Social Security Disability and SSI Benefits for Autism

Children with severe autism can qualify for Supplemental Security Income (SSI) benefits if their families meet the income and asset limit requirements. Adults with autism can also qualify for disability benefits, either through the SSI program or the Social Security disability insurance program (SSDI), depending on their work history and financial circumstances.

This article will give the basics of what autism means and when children and adults with autism can receive disability benefits.

Is Autism Considered a Disability?

Autism is a neurodevelopmental disorder that affects communication and social interaction skills. Autism is thought to be present from birth and is usually recognized by three years of age. Not everyone with autism displays the same behaviors.

Asperger's syndrome and "pervasive development disorder—not otherwise specified" (PDD-NOS) are often included on the "autism spectrum."

There are many signs and symptoms of autism, and they're experienced in varying degrees; only severe autism is considered a disability.

What Are the Symptoms of Autism?

A doctor will diagnose autism when a patient shows symptoms of social interaction impairment, communication impairment, and a restricted, repetitive pattern of behavior.

Communication symptoms can include a lack of responsiveness or unusual gestures. Estimates of the number of autistic children who are nonverbal or minimally verbal (meaning they don't develop speech and communication enough to meet the needs of daily life) range from 25% to 35%. Children do not need to be nonverbal to be considered disabled.

Restrictive behavior can include purposeless movements 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 autism, such as needing to do things the same way and at the same time every day, and resisting change in the environment.

Limited activity, focus, and interest is another symptom of autism in which children have trouble focusing on things that don't interest them, especially shared activities.

Some autistic children are prone to unusual responses to sensory stimuli and 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 in autism.

When a child has a number of the symptoms above and they prevent the child from learning, interacting, focusing, or taking care of themselves, the Social Security Administration (SSA) is likely to grant disability for autism.

Getting SSI for Children With Autism

Children whose symptoms meet the requirements of one of Social Security's "listings" can be approved for disability benefits. Listing 112.10, for autism spectrum disorder, requires that a child's medical records include documentation of all of the following:

• deficits in social interaction
• deficits in verbal and nonverbal communication, and
• significantly restricted, repetitive patterns of behavior, interests, or activities.

If all three items are documented, Social Security will look to see whether the child's functioning is severely limited by autism. The child must either have an extreme limitation in one of the following areas or a "marked" (severe) limitation in two of the following areas:

• understanding, remembering, or using information (ability to learn, remember, and use information, follow instructions, solve problems, use reason to make decisions)
• interacting with others (ability to engage in interactive play, cooperate with others, maintain friendships, handle conflicts, initiate or sustain conversation, understand social cues)
• focusing on activities (ability to engage in activities at a consistent pace, avoid distractions, complete tasks in a timely manner), and
• adapting or managing oneself (ability to regulate emotions, control behavior, protect oneself from harm, maintain personal hygiene).

Cognitive and communicative functioning can be measured through the use of standardized testing that is appropriate for a claimant's age and special tests for 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.

Healthy social interacting is defined by Social Security as a child's capacity to form and keep relationships. This includes relationships with peers, parents, and other adults. Impairments in social functioning may result in physically aggressive behavior, inappropriate response to authority figures, social isolation, and even lack of speech.

Focus is the ability to concentrate on a task, to stick with it, and to maintain a pace at the task that would be considered an age-appropriate level. This is measured both by observing the child and also measured by results obtained from standardized testing.

Managing oneself is measured by teachers' and doctors' observations of self-care skills (such as feeding oneself, personal hygiene, dressing, toileting) and the ability to manage one's behavior in an age-appropriate way.

How Do Children With Autism Qualify for SSI?

Children with autism may be eligible for SSI disability benefits if their family's income and assets aren't above the SSI limits. For more information, see our section on financial eligibility for SSI.

Getting SSI or SSDI for Adults With Autism

Many children with autism grow into adults with autism, though adult autism can appear in different ways. For instance, adults with autism may have trouble:

• keeping up a two-sided conversation
• interpreting what others are thinking
• regulating their emotions, and
• showing interest in things outside of a restricted range of special interests.

For adults, keep in mind that Social Security has two ways to be approved for benefits based on autism. The first is meeting listing 12.10 for adult autism, which requires that an individual must have:

• pronounced difficulty in interacting socially, especially in responding or reciprocating
• impaired communication skills, and
• limited interest and participation in varying activities.

The listing also requires adults to have at least two of the following:

• serious limitations in activities of daily living
• difficulty with social interaction for any amount of time
• problems concentrating or finishing tasks at a reasonable pace, and/or
• repeated episodes of severe symptoms.

If Social Security doesn't approve an applicant on the basis of meeting a listing, the agency will look at whether the applicant can be approved on the basis of what is known as a medical-vocational allowance. That means a person can be approved if, considering their work experience and work-related limitations, they'd be unable to perform substantial work.

In making this determination, the SSA will consider medical evidence including:

• psychological testing
• notes and opinions from treating physicians, and
• intelligence testing.

How Do Adults With Autism Qualify for SSI or SSDI?

An adult with autism syndrome can apply for SSI or SSDI. However, SSDI is available only to those with a work history from jobs that paid Social Security taxes. (For more information, see our section on SSDI requirements.)

Here's one exception: An "adult child" of a parent receiving Social Security retirement or disability benefits, meaning a child over the age of 18 who has had autism before turning age 22, can get SSDI benefits on the earnings record of the parent. For more information, see our article on disability benefits for adult children.

Adults without a sufficient work history or a parent who receives Social Security benefits are limited to the SSI program. To qualify, they must have limited income and limited assets.

How to Apply for Disability Based on Autism

If you or your child will only qualify for SSI (not SSDI), call Social Security at 800-772-1213 to start your claim. For more information, see our article on applying for Social Security disability benefits.

If you're an adult applying for Social Security disability insurance (SSDI), you can file the claim online on Social Security's website. Applying online is generally the fastest way to apply for benefits, but you can fill out the application at your own speed.

If you'd like help with your application, you may want to work with an SSDI expert. According to a survey of our readers, applicants who filed an initial application without expert help were denied 80% of the time.

_{Updated October 6, 2022}