Getting SSI Benefits for a Child or Teenager With Schizophrenia or Other Psychotic Disorder

Schizophrenia is a challenging mental illness that can cause your teenager to have abnormal thoughts and odd behavior that can be considered disabling. Your teenager may exhibit such symptoms as hearing people and observing things that are not grounded in reality (known as hallucinations), showing excessive anxiety around other people, having rapidly changing moods, and not keeping good personal hygiene.

To determine whether your teen's symptoms are consistent with schizophrenia, you should ask your child's pediatrician to refer you to a psychologist or psychiatrist specializing in the treatment of children and adolescents. Treatment for schizophrenia in children includes the use of therapy, medication, and school programs that can address specific needs.

Applying for SSI with a Childhood Psychotic Disorder

It can be difficult to obtain disability benefits (known as SSI, or Supplemental Security Income) for a childhood psychotic disorder. Schizophrenia rarely begins in childhood, though it can appear at age 16 or 17.

First, the Social Security Administration (SSA) will want evidence from a licensed psychiatrist or psychologist that your child has been diagnosed with schizophrenia or a similar mental illness. Second, the SSA will grant SSI benefits only if your child has had very serious limitations in his or her daily functioning, even with the use of medications, for at least 12 months, or is expected to have these limitations for 12 months.

To provide evidence of the severity of your child's problem, your child's psychiatrist can provide the results of psychological tests, clinical notes, and a medical opinion on your child's limitations to the SSA. If you are unable to afford medical care, the SSA may send your child to a psychologist for a paid consultative examination.

Meeting the SSA's Listing of Impairments for Schizophrenia

The most straightforward way to receive disability benefits is for your child to meet the limitations described under a particular listing in the Childhood Listing of Impairments (the "Blue Book"). Listing 112.03 is for schizophrenia spectrum and other psychotic disorders, and it was updated significantly in 2017. In addition to schizophrenia, the SSA will also evaluate schizoaffective disorder, delusional disorder, and other psychotic disorders under this listing.

Symptoms

To meet the requirements for this listing, your child's medical records must show that he or she experiences at least one of the following:

• delusions or hallucinations
• disorganized thinking (such as illogical thoughts), revealed in the child's speech, or
• grossly disorganized behavior or catatonia (rigid muscles, unresponsiveness, or inappropriate actions).

Note that emotional isolation and withdrawal from social interaction and having a blunt affect are no longer part of the listing for schizophrenia or psychotic disorders.

Limitations in Functioning

In addition, you must also show that your child has an extreme limitation in at least one of the following areas, or a severe limitation in at least two of the following areas:

• interacting with others (cooperating with others, maintaining friendships, handling conflicts with others)
• adapting or managing oneself (controlling one's behavior, protecting oneself from harm, practicing good hygiene)
• concentrating, persisting, or maintaining pace in performing tasks (completing tasks in a timely manner, engaging in an activity close to others without distracting them), and
• understanding, remembering, or applying information (learning new material, following oral instructions, applying new knowledge to tasks).

When a Child Has Made Marginal but Fragile Progress

Your child's condition may have improved with medication such that he or she no longer has severe or extreme limitations in functioning, but has minimal capacity to adapt to changes in his or her environment, or to demands that are not already part of daily life. Social Security calls this "marginal adjustment," meaning that the child's adaptation to the requirements of daily life is fragile. In some cases, past changes or increased demands may have caused a deterioration in the child's functioning or caused the child to be hospitalized or absent from school.

In this case, the child doesn't have to show that he or she currently has the severe limitations required above. But the child's condition must be "serious and persistent"; that is, there must be a medically documented history of a disorder over a period of at least two years. He or she must also be receiving ongoing medical treatment or mental health therapy that reduces the schizophrenic or psychotic symptoms.

Functional Equivalence and Childhood Schizophrenia

If your child does not meet the listing in the Blue Book for psychotic disorders, then the SSA will look at whether your child's psychotic disorder is nevertheless so serious that it "functionally equals" the disability listings.

In so doing, the SSA will evaluate your child's everyday activities using six domains of functioning. These domains include: gathering and processing information, focusing on tasks, working with others, moving objects around, personal care, and general well-being. To establish disability, your child must be markedly limitation in two domains or extremely limited in one domain of functioning. A marked limitation is described as more than moderate but less than extreme.

Two recent court cases can illustrate how the SSA might evaluate a child with a psychotic disorder. The first case concerned a 10-year old child who was diagnosed with a psychotic disorder. The child heard voices telling him to hurt others, and he had suffered past trauma by witnessing violent behavior as a very young child. The child had behavior problems at school and was put into special education classes. Here, the issue was whether the child was markedly limited in the domains of working with others and focusing on tasks. Ultimately, the SSA found that although the child had some limitations, the child was not disabled. The most important evidence came from the child's teachers, who explained that when on medication, the child no longer heard voices, was often cooperative with other kids, and had only rare instances of fighting. Moreover, testing showed the child's I.Q. was average and the child had reached all the grade level standards for reading, science, math, and writing.

Alternatively, in a second case, the SSA did find a child with a psychotic disorder to be disabled. The SSA found the child was markedly limited in the domains of personal self-care and focusing on tasks. This ten-year old child rapidly changed her moods and would sometimes isolate herself in the classroom by crying and refusing to answer questions. Significantly, the child had been hospitalized for 10 days after hearing the voices of animals telling her to harm herself. The child also would speak to imaginary friends, would often talk in a baby-type voice, and she had received C's, D's, and F's in her academic studies.

Next Steps

The SSA analyzes each child's disability application on a case-by-case basis. You can help by making sure your child's medical records and school records support your claim that your child's limitations are very serious. This is the key to whether your child will be granted disability benefits. If your have further questions about applying for children's disability benefits, please contact a disability lawyer in your area.