Getting SSI for a Child's Sensory Integration Disorder

Sensory integration disorder (SID), also known as sensory integration dysfunction or sensory processing disorder (SPD), affects a child's ability to organize sensory information received from the environment—everything the child sees, hears, smells, feels, or tastes.

In children with SID or SPD, the failure of the brain to organize the information gathered by the senses can cause problems ranging from delayed motor skills and nutritional difficulties to behavioral issues, poor school performance, and social isolation.

The exact cause of sensory integration disorder is unknown. Some experts believe it to be primarily an inherited disorder, but environmental and birth complications might contribute to its development.

SID can be treated using specialized occupational therapy focusing on sensory integration (OT-SI), with varying degrees of success. Even with treatment, some children with SID still face significant impairments.

Is Sensory Integration Disorder a Disability?

The Social Security Administration (SSA) hasn't included sensory integration disorder in the list of impairments that can automatically qualify as disabilities. But severe SID that persists and significantly limits a child's ability to function can meet Social Security's definition of disability.

To be found disabled, Social Security must determine that the child meets both of the following criteria:

• The child has a medically determinable physical or mental impairment that results in marked and severe functional limitations.
• The condition has lasted or is expected to last at least 12 consecutive months.

Some impairments can automatically qualify as disabilities if the condition is one of those outlined in Social Security's Childhood Listing of Impairments and the child meets the listing requirements. However, as mentioned above, SID isn't a listed impairment.

Instead, Social Security will use the Childhood Disability Evaluation Form (SSA-538) to determine the extent to which the child's disorder affects various aspects of the child's life—and whether those effects are enough to consider the child disabled.

How Social Security Evaluates a Child's SID

To find that a child is disabled due to sensory integration disorder, Social Security must determine how much the SID limits the child's ability to function.

Sensory integration disorder can affect many different areas, since every aspect of daily life involves sensory information that the brain must process, organize, and interpret, including:

• eating
• playing
• going to school
• listening to music, and
• getting dressed.

Domains of Functioning

The SSA evaluates six "domains" (areas) of functioning in childhood disability claims for unlisted impairment, including the child's ability to:

• attend and complete tasks
• interact and relate with others
• move about and manipulate objects
• care for personal needs, and
• have good health and physical well-being.

To qualify as a disability, the child's SID must cause a "marked" limitation in two domains or an "extreme" limitation in one—that's what Social Security considers to be equivalent to meeting a listing. (20 C.F.R. § 416.926a.)

What Qualifies as a Marked Limitation?

Social Security defines a "marked" limitation as one that interferes seriously with the child's ability to "independently initiate, sustain, or complete activities." A "marked" limitation is "more than moderate" but "less than extreme."

What Are Extreme Limitations?

Social Security defines an "extreme" limitation as very seriously interfering with the child's ability to independently initiate, sustain, or complete activities.

Assessing Your Child's Limitations

To determine how much your child is affected by the SID—the extent of your child's limitations—the SSA will compare your child's functioning with benchmarks established for an average child of the same age who doesn't have a disorder. Each "domain" has its own set of benchmarks.

Who Completes Form SSA-538?

Social Security will complete Form SSA-538 based on the evidence in your child's case file from many different sources, including:

• school reports
• individualized education plan (IEP) reports
• doctors' records, and
• reports from therapists.

You can also ask your child's educational and medical providers to fill out Form SSA-538 on your child's behalf. Doing so will help Social Security to clearly understand your child's limitations when the agency fills out its own disability evaluation form.

You can get a copy of the Childhood Disability Evaluation Form by requesting it from Social Security. If you have an attorney, they'll facilitate getting your child's educational and medical providers to complete the form and submit it correctly.

Examples of How Severe SID Must Be to Get Benefits

Here are some examples of childhood disability claims based on SID and how Social Security would evaluate them.

Example: An 8-Year-Old Girl Diagnosed With SID

Julia's primary areas of difficulty were in the domains of attending to and completing tasks and interacting and relating with others. Her school and medical records indicated that she startled easily and was highly distracted in the classroom by normal stimuli such as:

• the sound of pencil sharpeners
• the flickering of overhead lights, and
• the scuffing of chairs.

Because of this, her IEP called for a highly structured and controlled learning environment. Her limitations resulted in her failing to reach the benchmarks established for her age for these domains.

The girl's records also indicated that she was shy and seldom interacted with her peers, though she was close to her siblings and parents.

Given the evidence in her file and the opinion of her medical and educational providers, Social Security concluded that the child's SID caused an "extreme" limitation in the domain of "attending and completing tasks." The limitation in her ability to interact and relate to others was only moderate. However, because she had an "extreme" limitation in one of the domains of functioning, she could be approved for disability benefits.

Example: A 15-Year-Old Boy With SID

The symptoms of Aaron's SID included a large number of food and odor aversions that resulted in an inability to eat a majority of foods. Because of this, he required a highly structured eating environment to meet his nutritional needs, both at home and at school.

Additionally, the teen was unable to complete school-related tasks in a normal classroom setting due to distractibility, and he was enrolled in an IEP. His impairment affected two domains of functioning:

• his ability to care for his personal needs, and
• his ability to attend to and complete tasks.

Because of the extent of the impairments documented in his file and the opinions of his medical and educational providers, Social Security determined that the teen's symptoms caused "marked limitations" in the two functional domains discussed above, and the agency approved him for disability.

Example: A 12-Year-Old Boy Diagnosed With SID

Although Nate was enrolled in an IEP, this boy's educational records indicated that he was of average intelligence and was progressing in his classes. The boy's educational records also indicated that he played baseball and had made several friends. Additionally, he was enrolled in an OT-SI program (sensory integration therapy) and was demonstrating success and significant improvement.

In this case, Social Security would probably determine that the child's SID caused no more than a "moderate" limitation in any of the functional domains and would deny this child benefits.

What Benefits Can a Disabled Child Get?

Children who meet Social Security's definition of disabled might be able to receive Supplemental Security Income (SSI) disability benefits. Social Security disability insurance (SSDI) benefits are only available to adults who've worked long enough to qualify. SSI has no prior work requirement, but there are other eligibility criteria.

To be eligible for SSI, the child must meet both the medical requirements (qualifying as disabled) and the technical requirements, such as:

• being a United States citizen, U.S. national, or qualified noncitizen
• living in one of the 50 states, the District of Columbia, or the Northern Mariana Islands
• having a family income below the SSI limit, and
• having limited resources (family assets below the limit).

Learn more in our article on getting SSI disability benefits for children.

Applying for SSI for a Child With SID

Before you can submit a child's application for SSI disability benefits, notify Social Security that you want to do so. You can do that using one of the following methods:

• Call the SSA's national office at 800-772-1213 (TTY 800-325-0778).
• Contact your local Social Security office.
• Use the SSA's online notification form.
• Complete a child disability report online.

Social Security will then set an appointment for you to speak with a representative who will help you complete the child's application.

Learn more about applying for SSI disability benefits.

_{Updated March 27, 2024}