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Dr Ronan Glynn, Acting Chief Medical Officer, Department of Health and Professor Karina Butler, Chair of National Immunisation Advisory Committee (NIAC) Sasko Lazarov/RollingNews.ie

Q&A: Why Ireland changed its guidelines for the AstraZeneca vaccine - and how it'll affect the rollout

The HSE is going to consider over the next few days how this affects the vaccine rollout.

SENIOR HEALTH OFFICIALS answered questions last night about the implications of new advice on the administration of the AstraZeneca vaccine would have on Ireland’s vaccine strategy and the lifting of Covid restrictions.

NIAC has recommended that the Oxford-AstraZeneca vaccine be given only to people aged over 60 after reports of rare blood clotting events emerged.

Those rare blood clotting events occur in 4-10 cases in every million AZ vaccine doses administered, in which one person may die.

The HSE has cancelled AstraZeneca vaccine appointments due from today onwards, and is to consider how the announcement will affect the vaccine rollout over the coming days.

Here’s what we know so far.

The risk of blood clots versus the risk of Covid

20210412_201551 A graph comparing death (red) and ICU admission (blue) from Covid with the rare clotting side effect (yellow) from the Oxford-AstraZeneca vaccine. Gráinne Ní Aodha Gráinne Ní Aodha

Outlining the decision to limit the use of the vaccine to over 60s only, NIAC chair Professor Karina Butler said last night that someone aged 60-64 was 85 times more likely to die of Covid-19 than to have any clotting event from the vaccine – that includes all clotting events reported, and not just the rare thrombosis.

People aged 55-59 are 48 times more likely to die of Covid-19 than get a blood clot.

Among the 20-30 age group, the risk of dying from Covid was twice as likely, than to develop any clotting event related to the AstraZeneca vaccine, with the latter as a worst-case scenario.

Butler added that these figures only covered the most extreme possible result of contracting Covid-19, death, and didn’t take into account the “burdens” of Covid: the likelihood of getting hospitalised or being admitted to ICU with Covid, or the long-term effects of Covid-19, also known as long Covid.

The overall risk is taken from the EU regulator, the European Medicines Agency (EMA) and the UK regulator, the Medicines and Healthcare products Regulatory Agency (MHRA). The Covid risk figures are taken from the Irish data on Covid-19. 

Dr Niamh O’Connell also pointed out that of Covid-19 patients who are hospitalised, 8% experience clotting, and 27% of those who go into ICU could get a clot – though it was stressed that these were different clots to the rare ones linked to the AZ vaccine.

So can only 60-69-year-old get the AstraZeneca vaccine now?

No. The AstraZeneca vaccine was approved for use for the whole population before being limited to only under 70s over concerns about clinical trials not having enough data of the vaccine in over 65s.

However, those reports were subsequently reviewed and AstraZeneca was rolled out to over 70s again.

Professor Karina Butler said that on an operational basis, people aged over 70 have continued to receive mRNA vaccines (Pfizer and Moderna), and that yesterday’s announcement did not change that approach.

So, since that announcement, AstraZeneca is approved for “routine use” in people aged 60 and over.

The HSE is to decide whether over 70s will continue to receive the Pfizer and Moderna vaccines as the default, or whether there will be a reallocation of vaccines.

Why is the limit of the AstraZeneca jab to over 30s in the UK, but over 60s here in Ireland?

Acting Chief Medical Officer Dr Ronan Glynn stressed that although they are recommending the AstraZeneca vaccine for use over 60s, they could have put the limit at a lower age.

It was due to an abundance of caution that it wasn’t, he said.

He and Dr Lorraine Nolan of the HPRA pointed out that the AstraZeneca vaccine is still effective at stopping a significant proportion of the population from dying of Covid-19.

The reason the advice is changing, they added, is because they are in the “lucky” position of having other effective Covid-19 vaccines to choose from.

Can I choose what vaccine I get?

No.

There is no picking and choosing what vaccine you want, Professor Butler said.

For the age cohort specifically aged above 60, if you get offered an AstraZeneca vaccine, the advice is to accept that vaccine.

Speaking about how people should take what vaccine they’re offered, Dr Ronan Glynn said:

“If someone aged 65 is thinking of taking this vaccine if its offered to them in the coming weeks, versus waiting for the summer when there’s a surplus of other vaccines, I would highly, strongly recommend that they take what they are being offered now.”
“What’s being offered is a very safe, very effective vaccine for their age cohort. The risks of them catching Covid-19… and ending up dying of that disease are far, far, far higher than any potential risk on receipt of one of these vaccines.”

Can I still get the AstraZeneca vaccine if I’m under 60?

From today, all AstraZeneca vaccinations are paused, while the HSE comes up with an operational plan based on the new advice.

Professor Karina Butler said that she can’t speak for the programme on whether it would be “practical”, but said that NIAC’s recommendation is that the AstraZeneca vaccine can be given to those aged under 60 if they are made aware of the risks and an individual assessment is made for that person’s situation.

Why the delay between first and second doses for some people who have had the first AZ dose?

Health officials said that people under the age of 60 and with no conditions should be confident that the vaccine is safe and effective.

The reasoning for the delay between first and second doses being extended from 12 weeks to 16, was to reassure people as much as possible that the vaccine is safe.

Over 800,000 people in the UK have received a second AstraZeneca dose without any evidence of adverse events, Professor Butler said.

Germany and France have also begun to give mRNA vaccines as second doses to people who received their first AstraZeneca dose, and NIAC is monitoring how effective that approach will be, “so we will have more certainty” around that.

Are women under 60 more at risk?

Although initial studies suggested that it was mostly women under the age of 60 who experienced adverse blood clotting after receiving the vaccine, NIAC chair Professor Karina Butler said that this could be because it has been primarily given to healthcare workers, who are women aged under 60.

She noted that in the UK, the 79 rare blood clotting incidents of 30 million AstraZeneca doses administered were among men and women more evenly.

I’ve recently had the AstraZeneca vaccine – what should I do?

Dr Niamh O’Connell outlined the symptoms that people should keep a look out for – but added that these mightn’t necessarily be symptoms of a blood clot either:

The symptoms are: a persistent or severe headache, particularly if it is accompanied by a weakness in your leg or blurred vision. Other symptoms to watch out for are shortness of breath or a pain in your chest or tummy, or ‘pin-prick’ bruising.

Dr Ronan Glynn added that these rare blood clotting events tend to appear between four days and up to two weeks after receiving the AstraZeneca vaccine.

So there is no reason for the vast majority of those who have received AstraZeneca to worry – as they are past this time frame.

For those who are still within that time frame, it’s worth remembering that the incidence of these rare blood clotting events is extremely low: it’s 4-10 cases per 1 million doses administered, one of whom may die.

Have there been cases in Ireland?

The HPRA is still only aware of one suspected case of a rare blood clotting event – but it hasn’t been confirmed as an adverse event as a result of the AstraZeneca vaccine.

Dr Lorraine Nolan confirmed there was still one ‘case of special interest’, but didn’t confirm the details of the person’s condition, due to patient and data privacy reasons.

She did, however, say that as of now, there has been no reported incident of adverse events of low platelets and a clotting event together, which is the rare clotting incident associated with the Covid-19 AstraZeneca vaccine.

Dr Nolan also pointed out that European regulators were the first to become aware of this blood clotting event, and that when they began distributing the vaccine out to the population, they were “open” to the possibility of rare adverse events.

Dr Nolan said that Ireland’s population is so small that a rare event like this may not be spotted unless they looked at data abroad, as was done in this case with European and global data.

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    Mute aurilton
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    May 30th 2013, 7:51 AM

    “Diagnosis can bring a sense of relief” -
    It can also catapult you into an unknown, scary world when you realise you have a diagnosis and there are no services available for some years, depending on where you live. Lengthy waiting lists. You learn and research the diagnosis and realise Early Intervention is the KEY and the hope your child needs to give them a chance to progress and thrive but you could have to wait months or years.
    When you finally get intervention and meet wonderful people along the route you get to the never ending brick wall, listening to departments lacking in resources due to budgetary constraints, not being able to provide a service. You rejoice when you see progress, no matter how slow it takes.
    You are the voice your child needs and you will do everything to ensure they are allowed to achieve their goals.
    You learn to praise and encourage and most of all love.

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    Mute n365
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    May 30th 2013, 1:46 PM

    Excellent comment! Exactly as it is.

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    Mute Bridget Heappey
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    May 30th 2013, 8:00 AM

    I completely agree about children being wrongly diagnosed with ADHD; we told parents that spanking is unacceptable and parents are still unsure of how to discipline and what works.
    I have seen some truly disgusting examples of parenting including one parent who thought it was funny that their child was regularly biting other children in a playgroup. That child was diagnosed with a host of issues yet presented with no problems in playgroup when a new leader focused on that particular childs behaviour! We need to help parents with parenting skills instead of just giving a child a justification to behave in a way that’s going to leave them ostracised from their peers and things like birthday parties.

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    Mute Thomas
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    May 30th 2013, 10:01 AM

    When I was a baby doctors tried to label me as someone with development problems just because I didn’t communicate in the way expected. My dad knew the doctors hadn’t a clue and well here I am years later with a college degree under my belt.

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    Mute Sharon Clifford
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    May 30th 2013, 10:24 AM

    I’ve recently had a baby born with DS, we had no idea until he was born! The care and attention both he and I have gotten since then has been fantastic ! In fact I felt a bit smothered at the begining as we were trying to come to terms with this massive challenge both he and I would face in the future , I was so so worried about absolutely everything , but the systems that are in place for us are second to none! I am so grateful to all the staff in Drogheda and crumlin hospital and the public health nurses and the team from early intervention for making it so easy for us, they have given us space and also been there at the drop of a hat when we needed them! We have only just been told he will need heart surgery in a few weeks ( which was an absolute shocker when told) but with the reassurance and care I’m sure all will work out fine! I suppose I’m one of the lucky ones as I didn’t have to fight for anything , but who knows what’s around the corner and to every parent out there …. Keep strong and I’m sure everything will work out ok in the end ! X

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    Mute Smiley
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    May 30th 2013, 1:25 PM

    I know of several people born with Downs who received such good early intervention that they have been able to function in mainstream classrooms, and do fine, and gain employment in the workforce. Not in Ireland, though.

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    Mute Gar.
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    May 30th 2013, 2:21 PM

    Not in Ireland? Ireland is one of the best if not the best country in the world when it comes to Downs Syndrome. Don’t comment unless you are directly involved because you haven’t a clue about it. I know someone who knows someone is rubbish. Unless you are a parent of a child with DS like me or work directly with disabled people then your comment I’m afraid is pointless. Per head of population there are more people with DS in Ireland than any other country in the world and that’s why the facilities are good and the early intervention is excellent. All children in Ireland under the age of 5 have a combination of a speech and language therapist, a physio and an early learning teacher. The same services were not there 20 odd years ago so you can’t judge the progress children will make by observing adults in their 30′s and by what they do. The majority of children with DS go to mainstream school and thrive there. Sorry for rambling on.

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    Mute Smiley
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    May 30th 2013, 3:46 PM

    Gar. It’s no good for rambling on *after* your abusive comments. News for you Gar, I have loads of experience in the field in Ireland and abroad. Compared with other countries Ireland is not up with the play. In Ireland a school principal has the right not to enrol a child with disability. Most common reasons? It’s too hard to get resourcing; other parents might be uncomfortable.

    FWIW Ireland has such a high rate of child disability because there is no abortion. Not commenting pro or con abortion. Just stating from experience of colleagues.

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    Mute Smiley
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    May 30th 2013, 3:47 PM

    Oh, Gar. I didn’t say I know someone who knows someone. I have first-hand experience.

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    Mute Rkmr
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    May 30th 2013, 4:18 PM

    Is that true? Ireland has the highest rate of DS? If its true surly we should be looking at why, or are we already?

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    Mute Maria
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    May 30th 2013, 4:35 PM

    Most of the risk factors for DS are well known so I assume we know why, if it is true that is. Our abortion laws could also be something to do with it.

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    Mute Smiley
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    May 30th 2013, 6:08 PM

    Anyone who has worked in the UK will know that there are low rates of DS, CP, SB. They allow abortion and many parents take that option.

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    Mute Deirdre
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    May 30th 2013, 7:59 AM

    No mention of effect of speech and language delays and disorders on a child’s social and academic attainment. Specific Language Impairment, for example, where performance IQ is normal but language comprehension and expression is disordered, can cause severe difficulties and has been linked to bullying at a young age. Diagnosis is essential to gain access to appropriate services.

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    Mute karla carroll
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    May 30th 2013, 8:08 AM

    I have a son who was diagnosed at 4 and a half with a specific speech and language disorder, he was in the first percentile for receptive, expressive and phonological speech. Because it was so bad he presented with autistic and ADHD like characteristics.

    This was picked up in his 2 year developmental. My phn referred my son under the 2005 disability act and received early intervention from age 2.5 speech therapy, occupational therapy, early intervention education group sessions and 1 to one.

    He is now 6, a happy chap who is very popular amoung his class mates and who wins each adults heart with his big smile, big eyes innocent and funny behavior.

    I wouldn’t change him for the world.

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    Mute Phil
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    May 30th 2013, 8:15 AM

    You are the voice for your child so don’t always listen to the so called experts, they are not always right. Only recently did we have our 4 yr old diagnosed with autism and that was only after we fighting with HSE and the so called experts who wanted to send my wife and I on a another parenting course. Thrust your gut instinct and fight like hell for your child because you know them better than anyone else and not these health professionals who only observe them for a short time

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    Mute Michael G O'Reilly
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    May 30th 2013, 11:37 AM

    There is also of course the issue that a minority of parents actively seek a label for their child ….it lets them off the hook when the child’s problems are caused by poor parenting skills. You can all red thumb this ….but the truth is out there ….admit it, you see it everyday !

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    Mute Sally Aquilina
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    May 30th 2013, 12:38 PM

    while I think the ‘excuse factor’ is a very real problem, be careful not to automatically assume that is the case. A brilliant parent with a child who has severe ADHD may be able to love, encourage, discipline etc their child that they’re only slightly more hyperactive than a ‘normal’ child – which for the individual is massive progress and the result of a lot of hard work. To an outsider, the child appears to be slightly unruly and its easy to judge that ‘a bit of discipline would address that’.

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    Mute Smiley
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    May 30th 2013, 1:27 PM

    Michael, I personally know people who have sought and gained autism diagnoses for children who aren’t autistic. They were turned down by HSE professional assessors but then gained the ‘pay for the letter’ diagnoses in Dublin.

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    Mute Sara Mooney McSweeney
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    May 30th 2013, 6:02 PM

    Do you have a child with autism? What do you seriously think these parents have to gain by getting an incorrect diagnosis of autism for their child? I paid for an assessment of my child not for his diagnosis when I went to see a highly regarded professor of child & adolescent psychiatry in Dublin. The diagnosis gave me NO access to HSE services (I paid for these for another six months until the HSE service provider finally assessed him & gave him services a few months after again). The private dx meant my son got a place in an ASD unit straight away, as the DoE accepted it,when he was just three. Early intervention is critical & my son is living proof of that.

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    Mute Smiley
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    May 30th 2013, 6:14 PM

    Extra money on top of their family allowance, respite care (effectively, paid holidays), transport allowance, SNA/Resource at school… I have no problem with those who need it getting it, but telephone diagnoses, or a 20 minute diagnosis (with or without child present), a form letter, the expense for having to pay for the diagnosis all smell odd to me. Locally, if HSE turn you down, you’ll get the Dublin diagnosis. I personally know people who have.

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    Mute Sara Mooney McSweeney
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    May 30th 2013, 6:27 PM

    Are you joking – do you think a slip of paper from a private assessor will give you access to DCA, Carers & tax credits? You have to provide multi disciplinary reports from experts, diaries, GP letters & school letters. Most people are refused first time & have to appeal, it’s a long & exhausting process. Provision of an SNA is not automatic & in mainstream, children with ASD usually have SNA access, not an SNA to themselves. Maybe things were different a few years ago before I had direct experience of the system but you know very little about current realities. If you do not live with a child with autism – you have no right to judge people unless they have admitted they defrauded the system. If so, I suggest you report them.

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    Mute Smiley
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    May 30th 2013, 6:36 PM

    Sorry, Sara, but I am right up to date with current realities in my area of the country.

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    Mute Sara Mooney McSweeney
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    May 30th 2013, 6:40 PM

    Well I just hope you have reported what you are so sure of so.

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    Mute Kate Murphy
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    May 30th 2013, 8:04 AM

    I think that a problem with diagnosis is that the reaction is often medical treatment.
    ADD and ADHD are over diagnosed and too rapidly treated with medication. There are lots of different therapies that can be tried, from working with an educational psychologist to learn skills to aid concentration and organisation, to things like primitive reflex therapy that focus on correcting underlying physical coordination problems.

    All kids are different and learn and develop in different ways. The first solution for behavioral or educational problems should not be a pill.

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    Mute Carol Lennon
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    May 31st 2013, 10:47 AM

    Smiley I feel for the people who have to deal with you “firsthand”…… Ignorance is not bliss…… its ignorance…….. I have five children and as they were born without visual markers or without physical disabilities I got a hard time because of their behaviours…….their refusal to communicate…… their aggression…….. their eating habits…… Not all of them presented all of the same problems but I had no idea what I was doing wrong….. the excuses given by the “professionals” (teachers… PHN) was that I was a young mother…… maybe I had PND….. was I abused as a child which might result in me having a dysfunctional parenting method……I dod a cookery course for the nutrition and eating problem…… I did photography to cure my depression….. I did ECDL to ease the separation anxiety….. I did a parenting class just to be sure to be sure that I wasn’t the odd one…… My eldest was diagnosed at 14…… Second diagnosed at 6…. Third diagnosed at 9….. Fourth Diagnosed at 6 (by the pay per diagnosis specialist) fifth diagnosed at 3…….. So how did I do it??? Was it me??….. am I faulty?? NO it is genetic……it was always gonna be there……. As for the state payments and “holiday money” you have no idea what you are talking about……… Apply for it for your “firsthand” I dare ya……With diffabled kids and Health and education systems that don’t work most of the time the applying for financial assisntance is a battle that many parents (me included) cant be bothered to take on…… FACT!!!!

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    Mute Bunty Clancy Galvin
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    May 31st 2013, 2:33 PM

    No one buys a diagnosis for their child how insulting

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    Mute Michelle Corry
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    May 31st 2013, 2:03 PM

    Well smiley with all your “first hand experience” and knowledge of special needs services obviously you have had to spend months and months bringing your child to assessments, had to fight over and over for your autistic child to have access to an sna, had schools reject your child purely on the basis of them having special needs, had to fight everyday against the prejudice of ignorant people and their ill educated and informed opinions, had to pay privately for therapies that your child desperately needs that you can ill afford but the HSE waiting lists are endless so you have no choice….all of which I’ve had too and many parents I know have had too. You are such an expert after all….you personally “know people”…. Wow! Well I also work with people with special needs and have a sister with Down syndrome (in the uk by the way where there are many many people with that condition to further add to your extensive knowledge) your comments are ignorant, Ill informed and insulting to the vast majority of special needs parents who have to fight every day for every little thing for their child – especially your rubbish about grants etc which most of us spend months applying for before being routinely turned down over and over again.

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    Mute Bunty Clancy Galvin
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    May 31st 2013, 2:45 PM

    Ignorance is bliss , have you spent hours walking the floor averaging 2 hrs sleep a night , have you watched your child turn themselves inside out screaming and have no medical /physical reason .Have you had to bring them to A+E for three years for chest pain at 8 feeling as if their going to have heart attack to be eventualy told this is panic and anxaty due to asd.. Have you not had an undisturbed meal ,bath ,sleep for 9 years , have you had to stop going on holidays ,dread Christmas ,easter bank holl because it stops normal routine .

    Do you know that majority of people with asd children need some one home full time because it takes over your life ,familys struggle to function ,services are non existant resulting in holiday payments being used for essential equiptment or therapy ………….. Do you know there is no child phycolagy available for children after diagnosis in south east .

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    Mute Michelle Corry
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    May 31st 2013, 3:46 PM

    Btw smiley people don’t “buy” diagnosis for their child – they – like many and myself may I say have to go private because their service provider has had their staff cut back so much that they can’t do any diagnosis in time for parents and schools to apply for supports – there are cut off dates each year for this and any application needs to be accompanied by extensive detailed long reports that include the child’s diagnosis. We have been forced down this route even though it was obvious to everyone involved – Montessori staff – family and friends and our gp and HSE that our child had autism, because our HSE funded local service has had it’s psychologists halved in the past few years. It cost us four hundred euro which we struggled to find – but we did – otherwise our daughter would have received no sna or supports in school. That’s why people go private – because their kids will suffer if they don’t.

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    Mute Aodhan O Cuana
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    May 30th 2013, 10:28 AM

    Come on Editor! A professional (Education) writing about the pros/cons of classifying a child against a standard norm and then a crisis of conscious! Seriously; she has studies texts that reinforce her position in labelling the child. These text are based on the perfect middle class white boy (girls aren’t rational) and then she waffles about how this process impacts on the parents and less so about how education policy links funding to these labels! It’s tardy professional musings!

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