This page discusses the social security disability and SSI evaluative system, specifically as it relates to the handling of claims in which autism is the chief allegation. The information provided here may benefit applicants with Autism who have representation, as well as applicants who are not represented by a lawyer or non attorney representative. This is simply because understanding how the Social Security Disability system works can sometimes make the difference between winning a disability application or disability appeal...or not. |
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This section begins with a brief informational write-up regarding autism. However, this is followed by a discussion of the childhood autism listing, which appears in the social security disability listing of impairments, formally titled "Disability Evaluation under Social Security", and commonly referred to as the blue book. Please keep in mind that satisfying the requirements of a listing (referred to as meeting or equaling a listing) is not the only way to be approved for disability benefits, whether the disability claim is for a child or adult. Individuals whose claims are not approved on the basis of meeting a listing may still be approved on the basis of what is known as a medical vocational allowance (links regarding medical vocational allowances and various other aspects of the social security disability and SSI disability system may be found at the end of this article). Autism Autism is a neurodevelopment disorder that affects communication and social interaction skills. Autism is present from birth and is usually recognized by at least three years of age, if not sooner. Infants with the disorder may not be as attentive to social interaction and may not smile, laugh, babble or focus on social stimuli as much as infants without the disorder. As infants turn into toddlers they exhibit less eye contact and show a lack of communication skills, as well as showing repetitive or limited behavior. Not everyone with autism displays the same behaviors. There are many signs of autism and they may be experienced by varying degrees. Diagnosis depends upon the patient showing at least six symptoms. Two of the symptoms must be linked to social interaction impairment, while one must be a communication impairment and another one must be a restricted or repetitive behavior impairment. Communication symptoms can include a lack of responsiveness, babbling or gibberish, unusual gestures and it has been reported that at least one-third of autistic individuals do not develop speech and communication enough to meet the needs of daily life. Restrictive behavior can include purposeless movement such as rocking, head rolling, hand flapping and other movements. It can also include compulsive behavior such as rearranging objects and needing to control the physical environment. Ritual behavior is also a common symptom of austism, such as needing to do things the same way and at the same time everyday and resistance to change in the environment. Limited activity, focus and interest is also a symptom of autism, as well as self-injury, such as biting oneself, pulling hair and other self-injury activities. None of these symptoms are specific to autism, but these behaviors are often present , severe and reoccurring. Some patients with autism show rare talents and are categorized as autistic savants. Autistic savants can show unusual skills and rare talents, such as the ability to read a book and recite the entire book back from memory, the ability to play instruments without instruction and the ability to calculate large mathematical equations in one’s head. Around 10 percent of those with autism are thought to be autistic savants. How autism transpires is not entirely understood. It is a brain development disorder that affects many parts of the brain; studies are continually ongoing to understand the disorder. In all cases, autism is an entire pattern of symptoms and behaviors, and never just one characteristic. Many also exhibit aggression and severe tantrums. There are several theories on what causes autism, from unstable excitatory-inhibitory networks and a surplus of neurons in the brain, to abnormal formation of synapses and dendritic spines. Some also think it could be caused by unstable neuronal migration during early conception. Autism is not curable, but diagnosis and treatment early on can help manage the disorder. In some cases autism is thought to be genetic and in other cases it may be thought to be present because of gene mutations or birth defects. Although controversial, childhood vaccines are another suggested cause of autism. Listing 112.10 - Social Security Administration Blue Book listing for Autism in Children The required level of severity for these disorders is met when the requirements in both A and B are satisfied. A. Medically documented findings of the following (all three A-section requirements must be met) : 1. Qualitative deficits in the development of reciprocal social interaction; and 2. Qualitative deficits in verbal and nonverbal communication and in imaginative activity; and 3. Markedly restricted repertoire of activities and interests; and B. For older infants and toddlers (age 1 to attainment of age 3), resulting in at least one of the appropriate age-group criteria in paragraph B1 of 112.02; or, for children (age 3 to attainment of age 18), resulting in at least two of the appropriate age-group criteria in paragraphs B2 of 112.02. Some explanation regarding listing 112.10 1. If you'll notice, the section A criteria and the section B criteria are quite different. First of all, all portions of the section A criteria must be met in order to satisfy the listing, whereas only two portions of the B criteria must be satisfied in order to meet the listing and be approved for disability benefits. Secondly, however, from the language of the listing, it quickly becomes apparent that the A criteria addresses medical findings while the B criteria addresses impairment-related functional limitations. What do we mean by "satisfy the listing"? Simply that a claimant's medical records (including any statements provided by a claimant's medical treatment providers) must document the existence of functional limitations and deficits with regard to a claimant's impairments. 2. The phrase "medically documented findings" refers to medical evidence. Medical evidence (typically records obtained from a doctor, hospital, or clinic) serves to document symptoms, signs and laboratory findings, but, for the purpose of this listing, such evidence may also include the results of pyschological testing and developmental testing. 3. The childhood autism listing refers to "marked" restrictions in a child's repertoire of activities and interests. What does the social security administration mean by marked? As the SSA blue book states, marked limitations exist when one or several areas of activity or function are impaired and this impairment interferes "seriously with the ability to function, based upon age-appropriate expectations". Meeting listing 112.10 To meet the child autism listing, a claimant's medical records must satisfy all of the A-section requirements of listing 112.10: qualitative deficts in the development of reciprocal social interaction; qualitative deficits in verbal and nonverbal communication and in imaginative activity; and also a marked restriction in the repertoire of activities and interests). However, meeting the listing and being approved for benefits also means satisfying the age-based criteria set forth in section B of the listing. The following information addresses this criteria. For children ages 1 to 3, a claimant's records must show at least one of the following: 1. Gross or fine motor development at a level generally acquired by children no more than one-half the child's chronological age. 2. Cognitive/communicative function at a level generally acquired by children no more than one-half the child's chronological age. 3. Social function at a level generally acquired by children no more than one-half the child's chronological age. 4. Attainment of development or function generally acquired by children no more than two-thirds of the child's chronological age in two or more areas covered by 1, 2, or 3. For children ages 3 to 18, a claimant's records must document the existing of two of the following: 1. Marked impairment in age-appropriate cognitive/ communicative function. 2. Marked impairment in age-appropriate social functioning. 3. Marked impairment in age-appropriate personal functioning. 4. Marked difficulties in maintaining concentration, persistence, or pace. Comments regarding areas of functionality 1. Cognitive and communicative functioning may be measured through the use of standardized testing that is appropriate for a claimant's age. As the blue book states, the type of testing employed may vary with age. The manual also states that alternative criteria may be used to measure deficits that may exist in language development or speech pattern development. Regarding the measurement of cognition itself, a primary sign of limited function is a valid IQ score (either full scale, verbal or performance) of 70 or less. 2. Social functioning is defined in the blue book as a child's capacity to form and keep relationships. This includes relationships with peers, their parents, and with other adults. Impairments in social functioning may result in a number of expressions, including physically aggressive behavior, becoming socially isolated, and even mutism, while healthy and strong social functioning may be indicated by, among other things, a child's ability to form and maintain social relationships, participate and cooperate with other individuals and groups, and respond appropriately to authority figures (parents, teachers, etc). 3. Personal functioning refers to the development of self-care skills (such as feeding oneself, personal hygeine, dressing, grooming, toileting, etc). An impairment in personal functioning equates with a failure, to whatever degree, to develop such skills. 4. Concentration, persistence, and pace - The ability to focus attention to a task, to appropriately persist at it and to maintain a pace at the task (at would be considered an age-appropriate level) is measured both by observing the child and also measured by results obtained from standardized testing. Additional Pages 1. What to do if your disability is denied 2. Social Security Disability and SSI Appeals Process 3. Getting Prepared for a social security disability hearing 4. The SSI disability claim 5. How do you qualify medically - the medical vocational allowance Disability Advocates Help with Claims Experienced Representation |
SOCIAL SECURITY DISABILITY ATTORNEY, REPRESENTATIVE LAWYER LIST ANSWERS TO YOUR SSD & SSI QUESTIONS PAGE 8 ANSWERS TO YOUR SSD & SSI QUESTIONS PAGE 9 SOCIAL SECURITY DISABILITY BLOGPOSTS |
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