Getting SSI for a Child's Sensory Integration Disorder

Sensory integration disorder (SID), also known as sensory integration dysfunction, affects a child's ability to organize the sensory information he or she receives from the environment. Every aspect of daily life, including eating, playing, going to school, listening to music, and getting dressed, involves sensory information that the brain must process, organize, and interpret. In children with SID, the failure of the brain to organize this information can cause problems that include behavioral issues, delayed motor skills, nutritional issues, poor school performance, and social isolation.

The exact cause of SID is unknown, but scientists believe it is primarily an inherited disorder, though environmental and birth complications may contribute to its development. SID can be treated, with varying degrees of success, with specialized occupational therapy that focuses on sensory integration (called OT-SI).

Childhood Disability Requirements

To be found disabled, the Social Security Administration (SSA) 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, and
• the condition(s) has lasted, or must be expected to last, at least 12 consecutive months

Some childhood impairments are eligible for immediate approval if the condition is one outlined in the SSA's Childhood Listing of Impairments. However, SID is not a listed impairment; therefore, the SSA will use the Childhood Evaluation Form SSA-538 to determine the extent to which the disorder affects various aspects of a child's life, and, subsequently, whether the child is disabled.

Form SSA-538 and SID

To find that a child is disabled due to SID, the SSA must determine that the SID causes a "marked" limitation in two domains, or that it causes an "extreme" limitation in one domain. There are six domains that the SSA evaluates in childhood disability claims without a listed impairment. These are the 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.

Marked limitation. The SSA defines a "marked" limitation as one that interferes seriously with the child's ability to "independently initiate, sustain, or complete activities." It also states that a "marked" limitation as "more than moderate" but "less than extreme."

Extreme limitation. The SSA defines an "extreme" limitation as one that interferes very seriously with the child's ability to "independently initiate, sustain, or complete activities." (You can read more about these definitions on the SSA's website.)

To determine the extent of how your child is affected by the SID, the SSA will compare your child's functioning with the specific benchmarks established for an average unimpaired child of the same age. Each "domain" has its own set of benchmarks.

Who Completes the Form SSA-538?

The SSA will complete the Form SSA-538 based on the evidence that has been submitted. Some types of evidence used are school reports, individualized education plan (IEP) reports, doctors' records, and any reports from therapists. However, you must make sure that you take a Form SSA-538 to your child's educational and medical providers and ask that they complete a form on behalf of your child. You can view Form 538 online at the SSA's website, but you should ask the SSA for a copy. If you have an attorney, he or she will make sure that your child's providers receive the form and that it is completed and submitted properly.

Examples of How Severe SID Must Be to Get Benefits

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

• The claimant was an 8-year-old girl diagnosed with SID. Her primary areas of difficulty were in the domains of attending and completing tasks and interacting and relating with others. Her school and medical records indicated that the child 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 she was enrolled in an IEP that offered a highly structured and controlled learning environment. This limitation resulted in the child failing's to reach the benchmarks established for her age. Her 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, the SSA 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, she could be approved for benefits.
• The claimant was a 15-year-old child with SID. The symptoms of his SID included myriad food and odor aversions that resulted in his 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 child was unable to complete school-related tasks in a normal classroom setting due to distractibility and was enrolled in an IEP. The two domains affected by his impairment were his ability to care for his personal needs and his ability to attend and complete tasks. Because of the extent of the impairments documented in his file and the opinions of his medical and educational providers, the SSA could determine that his symptoms caused "marked limitations" in the two domains discussed above and approved him for disability.

• The claimant was a 12-year-old boy diagnosed with SID. Although he was enrolled in an IEP, his educational records indicated that he was of average intelligence and was progressing in his classes. His educational records also indicated that he played baseball and had made several friends. Additionally, he was enrolled in an OT-SI program and was demonstrating success and significant improvement. Accordingly, the SSA would probably determine that the SID caused no more than a "moderate" limitation in any of the domains and deny him benefits.

What Benefits Can a Disabled Child Get?

If the SSA determines that a child is disabled, he or she may be eligible for Supplemental Security Income (SSI). However, in order to receive SSI, the child's parents must meet the economic threshold set by the SSA. To learn more, see our article on Social Security benefits for children.