In determining disability in children’s cases, social security looks first at whether or not the child is engaged in substantial gainful activity. If not, the next step is to determine whether the child has a medically determinable impairment or combination of impairments that results in marked and severe functional limitations.
To determine this, an adjudicator must decide if a child’s impairments meet or medically equal the criteria set forth in social security’s listing of impairments. If not, then the adjudicator must determine if the child’s impairments are “functionally equivalent” to one of the listings.
In order to determine this, social security looks at the “whole child.” In other words, they look at all of the child’s activities, whether in the home, socially, at school, or on the community — the whole enchilada.
Social security has developed six broad domains of functioning that encompass all of what a child can or cannot do. In order to find “functional equivalence”, the fact finder must find the child to be “markedly limited” in two domains, or “extremely limited” in one domain.
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
A child develops in these six domains over time, from infancy through adolescence and early adulthood.
The domain of attending and completing tasks involves maintaining appropriate attention, following instructions and persevering to finish a task.
Oftentimes, a child who is severely limited in this domain has a mental impairment, although this is not always the case. A child with a physical impairment who experiences severe side effects from medications, for example, might be limited in this domain.
As with the other domains, in order to find a disability, there must be a medically determinable impairment, regardless of how limited a child may be in this domain. However, although all children struggle with attending and completing tasks from time to time, the persistence of severe limitations in the domain may suggest the presence of a medical impairment. Adjudicators should pay attention to this and more fully develop the evidence where appropriate.
Difficulties with attending and completing tasks can affect many aspects of a child’s functioning. For example, a child with ADHD may have difficulties focusing on and completing schoolwork. The same child may also have difficulties with social interaction. Considering limitations across all domains is not considered “double-weighting.”
Some examples of limitations in the area of attending and completing tasks, which are obviously age sensitive (what may be considered limited for a school age child may be entirely appropriate for a pre-school child) are:
Is easily startled, distracted, or overreactive to everyday sounds,
Is slow to focus on or fails to complete activities that interest the child,
Gives up easily on tasks that are within the child’s capabilities,
Repeatedly becomes sidetracked from activities, or frequently interrupts others,
Needs extra supervision to stay on task,
Cannot plan, manage time, or organize self in order to complete assignments or chores.
See Social Security Ruling (SSR) 09-4p.
Because children’s SSI cases can be tricky for a layperson, it is often helpful to consult an experienced professional in such cases.
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.