In children’s disability cases, social security looks first at whether a child is engaged in substantial gainful activity. If so, then the child is not disabled. If not, then social security will look at whether or not the child’s medical impairments meet or are medically equivalent to one of the listings of impairments in social security’s regulations. These listings encompass all major body systems and describe impairments that are severe enough to be considered disabling.
If the child’s impairments do not meet or medically equal one of the listings, then social security will determine whether or not the child’s level of functioning is compromised to such a degree that his or her impairments are “functionally equivalent” to one of the listings.
In making the determination of functional equivalence, social security looks at the “whole child.” In other words, they look at all of a child’s activities, whether they be at school, at home, in a social setting, or in the community.
Social security regulations for childhood disability outline six broad domains of functioning, which encompass virtually the entire universe of a child’s activities. In order for a child’s impairments to functionally equal one of the listings, the child must have “marked” limitations in two of the domains, or “extreme” limitations in one of the domains.
The six domains are:
1) Acquiring and using information,
2) Attending and completing tasks,
3) Interacting and relating with others,
4) Moving about and manipulating objects,
5) Caring for yourself, and
6) Health and physical well-being.
The domain of interacting and relating with others focuses on a child’s ability to form relationships in a variety of settings, whether it be family, school, or the community.
A physical or mental impairment may affect a child’s social interaction. For example, a child with anxiety disorder may be have difficulty making friends and forming relationships. A child with a missing limb, or with disfiguring burns may be self-conscious and have difficulty making friends. A child with an autism spectrum disorder may be limited in emotional and social responses.
In order to relate with others in an age appropriate manner, a child must have communication skills. Communication involves both speech and language. Receptive language refers to a child’s ability to understand what she hears or reads. Expressive language refers to a child’s ability to express what she wants to say, either verbally or in writing.
Communication also involves using both verbal and non-verbal skills in a variety of social situations. This is referred to as pragmatics. Non-verbal skills include maintaining appropriate eye contact, and using appropriate gestures, facial expressions, and physical postures. It also involves following certain “rules” of conversation, such as turn-taking, introducing and maintaining a topic, asking for clarification or giving feedback where appropriate, and using appropriate techniques for opening, maintaining, and closing a conversation.
It is perhaps a cliché, but of course, listening appropriately is an essential element of communication.
The domains of interacting with others and caring for yourself are similar but distinct. For example, a girl with hyperactivity disorder who habitually interrupts conversations is limited in the domain of social interaction. A girl with hyperactivity disorder who impulsively runs out into the street, thereby endangering herself, is limited in the domain of caring for herself.
Similarly, a boy with a language disorder who avoids other children is socially limited. A boy with a language disorder who lacks the ability for self-talk and thus, self-regulation in stressful situations, is limited in the area of caring for himself.
Of course, a child’s impairments may cause limitations in more than one domain. For example, a child with Oppositional Defiant Disorder who refuses to obey his parents’ injunction to not run on slippery surfaces is engaging in socially inappropriate behavior and failing to care for himself. A teenage girl with depression who isolates herself from social situations and develops an eating disorder has difficulties in both the social domain and that of caring for herself.
Social security will look at the effect of a child’s impairments across all of the domains. This is not considered “double weighting.”
Some examples of limitations in the domain of relating to and interacting with others (which are age-sensitive examples) are:
Does reach out to be picked up, touched, and held by a caregiver.
Has no close friends, or has friends who are much older or younger.
Avoids or withdraws from people he or she knows.
Is overly anxious or fearful of meeting new people or trying new experiences.
Has difficulty cooperating with others.
Has difficulty playing games or sports with rules.
Has difficulty communicating with others (for example, does not speak intelligibly or use appropriate nonverbal cues when carrying on a conversation).
See Social Security Ruling (SSR) 09-5p.
The rules governing childhood disability can be difficult for a layperson to understand. It is often helpful to consult an experienced attorney if you have a childhood disability case.
This material should not be construed as legal advice for any particular fact situation, but is intended for general informational purposes only. For advice specific to any individual situation, an experienced attorney should be contacted.
When it comes the family law and social security disability, each client and case is different. It is also important to select an attorney with the experience, skills and professionalism required to address your legal issues. To learn more, contact the Salt Lake City law offices of Melvin A. Cook and schedule an initial consultation to discuss your case.