilingualism context, and the following information must be on file:

- the mother tongue or tongues, the language or languages commonly used and the 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 only in a language he or she is learning is not presumed to be handicapped due to language disorders, unless the child has been exposed on a sustained basis to that language for a period of at least 2 years. In that respect, a child will be considered to be exposed on a sustained basis to the language he or she is learning if, for at least 40% of the child’s waking hours, the child interacts with a person who is proficient in that language.

2.5 Severe behavioural disorders

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1, if the following criteria are met:

(a) the child is 4 years of age or over and exhibits at least 2 of the following behaviours:

- physical aggression against himself or herself or against other persons;

- defiance of authority that results in an obstinate refusal to follow instructions and comply with the rules in effect in the child’s environment;

- temper tantrums that significantly exceed the norm for the child’s stage of development;

- deliberate destruction of material objects;

(b) despite the application of therapeutic measures recommended by members of a professional order, the behaviours exhibited present all the following characteristics:

- high level of intensity;

- high frequency;

- consistency, that is, the behaviours exist in the child’s various living environments.

Assessment parameters

A behavioural disorder must be confirmed by an assessment report made by a member of a professional order. The professional’s assessment report must contain a description of the nature and severity of the disorder and of its academic, family and social consequences, a description of the child’s abilities and disabilities and the professional’s observations.

Exclusion

A child who has an attention deficit disorder with or without hyperactivity the symptomatology of which is controlled with medication is not presumed to be handicapped due to severe behavioural disorders.

O.C. 1249-2005, s. 63; Erratum, 2006 G.O. 2, 963; O.C. 300-2006, s. 1; O.C. 1149-2006, s. 83; O.C. 134-2009, s. 1, Sch. A; S.Q. 2017, c. 29, s. 265; 965-2024O.C. 965-2024, s. 311.

2017-12-07 Show full text at this date

SCHEDULE A

(ss. 1029.8.61.19R2 and 1029.8.61.19R3)

TABLES OF PRESUMED CASES OF SERIOUS HANDICAP

(1) IMPAIRMENTS

1.1 Sight

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is less than 4 years of age and wears contact lenses because of bilateral aphakia;

(b) the child has a visual acuity of 6/60 or less;

(c) the child’s field of vision for both eyes is less than 30 degrees at the widest diameter, measured when focusing on a central point;

(d) one of the cases in A and one of the cases in B below both apply to the child:

A Cases B Cases

A.1 the child has a visual acuity B.1 special services are required to
of 6/21 or less. stimulate and maximize the child’s
visual potential.

A.2 the child’s field of vision for B.2 assistance is required to move
both eyes is less than 60 degrees about in an unfamiliar environment or
at the widest diameter, measured to go to school or move about there.
when focusing on a central point.

A.3 the child has a loss of sight of 30% B.3 adapted learning tools are
or more, calculated in accordance with required, particularly special school
the method and tables of the American books, audio recordings, magnifying
Medical Association and taking into devices or documents in braille.
account loss of central vision, field of
vision and eye motility.

Assessment parameters

Visual acuity must be measured in both eyes simultaneously following correction by adequate refraction lenses.

The method used to measure visual acuity must be specified in the expert’s report. If measured other than with a Snellen chart, the Allen method or ocular fixation, the data enabling the reliability and margin of error of the method to be assessed must be specified in the expert’s report.

1.2 Hearing

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the average threshold in air conduction tests before fitting is more than 70 dB for the better ear;

(b) the child is less than 6 years of age and the average threshold in air conduction tests before fitting is more than 40 dB for the better ear;

A Cases B Cases

A.1 the child is less than 6 years of B.1 in spite of an appropriate fitting,
age and the average threshold in air the child’s delayed language
conduction tests before fitting is development is comparable to the cases
25 dB or more for the better ear. in Table 2.4 on language disorders.

A.2 the child is 6 years of age or B.2 the child’s hearing impairment
older and the average threshold in requires specialized services outside
air conduction tests before fitting the school more than twice a month;
is 40 dB or more for the better ear. specialized services are audiologic,
medical or speech therapy follow-ups
and visits to a hearing-aid
acoustician.

Assessment parameters

Hearing loss is measured by taking into account the average threshold of pure sound at 500, 1,000, 2,000 and 4,000 Hz.

If the hearing is not measured by tonal audiometry, the data enabling the reliability of the method used to be assessed must be specified in the expert’s report.

The assessment must show the child’s usual level of hearing. It must not be carried out in the case of temporary conduction deafness, such as otitis media.

Exclusion

A child in respect of whom a central auditory processing disorder is inferred is not presumed to be handicapped unless an assessment of the child’s difficulties, using standardized tests, shows results comparable to those of the cases referred to in Tables 2.1 to 2.5 on developmental disabilities.

Specific rule

A child is not presumed to be handicapped before the first reliable measurement of hearing loss.

1.3 Musculoskeletal system

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child has a total brachial plexus palsy;

(b) the child is 2 years of age or less and requires several surgical procedures for clubfoot;

(d) the child is achondroplastic and the child’s height is less than the 3rd percentile;

(e) one of the cases in A and one of the cases in B below both apply to the child:

A Cases B Cases

A.1 the child has a deformity or B.1 the child is less than 5 years of
agenesis affecting the age and the ability to maintain sitting
musculoskeletal system. and standing positions, handle objects
A.2 the child has a type of and move about is less than that of the
dwarfism. average healthy child half that age.

A.3 the child has a neuromuscular B.2 the child is 2 years of age or
disease. older and has an upper limb impairment
A.4 the child has cerebral resulting in inefficient prehension in
palsy. one hand or hindering the activities
of daily living that require both
hands.

A.5 the child has myopathy. B.3 the child is 5 years of age or
A.6 the child has arthropathy. older and is unable to walk about in
A.7 the child has sequelae of places to which the child would
disease or trauma limiting motor normally go, to walk there or use
skills. public transportation to get there;
the abnormalities and limitations
described in the expert’s report imply
that the child requires the assistance
of another person, special apparatus
or devices, adapted transportation or
an adapted learning environment.

B.4 the child is 5 years of age or
older and prehension and coordination
skills are such that the child cannot
feed or dress or requires an inordinate
amount of time to do so, thus requiring
another person’s help or a special
apparatus or device.

B.5 the child must undergo several
specialized therapeutic interventions
because of the limited skills, thus
entailing more than 2 specific care
treatments per month outside the home.

Assessment parameters

The expert’s report must include a diagnosis, confirmed by significant observations during a physical examination, by biological tests or medical imaging, as well as an assessment of the child’s motor abilities and disabilities, in accordance with the child’s age.

The report must describe any abnormality in muscular tone, motor control, range of motion, coordination and balance, muscular strength and endurance and contain comments on the limitations they entail in maintaining posture and in motor, exploratory and manipulative activities.

1.4 Respiratory function

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child receives daily oxygen therapy at home;

(b) the child has bronchopulmonary dysplasia requiring the daily use of a bronchodilator;

(c) the child has a deformity of the thorax or a restrictive syndrome that reduces vital capacity to 50% or less compared to the normal vital capacity for the child’s size; vital capacity must be measured when the child’s condition is stable, in the absence of acute infection or decompensation;

(d) one of the cases in A and one of the cases in B below both apply to the child:

A Cases B Cases

A.1 the child is less than 2 B.1 the child is less than 2 years of
years of age and has been treated age and receives daily medication 6
for at least the past 3 months months a year or more administered by
as recommended by the Asthma wet nebulization, where a metered-dose
Committee of the Canadian inhaler is medically contraindicated.
Thoracic Society.

A.2 the child is 2 years of age B.2 in spite of adequate preventive
or older and has been treated for treatment, the child has had at least
asthma for at least the past 6 3 severe decompensation episodes in the
months as recommended by the last 12 months, requiring treatment in
Asthma Committee of the Canadian hospital for more than 48 hours or oral
Thoracic Society. corticosteroid treatment for more than
7 days.

B.3 in spite of inhaled beclomethasone
in doses of 1,000 g/day or 20 g/kg/day
with a metered-dose inhaler or its
equivalent, the child’s asthma cannot
be controlled and the child has
symptoms, at least 6 months a year,
that limit the child’s activities, or
a condition that requires a greater
dose of inhaled steroids or the
addition of another medication the
potential side effects of which require
close medical supervision.

Assessment parameters

The medical report must indicate the prescribed medication, dosage, frequency of medical visits, decompensation episodes, weight and height of the child, and the presence of avoidable respiratory irritants in the child’s environment. Where respiratory allergens complicate control of the asthma, the allergy test results must be attached to the medical report.

If control of the asthma is not achieved, it must be demonstrated in the medical report, in accordance with any applicable measures given the child’s age, through information concerning frequency of nocturnal symptoms, frequency of use of bronchodilators, variations in peak expiratory flow rates, results of bronchial and respiratory function challenge tests done when no infections or allergies are active. A preventive dose of a bronchodilator before exercise may not be considered in the assessment of daily needs.

A pharmaceutical record confirming the various medications and quantities purchased during the previous year must be attached to the medical report.

Where a nebulizer must be used, the medical report must describe the problems related to using a metered-dose inhaler or other method.

1.5 Cardiovascular function

Presumed cases of serious handicap

A child is presumed handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is 3 years of age or less, has a heart disease and requires diuretics and digitalis;

(b) from birth to the end of 2 full years following surgery, if the child was born with hypoplastic left heart syndrome, transposition of the great vessels, pulmonary atresia or a tetralogy;

(d) the child has a pacemaker, and complications related to the implant site require 2 or more surgical procedures during the year;

(e) one of the cases in A and one of the cases in B below both apply to the child:

A Cases B Cases

A.1 the child has a surgically B.1 the child, in spite of medication,
uncorrected malformation of the has symptoms at rest or with low effort
heart. that hinder the activities of daily
living.

A.2 the child has a malformation B.2 the child has seriously retarded
of the heart surgically corrected growth: weight or height less than the
with a palliative procedure. 3rd percentile or persistent weight or
height loss of more than 15
percentiles.

A.3 the child has arrhythmia. B.3 the progressive deterioration of
the child’s cardiovascular function
requires surgery and the activities of
daily living are affected, or the care
required imposes substantial
constraints on the child’s family.

A.4 the child has cardiac B.4 the child requires medical
insufficiency. follow-up at least once a month to
adjust medication according to the
child’s response to treatment and
variations in weight.

Assessment parameters

The medical report establishing the cardiovascular disability must indicate the diagnosis, the level of activity that triggers the cyanosis, dyspnea or tachycardia and must include a height and weight graph.

Exclusion

A child who has a malformation or cardiac disease with no active treatment, requiring only medically prescribed restrictions or limiting the playing of sports, is not presumed to be handicapped.

1.6 Nervous system abnormalities

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child has Lennox-Gastaut syndrome;

(b) one of the cases in A and one of the cases in B below both apply to the child:

A Cases B Cases

A.1 the child has epilepsy and B.1 in spite of medication, the child
has been undergoing anticonvulsive has more than 1 partial seizure a week.
therapy for more than 6 months.

A.2 the child has Tourette’s B.2 in spite of medication, the child
disorder. has more than 1 episode of generalized
seizures every 2 months.

A.3 the child has suffered a B.3 in spite of medication, the child
craniocerebral injury resulting has persistent tics that significantly
in a coma. affect the activities of daily living.

B.4 the side effects of the medication
significantly affect the activities of
daily living.

B.5 the child cannot attend a day care
centre or school without being
accompanied.

Assessment parameters

The diagnosis of nervous system impairments must be confirmed by a description of the objective abnormalities detected by a physical examination, analysis of diagnostic specimens, medical imaging or electrophysiology.

In the case of Tourette’s disorder, the expert’s report must describe the tics observed, stating at what age they began and how often they occur. A psychiatric assessment must be attached to the report.

Specific rules

Where a central nervous system dysfunction is the supposed cause of a cognitive, behavioural or communication disorder, or of dislexia, the provisions of Tables 2.1 to 2.5 on developmental disabilities apply.

Where the nervous system impairment is characterized by psychomotor retardation, the provisions of Table 2.1 on psychomotor retardation apply.

Where the nervous system impairment involves mainly motor skills, the provisions of Table 1.3 on impairments of the musculoskeletal system apply.

1.7 Nutrition and digestion

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is fed by naso-gastric hyperalimentation;

(b) the child has a gluten-free diet;

(d) the child has congenital anal imperforation and is 2 years of age or less;

(e) one of the cases in A and one of the cases in B below both apply to the child:

A Cases B Cases

A.1 the child has a malformation B.1 the child’s diet imposes
or disease of the digestive tract. substantial constraints on the child’s
family.

A.2 the child has oropharyngeal B.2 deglutition and mastication
dyspraxia. functions are such that the child
requires the services of an
occupational or speech therapist.

A.3 the child has an B.3 the child’s illness is not
inflammatory intestinal disease. controlled by medication and the child
has digestive problems, a deteriorated
general condition or symptomatic anemia
that restricts the activities of daily
living for more than 3 months a year.

B.4 the total period of hospitalization
because of the inflammatory intestinal
disease and its complications is more
than 1 month a year.

B.5 the child must go to a health care
facility or a doctor more that 10 times
a year because of decompensation due to
the inflammatory intestinal disease,
extradigestive manifestations,
endoscopy, biological tests and
therapeutic adjustments.

Assessment parameters

The diagnosis of an impairment related to nutrition must be confirmed, as the case may be, by a report from the occupational therapist or the speech therapist, by dated results of the abnormal biological tests, by the attending physician’s notes on its course, hospitalization dates and the height and weight graph.

Exclusion

A child who has lactose intolerance or cow’s milk protein intolerance is not presumed to be handicapped.

1.8 Renal and urinary functions

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child has a chronic renal insufficiency and is undergoing dialysis;

(b) the child uses a urinary catheter daily;

(d) the child is 5 years of age or older and diurnal incontinence requires daily care and sanitary products.

Exclusion

A child receiving prophylactic antibiotic therapy because of vesicourethral reflux is not presumed to be handicapped.

1.9 Metabolic or hereditary abnormalities

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child has a hemoglobinopathy of type SC, SS or Sß thalassemia with sickle cell anemia and is less than 7 years of age;

(b) the child has a phenylalanine-reduced diet due to phenylketonuria and is less than 7 years of age;

(d) the child has Gaucher’s disease, infantile form;

(e) the child has galactosemia;

(f) the child has tyrosinemia;

(g) the child has maple sugar urine disease;

(h) the child has lactic acidosis;

(i) the child has cystic fibrosis and pulmonary and digestive complications and is under continuous treatment with enzymes;

(j) the child is a hemophiliac with Factor VIII or IX activity of less than 1%;

(k) the child receives daily insulin therapy;

(l) one of the cases in A and one of the cases in B below both apply to the child:

A Cases B Cases

A.1 the child has a metabolic B.1 the child could experience severe
illness resulting in an essential decompensation after fasting for a few
metabolite deficiency. hours, with a fever or benign
infection, a condition which requires
specific care under medical
supervision.

A.2 the child has a metabolic B.2 the child must consume proteins,
illness resulting in an lipids or glucides of a specific type
accumulation of toxic or in closely supervised portions,
metabolites. which prevents the child from consuming
the same food as the child’s family.

A.3 the child has a metabolic B.3 the child requires at least every
illness resulting in an month a medical or paramedical
insufficient energy production. follow-up because of the illness,
decompensations or to prevent the
child’s development from being
affected.

B.4 the child’s fatigability restricts
the activities of daily living.

Exclusion

A child who has a metabolic abnormality that is compensated by medication, vitamin therapy, food supplements or by excluding a food is not presumed to be handicapped.

Specific rules

Where the metabolic or genetic impairment causes psychomotor retardation, the provisions of Table 2.1 on psychomotor retardation apply.

1.10 Immune system abnormalities and neoplasia

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is receiving chemotherapy or radiation therapy for leukemia or cancer;

(b) the child has AIDS and the condition imposes substantial constraints on the child’s family;

(d) the child has multiple food allergies to at least 3 different food groups consumed daily and the severity of the allergic reactions requires that emergency treatment be constantly available.

Assessment parameters

The diagnosis must be confirmed by information on the type of tumour, the stage of the disease and the abnormal biological test reports.

For allergies, the medical report must describe any previous allergic reactions and include the allergy test results.

Exclusions

A child who is allergic to one food only, to pollens or to animals is not presumed to be handicapped.

A child whose tumour has been totally removed by surgery without any sequelae is not presumed to be handicapped.

1.11 Congenital malformations and chromosomal abnormalities

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) until the child is 2 years of age, if born with a complete unilateral or bilateral cleft lip and palate;

(b) the child has a trisomy involving the autosomes without mosaicism;

Assessment parameters

The diagnosis must be confirmed by a description of the malformation. In the case of a syndrome in which the malformation or its degree varies from one subject to another, the child’s abnormalities and functional limitations must be specified in the expert’s report.

In the case of the chromosomal abnormalities referred to above, the karyotype analysis is sufficient.

Exclusion

A child who has a fissure of the soft palate or a cleft lip with an alveolar notch is not presumed to be handicapped.

2. MENTAL FUNCTION DISABILITIES

2.1 Global developmental delay

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 if the child is at least 2 years of age and less than 6 years of age and meets at least 2 of the following criteria:

(a) the child’s full scale intelligence quotient or the scale scores assessing the child’s level of cognitive development are in the 2nd percentile or below, for a confidence interval of 95%;

(b) the global scores on a test assessing the child’s global and fine motor skills are in the 2nd percentile or below; and

(c) the scores on a receptive vocabulary test normalized for the child’s population group are in the 2nd percentile or below.

Assessment parameters

Exclusion

2.2 Intellectual disability

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is 6 years of age or over and has a full scale intellectual quotient of 50 or less, for a confidence interval of 95%; or

(b) the child is 6 years of age or over and meets the following criteria:

- the child’s full scale intellectual quotient is in the 2nd percentile or below, for a confidence interval of 95%;

Assessment parameters

Exclusion

2.3 Autism spectrum disorder

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is 2 years of age or over, has been diagnosed with an autism spectrum disorder and presents at least 4 of the following characteristics:

- the child does not use communicative gestures;

- the child does not show interest in other persons;

- the child does not respond to social smiles, even with people the child knows;

- the child does not have fun with others, even with people the child knows;

- the child does not share interests with other persons by showing or bringing objects;

- the child does not pay attention to an object that is pointed to by another person;

- the child does not respond verbally or non-verbally to verbal messages;

- the child does not imitate other people’s behaviours;

- the child does not engage in functional play;

(b) the child is 3 years of age or over, has been diagnosed with an autism spectrum disorder and does not speak;

(c) the child is at least 3 years of age and less than 6 years of age, has been diagnosed with an autism spectrum disorder and meets at least 2 of the following criteria:

- the child’s full scale intellectual quotient or the scale scores assessing the child’s level of cognitive development have a standard deviation of 1.5 or more below average;

- the global scores at a test assessing the child’s global and fine motor skills have a standard deviation of 1.5 or more below average;

- the scores of all the tests administered and assessing the receptive language have a standard deviation of 1.5 or more below average;

Assessment parameters

Exclusion

2.4 Language disorders

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is 2 years of age or over and does not have at least 4 of the following prelinguistic skills:

- joint attention;

- motor imitation;

- oral imitation;

- use of communicative gestures;

- taking turns in communication;

- with respect to expressive language, at least 2 of the following language components are impaired:

• regarding vocabulary, the child obtains scores that are equal to or below the 5th percentile on at least one test normalized for the child’s population group;

• regarding sentence structure, the child’s statements are agrammatical and do not contain more than 3 or 4 words;

(e) the child is 6 years of age or over, the scores obtained on formal assessment tests are corroborated by a qualitative analysis of the child’s daily language skills and

- with respect to expressive language, at least 2 of the following language components are impaired:

• regarding vocabulary, the child obtains scores that are equal to or below the 5th percentile on at least one test normalized for the child’s population group;

• regarding sentence structure, the child uses simple syntactic structures, mostly without grammatical markers, and cannot use complex syntactic structures;

Assessment parameters

The language disorder must be assessed by a speech-language pathologist in accordance with the applicable standards of practice.

- the mother tongue or tongues, the language or languages commonly used and the dominant language or languages;

- the age of exposure, and the duration and percentage of exposure, to each of the languages.

Exclusion

2.5 Severe behavioural disorders

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1, if the following criteria are met:

(a) the child is 4 years of age or over and exhibits at least 2 of the following behaviours:

- physical aggression against himself or herself or against other persons;

- defiance of authority that results in an obstinate refusal to follow instructions and comply with the rules in effect in the child’s environment;

- temper tantrums that significantly exceed the norm for the child’s stage of development;

- deliberate destruction of material objects;

(b) despite the application of therapeutic measures recommended by members of a professional order, the behaviours exhibited present all the following characteristics:

- high level of intensity;

- high frequency;

- consistency, that is, the behaviours exist in the child’s various living environments.

Assessment parameters

Exclusion

O.C. 1249-2005, s. 63; Erratum, 2006 G.O. 2, 963; O.C. 300-2006, s. 1; O.C. 1149-2006, s. 83; O.C. 134-2009, s. 1, Sch. A; S.Q. 2017, c. 29, s. 265.

2012-09-01 Show full text at this date

SCHEDULE A

(ss. 1029.8.61.19R2 and 1029.8.61.19R3)

TABLES OF PRESUMED CASES OF SERIOUS HANDICAP

(1) IMPAIRMENTS

1.1 Sight

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is less than 4 years of age and wears contact lenses because of bilateral aphakia;

(b) the child has a visual acuity of 6/60 or less;

(c) the child’s field of vision for both eyes is less than 30 degrees at the widest diameter, measured when focusing on a central point;

(d) one of the cases in A and one of the cases in B below both apply to the child:

A Cases B Cases

A.1 the child has a visual acuity B.1 special services are required to
acuity of 6/21 or less. stimulate and maximize the child’s
visual potential.

A.2 the child’s field of vision for B.2 assistance is required to move
both eyes is less than 60 degrees about in an unfamiliar environment or
at the widest diameter, measured to go to school or move about there.
when focusing on a central point.

A.3 the child has a loss of sight of 30% B.3 adapted learning tools are
or more, calculated in accordance with required, particularly special school
the method and tables of the American books, audio recordings, magnifying
Medical Association and taking into devices or documents in braille.
account loss of central vision, field of
vision and eye motility.

Assessment methods

Visual acuity must be measured in both eyes simultaneously following correction by adequate refraction lenses.

1.2 Hearing

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the average threshold in air conduction tests before fitting is more than 70 dB for the better ear;

(b) the child is less than 6 years of age and the average threshold in air conduction tests before fitting is more than 40 dB for the better ear;

A Cases B Cases

Assessment methods

Hearing loss is measured by taking into account the average threshold of pure sound at 500, 1,000, 2,000 and 4,000 Hz.

If the hearing is not measured by tonal audiometry, the data enabling the reliability of the method used to be assessed must be specified in the expert’s report.

The assessment must show the child’s usual level of hearing. It must not be carried out in the case of temporary conduction deafness, such as otitis media.

Exclusion

Specific rule

A child is not presumed to be handicapped before the first reliable measurement of hearing loss.

1.3 Musculoskeletal system

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child has a total brachial plexus palsy;

(b) the child is 2 years of age or less and requires several surgical procedures for clubfoot;

(d) the child is achondroplastic and the child’s height is less than the 3rd percentile;

(e) one of the cases in A and one of the cases in B below both apply to the child:

A Cases B Cases

Assessment methods

1.4 Respiratory function

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child receives daily oxygen therapy at home;

(b) the child has bronchopulmonary dysplasia requiring the daily use of a bronchodilator;

(d) one of the cases in A and one of the cases in B below both apply to the child:

A Cases B Cases

Assessment methods

A pharmaceutical record confirming the various medications and quantities purchased during the previous year must be attached to the medical report.

Where a nebulizer must be used, the medical report must describe the problems related to using a metered-dose inhaler or other method.

1.5 Cardiovascular function

Presumed cases of serious handicap

A child is presumed handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is 3 years of age or less, has a heart disease and requires diuretics and digitalis;

(b) from birth to the end of 2 full years following surgery, if the child was born with hypoplastic left heart syndrome, transposition of the great vessels, pulmonary atresia or a tetralogy;

(d) the child has a pacemaker, and complications related to the implant site require 2 or more surgical procedures during the year;

(e) one of the cases in A and one of the cases in B below both apply to the child:

A Cases B Cases

Assessment methods

Exclusion

A child who has a malformation or cardiac disease with no active treatment, requiring only medically prescribed restrictions or limiting the playing of sports, is not presumed to be handicapped.

1.6 Nervous system abnormalities

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child has Lennox-Gastaut syndrome;

(b) one of the cases in A and one of the cases in B below both apply to the child:

A Cases B Cases

Assessment methods

Specific rules

Where the nervous system impairment is characterized by psychomotor retardation, the provisions of Table 2.1 on psychomotor retardation apply.

Where the nervous system impairment involves mainly motor skills, the provisions of Table 1.3 on impairments of the musculoskeletal system apply.

1.7 Nutrition and digestion

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is fed by naso-gastric hyperalimentation;

(b) the child has a gluten-free diet;

(d) the child has congenital anal imperforation and is 2 years of age or less;

(e) one of the cases in A and one of the cases in B below both apply to the child:

A Cases B Cases

Assessment methods

Exclusion

A child who has lactose intolerance or cow’s milk protein intolerance is not presumed to be handicapped.

1.8 Renal and urinary functions

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child has a chronic renal insufficiency and is undergoing dialysis;

(b) the child uses a urinary catheter daily;

(d) the child is 5 years of age or older and diurnal incontinence requires daily care and sanitary products.

Exclusion

A child receiving prophylactic antibiotic therapy because of vesicourethral reflux is not presumed to be handicapped.

1.9 Metabolic or hereditary abnormalities

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child has a hemoglobinopathy of type SC, SS or Sß thalassemia with sickle cell anemia and is less than 7 years of age;

(b) the child has a phenylalanine-reduced diet due to phenylketonuria and is less than 7 years of age;

(d) the child has Gaucher’s disease, infantile form;

(e) the child has galactosemia;

(f) the child has tyrosinemia;

(g) the child has maple sugar urine disease;

(h) the child has lactic acidosis;

(i) the child has cystic fibrosis and pulmonary and digestive complications and is under continuous treatment with enzymes;

(j) the child is a hemophiliac with Factor VIII or IX activity of less than 1%;

(k) the child receives daily insulin therapy;

(l) one of the cases in A and one of the cases in B below both apply to the child:

A Cases B Cases

Exclusion

A child who has a metabolic abnormality that is compensated by medication, vitamin therapy, food supplements or by excluding a food is not presumed to be handicapped.

Specific rules

Where the metabolic or genetic impairment causes psychomotor retardation, the provisions of Table 2.1 on psychomotor retardation apply.

1.10 Immune system abnormalities and neoplasia

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is receiving chemotherapy or radiation therapy for leukemia or cancer;

(b) the child has AIDS and the condition imposes substantial constraints on the child’s family;

(d) the child has multiple food allergies to at least 3 different food groups consumed daily and the severity of the allergic reactions requires that emergency treatment be constantly available.

Assessment methods

The diagnosis must be confirmed by information on the type of tumour, the stage of the disease and the abnormal biological test reports.

For allergies, the medical report must describe any previous allergic reactions and include the allergy test results.

Exclusions

A child who is allergic to one food only, to pollens or to animals is not presumed to be handicapped.

A child whose tumour has been totally removed by surgery without any sequelae is not presumed to be handicapped.

1.11 Congenital malformations and chromosomal abnormalities

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) until the child is 2 years of age, if born with a complete unilateral or bilateral cleft lip and palate;

(b) the child has a trisomy involving the autosomes without mosaicism;

Assessment methods

In the case of the chromosomal abnormalities referred to above, the karyotype analysis is sufficient.

Exclusion

A child who has a fissure of the soft palate or a cleft lip with an alveolar notch is not presumed to be handicapped.

2. DEVELOPMENTAL DISABILITIES

2.1 Psychomotor retardation

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 if one of the cases in A and one of the cases in B below both apply to the child:

A Cases B Cases

A.1 the child has a delay in B.1 the child is less than 2 years of
most areas of development which age and the skills in at least 2 areas
requires a specialized of development are the same as those
stimulation program. acquired by a child half the child’s
age, based on the mean age of skill
acquisition.

A.2 the child has a delay in B.2 the child is 2 to 5 years of age
most areas of development which and the child’s developmental quotient,
imposes substantial constraints assessed by an expert in accordance
on the child’s family. with a recognized development scale, in
particular that of Bayley, Griffiths or
Gesell, is less than 70.

B.3 the child is 2 to 5 years of age
and the child’s developmental quotient,
assessed by a standardized psychometric
test, in particular that of Leiter,
Brigance or the WPPSI, is less than 70,
for a confidence interval of 90%.

Assessment methods

The diagnosis of psychomotor retardation must be confirmed by an assessment of skills acquired by the child in the main areas of development, namely motor skills, autonomy, communication, language and social interaction. The mean age of skill acquisition in those areas of development is the age given in

— WEBER, M.L., Dictionnaire de thérapeutique pédiatrique. Montréal/Paris: Les Presses de l’Université de Montréal/Doin éditeurs, 1995, and thereafter the most recent edition; or

— NELSON, W.E., BEHRMAN, R.E., KLIEGMAN, R.M. and ARVIN, A.M., Nelson Textbook of Pediatrics. 15th Edition, Philadelphia, W.B. Saunders Company, 1996, and thereafter the most recent edition.

The expert’s report must enable the child’s developmental age to be determined or the child to be ranked within intragroup norms.

The developmental quotient is determined by multiplying the ratio of developmental age over chronological age by 100.

2.2 Mental retardation

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is more than 5 years of age and has a global IQ of 50 or less, for a confidence interval of 90%;

(b) one of the cases in A and one of the cases in B below both apply to the child:

A Cases B Cases

A.1 the child is more than 5 B.1 the assessment of the child’s
years of age and the psychometric adaptive skills using a recognized
assessment shows, for a scale, in particular the Échelle
confidence interval of 90%, a québécoise des comportements
global IQ equal to or less adaptatifs (ÉQCA) [Maurice, P. et al.
than 70. (1997, and thereafter the most recent
edition). Manuel technique (97,0).
Montréal: UQAM, Département de
psychologie], or the Vineland scale,
shows a standard deviation of 2 or more
below the average.

A.2 the child is more than 5 B.2 the child has an impairment in at
years of age and the psychometric least 2 of the following areas of
assessment shows, for a adaptive functioning: communication,
confidence interval of 90%, a personal care, domestic skills, social
percentile rank of 2 or less. skills, use of community resources,
autonomy, functional academic
abilities, leisure activities, work,
health and security.

A.3 the child is more than 5 B.3 the child’s behavioural, emotional
years of age and the psychometric and social problems described by the
assessment shows a standard expert markedly restrict the activities
deviation of 2 or more below the of daily living or impose substantial
average. constraints on the child’s family.

B.4 the child is 12 years of age or
less and school achievement is less
than that of a child who is less than
two-thirds the child’s age.

Assessment methods

The diagnosis of mental retardation must be confirmed by standardized psychometric tests done in the year preceding the application and, especially in borderline cases, in accordance with a recognized adaptive behaviour assessment scale, in particular the Échelle québécoise des comportements adaptatifs (ÉQCA) [Maurice, P. et al. (1997, and thereafter the most recent edition). Manuel technique (97,0). Montréal: UQAM, Département de psychologie], or the Vineland scale.

Exclusion

A child described as “with handicaps or learning or adjustment difficulties” according to the criteria of the Ministère de l’Éducation, du Loisir et du Sport is not presumed to be handicapped, unless an assessment shows that the child meets the conditions of this Regulation. The criteria are given in: Ministère de l’Éducation, Élèves handicapés ou élèves en difficulté d’adaptation ou d’apprentissage (EHDAA): Définitions, 2000, and thereafter the most recent edition.

2.3 Pervasive development disorders

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child cannot attend a day care centre or school without being accompanied;

(b) the child attends a psychiatric centre during the day;

Assessment methods

The diagnosis of a pervasive development disorder must be confirmed by a psychiatric or multidisciplinary assessment that refers to the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV published by the American Psychiatric Association, 4th Edition 1994, and thereafter the most recent edition.

2.4 Language disorders

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child is less than 5 years of age and language skills are those of a child less than half the child’s age;

(b) the child is more than 3 years of age and does not speak;

(c) the child is more than 6 years of age and the child’s speech is usually unintelligible to an adult who is not familiar with the child;

(d) the child obtained in the previous year, on standardized assessment tests for phonetic, semantic, morphosyntactic and pragmatic aspects, a result below the 2nd percentile and no result above the 10th percentile with respect to comprehension and expression;

(e) the child has a verbal IQ of less than 70, for a confidence interval of 90%;

(f) assessment of the child’s adaptive skills using a recognized scale, in particular the Échelle québécoise des comportements adaptatifs (ÉQCA) [Maurice, P. et al. (1997, and thereafter the most recent edition). Manuel technique (97,0). Montréal: UQAM, Département de psychologie], or the Vineland scale, shows a standard deviation of 2 or more below the average in the areas of communication and socialization;

(g) the child is 12 years of age or less and the language disorder hinders the child’s learning in school, which is less than that of a child who is less than two-thirds the child’s age.

Assessment methods

The language disorder must be confirmed by standardized tests specific to language. The results must rank the child in relation to the child’s group and the confidence interval must be stated. Where the tests cannot be used, the assessment report must describe the skills acquired and the deviation noted in the acquisition of the language code and give concrete examples of the use of language in the child’s activities of daily living.

The assessment must show that the language disorder is not a result of a hearing impairment, intellectual disability or a pervasive development disorder. The results of the audiogram and of the intellectual and behavioural assessment must be reported.

If the language disorder is associated with a hearing impairment, an intellectual disability or a pervasive development disorder, the provisions of Table 1.2 on hearing, Table 2.2 on mental retardation or Table 2.3 on pervasive development disorders apply.

A neurological assessment that does not show an abnormality at the somatic examination or a lesion visible through medical imaging or electrophysiology is not taken into account in the determination of the extent of the handicap caused by the language disorder.

Exclusions

A child less than 6 years of age who has not had a multidisciplinary cognitive assessment, in particular as regards the acquisition of symbolic thought, verbal and non-verbal skills and the integrity of sensorial functions, is not presumed to be handicapped because of a specific language disorder.

A child 6 years of age or older who has not had an assessment of verbal and non-verbal aptitudes through standardized psychometric tests selected or adapted to language problems is not presumed to be handicapped because of a specific language disorder.

2.5 Behavioural disorders

Presumed cases of serious handicap

A child is presumed to be handicapped within the meaning of section 1029.8.61.19R1 in the following cases:

(a) the child has had psychotherapy at least every month for at least 6 months and the therapist considers that it should continue at a monthly rate for a total duration of at least 1 year;

(b) the child cannot attend a day care centre or school without being accompanied.

Assessment methods

The behavioural disorder must be confirmed by a psychiatric assessment that describes the nature and the seriousness of the disorder and its consequences on the child’s family and in the school and social environment. The description must be sufficiently detailed to enable the Régie des rentes du Québec to assess the seriousness of the condition. The report must include the therapist’s recommendations.

Exclusion

A child who has an attention deficit disorder, with or without hyperactivity, and is treated solely through medication is not presumed to be handicapped.

O.C. 1249-2005, s. 63; Erratum, 2006 G.O. 2, 963; O.C. 300-2006, s. 1; O.C. 1149-2006, s. 83; O.C. 134-2009, s. 1, Sch. A.

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