With the increase in awareness of autism and autism spectrum disorders, many are surprised to know that doctors first put a name to the condition nearly 75 years ago. At that time, psychologist Leo Kanner first observed the condition in 11 children noting two central characteristics — the desire towards maintenance of sameness or a set routine, and a marked difference in how the children related to people or situations (social limitations). Similarly, the Social Security Administration (SSA) evaluates autism in both adults and children by determining whether the adult or child has deficits in reciprocal social interaction, in verbal and nonverbal communication skills, and in imaginative activity.
Financial Aid May be Available
There are two disability programs: Social Security Disability Insurance, which is known as SSDI, and Supplemental Security Income, commonly referred to as SSI. SSDI pays benefits to you and certain members of your family if you are disabled, and you worked long enough and paid Social Security taxes recently enough. SSI, on the other hand, is based on financial need. The SSA says, “It is designed to help aged, blind, and disabled people, who have little or no income.”
How does Social Security Evaluate Autism?
The Social Security Administration recognizes autism spectrum disorder (ASD) as a potentially disabling condition that may qualify individuals for benefits. As with all applications for disability benefits, it is not the diagnosis of an impairment that qualifies a person for benefits, but how the symptoms of their impairment impact their daily functioning and especially how they impair their ability to get and hold a job.
To determine if you are medically eligible for disability benefits, Social Security has a set of procedures in place. These procedures are published in a handbook known as the “Blue Book,” and it includes a list of various disabling conditions known as “listings”. If your condition matches the criteria in the Blue Book, you may be awarded disability benefits through the Social Security Administration. Autism is listed as a qualifying condition under Section 12.10 for adults.
To qualify for benefits, adults must demonstrate either an extreme limitation in one, or a marked (severe) limitation in two, of the following areas of functioning:
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- Understanding, remembering, or applying information.
- Interacting with others.
- Concentrating, persisting, or maintaining pace.
- Adapting or managing oneself.
Supplemental Security Income (SSI) benefits are available for children under the age of 18 with autism who meet specific medical and financial criteria. Section112.10 outlines the qualifying conditions for children. To meet the criteria in the Blue Book, medical evidence must show:
- Pronounced difficulty in social interaction, especially in responding or reciprocating.
- Impaired communication skills, both verbal and/or non-verbal.
- An inability to engage in imaginative or creative activities or thought.
- Limited interest and participation in varying activities.
Because SSI is a needs-based program, the child's income and resources, as well as those of their family living in the same household, cannot exceed limits set by Social Security.
Only a few people meet the Blue Book standards, but there is a second way to qualify: demonstrate that the symptoms of your impairment prevent you from sustaining full-time competitive employment on a consistent and reliable basis. To prove your case, your doctor should also explain how your medical conditions limit your ability to function in daily life and maintain consistent full-time employment. This is usually done using a form called the “Residual Functional Capacity” (RFC) form. The RFC form is separate from the medical records and helps your doctor to explain your limitations. To decide whether you qualify for Social Security disability benefits the Social Security Administration will consider the RFC form along with other medical evidence.
For a disability case involving autism, the most important evidence in an adult’s or child’s claim is that of a neuropsychological evaluation. This assessment will be documented proof of the severity of symptoms and show how those symptoms impact an individual’s ability to relate to and function in the world around them.
Children living with autism often will also have an Individualized Education Plan (IEP). An IEP is a written statement to fit the educational program designed to meet the needs of a student whom the school assessed as requiring extra services to meet their educational goals. It is developed by a team of teachers, therapists, school administrators and other support service staff who provide a detailed description of what the school will do to accommodate the student’s needs. These plans will change as the student’s needs evolve.
At Cuddigan Law we know that applying for Social Security Disability can be overwhelming and because symptoms of autism can vary, these cases can be highly complex and difficult to win. Our exclusive focus on disability law has provided us with extensive experience in helping clients to navigate the system and give them the best chance of being awarded benefits. You are 3 times more likely to be awarded disability benefits if you have a representative such as a disability attorney who will fight for your rights than if you have no representation at all, according to a Government Accounting Office study.
If you or a loved one need help making sense of the disability benefits available for autism, call or email us at Cuddigan Law for a free evaluation of your case.
