Can you get Social Security disability for Autism or Asperger's Syndrome?

Families are often shocked to receive a notice of denial when they know how much this impairment affects daily functioning. Even people with severe symptoms find themselves denied at first. Many valid initial claims are denied, and a good number of those same claims are found favorable further along in the appeals process.

Asperger’s syndrome and autism spectrum disorder

The DSM-5, released in May 2013, no longer contains a diagnosis of Asperger’s syndrome. That disorder, along with others such as pervasive developmental disorder NOS, is now included within the diagnosis of autism spectrum disorder.

As people with Asperger’s and their families know, it does not much matter what it is called. The symptoms and limitations remain.

For a disability claim, three things follow from this:

• An older diagnosis of Asperger’s syndrome is still valid evidence. You do not need to be rediagnosed.
• Social Security evaluates the condition under its autism spectrum disorder listing regardless of which term appears in your records.
• If your records use the older terminology, that is not a problem, but it helps if a current provider confirms that the diagnosis corresponds to autism spectrum disorder as it is now defined.

What Social Security assesses is the condition rather than the label, so a change in diagnostic terminology does not undo the evidence already in your file.

Symptoms of autism spectrum disorder and Asperger’s syndrome

Autism spectrum disorder is a neurodevelopmental condition affecting social interaction and communication, along with restricted or repetitive behavior. Severity ranges widely: one person may have relatively mild symptoms while another is profoundly affected.

Common symptoms include, but are not limited to:

• Difficulties with social interaction, usually including an inability to identify social cues
• Unusual facial expressions, and avoidance of eye contact
• Repetitive behaviors and difficulty accepting changes in routine
• Heightened sensitivity to textures, tastes, sounds, and light
• Speaking in a formal manner, repeating words or phrases, or talking at length about a single subject
• Extreme focus on one area of interest
• Language difficulties, including echolalia

In very young children the condition can be hard to detect, and symptoms are often first noticed as children enter kindergarten and begin interacting with their peers.

Something worth understanding about these claims: the symptoms are frequently not apparent in a brief interaction. It usually becomes clear only after spending time with a person that these difficulties are continuous. That matters a great deal, because a consultative examination is a brief interaction, and an examiner may come away with an impression that does not reflect daily reality.

How Social Security evaluates autism in adults

Social Security addresses the condition in its Listing of Impairments at listing 12.10, Autism spectrum disorder. The listing covers autism spectrum disorder with or without accompanying intellectual impairment, and with or without accompanying language impairment.

The listing is satisfied by paragraph A together with paragraph B. Both are required.

Paragraph A asks for medical documentation of both of the following:

• Qualitative deficits in verbal communication, nonverbal communication, and social interaction
• Significantly restricted, repetitive patterns of behavior, interests, or activities

Paragraph B asks how much the condition limits four areas of mental functioning:

• Understand, remember, or apply information
• Interact with others
• Concentrate, persist, or maintain pace
• Adapt or manage oneself

You need an extreme limitation in one of these areas, or a marked limitation in two. As with any claim, the condition also has to have lasted, or be expected to last, at least twelve months, which for autism is rarely in dispute.

One point of difference worth knowing: Some mental disorder listings, including those for depression and anxiety, offer an alternative paragraph C route for conditions that are serious and persistent. Listing 12.10 does not. Autism claims are met through paragraphs A and B only, so the functional evidence has to do the work.

In practice, autism claims most often turn on interacting with others and on adapting or managing oneself. Many of my adult clients could not sustain the social demands of a workplace, tolerate changes in routine or supervision, or manage the sensory environment of most job sites, even where their cognitive abilities are strong.

Benefits on a parent’s record

There is one route worth knowing about specifically, because families frequently do not know it exists.

An adult whose disability began before age 22, as autism will have done, may be able to claim on a parent’s earnings record once that parent retires, becomes disabled, or dies, even with no work history of their own. These are usually called disabled adult child benefits, and they are often worth considerably more than Supplemental Security Income.

That matters here more than for most conditions, because many adults with autism have little or no work history and would otherwise assume Supplemental Security Income is their only option.

How Social Security evaluates autism in children

Children are evaluated under listing 112.10, which mirrors the adult listing, with the difference that Social Security considers whether limitations are age-appropriate.

Children also have a second route that adults do not. If the listing is not met or medically equaled, Social Security goes on to assess whether the condition functionally equals the listings, using six domains of functioning. Understanding these domains is important for parents, because they are the roadmap Social Security uses:

• Acquiring and using information
• Attending and completing tasks
• Interacting and relating with others
• Moving about and manipulating objects
• Caring for yourself
• Health and physical well-being

A child is considered disabled under this route if they have marked limitations in two domains, or an extreme limitation in one.

In my practice, many children with autism have extreme limitations in interacting and relating with others. They may have difficulty holding simple conversations, have language difficulties, or repeat words and phrases. They do not recognize the social cues most of us take for granted. Most of these children are bright, but that inability to interact and relate can prevent them from functioning in a regular classroom.

Will good grades hurt my child’s claim?

This is one of the questions I am asked most often, and the answer reassures a lot of parents. Good grades alone do not disqualify a child. Academic performance sits within one domain out of six. A child can excel academically and still be severely limited in social interaction or in adapting to changes in routine. We have successfully represented high-functioning children whose autism significantly affects their functioning in other areas.

The financial requirement for children’s claims

Children’s claims are generally made under Supplemental Security Income, which is needs-based. Social Security conducts a resource interview and assesses the household’s financial situation before it evaluates the child’s medical condition.

I often meet families who assume they earn too much to qualify and therefore never apply. It is worth letting Social Security make that assessment rather than deciding for yourself, because the criteria are specific and not always what people expect.

The evidence these claims need

Thorough medical records from a qualified professional are often the key to a successful outcome. A long-standing relationship with a psychiatrist, psychologist, or therapist, with a clear diagnosis supported by treatment records, greatly strengthens a claim.

For adults, useful evidence includes:

• The diagnostic evaluation, whether recent or historical
• Treatment and progress notes describing functioning over time
• Any adaptive functioning or psychological testing
• A medical source statement addressing your limitations in the four functional areas
• Accounts from family or others who see you regularly, describing what daily life actually involves

For children, useful evidence includes:

• Complete school records showing accommodations and assistance received during the school day, along with grade reports, teacher comments, and progress reports
• Individualized Education Programs, or IEPs
• Records from doctors, therapists, and any other treating provider, with a clear diagnosis and progress notes recording their observations
• Records relating to any physical impairments the child is treated for
• Records from therapy programs such as ABA, speech, and occupational therapy
• Medical source statements setting out how the child’s symptoms and behaviors fit Social Security’s standards

When you apply, you do not need to gather all of these documents yourself. What matters most is providing a complete list of every healthcare provider, school, and program involved, since Social Security is responsible for obtaining the records once you identify them.

Securing medical source statements from treating providers helps an Administrative Law Judge understand the restrictions a person has in a school or work setting. Current treatments for people on the autism spectrum can include social skills training, cognitive, physical, occupational and speech therapy, and medication, and a record of what has been tried is useful in itself.

If you have been denied

Denials are common in these claims, and families are often bewildered by them.

If your initial application is denied, do not give up and do not start over with a new application. Appeal instead, and do so promptly, since you generally have sixty days from the date on the denial notice. Appealing protects your original filing date; a new application does not.

The first appeal is a request for reconsideration. Most reconsiderations are denied, but it is a necessary step before requesting a hearing before an Administrative Law Judge, which is where these claims have the best chance with proper representation.

Initial decisions commonly take several months, and appeals extend that considerably. It is worth preparing for a long process rather than expecting a quick answer.

Talk with an Indiana disability attorney

One of the more rewarding parts of my work is helping disabled children and their families get the benefits they deserve. A larger share of my practice consists of children’s SSI claims than is true of many disability attorneys, and other attorneys sometimes refer children’s autism cases to me because they do not handle these claims themselves.

If you are having difficulty finding an attorney because yours is a child’s claim, or you are simply frustrated with the process, call my office at (866) 950-5116 for a free consultation. During that call I will go through where you are in the process, whether I can help at your current stage, what Social Security looks for in evaluating autism claims, and what to do next. If I cannot help yet, I will explain why and tell you when to get back in touch.