Social Security Ruling (SSR) 98-1p explains that a child will be found to medically equal Listing 2.09 when the child has a marked impairment in both speech and cognitive functioning. The ruling also outlines criteria for determining when a child is considered “markedly” or “extremely” limited in these areas.
In order to be found disabled, a child must have a medically determinable impairment that results in “marked” or “extreme” limitations in functioning. Only then will the child be found to meet or medically equal one of social security’s listed impairments, or “functionally equal” the listings.
Cognition involves the ability to learn, process information, understand, and problem solve by means of intuition, perception, auditory and visual sequencing, verbal and non-verbal reasoning, and application of knowledge.
Speech involves the production of sounds (phonemes) in a smooth, fluid and rhythmic pattern for purposes of oral communication. This includes articulation, voice (pitch, volume, and quality), and fluency (the flow, or rate and rhythm, of speech). Precise neuromuscular functioning and coordination (of lips, vocal folds, tongue, hard palate, and respiratory mechanism) is required n order to produce speech.
Speech differs from language in that speech involves the production of sound for the purpose of oral communication, whereas language denotes the messages that are conveyed, expressed and understood by means of semantics (vocabulary), syntax (grammar), and pragmatics (use of language in social contexts).
There are a variety of causes of speech impairments, some of which include: cleft palate producing hypernasality, cerebral palsy producing dysarthria, or brain lesions resulting in apraxia.
Cognitive level is the level of a child’s thinking. It may be determined by a variety of tests, such as the Bayley’s Scale of Infant Development, Wechsler composite scores (verbal, performance, full-scale), or Stanford-Binet score.
Lower cognitive functioning can combine with speech impairments to demonstrate a child’s difficulties in functioning effectively in an age appropriate manner. A child with extreme limitations in cognitive functioning will be found disabled. A child with milder cognitive limitations may also be found disabled if there is a severe speech impairment ad well.
In assessing a child’s sound production and intelligibility, ideally at least two listeners’ descriptions are needed — one lay and one professional.
Speech production refers to a young child’s vocalizations that gradually become more complex until they develop into recognizable speech sounds.
Intelligibility is the degree to which the child can be understood by the listener. The expected degree of intelligibility increases with a child’s age. Ratings of intelligibility should be evaluated with respect to the familiarity of the listener with the child and the frequency of the contact. Consideration must also be given to the listener’s familiarity with the topic, or content of the speech.
Speech patterns refers to sounds, omissions, distortions, phonological patterns, and the fluency, or rate and rhythm of speech.
Phonological patterns refers to the selections, sequence, combination, and placement of sounds that the rules of sound production comprise.
Misarticulations are incorrect production of speech sounds, and may include various “speech errors”, including vowel distortions (such as lateralized “s”), substitutions (such as lisping), or omissions.
Dysfluency is a break in the rhythm and rate of speech.
Voice refers to the pitch, quality, and intensity of a child’s voice.
Information from an appropriate professional is needed in assessing a child’s speech impairment. This may be a speech pathologist, a preschool or special education teacher, a pediatric neurologist, an occupational therapist, a developmental pediatrician, or other person qualified by appropriate training or experience.
Children who develop speech difficulties will often ” outgrow” them. It is necessary to assess whether the impairment has lasted or is expected to last at the “marked” level for at least 12 consecutive months.
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.