KRVT and National Disability Insurance Agency (NDIS) - [2025] ARTA 1761

KRVT and National Disability Insurance Agency (NDIS) [2025] ARTA 1761 (11 September 2025)
Applicant/s:  KRVT
Respondent:  CEO, National Disability Insurance Agency
Tribunal Number:                2023/8193

Tribunal: Senior Member A Clues
Place:Hobart
Date:11 September 2025
Decision:The Tribunal sets aside the decision under review pursuant to section 105(c)(ii) of the Administrative Review Tribunal Act 2024 (Cth). The matter is remitted to the Agency for reconsideration with a direction that:
a)Within 14 days of this decision, the applicant’s statement of participant supports includes as reasonable and necessary:
·1 hour for speech therapy per week.
·1 hour for occupational therapy per week.
·9 hours for a therapy assistant, level 2 per week.
·1 hour of oversight per week by an allied health practitioner.
·1 hour of parent training per month with an allied health practitioner.
·4 hours of report writing.
b)Existing core supports are to be replicated on a pro-rata basis from the date on which the supports in the paragraph above are included in the applicant’s statement of participant supports, until 10 February 2026.
c)The date by which the Agency must reassess plan is on or before 10 February 2026.

.........................[SGD]...............................
Senior Member A Clues
Catchwords
NATIONAL DISABILITY INSURANCE SCHEME –- reasonable and necessary supports – consideration of s 34 National Disability Insurance Scheme Act 2013 (Cth) – autism – ESDM therapy – duplication – value for money – effective and beneficial - current good practice
Legislation
Administrative Review Tribunal Act 2024 (Cth).
National Disability Insurance Scheme Act 2013 (Cth).
Administrative Review Tribunal (Consequential and Transitional Provisions No. 1) Act 2024.
National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Act 2024.
National Disability Insurance Scheme (Supports for Participants) Rules 2013.
Education Act 1990 (NSW).
Cases
Shi v Migration Agents Registration Authority [2008] HCA 31; (2008) 235 CLR 286.
Esber v The Commonwealth [1992] HCA 20; (1992) 174 CLR 430, 440.
Frugtniet v Australian Securities and Investment Commission [2019] HCA 16; (2019) 266 CLR 250.
QDKH, by his litigation representative BGJF v National Disability Insurance Agency [2021] FCAFC 189.
Re Drake and Minister for Immigration and Ethnic Affairs (No 2) [1979] AATA 179; (1979) 2 ALD 634.
Secondary Materials
NDIS – Operational Guidelines – Reasonable and necessary supports.
NDIS – Operational Guidelines – Early childhood approach.
Statement of Reasons
Background.

The applicant is five years old. He was granted access to the National Disability Insurance Scheme (NDIS) on 19 January 2023 on the basis of his diagnosis of autism spectrum disorder.[1]
[1] JTB 1586.
On 18 June 2023, the respondent made a decision under section 33(2) of the National Disability Insurance Scheme Act 2013 (Cth) (the NDIS Act) to approve the applicant’s statement of participants supports (SOPS). In that plan the following supports were approved:
·Core supports: $350.
·Capacity Building supports: $76,141.07.[2]
[2] JTB 102.
On 29 August 2023, the applicant requested an internal review of that SOPS, pursuant to section 99 of the NDIS Act.[3] On 16 October 2023, the respondent made a decision and confirmed that the decision made on 18 June 2023 was correct (the internal review decision).[4] On 3 November 2023, the applicant, via his mother and representative (M), filed an application for review of the internal review decision in the Administrative Appeals Tribunal (AAT) pursuant to section 103 of the NDIS Act.[5] The AAT was abolished on 13 October 2024 and the Administrative Review Tribunal (the Tribunal) began on 14 October 2024. By virtue of the transitional provisions of the Administrative Review Tribunal (Consequential and Transitional Provisions No. 1) Act 2024 (the Transitional Act), applications for review to the AAT that were not finalised before 14 October 2024 are taken to be an application for review to the Tribunal. The Transitional Act gives the Tribunal the authority to continue and finalise any aspect of the review not already completed by the AAT.
[3] JTB 77.
[4] JTB 27-33
[5] JTB 1-6.
Further, the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Act 2024 (the Back on Track Act) commenced on 3 October 2024 and made significant amendments to the NDIS Act. The amendments pursuant to section 34 of the NDIS Act will apply to this review.[6]
[6] See s129 of the Back on Track Act.
On 27 February 2024, a new SOPS for the applicant was approved for a further three-month period until 27 May 2024. Funding was allocated for that three-month period on a pro rata basis as per the previous SOPS.[7]
[7] JTB 489-502.
On 17 May 2024, a new plan was implemented for a six-month period which included the previous funding on a pro rata basis as per the previous SOPS, plus an amount for support coordination ($2,403.36 over 12 months).[8]
[8] JTB 503-521.
On 16 October 2024, a new plan was implemented for a six-month period which included the previous funding on a pro rata basis, as per the previous SOPS. [9]
[9] JTB 550-571.
On 12 March 2025 a new plan was implemented for a six-month period which included the previous funding on a pro rata basis as per the previous SOPS, plus an allowance for Assistance with Daily Life ($14,879.82 for 10 hours of support worker assistance per week).[10]
[10] JTB 598-615.
The hearing
The hearing took place on 9, 10 and 11 July 2025, via Microsoft teams video. The applicant was represented by M. At the request of M, a Portuguese interpreter was available for her during the hearing. However, M only needed limited assistance from the interpreter during the hearing. The respondent was represented by Ms Douglas-Baker, counsel, who was instructed by Ms Thomson of Moray and Agnew Lawyers.
The following documents were admitted into evidence by consent:
·E1, Joint Tender Bundle (JTB) pages 1-1585. (The JTB included the respondent’s statement of facts issues and contentions (SOFIC), which is not evidence, pages 1586 – 1595).
·E2, report by M Bansal (paediatric occupational therapist) dated 3 June 2025. A27 pages 1 -2.
·E3, record by H Tsamoulos (psychologist) in relation to an assessment she conducted on 2 April 2025, A28 pages 1-17.
Oral evidence was given at the hearing by the following witnesses for the applicant:
·M, the applicant’s mother.
·Ms Singhi, speech therapist.
·Ms Bansal, occupational therapist.
·Ms Weatherall, occupational therapist.
·Ms Duffy, psychologist.
·Dr Oo, paediatrician.
Dr Pincus, paediatrician gave oral evidence for the respondent.
Role of the Tribunal
The role of the Tribunal is to make the correct or preferable decision based on the material before it.[11] In reviewing the decision:
(i) the Tribunal stands in the shoes of the delegate/internal reviewer and must make the correct or preferable decision based upon the evidence and other material before it,[12] and
(ii) the scope of the Tribunal’s jurisdiction is determined by reference to the scope of the internal reviewer’s powers under section 100 of the NDIS Act, which is in turn informed by the scope of power under section 33(2) of the NDIS Act.[13]
[11] Shi v Migration Agents Registration Authority [2008] HCA 31; (2008) 235 CLR 286.
[12] Esber v The Commonwealth [1992] HCA 20; (1992) 174 CLR 430, 440; Frugtniet v Australian Securities and Investment Commission [2019] HCA 16; (2019) 266 CLR 250.
[13] QDKH, by his litigation representative BGJF v National Disability Insurance Agency [2021] FCAFC 189.
The relevant provisions under the Administrative Review Tribunal Act 2024 (Cth) (the ART Act) are sections 54 and 105.
THE LEGISLATIVE SCHEME
The objectives of the NDIS Act are set out in section 3. A participant’s plan must include a SOPS, approved in accordance with section 33 of the NDIS Act. Section 34 of the NDIS Act identifies what establishes a ‘reasonable and necessary’ support under the scheme. It states as follows:
Reasonable and necessary supports
(1) For the purposes of specifying, in a statement of participant supports, the general supports that will be provided, and the reasonable and necessary supports that will be funded, the CEO must be satisfied of all of the following in relation to the funding or provision of each such support:
(aa) the support is necessary to address needs of the participant arising from an impairment in relation to which the participant meets the disability requirements (see section 24) or the early intervention requirements (see section 25);
(a) the support will assist the participant to pursue the goals, objectives and aspirations included in the participant's statement of goals and aspirations;
(b) the support will assist the participant to undertake activities, so as to facilitate the participant's social and economic participation;
(c) the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support;
(d) the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice;
(e) the funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks, and the community to provide;
(f) the support is a NDIS support for the participant.
Note: For the purposes of paragraph (aa):
(a) the time at which the disability requirements or the early intervention requirements need to be met is the time the CEO decides to approve the statement of participant supports; and
(b) a participant’s disability support needs arising from an impairment in relation to which the participant meets the disability requirements or the early intervention requirements may be affected by a variety of factors, including environmental factors or the impact of another impairment in relation to which the participant does not meet either of those requirements.
The relevant rules in respect of this review are the National Disability Insurance Scheme (Supports for Participants) Rules 2013 (the Supports for Participant Rules). Rules 3.1 to 3.5 of the Supports for Participant Rules relate specifically to sections 34(1)(c) - (e) and state:
Value for money
3.1 In deciding whether the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support, the CEO is to consider the following matters:
(a) whether there are comparable supports which would achieve the same outcome at a substantially lower cost;
(b) whether there is evidence that the support will substantially improve the life stage outcomes for, and be of long-term benefit to, the participant;
(c) whether funding or provision of the support is likely to reduce the cost of the funding of supports for the participant in the long term (for example, some early intervention supports may be value for money given their potential to avoid or delay reliance on more costly supports);
(d) for supports that involve the provision of equipment or modifications:
(i) the comparative cost of purchasing or leasing the equipment or modifications; and
(ii) whether there are any expected changes in technology or the participant’s circumstances in the short term that would make it inappropriate to fund the equipment or modifications;
(e) whether the cost of the support is comparable to the cost of supports of the same kind that are provided in the area in which the participant resides;
(f) whether the support will increase the participant’s independence and reduce the participant’s need for other kinds of supports (for example, some home modifications may reduce a participant’s need for home care).
Effective and beneficial and current good practice
3.2 In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to consider the available evidence of the effectiveness of the support for others in like circumstances. That evidence may include:
(a) published and refereed literature and any consensus of expert opinion;
(b) the lived experience of the participant or their carers; or
(c) anything the Agency has learnt through delivery of the NDIS.
3.3 In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to take into account, and if necessary, seek expert opinion.
Reasonable family, carer, and other support
3.4 In deciding whether funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks, and the community to provide, the CEO is to consider the following matters:
(a) for a participant who is a child:
(i) that it is normal for parents to provide substantial care and support for children; and
(ii) whether, because of the child’s disability, the child’s care needs are substantially greater than those of other children of a similar age; and
(iii) the extent of any risks to the wellbeing of the participant’s family members or carer or carers; and
(iv) whether the funding or provision of the support for a family would improve the child’s capacity or future capacity, or would reduce any risk to the child’s wellbeing;
...
(c) for all participants—the desirability of supporting and developing the potential contributions of informal supports and networks within their communities.
Supports appropriately funded or provided through the NDIS
3.5 Schedule 1 sets out matters for the CEO to have regard to in considering whether supports are most appropriately funded or provided through the NDIS, rather than through other service systems (service systems is defined in paragraph 6.4).
Part 5 of the Supports for Participant Rules sets out the general criteria for supports:
General criteria for supports
5.1 A support will not be provided or funded under the NDIS if:
(a) it is likely to cause harm to the participant or pose a risk to others; or
(b) it is not related to the participant’s disability; or
(c) it duplicates other supports delivered under alternative funding through the NDIS; or
(d) it relates to day-to-day living costs (for example, rent, groceries and utility fees) that are not attributable to a participant’s disability support needs.
5.2 The day-to-day living costs referred to in paragraph 5.1(d) do not include the following (which may be funded under the NDIS if they relate to reasonable and necessary supports):
(a) additional living costs that are incurred by a participant solely and directly as a result of their disability support needs;
(b) costs that are ancillary to another support that is funded or provided under the participant’s plan, and which the participant would not otherwise incur.
Schedule 1 of the Supports for Participant Rules outlines supports appropriately funded, as referenced in Rule 3.5, as follows :
Early childhood development
7.8 The NDIS will be responsible for personalised supports, specific to a child’s disability (or developmental delay), which are additional to the needs of children of a similar age and beyond the reasonable adjustment requirements of early childhood development service providers.
7.9 The NDIS will be responsible for early interventions for children with disability (or developmental delay) which are:
(a) specifically targeted at enhancing a child’s functioning to undertake activities of daily living, but not supports which are specifically for the purpose of accessing a universal service such as school readiness programs that prepare a child for education; and
(b) likely to reduce the child’s future support needs, which would otherwise require support from the NDIS in later years, including through a combination and sequence of supports.
7.10 The NDIS will not be responsible for:
(a) meeting the early childhood education and care needs of a child with a developmental delay or disability required by children of a similar age including through inclusion supports that enable children to participate in early childhood education and care settings; or
(b) supports, which are clinical in nature provided in the health system, including acute, ambulatory or continuing care; or
(c) new-born follow-up provided in the health system, including child and maternal health services.
A further consideration is section 5(f) of the NDIS Act which contains the general principle guiding the actions of people who may do acts or things on behalf of others under the scheme. It provides as follows:
...
(f) if the person with disability is a child-the best interests of the child are paramount, and full consideration should be given to the need to:
(i) protect the child from harm; and
(ii) promote the child's development; and
(iii) strengthen, preserve and promote positive relationships between the child and the child's parents, family members and other people who are significant in the life of the child.
The purposes and objects of the NDIS Act must be considered in conformity with section 34(1) and the Supports for Participant Rules, noting that if one of the requirements in ss 34(1)(aa)-(f) is not satisfied, the support will not be funded under the NDIS.
OPERATIONAL GUIDELINES
The NDIS has Operational Guidelines in relation to ‘reasonable and necessary supports’ in a participant’s plan. The Tribunal is not bound by the Guidelines and any policy set out in them, the Federal Court has held that the Tribunal should consider relevant government policy which is not inconsistent with the provisions or objects of the legislation.[14]
[14] Re Drake and Minister for Immigration and Ethnic Affairs (No 2) [1979] AATA 179; (1979) 2 ALD 634.
The Guidelines relevant to this review are the NDIS Reasonable and Necessary supports[15]and Early Childhood Approach. The Early Childhood Approach Guidelines[16] relevantly state:
Best practice not only considers broad early childhood intervention research, but also evidence relating to the needs of children with a specific diagnosis, such as autism spectrum disorder or cerebral palsy.
[15] Dated 28 March 2025.
[16] Dated 28 October 2024.
Scope of the Review
At the hearing, the respondent submitted that the applicant turns six in May next year and pursuant to section 22 of the Education Act 1990 (NSW) he is required to be enrolled at and attend school unless an exemption is obtained. The applicant’s mother submitted that no decision has yet been made in relation to the applicant’s schooling. The respondent submitted that in the absence of evidence about what the applicant is doing next year in relation to schooling, funding for supports in his plan can only extend until the start of the school year in 2026[17] because supports for the applicant at school will be very different to those for pre-school. At the hearing it was agreed and the Tribunal determined pursuant to section 53 of the ART Act, that the scope of the review would be limited to determining the reasonable and necessary supports for the applicant until the commencement of the 2026 school year, 27 January 2026.
[17] 27 January 2026.
Applicant’s current weekly routine
Prior to the hearing the applicant’s weekly routine was as follows:
a)ESDM (Early Start Denver Model therapy) through Early Start Australia, Little Oaks Therapy Centre, two days per week for three hours each day, a total of six hours per week plus parent training of one hour per week. (M gave evidence that at the time of the hearing the applicant was having a break from Little Oaks and was not attending).
b)Private speech therapy one hour per week.
c)Private occupational therapy one hour per week.
d)Childcare two days per week.
e)Swimming lesson, 30 minutes per week.

Pursuant to a current court order the applicant stays with his father on Wednesday from 5 pm until Thursday 7 am every week, and from Friday 5pm until Sunday 7pm every second week. The applicant has support worker assistance for 10 hours per week whilst he is with his mother.
The applicant’s position
The applicant seeks to attend ‘The Seedlings Program’ at Little Oaks Therapy Centre, which consists of:
Direct Therapy:
·     3 mornings per week at Therapy Centre for face-to-face direct therapy (9 hours); $1102.71
·     1- Parent training delivered via telemetry held following the P-ESDM parent manual (Parent training 60 minutes + 30 minutes Feedback and review time); $290.99
·     Weekly Group Parent Support session – (1 hour); $97
Total direct therapy hours per week = 11.5
Non-Direct therapy.
·     1-hour weekly programming time allocated to Scout/Keyworker (Supervisor of child’s program) (Client review/Goal updates/Team updates/ Meetings with family) $193.99
Total non-direct therapy hours per week = 1 hour
Total 12.5 hours per week + 2 hours per term program review with team (Occurring in staff meetings and clinical processes meetings)
Weekly fee $1684.69.[18]
[18] JTB 432.
In addition to this the applicant seeks 2 hours per week for private speech therapy and 1 hour per week for private occupational therapy.
The applicant seeks to keep the current level of funding for Core Supports, which includes support worker assistance with daily life (10 hours per week, $14,879.82 over 6 months) and consumables ($349.98 over 6 months), as per his current plan from 12 March 2025 to 11 September 2025.[19]
[19] JTB 601-615.
The respondent’s position
The respondent’s position is that it does not approve funding based on specific programs or quotes from providers such as Little Oaks. It must consider the evidence in relation to the level of capacity building support that is required. The respondent’s funding decisions are based on what is deemed reasonable and necessary. In some cases, the level of funding may not fully align with the intensity or cost structure proposed by specific programs, providers, or a parent’s preferred model of service.
The respondent submits the support provided through the Little Oaks program duplicates the therapy provided by the occupational therapist and a speech therapist that the applicant sees privately. The respondent relies upon the evidence of Dr Pincus (paediatrician) who says that ‘there is very little objective evidence in the reports provided related to specific goals of therapy and assessments as to their success or otherwise’[20] which makes it very difficult to judge the effectiveness of the therapy.[21]
[20] JTB 582.
[21] JTB 1593.
The respondent also submits[22] that Dr Pincus notes there are many statements that the applicant has made significant improvements from therapy, but it is difficult to be certain regarding their justification. He says:
Further complicating such judgement is the fact that [the applicant] has such a spread of abilities with some areas of development showing very slow improvement (for instance language and social interactions) whereas other areas have progressed steadily and are close to the expected range.[23]
Dr Pincus does not doubt that the applicant has benefited from the therapy he has received but he is ‘unable to confirm which interventions have made a difference and how much interventions have made a difference and how much intervention has improved his rate of progress compared to his innate progress.’[24]
[22] JTB 1594.
[23] JTB 583.
[24] JTB 583.
After some initial confusion at the hearing, the respondent submitted that the applicant’s current level of funding for Core supports was not in dispute.
THE EVIDENCE
M
M gave evidence that as a result of the applicant’s autism spectrum disorder (ASD) he is very challenging. He has difficulty understanding emotions. He does not have the capacity to regulate his emotions and becomes dysregulated. He has difficulty with the timing and synchronisation of movements and cognitive processes, impacting his development and limiting various physical activities. He has limited communication and language skills which creates challenges with simple tasks such as eating and bathing. He communicates using visual cards. He has a limited vocabulary. The applicant lacks the ability to socially integrate. He doesn’t have friends. He plays alone and is socially isolated. He often becomes involved in repeated actions whilst playing. He has increased sensitivity to sounds, textures and smells. He exhibits many rigid behaviours. He plays inappropriately and makes his playmates angry. He throws toys and pushes other children. He finds it hard to engage in age-appropriate interactions. He demonstrates behavioural anxiety.[25]
[25] JTB 382-391.
M has dedicated her entire life to organising the applicant’s supports. His needs change on a regular basis. M is a childcare educator, but she ceased work in 2023 to care for the applicant. She is a single mother. She has suffered “two burnout crises in the same year, due to the demand for care along with the necessary documents all processes.”[26] Her parents have paid for her psychological help. They do not live in Australia. She has no family support. The applicant’s father pays the basic household bills, which requires him to work full-time and over time. She is not entitled to any benefit or subsidy from the government.[27]
[26] JTB 389.
[27] JTB 389-390.
The applicant has benefited from the ESDM therapy offered through Early Start Australia, Little Oaks. M explained that ESDM is an individualised approach that focuses on modifying behaviours, breaking them down into smaller, manageable components, helping the applicant to acquire new skills such as communication, social interaction, and also addresses challenging behaviours by often reducing behaviours associated with autism, such as self-harm or repetitive behaviours. ESDM therapists can implement strategies to replace them with more suitable alternatives. M has applied many of the strategies learned in parental training and they have helped her understand more about the applicant and support him more effectively.[28]
[28] JTB 387.
M gave evidence that the applicant attends Little Oaks 2 days per week, for 3 hours each day. At Little Oaks, the applicant is part of a small group of 3 to 4 children where he is fully supported, by qualified allied health professionals. The applicant goes into childcare two days per week. M spends approximately 1.5 hours with him each day he attends child-care because he will not engage with other children if she is not there, instead he chooses to play by himself in the corner. The support at childcare does not meet the needs of an autistic child. The applicant only receives a support ratio of 20 children to 3 educators and every day there is a different educator who does not have an established bond with the applicant and does not understand his individual development process. M believes the applicant needs full-time individualised support at preschool. M believes that if the applicant does not receive individual support, ‘the school environment will not be beneficial for him.’ By this she means she ‘will have to let him do therapies intensively.’[29]
[29] JTB 388.
M is of the opinion that in addition to the ESDM therapy at Little Oaks that the applicant receives, he also needs to do intense private therapy with Ms Singhi (speech therapist) two hours per week and with Ms Bansal (occupational therapist) one hour per week. The reason for this is that they are familiar with the applicant. Mrs Singhi has worked with him for 2 ½ years. Ms Bansal has worked with him since February 2025 as a result of previous occupational therapist (Ms Ferrari) going on parental leave. M is of the view that the applicant learns skills from Ms Singhi and Ms Bansal in his private sessions with them and then he applies them at Little Oaks. In cross examination M did not accept that there was duplication of supports even though the applicant worked with registered speech therapists and occupational therapists as part of the ESDM therapy at Little Oaks. M was asked in cross examination whether, if she had to make a choice, she would continue private therapy sessions with Ms Singhi and Ms Bansal or continue with the occupational therapists and speech therapists that have been working with the applicant at Little Oaks, her response was that she wanted both and that the applicant had a right to an individual plan.
Ms Singhi – Speech Therapist
Ms Singhi’s two reports dated 2 May 2023 and 4 March 2024 were part of the joint tender bundle and she gave oral evidence by video. Ms Singhi has been providing speech therapy to the applicant since he was two years old on a regular basis, usually one session per week except during school holidays, since October 2022. Her evidence was that the applicant has made a lot of progress during that time. He is using more words; his attention is improving, and he is able to respond to one and two part commands. He has a ‘flipbook’ with pictures of objects in it which he uses when he wants to communicate that he needs or wants something. Initially the applicant was pointing to objects but is now using two to three word phrases.
Ms Singhi confirmed the information in her first report dated 2 May 2023 that ‘on initial assessment [the applicant] was said to have around 20 words or word approximations’. By May 2023 he had over 40 words he could say in response to a picture or object presentation’. In 2025, the applicant is using many more single words and short phrases. He can also sing songs. Ms Singhi guessed that he may have about 80 words now, but he does not always use his words at the times he needs to. He cannot use phrases to let people know his needs and wants.
Ms Singhi said that all of her therapy with the applicant takes place in her rooms and involves play-based methods involving the use of figurines and other toys. Her interaction with other therapists has been limited to one meeting and one discussion with a keyworker from Little Oaks. Assistive technology, in the form of the LAMP Augmentative system (AAC), was not successful for the applicant.
Ms Singhi said that the applicant’s challenges include; moving from one task to another; fixation on numbers and trying to move him away from a number-based activity once he is engrossed in it and his stimming/repetitive behaviour. Ms Singhi believes that the more therapy she gives the applicant and his parents the more gains he will achieve with his speech. She wants to provide the applicant with intensive treatment blocks. She believes the applicant is at a pivotal time and the demands upon him as he moves into school will be substantial. She is of the view that the applicant’s communication skills are at the level of a 2.5 – 3 year old.
In her report of 2 May 2023, Ms Singhi recommends that the applicant:
receives ongoing intensive twice weekly Speech Pathology totalling 2 hours per week. Intensive individualised therapy is recommended as the gold standard for good practice in early intervention for children with Speech and Language developmental delays. He will also require intensive therapy from his other allied health disciplines and the speech pathologist will liaise with the health professionals to ensure that the team are working in a well-coordinated manner to support [the applicant] and his parents in his therapy program.
For the intensive programming of an additional minimum 15 hours per week of childcare educator/ trained assistant delivered programing as instructed by Speech Pathologist and Occupational Therapist to be carried out during the childcare hours for [the applicant]. In this way he will receive the gold standard of dosing for therapy as recommended by ASHA and SPA for children diagnosed with ASD/ADHD.[30]
[30] JTB 38.
In her report of 4 March 2024 Ms Singhi refers to the gold standard for children with autism as a minimum of 20 hours of intensive therapy per week and further says that 15 to 25 hours per week of treatment is generally recommended for autism early intervention.[31] In that report Ms Singhi concludes as follows:
A single 60-minute weekly speech therapy session or even twice-a-week 1 - 1 sessions are simply not what the research provides us with as the gold standard for [the applicant]. This is why I am writing to support the application that [the applicant] should be attending multiple sessions per week, enabling him to benefit from a range of therapies supporting his skill building and practice opportunities, in different settings-1-1 therapy sessions and in group therapy sessions, and supported preschool environments.[32]
[31] JTB 371.
[32] JTB 371.
Ms Bansal – Occupational Therapist
Ms Bansal’s report dated 3 June 2025 was tendered in evidence and she gave oral evidence by video. Ms Bansal has been providing occupational therapy to the applicant since February 2025. The applicant has been receiving occupational therapy since May 2023, his previous occupational therapist (Ms Ferrari) went on parental leave, and he transitioned to Ms Bansal.
Ms Bansal gave evidence that all the applicant’s therapy is delivered in her rooms which includes a sensory gym environment. Occasionally there will be another child in the sensory gym environment with whom organised interaction will be arranged. Ms Bansal has not observed the applicant in a natural environment.
Ms Bansal said the applicant’s therapy involves activities designed to assist him with impulse control, problem-solving, sensory regulation, body awareness, prevention of stimming, flexible thinking and interacting with other people. Ms Bansal is of the view that if the applicant does not develop skills in those areas, his dependence on others will increase. Ms Bansal has noticed an improvement in the applicant’s participation in nonpreferred tasks, such as tabletop activities (cutting and drawing) as well as packing away. She said that occasionally they can work on social interaction in the sensory gym with another child. They have had a session where they worked on sharing equipment and taking turns using equipment in an obstacle course. The applicant found it hard to take turns and on one occasion he tried to jump on a trampoline when another child was on it. He became dysregulated when he was told to wait his turn.
In her report dated 3 June 2025 she concludes:
[The applicant] is at a critical stage of development in which intensive, multidisciplinary support is most beneficial to develop crucial skills due to the complexity of functional impacts of his disability. Considering that [the applicant] is due to commence school in 2026, priorities for intervention are those that will increase his safety, set him up for a smooth transition into the schooling environment and increase access to mainstream services and activities to reduce reliance on supports in the future. These include supporting [the applicant] to:
·     Manage his safety in different environments by improving his impulse control and body awareness.
·     Increase his engagement in non-preferred everyday tasks such as table top and self-care activities.
·     Increase his participation in group activities and environments (for school and mainstream activities).[33]
[33] JTB 488B.
Ms Weatherall – Occupational Therapist and ESDM Therapist
Ms Weatherall is the co-author of a report dated 6 November 2024.[34] Ms Weatherall is a qualified occupational therapist and a certified therapist in the Early Start Denver Model (ESDM). ESDM incorporates a play based naturalistic style of learning. ESDM is the learning approach used at Little Oaks. Ms Weatherall said that ESDM uses play to build positive and fun relationships and through play and joint activities the child is encouraged to boost their language, social and cognitive skills.
[34] JTB 410-440
Ms Weatherall gave evidence that at Little Oaks the applicant had been attending 2 x 3 hours weekly on Mondays and Wednesdays. She noted that at the time of the hearing the applicant had exited the program and was not attending. At Little Oaks the team that assists the applicant comprises; two registered speech therapists, one registered psychologist, one registered occupational therapist and two registered teachers.[35]
[35] JTB 412.
The details of each session that the applicant attends are; 9-10:30am one allied health professional and 10:30am another allied health professional. Apart from the following times the applicant has 1:1 therapy with an allied health professional:
·10 minutes of mat time x 2, 1:1 support as needed.
·15 minutes for snack time, 1:1 support as needed.
·30 minutes - 1 hour small group time, either 1:1 or 2:3 ratios depending on the skills and needs of the children in the group.[36]
[36] JTB 412.
At Little Oaks, other children of similar ages and skill level are in the centre together. This allows for group opportunities to encourage children to transfer their skills with peers. The morning has components of a kinder setting e.g.) mat time and group snack time.[37]
[37] JTB 413
Ms Weatherall recommends that the applicant attends 12.5 hours at Little Oaks in their “Seedlings Program,” which is an increase by one morning per week from what the applicant was doing. She believes this “will allow for greater benefit for [the applicant] to continue to work on his full goal set including his communication skills, skills with his peers, and behaviours of concern.”
At the time the report was written the applicant’s identified behaviours of concern were:
·absconding when doors are open.
·snatching off others.
In relation to absconding, the goal is for the applicant to respond to ‘stop’ and ‘no’ at an age-appropriate level. In relation to snatching, the goal is for the applicant to take turns with a peer giving and taking back.[38]
[38] JTB 413
According to the report, the Little Oaks program ensures collaboration and consistency in goals through:
·bi-weekly team meetings to discuss progress and goal updates.
·shared data tracking platform.
·allocated Scout (key worker) time to provide opportunities to consult with kinder to ensure consistency at kinder.
·weekly parent coaching sessions to ensure consistency in strategies at home.[39]
[39] JTB 413-414.
Ms Weatherall noted that in the applicant’s case there is a duplication of support which they have explained is not necessary. The applicant has access to allied health professionals at Little Oaks including occupational therapy and speech therapy. He does not need to access these health practitioners externally.[40]
[40] JTB 414.
Ms Weatherall said that the Little Oaks program is age specific and is targeted at children between 0 to 5 years of age. She advised that the program could arrange for occupational therapists and speech therapists to be available to assist in community-based sessions. She agreed that due to the applicant’s age he should be working towards more community-based learning.
Ms Duffy- Psychologist
Ms Duffy is a qualified psychologist. She met the applicant when she was working as a psychologist at Little Oaks. She was not involved in the applicant’s actual care and program at Little Oaks, but she knows who he is and she observed him for a short period of time every week as she circumnavigated the centre as part of her role. She has not worked at Little Oaks for over 10 months. In March 2024 she prepared a report in relation to the applicant in support of his ‘appeal to the NDIS Tribunal for review of his funding’.[41] At the time Ms Duffy prepared her report the applicant had attended Little Oaks for 8 weeks. In that time, she noted the applicant had ‘made progress at the expected, targeted level for goals which have been measured each week as well as the goals around emotional regulation and general interest in people around him.’[42]
[41] JTB 470.
[42] JTB 477.

In her report Ms Duffy expressed the view that if the applicant was unable to continue with his current intensive program, which comprised 2 x 3 hour morning sessions each week, his ‘progress would be significantly undermined as his other individualised therapies cannot provide the wrap around, multidisciplinary therapy with multiple opportunities each day to address his socialisation and the emotional dysregulation that can arise when he struggles with disappointment and frustration (as all children must learn to do!) in a small group setting’.[43]
[43] JTB 477.
Ms Duffy recommended an increase in the applicant’s therapy hours which ‘could include an additional morning in the Little Oaks programme (i.e. 3 mornings a week) and/or funding for community early intervention sessions at childcare (a 3 hour “community

add-on session), to help the applicant generalise his skills and to support him in interacting with his peers.
Ms Duffy said she did not think the applicant needed additional psychological assistance and she could not comment on his needs to see an external speech therapist or occupational therapist. She understood that the applicant continued with these therapists for consistency. She advised that if the applicant goes to school, he will need to have ongoing occupational therapy and speech therapy.
Dr Oo – Paediatrician
Dr Oo is a qualified paediatrician. He has only seen the applicant on three occasions namely 21 July 2022, 17 November 2022 and in February 2025. He prepared a letter for the NDIS dated 6 December 2022 noting that the applicant was 30 months old. In that report he summarises the applicant’s diagnoses and impairments as follows:
·Autism spectrum disorder
oSocial communication required level 3 support.
oRepetitive behaviours and restricted interests required level 2 support.
·Moderate to severe global developmental delay
oSevere speech delay (18 months equivalent age) and (Bilingual-English/Portuguese
oSevere social skill delay
oDelayed in cognitive skills (equivalent 1 – 2 years)
oDelayed in fine motor skills
oDelayed play skills
·parental separation - shared care[44]
[44] JTB 9.
Dr Oo prepared a more detailed report to support the above summarised conclusions. In that report he says that the applicant ‘met the DSM-V Criteria of Autism Spectrum Disorder which is associated with language disorder.’ In terms of the level of support for the applicant’s ASD, Dr Oo states that the applicant ‘will require very substantial support – level 3 in Social Communication and the Restricted and Repetitive Behaviours required level 2 support’. In relation to Social Communication Dr Oo records that the applicant had severe deficits in verbal and non-verbal social communication skills causing severe impairments in functioning; very limited initiation of social interactions and minimal responses to social overtures from others. In relation to Restricted Interests and Repetitive Behaviours (RRBs), Dr Oo records that the applicant’s ‘RRBs and/or preoccupations or fixated interests appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress or frustration is apparent when RRBs are interrupted; difficult to redirect from fixated interest.’[45]
[45] JTB 297.
Dr Oo saw the applicant for a follow-up appointment in February 2025 as the parents were seeking a referral for the applicant to undergo a cognitive assessment which had been requested by a school. He prepared the referral dated 27 February 2025.[46]
[46] JTB 444.
Dr Oo said that is usual for a child diagnosed with autism to be reviewed by a paediatrician at least every six months, but that has not occurred in this case, and he has not been receiving any updated reports from the applicant’s treating therapists. He does not know how much progress the applicant has made since the end of 2022 when he formally assessed him, and he does not know what current support is required for the applicant. He said that because the applicant has severe autism and global developmental delay, he is likely to also have ADHD. However, he said his position on ADHD with respect to the applicant is that as yet there is no firm diagnosis of ADHD. If there was a diagnosis, he would recommend treatment with a therapist that is ADHD specific and only if the applicant could not engage with therapy at all he may recommend medication, but there are risks to a preschooler associated with that medication, including side-effects of irritability and aggression.
Ms Tsamoulos – psychologist
At the hearing M advised that the applicant had seen a new paediatrician, Dr Taitz who referred to a psychologist for cognitive and behavioural assessment. That assessment was undertaken by Ms Tsamoulos on 2 April 2025. By consent the report prepared by Ms Tsamoulos as a result of that assessment was tendered in evidence A28 pages 1-17. The first page of that report contains the following executive summary:

Reason for Referral - assessment of psychometric and behavioural profile to explore any underlying considerations that may be impacting on [the applicant’s] learning.
Summary of results:
1)Borderline overall cognitive skills with average Visual Spatial skills and borderline Verbal Comprehension, Working Memory and Processing Speed skills.
2)Emerging ADHD profile suggested by parent responses, assessment (cognitive proficiency/executive functioning results), observation and interview.
Referral Recommendations
Paediatric consultation to discuss [the applicant’s] ADHD and to explore treatment options.
Continued access to intensive occupational therapy intervention to assist with his ADHD/emotion regulation. Continued access to speech therapy intervention to address expressive/receptive language skills.
Continued access to learning support to assist [the applicant] with consolidating his learning/social/emotional experiences. Consideration regarding school placement and a thorough transition to kindergarten program.[47]
[47] JTB A28 p1.
Dr Pincus – Paediatrician

Dr Pincus is a consultant paediatrician. He prepared a report dated 18 December 2024[48] at the request of the respondent’s solicitors. He did not conduct an independent medical examination of the applicant. His report is based on a review of the documents and reports that were provided to him by the respondent’s solicitors. He also gave oral evidence at the hearing. Prior to the hearing he was provided with reports from Dr Oo, Ms Bansal and Ms Tsamoulos, that he had not seen at the time of preparing his report. He advised that nothing in those reports caused him to change the opinions in his report.
[48] JTB 578-597.
Dr Pincus said that the recent testing shows that the applicant has good learning abilities and that his challenges are with socialisation and communication. He is of the view that the applicant has significant potential. He has good cognitive skills but has some social and communication challenges.
In Dr Pincus’s report he says that the applicant’s ‘primary manifestations of his autism relate to his severe impairments in social and particularly expressive language skills. He has some lesser impairments with receptive language and sensory issues and has impressively well-developed daily living skills. He also appears to have some islands of cognitive strength, for instance in recognising numbers and letters. [The applicant] does suffer from emotional dysregulation which is likely to be part of his autistic disorder and communication challenges.’[49]
[49] JTB 582.
Dr Pincus states that there are many comments throughout the reports which lead him to strongly consider a diagnosis of ADHD which appears to be a major barrier to the applicant’s development. He notes there are multiple comments mentioning the applicant’s high levels of activity, poor focus, distractibility, and impulsivity. This has meant that he has been unable to attend to tasks for any period of time, and that his behaviour can be dangerous both for other children and for himself.[50] In his report and during his oral evidence Dr Pincus noted that there had not yet been a formal diagnosis of ADHD and this should be further explored with the applicant’s paediatrician and parents.
[50] JTB 582.
Dr Pincus observed that there is very little objective evidence in the reports provided that related to specific goals of therapy and assessments as to their success or otherwise. He says it is clear that the applicant has made some gains as one would expect over a period of 50% of his life. He found that most of the enunciated goals were very general, and there appears to be little emphasis on deciding which particular therapy is aiming for which particular improvement and how each therapists’ goals will complement other provided intervention. He found this very disappointing and said it makes it very difficult to be able to judge the effectiveness of the therapy.[51] Dr Pincus notes that there are many comments in the reports he read stating that the applicant ‘has made significant improvements since starting a particular service, but it is hard to be certain regarding their justification. Further complicating such judgement is the fact that [the applicant] has such a spread of abilities with some areas of development showing very slow improvement (for instance language and social interactions) whereas other areas have progressed steadily and are close to the expected range.’[52]
[51] JTB 582.
[52] JTB 582.
Dr Pincus does not doubt that the applicant has benefited from his therapy but says that in his experience as a paediatrician over the past 30 years that he has followed many children such as the applicant throughout their childhood years until they become an adult and that the rate of progress that the applicant has made over the past two years of intervention is relatively similar to many other children who have received different and often less intensive interventions. He does acknowledge that has also experienced other children whose presentation was similar to the applicant at 18 months or two years of age, who have made much slower progress, even at times with much more intensive intervention than the applicant has received. He says he is unable to confirm which interventions have made a difference and how much intervention has improved the applicant’s rate of progress compared to his innate progress.[53]
[53] JTB 583.
In his oral evidence Dr Pincus said that during the Covid-19 pandemic, there was a period of between 6 and 12 months when children that he sees in his practice stopped therapy and he found that they did progress in any event. He does not believe that doing more treatment will overcome the applicant’s problems and that he will always have weaknesses in relation to communication and social skills.
Dr Pincus does support a moderate quantum of early intervention for children with disabilities such as being on the autistic spectrum.[54] His understanding of ESDM is that it has been developed as a comprehensive developmental behavioural intervention designed for toddlers with ASD, aged up to 4 years. It is said to integrate principles from both developmental psychology and ABA, and to emphasise naturalistic, play-based interactions. Importantly, it is delivered in natural settings such as the home or daycare. The therapy involves both therapists and parents, focuses on building positive relationships and using play to promote language, cognitive and social skills. Studies have demonstrated that ESDM can lead to significant improvements in IQ, adaptive behaviour, and reduction in autism severity.[55]
[54] JTB 592.
[55] JTB 591.
With respect to the applicant’s progress over the past two years whilst he has been participating in the ESDM program, Dr Pincus’s observation is even with this intervention the applicant has made relatively slow progress with his language and social skills. He says that it is not possible to judge whether the applicant’s progress has been faster because of the provided interventions, and whether the ESDM approach or that used by the speech pathologist has been more effective for the language skills. He hopes that the ESDM approach provided at Little Oaks will improve the applicant’s acquisition of appropriate life skills, but he cannot be certain this will be the case.[56]
[56] JTB 592.
Dr Pincus considered the report dated 6 November 2024 that was co-authored by Ms Weatherall and Mr Connolly from Early Start Australia, the organisation that delivers the Little Oaks program. Dr Pincus notes that in that report the authors have not quoted some excellent meta analyses conducted in the past 2 to 3 years and which give a contrary view to those provided in the report. He notes that many of the quoted studies in that report are from almost 10 years ago. He says:
I have looked through several of the quoted articles and found them to be of variable value. I would summarise overall that they do support EDSM as being likely to be helpful long-term for autistic children particularly for language, cognitive and adaptive behaviour skills. I believe this is also supported by the meta analyses , the question that they raise is really regarding the quantum of therapy and generally finds that more and longer intervention does not work better than less and shorter intervention.
The seminal article on this was published in June 2024 Sandbank et al in JAMA Paediatrics and is entitled “Determining Associations between Intervention Amount and Outcomes for Young Autistic Children. A Meta Analysis.” This looked at 144 studies including over 9000 children and found that none of the meta regression models showed a significant, positive association between any index of intervention amount and intervention effect size when considered within intervention type. In other words, increasing the quantum of intervention did not improve its effectiveness.”[57]
[57] JTB 593
Dr Pincus refers to the applicant’s weekly schedule which comprises, two days at childcare from 9 AM until 4 PM; two mornings (three hours each) of ESDM therapy at Little Oaks; one hour per week with an occupational therapist and a speech pathologist, one hour of early start parent training and 30 minutes of swimming at Rainbow Club.[58]
[58] JTB 581-582.
Dr Pincus notes that M and Little Oaks are requesting three sessions of three hours each per week for the applicant. On the other two days a would attend childcare. M is requesting two hours per week of speech therapy and one hour of occupational therapy per week. Dr Pincus believes the focus for the applicant needs to be strongly on communication, social skills, and behaviour/emotional regulation. His observation of the applicant’s progress over the past two years suggests that even with the intervention he has made relatively slow progress with his language and social skills. He says it is not possible to judge whether the applicant’s progress has been faster because of the provided interventions, and whether the EDSM approach or that used by the speech pathologist has been more effective for the language skills.[59]
[59] JTB 592.
Dr Pincus supports 2 x 3 hour sessions of early intervention, two hours with allied health specialists and two days at daycare. He notes the question becomes what should happen on the fifth day? He believes that more formal sessions will be ‘socially and cognitively demanding’ for the applicant. He says:
My inclination would therefore be to use the fifth day of the working week for an extra session at daycare or even preferably a transition session to the new school, however, [I] recognised there are arguments that could be made both ways. Certainly, if it was possible to provide some extra and expert assistance at childcare which is clearly the place that provides the best social opportunities, I would prefer that option.[60]
[60] JTB 595.
Dr Pincus is of the opinion that the focus should now be on getting the applicant ready for school in 2026. He supported the applicant going to a local state school with a specialised education unit. In 2026, he thought that the applicant should attend school full-time and therapy outside of school should be limited to 2 hours per week. With respect to getting the applicant ready for school over the next few months, Dr Pincus believes that the applicant should be maximising the time he spends at daycare with some specialised support.
CONSIDERATION
The evidence is that the applicant has autism and that his main impairments relate to his language and communication skills, his social skills, and his emotional regulation skills. The applicant’s goals listed in his current plan from 12 March 2025 to 11 September 2025 seek to develop his skills in these areas as well as his fine and gross motor skills, his self-care skills, and his learning skills.
The applicant is legally required to attend school next year (unless he is granted an exemption). Assuming he does go to school, he will need to be part of a special education unit, which falls within the auspices of the Education Department. What the applicant’s weekly timetable will look like when he goes to school will be very different to his current weekly timetable. Accordingly, until decisions are made with respect to the applicant schooling, the Tribunal can only make findings based on the evidence before it and which is restricted to the funding of reasonable and necessary supports for the applicant until 26 January 2026 after which he should be starting school.
In the applicant’s current plan, the respondent currently provides funding for Core Supports of $15,229.80 (Assistance with Daily Life: $14,879.82 and Consumables: $349.98) as well as Capacity Building Supports of $39,223.74 (Improved Daily Living Skills: $38,022.06 and Support Coordination and Psychosocial Recovery Coaches $1201.68). The funding for Core Supports is not in issue. The issue for the Tribunal to determine is what level of Capacity Building Supports is reasonable and necessary for the applicant.
Duplication
Rule 5.1(c) of the Supports for Participant Rules will not be provided or funded under the NDIS if it duplicates other supports delivered under alternative funding through the NDIS.
The respondent submits that the Little Oaks program provides occupational therapy and speech therapy to the applicant and therefore the additional hours for those therapies sought by the applicant are a duplication of supports. M gave evidence that the applicant learns skills at his private speech and occupational therapy sessions and then applies those learnt skills at Little Oaks. The Tribunal notes there has been virtually no liaison between the applicant’s private therapists and Little Oaks and further Ms Weatherall gave evidence, which is also in the report she co-authored, that the external therapies the applicant receives ‘is duplication of support which we have explained is not necessary.’[61]
[61] JTB 414.
In the report prepared by Ms Bansal, occupational therapist, she says that whilst the applicant accesses mainstream preschool and other group programs, he requires individual occupational therapy intervention to address underlying sensory processing, flexible thinking and play skills required for social participation. Like M, Ms Bansal, sees Little Oaks as an opportunity for the applicant to practice social development but believes he requires in clinic individual occupational therapy ‘to provide evidence-based, individualised, and graded interventions which can then be generalised and implemented into group environments.’[62] Ms Bansal notes that in the 3 months she has been working with the applicant he has been able to increase his engagement in graded semi-preferred tasks for up to 20 minutes and he can transition smoothly between preferred and non-preferred activities with only minimal adult support and visual strategies. She believes this progress demonstrates the effectiveness of individual occupational therapy intervention.[63]
[62] A27 p2.
[63] JTB 488B

In the most recent report from Ms Singhi dated 4 March 2024, she states that during the time she has been treating the applicant he has made progress in attention, turn taking, imitation, expressive language, receptive language and social communication. She provides some examples of this progress.[64]
[64] JTB 366-372.
In the report co-authored by Ms Weatherall it states that the applicant ‘requires support in including social communication, peer social communication skills, skill building to reduce unwanted behaviours, communication, play skills, motor skills, personal independence and cognitive skills.’ At the time the report was written the goals being worked on were: ‘responding to “stop” or “no” at an age appropriate level’ and ‘taking turns with peer with simple action toy when peer requests gives and takes back.’[65]
[65] JTB 413.
As observed by Dr Pincus in the reports relied upon by the applicant, ‘most of the enunciated goals were very general, and there appears to be little emphasis on deciding which particular therapy is aiming for which particular improvement and how each therapists’ goals will complement other provided intervention.’[66]
[66] JTB 582.
It can be seen from these reports, that the therapy the applicant is receiving relates to developing his skills in the same areas. The applicant receives speech therapy from both Ms Singhi and from Little Oaks, he also receives occupational therapy both from Ms Bansal and Little Oaks. The funding model from Little Oaks includes one hour of therapy from a qualified specialist and 2 hours from a therapy assistant, each day that the applicant attends that program. The private therapists and the therapists from Little Oaks are all working on building the same skills for the applicant but without any knowledge or understanding of what each of the therapists is specifically working on at any particular time. The Tribunal finds that this is a duplication of costs.
Section 34(1)(aa)- (f)
As submitted by the respondent, in this case the Tribunal must be ‘positively satisfied’ of each criterion set out in s34(1)(aa)- (f) of the NDIS Act in relation to each of the supports requested. If the Tribunal is not positively satisfied that any one of the criteria in s34(1) is met in relation to a particular support, then the Tribunal must find that that support is not a reasonable and necessary support and must be rejected.[67]
[67] JTB 1590.
Section 34(1)(aa)
The Tribunal must determine whether the therapy requested is necessary to address the needs arising from the impairment in relation to which the applicant met the disability requirements.
The respondent does not contend and that s34(1)(aa) is in issue in relation to the requested supports. It is not contested that the additional supports requested by the applicant seek to address his impairments arising from his autism diagnosis. On the evidence provided the Tribunal is satisfied that the therapy the applicant receives at Little Oaks and the private therapy he receives from an occupational therapist (Ms Bansal) and a speech therapist (Ms Singhi) is reasonable and necessary to address the applicant’s impairments arising from his autism. Therefore, s34(1)(aa) is met.
Section 34(1)(a)
The Tribunal must determine whether the funding sought by the applicant will assist him to pursue his goals, objectives and aspirations set out in his statement of goals and aspirations. The applicant’s goals in his current plan are to develop his emotional regulation skills, fine and gross motor skills, self-care skills, language and communication skills, social skills and learning skills. The Tribunal is satisfied that the program undertaken at Little Oaks and the skills taught by his private speech therapist and occupational therapist align with his plan goals. Therefore, s34(1)(a) is met.
Section 34(1)(b)
The Tribunal must also determine whether the support requested will assist the applicant to undertake activities to facilitate his social and economic participation. The Tribunal is satisfied on the evidence that the Little Oaks program and his private therapy with his speech therapist and occupational therapist will provide him with opportunities to learn skills to facilitate his social and economic participation. Therefore, s34(1)(b) is met.
Section 34(1)(c) and (d)
It is convenient for the Tribunal to consider together whether the requested supports represent value for money and whether they are effective and beneficial.
The Tribunal must consider whether the requested supports represent value for money in that the costs of the supports are reasonable relative to both the benefits achieved and the cost of alternative support, s34(1)(c). Further the Tribunal must consider whether the support requested will be, or is likely to be, effective and beneficial having regard to current good practice s34(1)(d).
Rule 3.1 of the Support for Participant Rules sets out the matters to be considered by the Tribunal in deciding whether the requested support represent value for money. The relevant parts of that rule are:
(b) whether there is evidence that the support will substantially improve the life stage outcomes for, and be of long-term benefit to, the participant;
(c) whether funding or provision of the support is likely to reduce the cost of the funding of supports for the participant in the long term (for example, some early intervention supports may be value for money given their potential to avoid or delay reliance on more costly supports);
Rules 3.2 and 3.3 are relevant to determining whether the supports requested will be or are likely to be effective and beneficial.
3.2 In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to consider the available evidence of the effectiveness of the support for others in like circumstances. That evidence may include:
(a) published and referred literature and any consensus of expert opinion;
(b) the lived experience of the participant or their carers; or
(c) anything the Agency has learnt through delivery of the NDIS.
3.3 In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to take into account, and if necessary, seek, expert opinion.
The respondent submits that substantially less costly alternatives may produce the same or similar outcomes for the applicant.[68] The preferred option for Dr Pincus is that the applicant attend more childcare, with extra and expert assistance, if possible, as childcare provides the best social opportunities for the applicant.[69]
[68] JTB 1593
[69] JTB 595.
The Tribunal accepts that the applicant does require ongoing speech therapy and occupational therapy as well as support from a therapy assistant in implementing the skills that he learns from speech and occupational therapy. However, there is no evidence that there will be substantial improvement in the applicant’s life stage outcomes or that the cost of funding of supports for the applicant in the long term will be reduced if he continues to receive speech and occupational therapy from professional allied health specialists at Little Oaks as well as speech and occupational therapy from professional allied health specialists at in-clinic sessions. There is little or no coordination between the therapists at Little Oaks and the therapists that the applicant sees privately. The Tribunal does accept that the applicant has benefited from the therapy he has received to date, but it is not clear which interventions have made a difference and improved his progress. It is difficult to determine whether his improvements are due to the number of therapy hours he receives or his innate progress and the support he receives from his parents, especially his mother.
Dr Pincus recommends that the applicant persist with his one hour of occupational therapy and one hour of speech therapy per week. Dr Pincus is supportive of the applicant attending more childcare or preferably a transition session to the applicant’s new school. He says that if it was an option he is supportive of providing the applicant with some extra and expert assistance at childcare which is clearly the place that provides the best social opportunities.[70]
[70] JTB 595
The evidence of M and Ms Bansal suggests that the support the applicant receives at Little Oaks is akin to that which could be provided by a therapy assistant. M refers to the applicant learning skills from his in-clinic sessions with his speech therapist and occupational therapist and that he applies what he has learnt from those in-clinic sessions at Little Oaks. Ms Bansal refers to the applicant’s access to Little Oaks as an opportunity for social development.[71] From this it follows that paying for extra hours for an allied health professional at Little Oaks for the applicant is not value for money, when the same support could be provided by a therapy assistant, level 2. The therapy assistant could attend the private speech and occupational therapy sessions with the applicant and then assist the applicant with applying the skills he has learned from those therapists in social settings, including childcare or as suggested by Dr Pincus in a transition session at the school the applicant will be attending.[72]
[71] JTB A488B.
[72] JTB 595.
The applicant wants an additional session of 3 hours at Little Oaks per week and an extra hour session of speech therapy per week. As stated, the evidence is that the support the applicant receives at Little Oaks is akin to that which could be provided by a therapy assistant. The evidence from Little Oaks is that the applicant currently receives duplication of support which they have explained is not necessary.[73] Little Oaks is of the view that the applicant does not need to seek external therapy because they provide trained therapists to support the applicant during his attendance at that program.
[73] JTB 414.
The Tribunal finds that it is not value for money for the applicant to pay for a one hour in-clinic session with a speech therapist and a one hour in-clinic session with an occupational therapist as well as pay for sessions with a speech therapist and/or an occupational therapist at Little Oaks. There is clear overlap of supports from allied health specialists in this case. Further, the specialists are not working together, and they are not identifying how their goals will complement each other.[74]
[74] JTB 582.
The applicant’s request for an additional 3 hour session at Little Oaks and an extra hour session of speech therapy is apparently based on the premise that more therapy for the applicant will improve his skills.
Evidence was given by some of the witnesses in relation to the ‘gold star standard’ for therapy for autistic children. It was said that the gold star standard is between 15 and 25 hours of intensive therapy per week. The Tribunal finds that this is not supported by the evidence. The Tribunal is not satisfied that 15 to 25 hours of intensive early childhood intervention is more effective than less intensive supports. The Tribunal is not satisfied that there is evidence to support the view that more hours of intensive therapy consistently leads to better outcomes for children with autism.
The opinions of Dr Pincus in relation to the reasonable and necessary supports for the applicant are based on the research conducted by Dr Sandbank, referred to in his report. The Tribunal is persuaded by Dr Sandbank’s findings from her research that increasing the quantum of intervention does not improve its effectiveness.[75]
[75] JTB 593.
As at the date of the hearing M said that the applicant was having a break from Little Oaks. It is unknown whether he has resumed his attendance at Little Oaks. The Little Oaks program is focussed on children between the ages of 0-5 years old. The applicant should be transitioning out of that program. Ms Weatherall gave evidence that it has staff that are able to assist with transferability of skills into kindergarten or childcare. The evidence indicates that this is the support that would be most beneficial to the applicant at this time.
Based on all of the evidence, the Tribunal is not satisfied that the Seedlings Program at Little Oaks which comprises 3 hours of intensive early intervention therapy over 3 days of the week plus the additional costs including parent training at a cost of $1,684.69 per week,[76] is value for money or effective and beneficial.
[76] JTB 433
The Tribunal finds that sections 34(1)(c) and (d) are not satisfied in relation to the Little Oaks Seedlings Program. As these are cumulative criteria, it is not necessary for the Tribunal to consider section 34 further in relation to that program. The Tribunal finds that the Little Oaks Seedlings Program is not a reasonable and necessary support for the applicant.
However, the Tribunal accepts that the evidence does establish that the applicant should continue with one hour of private speech therapy and one hour of private occupational therapy. The Tribunal accepts that early intervention therapy, at a reduced intensity to that offered at Little Oaks and in a childcare or kindergarten setting would be, or would likely be, beneficial to the applicant. The Tribunal finds that early intervention at the level 2 therapy assistance rate for nine hours per week is supported by the evidence (including the evidence of Ms Singhi and Ms Duffy) as being reasonable and necessary. This would allow the level 2 therapy assistant to attend the private speech therapy and occupational therapy sessions with the applicant and then work with the applicant in other environments outside of the clinical setting in other social settings including, childcare and kindergarten (if the applicant is enrolled).
In his report Dr Pincus does not support M’s request for an additional one hour per week of speech therapy. He recommends that the applicant persist with one hour of occupational therapy and one hour with a speech pathologist per week as he believes the applicant should focus on language and communication in more social situations, particularly in childcare. He supports ‘early intervention’ but says this would be preferable to occur at daycare or in a transition session to the applicant’s new school.[77]
[77] JTB 587 and 595
CONCLUSION
Taking into account all of the evidence the Tribunal finds that the following supports are reasonable and necessary:[78]
·1 hour for speech therapy per week.
·1 hour for occupational therapy per week.
·9 hours for a therapy assistant, level 2 per week.
·1 hour of oversight per week by an allied health practitioner.
·1 hour of parent training per month with an allied health practitioner.
·4 hours of report writing.
[78] JTB 1594.
The Tribunal takes the view that this breakdown of hours allows the applicant’s parents to choose to send the applicant to Little Oaks and make up any shortfall in the funding provided, or continue with private sessions with his speech and occupational therapists, with the ability to have the therapy assistant, level 2 attend those sessions and then support the applicant apply the skills he learns in childcare, kindergarten or other social settings. This funding does not allow the applicant to access allied health practitioners both privately and at Little Oaks.
As previously stated, this decision is based on a plan duration that commences from the date the plan is implemented by the respondent until 26 January when the applicant is required to enrol at school unless an exemption is granted.
DECISION

The Tribunal pursuant to section 105(c)(ii) of the Administrative Review Tribunal Act 2024 (Cth) the decision under review is set aside. The matter is remitted to the Agency for reconsideration with a direction that:
1)Within 14 days of this decision, the applicant’s statement of participant supports includes as reasonable and necessary:
i.1 hour for speech therapy per week.
ii.1 hour for occupational therapy per week.
iii.9 hours for a therapy assistant, level 2 per week.
iv.1 hour of oversight per week by an allied health practitioner.
v.1 hour of parent training per week with an allied health practitioner.
vi.4 hours of report writing.
2)Existing core supports are to be replicated on a pro-rata basis from the date on which the supports in the paragraph above are included in the applicant’s statement of participant supports, until 10 February 2026.
3)The date by which the Agency must reassess the plan is 10 February 2026.
Dates of hearing: 9, 10, 11 July 2025
Representative for the Applicant: Mother of the applicant
Counsel for the Respondent: Ms A Douglas-Baker
Solicitors for the Respondent: Ms J Thomson, Moray & Agnew