Are Children More Easily Approved for Social Security Disability?

If your child has a disability and your family has limited resources, programs such as Supplemental Security Income (SSI) can provide financial support to help meet your child’s basic needs. While there’s a lot of overlap between childhood SSI claims and adult cases when it comes to evidentiary requirements, it’s often harder for children to get approved for disability than it is for adults.

Because applying for childhood SSI benefits can be lengthy and complicated, many parents of disabled children abandon the claim out of frustration. But with a basic understanding of Social Security’s rules and regulations, you can make the process go more smoothly and increase your ability to effectively advocate for your child.

Why Child SSI Disability Claims Are Harder to Prove

Children’s SSI claims are harder to prove because they’re based almost entirely on medical records, while adult claims use a combination of medical and vocational factors to determine disability. Because children aren’t expected to show that they can’t work full-time—which is one of the most common reasons why adults are awarded benefits—they’ll need to have stronger medical records in order to qualify for disability.

To qualify for SSI, children must have medical records that meet or functionally equal a Blue Book listed impairment. Social Security won’t consider how their medical condition affects their ability to work until they turn 18, so you’ll need to make sure your child’s medical conditions are very well documented in order to meet the high standards of the Blue Book listings.

What You Need to Win an SSI Claim for a Child

Before approving a child’s SSI disability benefits, Social Security requires detailed information about the child’s medical condition and what effect the condition has on the child’s ability to function on a daily basis. The agency will review the childhood disability listings to see if your child’s condition is one of the listed impairments and, if so, whether their medical records exactly match the requirements of the listing. If not, then Social Security will need to determine your child is functionally equivalent to the listings.

Getting SSI by Meeting a Childhood Listing

There are over 100 specific childhood listings in Social Security’s Blue Book of conditions that are considered automatically disabling. The exact medical evidence you’ll need to provide for your child to meet a listing will necessarily vary according to the type of medical condition. Here are a few examples:

• Children with asthma may meet listing 103.03 if they’ve been hospitalized for several asthma attacks within a certain period of time.
• Children with epilepsy may meet listing 111.02 if they’ve had frequent seizures over several months despite taking anti-convulsant medications.
• Children with ADHD or a learning disability may meet listing 112.11 if they have certain abnormal behavior patterns that interfere with their ability to complete mental tasks.

It’s a good idea to review the childhood listings for the body system most affected by your child’s medical impairment and see whether the record supports a finding that your child meets a listing. If so, you may want to ask the child’s pediatrician or doctor to complete a medical source statement to that effect and submit it to Social Security.

Getting SSI by Functionally Equaling a Childhood Listing

Social Security will use the information you submit to determine whether your child’s condition meets the requirements of a listing. If your child doesn’t meet a listing, the agency will see whether your child has limitations that are “functionally equivalent” to a listing. Functional equivalences means that your child is as disabled as someone who meets a listing exactly due to their difficulties in one or more “functional domains.”

There are six functional domains that Social Security uses to determine whether your child is disabled. In order to be functionally equivalent to a listing, your child’s records must demonstrate “marked” limitations in two, or an “extreme” limitation in one, of the following areas:

• acquiring and using information
• attending to and completing tasks
• interacting with and relating to others
• moving around and manipulating objects
• caring for oneself, and
• health and physical well-being.

“Marked” limitations are in areas where your child finds it very difficult to function. “Extreme” limitations are in areas where your child may be able to function independently with a lot of help. “Extreme” is worse than “marked,” but the line between the two isn’t always clear, so it helps to have a doctor’s opinion about how severely your child struggles in one or more areas.

Medical Records Social Security Will Review to See If Your Child is Disabled

Your child’s medical records are the foundation of their SSI claim. Without clinical notes from doctors, results of physical or mental examinations, and objective medical testing, Social Security won’t be able to determine whether your child’s diagnosis meets or functionally equals a listed impairment.

The agency will also consider evidence from non-medical professions who have information about your child’s health, like their teachers or guidance counselors. They’re usually in a good position to provide assessments on how your child is doing at school relative to their peers. When you apply for SSI for your child, Social Security may ask for the following information:

• academic performance records (like report cards) and other teacher assessments
• attendance records
• standardized test scores and other specialized testing (like IQ evaluations)
• school-based therapeutic interventions (such as speech or language therapy for an auditory processing disorder), and
• any other special services your child receives.

Children with cognitive, neurologic, or mental impairments in particular will likely be asked to provide evidence of an individualized education program (IEP) or 504 plan. These academic roadmaps can help Social Security identify the areas in which your child is struggling and apply that knowledge to make an informed disability determination.

Individualized Education Programs (IEPs)

IEPs are developed for your child by the special education professionals at their school. IEPS can be particularly helpful in proving disability because they’re tailored to each child’s unique needs. For example, an IEP can provide insight into:

• your child’s limitations and current level of function
• annual academic and functional goals
• how your child’s progress will be measured
• the specific educational environment and support services your child needs, and
• any vocational and placement needs (for a child age 16 or older).

If your child hasn’t been evaluated for special education, you should know that a federal law called the Individuals with Disabilities Education Act (IDEA) gives you the right to have your child assessed for any special education eligibility and needs. IDEA requires your child’s school to offer testing if there's any evidence that a disability is adversely affecting your child's academic performance.

504 Plans and Necessary Accommodations

Named after Section 504 of the Rehabilitation Act, these plans focus on the accommodations your child needs to ensure they have a learning environment that fosters success. Under the act any child whose access to learning in the educational setting is “substantially” reduced because of a learning, behavioral, or medical condition is entitled to any accommodations they need to help them learn. If your child has a 504 plan, it will detail the adjustments and modifications your child needs in an academic setting.

For instance, a child with ADHD could have a 504 plan that includes accommodations like allowing the student to take 15-20 minute “brain breaks” or providing the student with “fidget items” during instruction. Or, the 504 plan for a visually impaired child might include using audiobooks or computer-aided instruction.

Keep in mind that simply having an IEP or 504 plan doesn’t necessarily mean the child will qualify for SSI benefits. But IEPs and 504 plans can play a large role in documenting functional limitations that can establish disability, so don’t neglect to inform Social Security if your child has one.

What Happens If Your Child’s Condition Improves In The Time It Takes to Get SSI

As your child grows older, their condition can improve. That’s obviously good news for your child’s development in the long run, but it can actually hurt your child’s SSI claim. It can take a couple of years just to get a disability hearing before an administrative law judge, which represents your best shot at getting benefits for your child. By the time your child’s claim has reached this stage, they may no longer meet the medical criteria to be considered disabled.

If you aren’t sure how strong your child’s claim is—or you’ve been denied already and want some help with your appeal—it’s a smart move to contact an experienced disability lawyer. Disability attorneys work on contingency (meaning they don’t cost anything upfront) and many offer free consultations, so there’s little risk in asking around to find an attorney who is a good fit for your family.