The financial burden on families with an autistic child or an adult with autism can be difficult and the Social Security Administration (SSA) offers disability benefits to help such families with their medical and living costs. Autism Spectrum Disorder (ASD) is a mental disorder which includes autism, Asperger Syndrome (AS), and Pervasive Developmental Disorder-not otherwise specified (PDD-NOS) that affects how the brain processes information. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors.
Symptoms and Diagnosis
Autism is a mental disorder specifically enumerated in the SSA’s Blue Book. Symptoms of autism may be evident at birth but is usually recognized by age three. The inability to interact with others or repetitive behaviors such as rocking or hand flapping are possible signs of autism. An infant with autism will not respond to social stimulation with healthy behaviors such as babbling, laughing, smiling, or making eye contact. Notably, many autistic individuals do not develop speech and communication enough to meet the needs of daily life.
Children with autism may cope with their condition to different degrees with the help of early intervention, but most are unable to live independently as adults. Sometimes ASD is diagnosed later in life, often in relation to learning, social or emotional difficulties.
According to medical articles, diagnosis of autism currently depends upon the patient showing at least six symptoms. Two of the symptoms must be linked to social interaction impairment, while one must be a communication impairment, and another one must be a restricted or repetitive behavior impairment. These behaviors affect the ability to function normally.
Individuals with autism may display:
- Restrictive behavior – purposeless movement such as rocking, head rolling, hand flapping, and other movements
- Compulsive behavior – rearranging objects and needing to control the physical environment
- Ritual behavior – needing to do things the same way and at the same time every day and resisting change in the environment
- Limited activity, focus, and interest
- Self-injury – biting oneself, pulling hair, and other self-injury activities
Although none of these symptoms are specific to autism, these behaviors are often present, severe, and reoccurring and affect one’s ability to work.
While there is no medical test that can diagnose autism, there are autism-specific behavior evaluations by trained physicians and psychologists that help recognize symptoms. ASD can be associated with intellectual disability, difficulties in motor coordination and attention and physical health issues such as sleep and gastrointestinal disturbances. Others with ASD may excel in visual skills, music, math and art.
Causes of ASD
There is no known single cause of ASD. Scientific theories regarding the cause of autism range from the abnormal formation of brain synapses to genetic abnormality. Other possible causes may include problems during pregnancy or environmental factors, such as exposure to heavy metals or pesticides.
Meeting the definition of “Disabled”
In order to receive Social Security Disability benefits the first thing to consider is whether you meet the SSA’s definition of “disabled.” This is different for children and adults:
Children under the age of 18 must:
- Not be working a job that is considered to be ‘substantial work’;
- Have a medical condition which very seriously limits their activities; and
- The condition is expected to last at least one year.
In contrast, adults must show:
- They can’t do the type work that they did before;
- They can’t do other types of work because of their medical condition; and
- The condition will last for at least one year.
Once these conditions have been met, the next step is applying another set of rules just about autism found in the SSA’s Impairment Listing Manual, or “Blue Book” which has separate sections for adults and children.
Proving Childhood Autism
Childhood autism is found as a listing under Section 112.10 of the Blue Book. To meet the listing, you will need to show that the child’s social and communication skills and other activities are delayed for their age. To qualify a child for disability benefits the requirements of both Paragraphs A and B must be satisfied.
The required level of severity for autistic disorders is met when the following requirements are satisfied. A doctor must have found the child has:
- Deficits in reciprocal social interaction,
- Deficits in communication and imagination, and
- A restricted repertoire of activities and interests (not needed for Asperger’s syndrome).
And these deficiencies must cause serious limitations in at least two of the following:
- Communicative/cognitive functioning
- Social functioning
- Personal functioning
- Sustaining concentration, persistence, or pace
OR the child displays marked age appropriate impairment in two of the following areas:
- Cognitive/communicative function – measured by standardized and special tests
- Social functioning – ability to form and keep relationships, cooperate with others and groups, and respond appropriately to authority figures
- Personal functioning – ability to develop self-care such as feeding oneself, personal hygiene, dressing, grooming, and toileting
- Maintaining concentration, persistence, or pace – ability to focus on a task and stick with it
Gather all the information you can for your claim to prove these conditions are met. Try to obtain doctor’s notes, results from medical tests, and information about any therapies. Statements from teachers and other professionals who work with your child are helpful. The more details you can provide in the application about your child’s autism the better chance you will have of being approved.
After you have gathered the necessary information you may begin your application. When applying for social security benefits for a child with ASD, you will have to complete that application during an in-person interview at the SSA office before deciding whether or not to award benefits. These benefits are helpful when it comes to paying for therapies and other treatments, or simply affording daily expenses that become difficult when families are unable to work.
Proving Adult Autism
In Blue Book Section 12.10, besides showing the signs of autism, adults also have to show they have trouble with concentration, social interactions, or daily activities.
Despite Blue Book Section 112 listing the disability requirements for childhood autism, the SSA does not have a specific listing for a diagnosis of adult Autism (AS or PDD-NOS). Thus, since there are no specific criteria to disability approval, it is difficult to prove total disability and successfully obtain disability benefits based on AS or PDD-NOS diagnosis. In such cases, it is critical to:
- Demonstrate the inability to function well enough to meet the SSA’s threshold for gainful employment as a result of autism, and
- Presenting medical evidence of its severity
Before you file your application for disability with the SSA gather the necessary medical information to support your claim. Again, try to get doctor’s notes, results from medical tests, and information about any therapies. The key is collecting the most information to show you case matches the autism requirements.
If you are seeking to obtain Social Security Disability benefits for Autism Spectrum Disorder, consult our knowledgeable and experienced representatives with Adams & Associates Disability, Inc. by calling (888) 551-1190.
