Social Security Disability and SSI Benefits for Autism

Children with severe autism can qualify for Supplemental Security Income (SSI) benefits if their family meets the income and asset limit requirements. Adults with autism can also qualify for disability benefits, either SSI or Social Security Disability (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.

What Is Autism?

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.

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

Diagnosing 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. It has been reported that at least one-third of autistic individuals don't develop speech and communication enough to meet the needs of daily life.

Restrictive behavior can include purposeless movement 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 also a symptom of autism, as well as 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.

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

Children's Social Security Disability Claims on the Basis of 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 all of the following are documented in a child's medical records:

• 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 (a deficit in imaginative activity is no longer required by the listing), 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 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 mutism.

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.

SSI for Children on the Autism Spectrum

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.

SSI or SSDI for Adults With Autism

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.)

For adults, keep in mind that there are 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
• Limited interest and participation in varying activities

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

• Limitations in activities of daily living
• Difficulty with social interaction for any amount of time
• Problems concentrating or finishing tasks at a reasonable pace
• Repeated episodes of severe symptoms

Individuals whose claims are not approved on the basis of meeting a listing may still 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.

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 earning record of the parent. For more information, see our article on disability benefits for adult children.